The comparison of four-point Nerve Block Anaesthesia and Intravenous Regional Anaesthesia of ...

277 Pages·2016·4.28 MB·English

by  Yavari, Samaneh

University of Veterinary Medicine Hannover
[Cattle Clinic]

The comparison of four-point Nerve Block
Anaesthesia and Intravenous Regional Anaesthesia of
the distal hind limb in cattle: efficacy, onset and
hormonal-metabolic and cardio-respiratory stress
responses

THESIS
Submitted in partial fulfillment of the requirements for the degree

DOCTOR OF PHILOSOPHY
(PhD)

awarded by the University of Veterinary Medicine Hannover

by

Samaneh Yavari (DVM)

(Mashhad, IRAN)

Hannover, Germany 2016
Supervisor: P r o Pfr. oDf.r .D Jür.r Jgüerng eRne hRaeghea ge

Supervision Group: P r o fP. rDofr.. DJürr.g Jeünr gReenh Rageeh age

Prof. Dr. Sabine Kästner
Prof. Dr. Sabine Kästner
Prof. Dr. Alexander Starke
Prof. Dr. Alexander Starke

1st Evaluation: P r oPfr. oDf.r .D Jrü. rJgüerng eRne Rhaeghea ge
Clinic for Cattle, University of Veterinary
Clinic for Cattle, University of Veterinary
Medicine Hannover, Germany
Medicine Hannover, Germany
P r o f . D r . Sabine Kästner
C l i n i cP rfoofr. SDmr.a Slla Abinniem Kaläss, tUnenri v ersity of
Clinic for Small Animals, University of
Veterinary Medicine Hannover, Germany
Veterinary Medicine Hannover, Germany
Prof. Dr. Alexander Starke

Clinic for Ruminants, Veterinary Faculty
Prof. Dr. Alexander Starke
of the University of Leipzig, Germany
Clinic for Ruminants, Veterinary Faculty

2nd Evaluation:
Prof. Dr. Thomas Wittek
U nUivneivrseirtsyi tCy lCinliicn ifco rf oRr uRmuimnainnatsn,t s,
D e p aDrtempeanrttm oefn At noifm Aanl iPmraold Pucrotidounc atinodn and
P u b l i cP uHbelaiclt hH eina lVthe tienr iVaeryte Mriaerdyi cMineed,i cine,
U n i v Uernsiitvye rosfi tVye otef rVineatreyri nMaeryd iMcinede,i cVinieen, nVai e n n a

Date of final exam: 20.09.2016
Parts of this thesis have been presented and published previously as below:

Samaneh Yavari, Nimer Khraim, George Szura, Alexander Starke, Elisabeth Engelke, Christiane
Pfarrer, Klaus Hopster, Marion Schmicke, Wolfgang Kehler, Maike Heppelmann, Sabine B.R.
Kästner, Juergen Rehage. Evaluation of efficacy of intravenous regional anesthesia and four-point
nerve blocks in the distal hind limb of dairy cows. BMC Veterinary Research (Submitted)
Yavari et al., Efficacy of intravenous regional anaesthesia and nerve blocks for pain management
in the distal hind limb of dairy cows. 7th Graduate School Days, 28th – 29th November 2014, TiHo
Hannover, Abstract Book, VetRes V10
Yavari et al., Evaluation of efficacy of intravenous regional anesthesia and nerve blocks on pain in
the distal hind limb of dairy cows. 12th World Congress of Veterinary Anaesthesiology, 1st – 4th
September 2015, Kyoto, Japan, Congress Proceeding Book, P – 28, Page: 191
Yavari et al., Is intravenous regional anaesthesia more effective than nerve blocks to desensitize
bovine distal hind limb?. 32nd World Veterinary Congress, 13th - 17th September 2015, Istanbul,
Turkey, Congress Proceeding, P – 061, Page: 226
Yavari et al., Comparison of two techniques of anaesthesia in the distal hind limb of dairy cows. 8th
Graduate School Days, 27th – 28th November 2015, TiHo Hannover, Abstract Book, VetRes P10,
Page: 31
Yavari et al., The effect of Esmarch Bandage on pain in bovine distal hind limb analgesia. 10th
International Conference on Lameness in Ruminants, 22nd – 25th November 2015, Valdivia, Chile,
Congress Proceeding, Page: 180
Yavari et al., Comparison of efficacy and onset of intravenous regional and nerve block anesthesia
in the distal hind limb of dairy cows. 29th World Buiatrics Congress, 3rd – 8th July 2016, Dublin,
Ireland, Congress Proceeding, P - 02-002-011, Page: 274 – 275
Whether our efforts are or not favored by life, let us be able to say, when we come near the
great goal, “I have done what I could”.
Louis Pasteur
To my father who is my biggest love
and my lovely family….

