Standing sedation and pain management for ophthalmic patients

Several ocular procedures, including examination, removal of corneal foreign bodies, nictitans surgery, eyelid repair, and tumor excision,can be successfully performed in the appropriately restrained and sedated standing horse. Sedation is best achieved with xylazine,with or without the addition of acepromazine. Additional analgesia can be provided with appropriate local anesthetic blocks. Surgical conditions are greatly improved by using an auriculopalpebral and supraorbital block and topical anesthetics. More elaborate standing sedation involving continuous rate infusions of lidocaine or detomidine combined with butorphanol may facilitate more involved surgery with appropriate support staff and equipment in animals that are at high risk for general anesthesia or when the latter is not an option. Short-term or long-term analgesia is most commonly provided with nonsteroidal anti-inflammatory drugs, but several newer techniques, including lidocaine and butorphanol infusions, may be effective. Topical treatment with opioids to provide analgesia and opioid antagonists to enhance corneal healing is an exciting new development that may revolutionize our approach to corneal ulcer therapy in the future if current research findings are supportive.

Detection of lameness and determination of the affected forelimb in horses by use of continuous wavelet transformation and neural network classification of kinematic data

OBJECTIVE

To investigate continuous wavelet transformation and neural network classification of gait data for detecting forelimb lameness in horses.

ANIMALS

12 adult horses with mild forelimb lameness.

PROCEDURE

Position of the head and right forelimb foot, metacarpophalangeal (ie, fetlock), carpal, and elbow joints was determined by use of kinematic analysis before and after palmar digital nerve blocks. We obtained 8 recordings from horses without lameness, 8 with right forelimb lameness, and 8 with left forelimb lameness. Vertical and horizontal position of the head and vertical position of the foot, fetlock, carpal, and elbow joints were processed by continuous wavelet transformation. Feature vectors were created from the transformed signals and a neural network trained with data from 6 horses, which was then tested on the remaining 2 horses for each category until each horse was used twice for training and testing. Correct classification percentage (CCP) was calculated for each combination of gait signals tested.

RESULTS

Wavelet-transformed vertical position of the head and right forelimb foot had greater CCP (85%) than untransformed data (21%). Adding data from the fetlock, carpal, or elbow joints did not improve CCP over that for the head and foot alone.

CONCLUSIONS AND CLINICAL RELEVANCE

Wavelet transformation of gait data extracts information that is important for the detection and differentiation of forelimb lameness of horses. All of the necessary information to detect lameness and differentiate the side of lameness can be obtained by observation of vertical head movement in concert with movement of the foot of 1 forelimb.

Comparison of the retrobulbar and Peterson nerve block techniques via magnetic resonance imaging in bovine cadavers

OBJECTIVE

To use magnetic resonance (MR) imaging to describe and compare the anatomic distribution of a lipid contrast medium injected via the retrobulbar and Peterson nerve block techniques in heads of bovine cadavers.

DESIGN

Original study.

SAMPLE

5 grossly normal heads obtained from cattle at necropsy.

PROCEDURE

Standardized techniques for the modified retrobulbar and Peterson nerve blocks were established. Each cadaver had 1 treatment performed on a randomly selected side of the head; the second treatment was performed on the alternate side of the head. Injections were performed with canola oil, which is an MR-positive contrast medium. Images of heads in the transverse and dorsal planes were obtained with a 3.0 Tesla short-bore MR system.

RESULTS

The retrobulbar technique was characterized by widespread distribution of the contrast medium around the periorbital structures; further distribution of the medium was detected along the optic nerve and in the ethmoid turbinates and nasopharynx. After the Peterson nerve block technique, contrast medium was repeatedly located in the pterygopalatine fossa, but distribution to surrounding structures was minimal.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicate that the retrobulbar injection technique results in a greater distribution of contrast medium to the target nerves and surrounding structures, compared with that achieved via the Peterson nerve block technique. This may explain the previously reported clinical impression that the retrobulbar block is more reliable than the Peterson nerve block but is associated with a greater risk of complications.

Diagnosis, treatment, and farriery for horses with chronic heel pain

In conclusion, horses with heel or navicular area pain vary, and no one treatment option is suitable for all horses. Each horse must be evaluated individually to determine which structure in the palmar aspect of the foot is injured, severity of disease, horse and hoof conformation, and horse use and level of performance expectation before a treatment plan can be developed. Overall, there are many treatment options to help these horses to perform their intended athletic event.

