SUZANITA UTAMA

Division of Obstetrics and Infertility

Fac of Veterinary Medicine
Airlangga University
 anesthetic blocks
work by
preventing painful signal from getting
to the spinal cord
blok anestesi
bekerja dengan
Menghalangi signal rasa sakit
mencapai saraf tulang belakang
OBSTETRIC ANESTHESIA

1. LOCAL
2. REGIONAL
2.1. (caudal) epidural
2.2. blok “L” / “7” terbalik
2.3. blok paravertebral
 proximal (Farquharson, 1940)
 lateral (blok paralumbal)
 LOCAL (INFILTRATION)

• injected near or at the site of procedure (beneath

the skin or other tissue along the site of incision)
• Area anesthetised usually small and superficial
• large volume of anesthetic solution
• less favourable for wound healing
• impossible to extend planned incision
• no muscle relaxation
• incomplete anesthesia of the deeper layer
 REGIONAL

Used to block sensation in a particular

region by injecting anesthetic around a
single nerve or a network of nerves
2.1. EPIDURAL ANESTHESIA

• Multiple spinal nerve block

• Single injection > epidural space
• Anus, perineum, vulva, vagina > painless birth
• does not affect uterine contraction
 Main force of labour is not antagonised
 Placenta expulsion & uterine involution not
affected
 EPIDURAL ANESTHESIA

• Additional advantage:

Pelvic sensation abolished > prevention of straining

(reflex abdominal contraction) > intravaginal
manipulation facilitated
o Reposition is easier
o Fetal fluid supplements are retained
o Defaecation is suspended
o Patient stands more quietly
 EPIDURAL ANESTHESIA
INDICATION
Useful whenever straining is troublesome
• Prolapse of the uterus, vagina (rectum, bladder)
• Episiotomy
• Suturing vulva, perineum

DISADVANTAGE
Overdose > loss of hind limb control > animal fall
> induce recumbency
 EPIDURAL ANESTHESIA

PROCEDURE
• Epidural needle is passed downward until it
strikes the floor of the vertebral canal then very
slightly withdrawn and the injection made
• 2-2.5 % solution of local anaesthetic
• Addition of 2 % adrenaline prolongs duration of
anesthesia from 1½ to 3 hours
(vasoconstriction, slowing the up-take)
 EPIDURAL ANESTHESIA

EPIDURAL NEEDLE

length Gauge volume

bovine 5 cm 16-17 7-10 ml

equine 10 cm 16-17 < 15 ml

ovine 4 cm 18 2-4 ml
 EPIDURAL ANESTHESIA

 Flacidity of the tail

 Onset 1-2 mins
 Duration 1-2 hours
 Hanging drop
 Trial injection – no
resistance
 LOCAL ANAESTHETICS USED

a. Procaine hydrochloride (esters)

• An older drug
• Slow onset of action
• poor spreading powers
• Poor potency
• May cause allergic reactions
 LOCAL ANAESTHETICS USED

b. Lidocaine hydrochloride (amides)

• Most widely used
• Rapid onset
• Moderate duration (< 60 mins)
• Good spreading powers
• Good potency
• Topical anesthetic activity
• May cause some local irritation and swelling
 GENERAL PREPARATION

- the area is clipped

- thoroughly washed with soap and water
- dressed w/ alcohol
- (desensitization of the skin – fine short
needle)
 EPIDURAL ANESTHESIA
LOCATION

- sacrococcygeal space
- first intercoccygeal space
2.2. “INVERTED L” / “7” BLOCK (infiltration)

Field block/anesthesia = wall of anesthesia

 surgical site
 “INVERTED L” / “7” BLOCK

 Anesthetizes the entire paralumbar

/abdominal fossa
 No anesthetic solution at the incision site
 Needle: 8-10 cm, 16-18 G
 Volume < 100 ml
 Onset: 10-15 mins
 2.3. PARAVERTEBRAL BLOCK
ANESTHESIA

ADVANTAGES
 Anesthetizes the entire paralumbar/abdominal
fossa
 Less volume of the anesthetic solution
 Good anesthesia of all the layers to be incised
 Incision can be extended readily if necessary
during surgery
 PARAVERTEBRAL BLOCK ANESTHESIA

DISADVANTAGES
• More difficult
• Aorta, kidney or abomasum may inadvertently
punctured
• Cow might be unsteady due to loss of lumbar
muscle tone and paresis of the ipsilateral hind
limb
• Vasodilatation in muscle layers causes greater
degree of haemorrhage
 PARAVERTEBRAL BLOCK

Signs of successful block

• Skin hyperthermia
• Relaxation of flank muscle
• Scoliosis (curving of the spine) towards
the desensitized side
PARAVERTEBRAL BLOCK

the spinal nerves,

after emerging
from the
intervertebral
foramina
immediately divide
into dorsal and
ventral branches
dorsal PARAVERTEBRAL BLOCK
view
ANESTHESIA

LUMBAL 1-6
cranio-lateral view

6
1 5
2 4
3
 OBSTETRIC ANESTHESIA
PARAVERTEBRAL ANESTHESIA

Dr. O.W. Sack

 PARAVERTEBRAL BLOCK

 Proximal injection
= FARQUHARSON/HALL/CAMBRIDGE method

 lateral/distal injection
= PARALUMBAL
= CAKALA/MAGDA/CORNELL method
 A A

B B
A = proximal injection

B = lateral/distal
injection
 PARAVERTEBRAL BLOCK

PROXIMAL INJECTION
• 5 cm from midline
• Needle 7 cm, 14 G → 10-12 cm, 18 G
• 10 ml each nerve root
• Onset 10 mins
• Duration 90 mins
 PARAVERTEBRAL BLOCK

LATERAL INJECTION
• Dorsal and ventral branch of spinal nerves T13,
L1, L2 at distal/lateral end of L1, L2 and L4
• Fan shaped infiltration pattern
• Needle 7.5 cm, 18 G
• 20 ml per transverse process
• Onset 10 mins
• Duration 90 mins
SUMMARY
 FURTHER READING
 Arthur, G.H., Noakes, D.E. and Pearson, H. 1992. Veterinary
Reproduction and Obstetrics (Theriogenology) 6th Ed, Bailliere
Tindall. London.

 Mahaputra, L. 2003. Ilmu Kebidanan Veteriner (Diktat).

Laboratorium Kebidanan Fakultas Kedokteran Hewan Universitas
Airlangga.

 Mahaputra, L. 2003. Teknik Diagnosis Reproduksi (Diktat).

Laboratorium Kebidanan Fakultas Kedokteran Hewan Universitas
Airlangga.

 http://instruction.cvhs.okstate.edu/vmed5412/pdf/14LocalAnesthesi
a2006b.pdf
Ruminants are not good subjects for general anesthesia

The danger of regurgitation and inhalation of ingesta is

much greater in these species compared to other
common domestic species

(Lee, L.)