LIST OF CONTENTS
Table of contents
Contents Page
Abbreviations ........................................................................................................................... VI
List of tables ............................................................................................................................. XI
List of figures ......................................................................................................................... XIII
Abstract .................................................................................................................................. XVIII
Zusammenfassung ................................................................................................................... XX
Chapters
1. Introduction and objective .............................................................................................. 1
2. Literature review .............................................................................................................. 5
2.1. The importance of lameness in cattle herds .............................................................. 5
2.2. Common diseases associated with lameness in cattle ............................................... 6
2.3. Special surgical interventions at hind limb ............................................................... 7
2.3.1. Digital amputation (DAMP) .................................................................................... 7
2.3.2. Resection of distal interphalangeal joint (JRES) ..................................................... 8
2.3.3. Resection of the distal sesamoid bone ..................................................................... 8
2.3.4. Joint lavage and arthrotomy .................................................................................... 9
2.4. Hind limb anaesthesia in cattle .................................................................................. 9
2.4.1. Intravenous Regional Anaesthesia ........................................................................... 9
2.4.1.1. Different types of Intravenous Regional Anaesthesia ....................................... 10
2.4.1.1.1. IVRA in Cattle ............................................................................................. 10
2.4.1.2. Use of tourniquets in Intravenous Regional Anaesthesia .................................. 14
2.4.1.3. Side effects and risks associated with Intravenous Regional Anaesthesia ........ 16
2.4.1.3.1. Haematoma formation, Thrombophlebits at injection site ........................... 16
2.4.1.3.2. Ischemia/reperfusion effects of tourniquet ................................................... 16
2.4.1.3.2.1. Pain ........................................................................................................ 18
2.4.1.3.2.2. Metabolic changes .................................................................................. 19
2.4.1.3.2.3. Nerve damages ....................................................................................... 19
2.4.1.3.2.4. Systemic effectiveness of tourniquet ....................................................... 21
I
LIST OF CONTENTS
2.4.2. Regional nerve block .............................................................................................. 22
2.4.2.1. Different techniques of regional Nerve Block Anaesthesia ............................. 23
2.4.2.2. Complications, side effects and different aspects of Nerve Block Local –
Anaesthesia ...................................................................................................... 25
2.4.3. Epidural anaesthesia ................................................................................................ 28
2.5. What is pain ? .............................................................................................................. 30
2.5.1. Nociceptive pain ...................................................................................................... 30
2.5.2. Inflammatory pain ................................................................................................... 32
2.5.3. Neuropathic pain ..................................................................................................... 32
2.6. How can pain be measured? ...................................................................................... 32
2.6.1. Sensory nociceptive measurements ....................................................................... 33
2.6.1.1. Mechanical threshold ......................................................................................... 33
2.6.1.2. Thermal threshold .............................................................................................. 35
2.6.1.3. Electrical nociceptive threshold ......................................................................... 36
2.6.2. Physiological parameters ....................................................................................... 37
2.6.3. Behavioural factors ................................................................................................ 38
2.7. Factors which influence results of nociceptive threshold testing ............................ 39
2.7.1. Tissue damage ......................................................................................................... 39
2.7.2. Temperature ............................................................................................................ 39
2.8. Drugs used for anaesthesia and/or analgesia ............................................................ 40
2.8.1. Local anaesthetics ................................................................................................... 40
2.8.1.1. Classification of LAs ......................................................................................... 40
2.8.1.2. Mode of action ................................................................................................... 41
2.8.1.3. Side effects ......................................................................................................... 42
2.8.1.4. Most commonly used LAs in cattle ................................................................... 43
3. Materials and methods .................................................................................................... 44
3.1. 1st Study ........................................................................................................................ 45
3.1.1. Animals .................................................................................................................... 45
3.1.2. Housing and feeding ............................................................................................... 45
II
LIST OF CONTENTS
