TECHNIQUE

Lumbosacral Epidural Anaesthesia in Cattle

Summary Information
Type of technique Health & Management / Ruminants Pain Management / INDIVIDUAL Technique:
Synonyms and Keywords --
Description Lumbosacral epidural analgesia may be induced in cattle either by injection at the sacrococcygeal site, as for caudal epidural block, or by injection at the lumbosacral foramen. (B205.12.w12)

Injection at the lumbosacral site:

  • Injection at the lumbosacral site is problematic in adult cattle due to the risk of the needle entering the subarachnoid space. (B205.12.w12)
  • If the needle does enter the subarachnoid space then proceeding with injection will produce subarachnoid, not epidural, block. Several hours are required for a hole in the dura to seal. (B205.12.w12)
  • In small animals a subarachnoid block may be performed, and gravity can be used (by positioning of the patient) to control the extent of neural blockade. This is not a practical proposition with adult cattle. (B205.12.w12)

Injection at the sacrococcygeal site:

  • Provide deep bedding so that the animal will not bruise itself as it becomes recumbent. (B121.12.w12)
  • The injection is carried out as for Caudal Epidural Anaesthesia of Cattle. (B121.12.w12)
  • A larger dose of local anaesthetic agent is used: 100 to 150 ml of 2% lidocaine with 1:200,000 adrenaline for difficult obstetrical cases. (B121.12.w12)
  • Loss of sensation spreads cranially depending on the dose: "over the croup, between the hind-limbs to the inguinal regions, prepuce and scrotum, the hind limbs, mammary glands, and finally flanks and abdominal wall to the region of the umbilicus." (B121.12.w12)
  • Motor control of the hind limbs is affected. This varies from partial to total.
    • For partial loss of motor control standing support or restraint with hobbles in recumbency is required. (B121.12.w12)
    • For complete hind-limb paralysis, place the animal in sternal recumbency with the hind limbs beneath it for at least 10 to 15 minutes to ensure bilateral analgesia; if unilateral analgesia is required the animal should be restrained on its side; analgesia will develop in the downward side. (B121.12.w12)
  • Note: paralysis lasts longer than analgesia. With full paralysis the animal will be unable to rise for two hours or longer and may remain ataxic for three to four hours or more. The animal should be maintained in sternal recumbency with the legs hobble until full motor function has returned. (B121.12.w12)
    • When motor power has returned to the tail it is probable that the animal will be able to rise and stand. (B121.12.w12)

Segmental epidural block:

Correct dosing of agents at this site allows production of a "belt" of analgesia without affecting the hind limbs. (B205.12.w12)

  • Restrain the animal in a standing position. (B205.12.w12)
  • Identify the site for needle insertion, just to the right of the lumbar spinous process, 1.5 cm behind the cranial edge of the second lumbar transverse process. (B205.12.w12)
  • Using a fine needle inject an initial skin weal of local anaesthetic.
  • Incise the skin in a 2 to 3 cm incision longitudinally. (B205.12.w12)
  • Insert a 14 gauge 12 cm spinal needle, directed at an angle of 10-13 degrees to the vertical ventrally and medially from the insertion point for a distance of about 7.5 cm; at this point the neural canal will be entered. (B205.12.w12)
  • Penetration of the interarcuate ligament appears to be painful even if small quantities of local anaesthetic are injected along the track of the needle. Adequate restraint is important. (B205.12.w12)
  • As soon as penetration of the interarcuate ligament is felt, withdraw the stilette from the needle; if air is heard entering the needle then the epidural space has been entered. (B205.12.w12)
    • Make a trial injection to confirm correct placement: there should be practically no resistance to injection. (B205.12.w12)
  • If cerebrospinal fluid flows from the needle when the stilette is withdrawn, gently and quickly withdraw the needle until the flow stops, then inject. (B205.12.w12)
Appropriate Use (?)
  • Lumbosacral epidural block may be used for: "difficult manipulative reposition; extensive embryotomy; amputation of the prolapsed uterus; caesarean section; examination of and operation on the penis; cutting operations about the prepuce and inguinal regions; castration; operative interferences on the udder; operations on the hind limb such as amputation of the digit." (B121.12.w12)
Notes Cardiovascular responses to segmental lumbar block T13 to L1:
  • These changes do not appear to be of clinical significance. (B205.12.w12)
  • Reduced mean arterial pressure. (B205.12.w12)
  • Increased carbon dioxide due to increased heart rate which occurs as a response to decreased vascular resistance. (B205.12.w12)
Complications/ Limitations / Risk
  • With injection from the caudal epidural (sacrococcygeal) site, satisfactory cranial spread for lumbar epidural block is not always achieved. (B205.12.w12)
  • Lumbosacral epidural with lumbosacral injection: The needle may enter the subarachnoid space, in which case proceeding with injection will produce subarachnoid, not epidural, block. Several hours are required for a hole in the dura to seal. (B205.12.w12)
  • There is a risk of infection particularly if vaginal examination has been carried out with a dead/putrid fetus present prior to the injection being made, or if a second injection is required. (B121.12.w12)
  • There is a risk of development of hypotension. (B121.12.w12)
Equipment / Chemicals required and Suppliers
  • Local anaesthetic solution e.g. 2% lidocaine hydrochloride.
  • A spinal needle.
  • Syringe.
Expertise level / Ease of Use Procedure should only be undertaken by an individual with appropriate clinical training and practical experience; this would usually be a veterinarian or someone with advanced veterinary technician training.
Cost/ Availability
  • Appropriate spinal needles for cattle may not always be readily available.
Legal and Ethical Considerations In some countries there may be legislation restricting the use of this type of technique to licensed veterinarians. For example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery." (see: LCofC1 - RCVS Guide to Professional Conduct 2000 - Treatment of Animals by Non-Veterinary Surgeons).
Author Dr Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee Graham Bilbrough MA, VetMB, CertVA, MRCVS (V.w69)
References B121.12.w12, B205.12.w12, LCofC1 

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