Effect of alkalinization on the local analgesic efficacy of ketamine in the abaxial sesamoid nerve block in horses

The objective of this study was to determine the effects of the alkalinization on the local analgesic efficacy of 1% ketamine in the abaxial sesamoid nerve block in horses. Thirty-six mature healthy horses were randomly assigned to four groups for the following treatments; an abaxial sesamoid block with 5 mL of saline solution (control saline); an abaxial sesamoid block with 5 mL of a solution containing 1% ketamine (KETs 1%); an abaxial sesamoid block with 5 mL of a solution containing saline solution and 0.5 mEq of sodium bicarbonate (control bicarbonate); and an abaxial sesamoid block with 5 mL of a solution containing 1% ketamine and 0.5 mEq of sodium bicarbonate (KETb 1%). All blocks were performed in one randomly selected front leg. To determine analgesia, hoof withdrawal from thermal stimulus from radiant heat lamp was assessed. Before each block, the hoof withdrawal reflex latency (HWRL) (time between lamp illumination and withdrawal of the hoof) was determined; after the block, local analgesic effects were determined using the heat lamp at 2 and 5 min after the injection and then every 5 min for 1 h. In KETs 1% group, there were significant increases in HWRL between basal values and values from 2 to 10 min after an abaxial sesamoid block. In KETb 1% group, significant increases in HWRL was collected between the basal value and values from 2 to 25 min following an abaxial sesamoid block. In KETs 1% group, of the nine horses, four had an abaxial sesamoid block that was unsuccessful. However, in KETb 1% group, only one of the nine horses had an abaxial sesamoid nerve block that was unsuccessful. The alkalinization of a 1% ketamine solution produced a more consistent and persistent local analgesia in horses when compared with 1% ketamine solution alone.

Evaluation of the local analgesic effect of ketamine in the palmar digital nerve block at the base of the proximal sesamoid (abaxial sesamoid block) in horses

OBJECTIVE

To evaluate the local analgesic effect of ketamine in a palmar digital nerve block at the base of the proximal sesamoid (abaxial sesamoid block) in horses.

ANIMALS

36 mature healthy Andalusian horses.

PROCEDURE

Horses were randomly assigned to 4 groups of 9 horses each and received an abaxial sesamoid block in a randomly chosen forelimb with 1 of the following: saline (0.9% NaCl) solution, 1% ketamine solution, 2% ketamine solution, or 3% ketamine solution. To determine analgesia, the radiant heat lamp-hoof withdrawal model was used as a noxious thermal stimulus. Before each nerve block, baseline hoof withdrawal reflex latency (HWRL, time between lamp illumination and withdrawal of the hoof) was determined; after the nerve block, local analgesic effects were determined by measuring HWRL at 2 and 5 minutes after injection and then every 5 minutes for a total period of 1 hour.

RESULTS

Significant differences in HWRL were found between baseline values and values at 2 to 15 minutes following a nerve block with ketamine. Significant differences were found between HWRL values at every time point from 2 to 10 minutes following a nerve block with saline solution, compared with 1 or 2% ketamine solution. Similarly, significant differences were found between HWRL values at every time point from 2 to 15 minutes following a nerve block with saline solution, compared with 3% ketamine solution.

CONCLUSIONS AND CLINICAL RELEVANCE

Abaxial sesamoid block with ketamine ensures adequate analgesia in horses with an onset of action of 2 minutes and a maximal duration of action of 15 minutes.

Electrical nerve stimulation as an aid to the placement of a brachial plexus block

Most local anaesthetic blocks are placed blindly, based on a sound knowledge of anatomy. Very often the relationship between the site of deposition of local anaesthetic and the nerve to be blocked is unknown. Large motor neurons may be stimulated with the aid of an electrical current. By observing for muscle twitches, through electrical stimulation of the nerve, a needle can be positioned extremely close to the nerve. The accuracy of local anaesthetic blocks can be improved by this technique. By using the lowest possible current a needle could be positioned with in 2-5 mm of a nerve. The correct duration of stimulation ensures that stimulation of sensory nerves does not occur The use of electrical nerve stimulation in veterinary medicine is a novel technique that requires further evaluation.