3.1.3. Study design ............................................................................................................ 46
3.1.4. Instrumentation ....................................................................................................... 46
3.1.5. Treatment ................................................................................................................ 46
3.1.5.1. Regional Intravenous Anaesthesia (RIVA) with Procaine (Procasel 2%) ......... 46
3.1.5.2. Distal Limb Nerve Blocks (DLNB) with Procaine (Procasel 2%) ................... 47
3.1.6. Blood sampling and analysis .................................................................................. 49
3.1.7. Cardio-respiratory ................................................................................................... 50
3.1.7.1. Heart and respiratory rates ................................................................................ 50
3.1.7.2. Blood Pressure Measurement ........................................................................... 50
3.1.8. Nociceptive threshold measurements .................................................................... 50
3.1.8.1. Thermal Nociceptive Threshold measurement ................................................. 51
3.1.8.2. Mechanical Nociceptive Threshold measurement ............................................ 51
3.1.8.3. Electrical Nociceptive Threshold measurement ............................................... 52
3.1.9. Analytical procedures for laboratory parameters ................................................... 53
3.1.10. Statistical evaluation .............................................................................................. 53
3.1.10.1. Calculations and statistical analyses ................................................................ 53
3.2. 2nd Study ........................................................................................................................ 56
3.2.1. Animals .................................................................................................................... 56
3.2.2. Housing and feeding ................................................................................................ 56
3.2.3. Study design ............................................................................................................. 56
3.2.4. Treatment ................................................................................................................. 56
3.2.4.1. Regional Intravenous Anaesthesia (RIVA) with Procaine (Procasel 2%) .......... 56
3.2.4.2. Distal Limb Nerve Blocks (DLNB) with Procaine (Procasel 2%) .................... 56
3.2.5. Nociceptive threshold measurements ...................................................................... 56
3.2.5.1. Mechanical Nociceptive Threshold measurement ............................................. 56
3.2.5.2. Electrical Nociceptive Threshold measurement ................................................ 57
3.2.6. Calculations and statistical analysis ......................................................................... 57
4. Results ............................................................................................................................... 58
4.1. Hind limb dissection .................................................................................................... 58
III
LIST OF CONTENTS
4.2. Heart rate ...................................................................................................................... 60
4.3. Respiratory rate ........................................................................................................... 67
4.4. Systolic Arterial Blood Pressure .................................................................................. 72
4.5. Diastolic Arterial Blood Pressure ............................................................................... 77
4.6. Mean Arterial Blood Pressure (MAP) ........................................................................ 82
4.7. Thermal Pain Stimulations ......................................................................................... 89
4.7.1. Thermal Nociceptive Threshold response baseline .................................................. 89
4.7.2. Thermal Nociceptive Threshold following treatment .............................................. 89
4.8. Electrical Pain Stimulations ........................................................................................ 90
4.8.1. Electrical Nociceptive Threshold response baseline (1st study) ............................... 90
4.8.2. Electrical Nociceptive Threshold response after treatment (1st study) .................... 90
4.8.3. Electrical Nociceptive Threshold response baseline (2nd study) ............................... 91
4.8.4. Electrical Nociceptive Threshold response after treatment (2nd study) .................... 91
4.9. Mechanical Pain Stimulation ...................................................................................... 93
4.9.1. Mechanical Nociceptive Threshold response baseline (1st study) ........................... 93
4.9.2. Mechanical Nociceptive Threshold responses after treatment (1st study) ................ 93
4.9.3. Mechanical Nociceptive Threshold response baseline (2nd study) ......................... 101
4.9.4. Mechanical Nociceptive Threshold responses after treatment (2nd study) ............. 102
4.10. Blood parameters ..................................................................................................... 119
4.10.1. Glucose concentration .......................................................................................... 119
4.10.2. Lactate concentration ........................................................................................... 124
4.10.3. NEFA concentration .............................................................................................. 130
4.10.4. Cortisol concentration ........................................................................................... 135
4.11. Effect of application of tourniquet in hind limb intravenous regional -
anaesthesia ................................................................................................................. 141
5. Discussion and Conclusion ............................................................................................ 145
5.1. Nociceptive threshold techniques (electrical, mechanical and thermal) for
evaluation of anaesthesia .......................................................................................... 145
5.1.1. Electrical nociceptive thresholds ........................................................................... 145
IV