HOW TO PERFORM FIELD ANESTHESIA AND PAIN MANAGEMENT Materials (Fig. 2A)
1. 5% Chlorhexidine scrub 2. 99% Alcohol 3. Sterile gloves 4. Clippers 5. 2% lidocaine 6. Sterile 0.9% saline 7. Epidural catheter kita including: A. Epidural catheter with wire stylet a. 20 gauge, 90 cm b. Closed end with side holes
B. Tuohy introducer needle C. Loss of Resistance syringe D. Catheter adapterb E. Filter F. Injection adapter (PRN)
Fig. 1. The sacral coccygeal joint of the horse. The red arrow indicates the site at which the Tuohy needle will be placed.
2. Materials and Methods
Landmarks (Fig. 1) The epidural catheter is placed at the first coccygeal interspace (Co1–Co2) in horses. This region can be located by moving the tail up and down and palpat- ing the first moveable joint caudal to the sacrum. Additionally, this location is commonly in a midline depression approximately 5 cm from the tail head.
8. Bandage tape 9. Blade
10. Drape 11. Tape measure 12. Non-absorbable suture or stapler
Patient Preparation
Prior to preparation of the epidural site, the horse must be adequately sedated to allow for the proce- dure. Measure the space from the sacrocaudal vertebrae to lumbosacral vertebrae. This is the dis- tance you will advance your catheter past the tip of the Tuohy needle. A 5-inch 5-inch square can be clipped on midline, centered at the Co1–Co2 space
Fig. 2. A, Layout of supplies required for epidural catheter placement. B, Clipped epidural catheter site. C, Palpation of the first moveable coccygeal joint space with assistant raising the tail. D, Placement of Tuohy needle at 45° angle.