Comparison of lidocaine and compression for velvet antler analgesia in wapiti

This research compared ring block lidocaine anesthesia (L) and compression (C) for velvet antler removal in elk. Thirty-two wapiti were given 1 mg/kg body weight of zuclopenthixol acetate. The next day, they were restrained in a hydraulic chute and given either a compression device or a lidocaine ring block on the antler pedicle. Behavioral and physiological responses to treatment application and antler removal were recorded, and blood was collected for cortisol analysis. During application of L and C, increases in mean heart rate and systolic arterial blood pressure were greater in the C treatment group (P < 0.05, and P = 0.05, respectively). When antler was removed, more behavioral responses occurred in the C treatment group (P = 0.02) and its median behavior score was higher (P = 0.03). Mean heart rates increased for both treatment groups when antlers were removed (P < 0.01). It was concluded that application of C may be painful, and that C was not as effective as L for analgesia for velvet antler removal.

Use of infrared thermography to detect injections and palmar digital neurectomy in horses

Thermography is a non-contact, non-invasive technique that detects surface heat emitted as infrared radiation. Because skin temperature reflects the status of underlying tissue metabolism and blood circulation, abnormal thermal patterns can signify areas of superficial inflammation. The objective of this study was to determine if thermography could detect the injection of analgesic and neurolytic agents and surgical palmar digital neurectomy. Procedures evaluated include injection of the lumbar region, suspensory ligaments, tibial nerve, palmar digital nerves, and palmar digital neurectomy. Thermographic images were obtained before and after the procedures until a significant difference was no longer detected. Local injection of the lumbar region and the suspensory ligament produced detectable thermal patterns for two days, and tibial nerve infiltration with a neurolytic agent was significant for two days. Analgesia of the palmar nerves was significant for 24h with bupivicaine, compared to five days for ammonium chloride. Palmar digital neurectomy produced more variable thermal patterns. While sensitive enough to detect changes in heat patterns from control regions, thermography is not specific enough to discriminate between procedures and injury inducing an inflammatory response.

Comparison of analgesic techniques for antler removal in wapiti

The purpose of this research was to compare the effectiveness of ring block anesthesia (LA) and electroanesthesia (A) for antler removal in elk given a long-acting tranquilizer to remove stress from restraint. Thirty-two male wapiti were given 1 mg/kg body weight of zuclopenthixol acetate; the next day, they were restrained in a hydraulic chute, provided with electroanesthesia or a lidocaine ring block, and had their antlers removed. Behavioral response to antler removal was scored. Significantly more (P = 0.032) animals responded to antler removal in the EA group. Heart rates and arterial pressures were measured by a catheter connected to a physiological monitor. Heart rate increased significantly over time with EA, but not with LA. Heart rate increased from baseline significantly more in the EA group immediately prior to antler removal (P = 0.017), immediately post antler removal (P = 0.001), and at 1 min post antler removal (P = 0.037). It was concluded that EA is not as effective a method of anesthesia as is LA for antler removal.

The effect of bilateral palmar digital nerve analgesia on the compressive force experienced by the navicular bone in horses with navicular disease

Horses with navicular disease have an increased load on the navicular bone in early stance. This has been suggested to be a response to pain in the heel region. Seven horses with clinical, radiographic and scintigraphic signs of navicular disease underwent forceplate and kinematic analysis before and after desensitisation of the heel region with a bilateral palmar digital nerve block. The compressive force exerted on the navicular bone during stance, and stride kinematics, were determined in each state. After regional analgesia of the palmar digital nerves (PDNB) the compressive force on the navicular bone was lower throughout stance. The mean +/- s.d. peak force at the beginning of stance was 7.05+/-1.10 N/kg before, and 6.46+/-1.15 N/kg after PDNB (P = 0.01) and at the end of stance the mean peak values were 5.00+/-2.05 N/kg before, and 4.39+/-1.65 N/kg after PDNB (P = 0.05). We explained this finding as indicating that the horse responds to heel pain (including pain in the navicular region) by contracting the deep digital flexor muscle to unload the heels. This increases the compressive load on the navicular bone, which may cause remodelling and, in some horses, damage to the overlying flexor cartilage, which is then painful and identified as navicular disease. This mechanism identifies navicular disease as a possible end point for a variety of heel related conditions.

Locomotor characteristics of horses with navicular disease

OBJECTIVE

To determine whether force-plate evaluation of horses with navicular disease would reveal an abnormal gait that persists despite loss of sensation to the palmar foot region, which may predispose such horses to navicular disease.

