Quarterly Newsletter

2014-August_IVG Newsletter-Toxicology-Interventional Analgesia

The IVG Hospitals Quarterly Veterinary Newsletter features articles of interest to the veterinary medical community, written by veterinarians and veterinary specialists at our four locations.

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| 5 | most analgesic interventions. Ultrasonography has many advantages in that it is less cumbersome and faster than fluoroscopy and CT for perineural or soft tissue visualization. This diagnostic modality can be utilized in awake or lightly sedated patients, is very mobile, and the cost of the procedure is significantly less than other imaging modalities such as MRI or fluoroscopy studies, making it widely accessible to assess both soft tissue and nerve structures, especially on recheck exams. NEUROLOCATION Neurolocation (aka electrostim-location, electrolocation, neurostim-location) is a technique whereby electric current is directed onto nerve fibers suspected of supplying a painful, or potentially painful (upcoming surgery), area with stimulation. The nerve will depolarize and contractions of the innervated muscle bodies will occur. Neurostimulation techniques have been identified for major nerves, nerve roots, and plexi in both human and veterinary patients. These techniques have guided perioperative pain control with local anesthetics for the past decade in veterinary medicine. Recent developments in nerve stimulation location include the use of a peripheral nerve stimulator to determine the location of a peripheral nerve with purely sensory fiber components, percutaneous guidance to guide actual initial needle insertion, and even stimulating catheters for continuous infusion of substances. WHAT TYPE OF IMAGING OR TECHNIQUES ARE INVOLVED IN INTERVENTIONAL PAIN DIAGNOSIS AND MANAGEMENT? Radiography is useful as a baseline screening tool for skeletal interventions. However, newer modalities such as computed tomography (CT) allow even better resolution of boney structure and disruption with spatial resolution; CT is particularly useful in massive tissue damage such as that induced by trauma in small animals whereby multiple body cavities can be "scanned" without regard to radiographic technique. Fluoroscopy has proved very fruitful for larger joint or facet injections, epidural and spinal injections, but requires ionizing radiation as well. Magnetic resonance imaging (MRI) and functional MRI has been ultimately linked to incredible advances in pain management, specifically concerning human neurologic disease/neuropathic pain and soft tissue disease (such as fascial, tendon, ligament and intra-articular/periarticular structures) but both require general anesthesia and cost is considerable for veterinary patients. In recent years ultrasonography has been recognized as a non-invasive, practical method for localizing "soft tissues", and in particular analgesia-wise, peripheral nerves, plexi, difficult joints (facets), tendons, and even epidural spaces; this modality vastly improves block success and safety. It is my choice of diagnostic modality for As veterinary pain management becomes more like human pain management in offering patients a broader range of strategies for the treatment of acute and chronic pain, the interventional strategies and the techniques described below will become more commonplace. For a detailed discussion of the pathophysiology of pain, please refer to part I of this series on interventional analgesia. Andrea Looney, DVM, DACVAA, CCRP supports all of the practices within the IVG network of hospitals. Andrea L. Looney, DVM, DACVAA, CCRP Interventional Analgesia: Part II Strategies and Techniques

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