Evaluation of frontal and infratrochlear nerve blocks for standing sedated frontonasal sinusotomy in horses.
Authors: Elliott Singen M, Giancola Shyla C, Moorman Valerie
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Frontal and Infratrochlear Nerve Blocks for Standing Frontonasal Sinusotomy Addressing frontal sinus disease in standing sedated horses has traditionally relied on line blocks or regional techniques with variable analgesia along the surgical approach. Singen, Giancola and Moorman evaluated whether targeted blocking of the frontal and infratrochlear nerves could reliably anaesthetise the frontonasal sinusotomy site, using a two-part design: Part 1 compared mechanical nociceptive thresholds (MNT) across five sites along the proposed incision line following either nerve blocks or conventional line blocks in six horses (crossover design, 2% mepivacaine), whilst Part 2 assessed the feasibility of creating and closing skin and periosteal incisions under nerve block analgesia alone in six additional horses. Both blocking techniques increased median MNT values at least twofold above baseline across all five measurement sites (p <0.0025), with targeted nerve blocks proving effective enough to allow successful incision creation in five of six horses, achieving median incision dimensions of 6.5 × 5 cm. For practitioners performing frontonasal sinusotomies in standing patients, these findings demonstrate that precise frontal and infratrochlear nerve blocks offer a viable alternative to traditional line blocks, potentially providing more consistent analgesia with reduced local anaesthetic volumes and improved surgical conditions during the approach phase.
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Practical Takeaways
- •Frontal and infratrochlear nerve blocks offer a viable alternative to line blocks for frontonasal sinusotomy in standing horses, potentially reducing local anesthetic volume and improving surgical access
- •This technique successfully desensitized the surgical approach in 83% of horses (5/6), making it a reliable option for practitioners performing sinus surgery
- •The targeted block approach may improve efficiency and safety of standing sinus procedures by providing focused anesthesia without extensive tissue infiltration
Key Findings
- •Both frontal/infratrochlear nerve blocks and line blocks increased mechanical nociceptive thresholds at least two-fold compared to baseline across all five measured sites (p < 0.0025)
- •Frontal and infratrochlear nerve blocks enabled completion of skin and periosteal incisions in 5 of 6 horses with median incision size of 6.5 × 5 cm
- •Targeted nerve blocks provide effective anesthesia for the frontonasal sinusotomy approach in standing sedated horses