ANIMALS

17 clinically normal Thoroughbreds and 8 Thoroughbreds with navicular disease.

PROCEDURE

Data on ground reaction forces were obtained in trotting horses, using a force plate. Force-time curve variables for clinically normal horses were derived from 4 points at the beginning and 4 points at the end of the vertical and craniocaudal horizontal plots. Principal component analysis was undertaken separately on beginning-of-stride and end-of-stride data, and the first 2 components were represented graphically. Rotation matrices were applied to equivalent data for horses with navicular disease before and after disruption of sensation by administration of a palmar digital nerve blockade.

RESULTS

Prior to nerve block, horses with navicular disease differed significantly from normal horses for beginning-of-stance phase and end-of-stance phase variables. After nerve block, horses with navicular disease maintained the same significant differences from clinically normal horses only for variables at the beginning-of-stance phase.

CONCLUSIONS AND CLINICAL RELEVANCE

Horses with navicular disease have abnormal limb-loading force patterns that are not altered by loss of sensation in the palmar region. These abnormal patterns were detected in a horse without navicular disease. Some horses are predisposed to navicular disease as a result of an inherent abnormal gait pattern. Analysis of gait patterns could be used for detection and appropriate management of horses susceptible to development of navicular disease.

The use of a catheter to provide brachial plexus block in dogs

The objective of the study was to devise a method to facilitate catheter placement to perform brachial plexus block in the dog. Lidocaine plus epinephrine was injected through a 3.5 French feeding tube secured in proximity of the brachial plexus. Cutaneous areas for the nerves of the distal forelimb were tested for nociceptive sensation by pinching the skin with hemostats. Five out of the 7 dogs developed a full motor and sensory block. The onset time for a full block and duration of blockade were 54 min, s = 17.1 and 39 min, s = 37.6, respectively. A second blockade was successfully achieved in 2 dogs in which the catheter was not displaced. An indwelling feeding tube is an effective way to provide blockade of the brachial plexus in the dog. The placement and the fixation of the catheter were critical for the production of a full block.

Electrically induced blink reflex and facial motor nerve stimulation in beagles

Electrophysiologic assessment of the blink reflex test and the muscle-evoked potentials evoked by stimulation of the facial nerve were performed in 15 healthy adult Beagles before and after supraorbital (trigeminal) and facial anesthetic nerve blocks performed by lidocaine injections. Unilateral electrical stimulation of the supraorbital nerve elicited 2 ipsilateral (R1 and R2) and a contralateral (Rc) reflex muscle potential in orbicularis oculi muscles. Electrical stimulation of the facial nerve elicited 2 muscle potentials (a direct response [D] and a reflex faciofacial response [RF]) in the ipsilateral orbicularis oculi muscle. Anesthetic block of the left supraorbital nerve resulted in bilateral lack of responses upon left supraorbital nerve stimulation, but normal responses in right and left orbicularis oculi muscles upon right supraorbital stimulation. Right facial anesthetic block produced lack of responses in the right orbicularis oculi muscle regardless the side of supraorbital nerve stimulation. Results of this study demonstrate that the blink reflex can be electrically elicited and assessed in dogs. Reference values for the blink reflex responses and for the muscle potentials evoked by direct facial nerve stimulation in dogs are provided. The potential usefulness of the electrically elicited blink reflex test in the diagnosis of peripheral facial and trigeminal dysfunction in dogs was demonstrated.

Electrically elicited blink reflex in horses with trigeminal and facial nerve blocks

OBJECTIVE

To reassess reference values for the components of the electrically induced blink reflex, document reference values for facial motor nerve conduction velocity, and demonstrate usefulness of the blink reflex as a diagnostic tool in peripheral facial and trigeminal nerve dysfunction in horses.

ANIMALS

10 healthy adult horses (8 males, 2 females) without neurologic abnormalities.

PROCEDURE

Blink reflex tests were performed by electrical stimulation of the supraorbital nerve and facial (auriculopalpebral) nerve. Reflex and direct muscle-evoked potentials of the orbicularis oculi muscles were recorded from concentric needle electrodes inserted bilaterally in these muscles. Supraorbital and auriculopalpebral nerve blocks were performed by lidocaine hydrochloride injections.

RESULTS

Supraorbital nerve stimulation elicited 2 or 3 ipsilateral and 1 contralateral reflex muscle potential in the orbicularis oculi muscles. Auriculopalpebral nerve stimulation elicited a direct and a reflex potential in the ipsilateral orbicularis oculi muscle. After left supraorbital nerve block, no responses could be elicited ipsilaterally or contralaterally upon stimulation of the blocked nerve, but bilateral responses were obtained upon stimulation of the right supraorbital nerve. After right auriculopalpebral nerve block, no responses were recorded from the right orbicularis oculi muscle upon stimulation of left or right supraorbital nerves.

CONCLUSIONS AND CLINICAL RELEVANCE

Reference values for the components of the blink reflex and facial motor nerve conduction velocity will allow application of these tests to assist in the diagnosis of equine neurologic disorders involving the trigeminal and facial nerves, the brainstem, and the cranial end of the cervical segment of the spinal cord. This study reveals the usefulness of the blink reflex test in the diagnosis of peripheral trigeminal and facial nerve dysfunction in horses.

Nerve block and intra-articular anaesthesia of the forelimb in the sound horse

Nerve blocks and intra-articular anaesthesia are used extensively as routine methods in lameness evaluation. The method is based on the assumption that the technique itself does not change the movement pattern. The aim of this study was to carry out a quantitative kinematic study to confirm or reject the hypothesis that high palmar digital nerve block (HPDN) and intra-articular fetlock joint anaesthesia (IAF) influence significantly the movement pattern of the horse. Seven Standardbred horses trotting at 4.5 m/s were recorded at 240 Hz on a treadmill before and after anaesthesia by use of a ProReflex video system. Time variables, segment and joint angles were calculated. The high palmar digital nerve block (HPDN) resulted in a longer stance time and caused a greater fetlock joint angle range and greater maximal pastern joint angle. No systematic differences in time and angle variables were observed after intra-articular fetlock joint anaesthesia (IAF). In conclusion, HPDN but not IAF affects locomotor pattern in sound horses. Distal limb proprioception is important in normal movement, while fetlock intra-articular proprioception is apparently not. Interpretation of the effect of HPDN in lame individuals should incorporate more variables than maximal overextension of the fetlock joint.

Dental disease in geriatric horses

The dental management of geriatric horses can be a rewarding challenge to the practitioner. Owners become dissatisfied when their expectations are unrealistic. Consequently, communication between the owner and the practitioner is essential prior to the start of any dental procedure in a geriatric horse. Owners often expect the practitioner to correct what has been neglected for years. It is critical that the owner understand the possible complications associated with dental procedures and that some procedures (e.g., trephination) may necessitate protracted care. Often, when a tooth has been removed, there is a need for more frequent masticatory examinations to curtail any potential problems (i.e., development of step mouth). The owner needs to be aware of the extra dental maintenance costs that must be included in the upkeep of the horse.

[Basis and use of neural therapy in diagnosis and treatment]

Pain treatment by using local anesthetics is of old tradition and its utilization in functional disorders might be the remedy of choice; an existing pathomorphology is at least an indication for a supporting use. Findings of segmental reflexes and knowledge of chronically stressing factors can help for an efficient and cost-sparing treatment. The major part of time has to be spent on examination but there is no need for high-tech instruments when anamnesis is carefully directed and palpation examination and functional probes are carried out conscientiously (including well-founded anatomical knowledge). In therapy there are also used the segmental reflective pathways as well as "neural techniques" meaning blocks of vegetative structures (sympathetic trunk, ganglions and plexuses). In question of resistance to therapy is, considering chronic irritating conditions, the so-called "treatment of the disturbing region" a causal treatment in a strict sense.

Effects of bilateral hypoglossal and glossopharyngeal nerve blocks on epiglottic and soft palate position in exercising horses

OBJECTIVE

To determine the effect of bilateral hypoglossal and and glossopharyngeal nerve block on epiglottic and soft palate position and tracheal and pharyngeal pressures in exercising horses.

ANIMALS

5 Standardbreds.

PROCEDURE

Tracheal and pharyngeal pressures were measured in 5 Standardbreds exercising at the speed at which the horses achieved 50, 75, and 100% of maximal heart rate after bilateral hypoglossal and glossopharyngeal nerve block and without nerve block. Nerve block was achieved by injection of 1 to 2 ml of 2% mepivicaine hydrochloride between the glossopharyngeal and hypoglossal nerves, as they coursed through the medial compartment of the diverticulum of the auditory tube (guttural pouch), using videoendoscopic guidance and an injection apparatus.

RESULTS

Compared with control values, peak inspiratory tracheal pressure was significantly (P = 0.02) more negative, and peak pharyngeal inspiratory pressure was less negative (P = 0.004) after bilateral hypoglossal and glossopharyngeal nerve block. Respiratory frequency was significantly (P = 0.024) lower after nerve block, compared with control values. The epiglottis was unstable and retroflexed through the rima glottis during inspiration after bilateral hypoglossal and glossopharyngeal nerve block. Despite loss of contact between the epiglottis and the caudal free margin of the soft palate, dorsal displacement of the soft palate did not occur.

CONCLUSIONS AND CLINICAL RELEVANCE

Loss of contact of the epiglottis with the soft palate did not affect soft palate position, suggesting that when the soft palate is normal, the epiglottis does not function as a support, holding the soft palate in a ventral position. Therefore, epiglottic dysfunction is not solely responsible for intermittent dorsal displacement of the soft palate in horses, and neuromuscular dysfunction involving the hyoepiglotticus muscle, geniohyoideus muscle, or the hypoglossal nerve may cause epiglottic retroflexion in horses.

Comparison of three methods for relief of pain after ear canal ablation in dogs

This study compared three methods of pain relief in dogs that had total ear canal ablation with lateral bulla osteotomy. The hypothesis was that systemic opioids with preoperative local nerve blocks would provide superior pain relief. Thirty-one dogs with chronic otitis externa were included in the study. Dogs were randomly assigned to one of three protocols: systemic opioids alone (10 dogs, group 1), systemic opioids with bupivacaine splash block (11 dogs, group 2), and systemic opioids with preoperative local bupivacaine nerve blocks (10 dogs, group 3). Twenty-one dogs had bilateral ear ablation and 10 had unilateral ablation. Pain was assessed preoperatively, at extubation, 2 hours postextubation, and 1 day postoperatively by a single observer blinded to the analgesic protocol used. Pain scores were not significantly different within or between groups, nor did unilateral versus bilateral ablation have a significant effect on the score. Mean scores were less than 3 (scale 1 to 5) for all groups at all observation times. Rough recoveries were noted in 30% of group 1 dogs, 0% of group 2, and 20% of group 3 dogs. Ninety-four percent of dogs were moderately to heavily sedated at extubation. Sixty percent of group 3 dogs remained moderately to heavily sedated 2 hours postextubation. Rectal temperature, pulse rate, respiratory rate, and postoperative change in serum cortisol levels were not significantly different between groups. Postoperative increase in blood glucose was significantly higher in groups 1 and 3 compared with preoperative levels. Twenty-three percent of the dogs required additional analgesia or tranquilization after surgery, as determined by the anesthetist; 1 dog in group 1, 2 in group 2, and 4 in group 3. Each of the three analgesic protocols provided similar pain relief in dogs undergoing total ear canal ablation.

Possibility of blocking n. ischiadicus within foramen ischiadicum majus in sheep

The blocking of the ischiadic nerve within foramen ischiadicus majus of 8 sheep was performed with 6-12 ml 2% xylocain from three different places: 1. From the middle of a line joining the top of processus spinosus of the 1st sacral vertebra and the peak of trochanter major. The needle pierces vertically through the skin, gluteal fascia and m. gluteus medius till foramen ischiadicum majus. 2. Along the most prominent part of crista iliaca on the gluteal surface of ala ossis ilium along the medial side of well expressed linea glutea. The needle pierces by an angle of 45 degrees through the skin, gluteal fascia and m. gluteus medius till the nerve itself. When the nerve is touched the animal makes a jerk. 3. Along the caudal part of tuber sacrale with the needle orientated caudo-ventro-laterally through the skin, gluteal fascia and m. gluteus medius toward foramen ischiadicum majus. The most appropriate approach for blocking is along crista glutea on the gluteal surface of ala assis ilii. In this approach the success is complete. The symptoms of the blocking appear immediately after the application. The complete akinesia of the limb appears 15 minutes after the application of 6 ml, and 5-10 minutes after being applied 12 ml of 2% xylocain. The blocking symptoms disappear within 90-100 or 120-140 minutes. Beside the blocking of n. ischiadicus, a simultaneous blocking of n. gluteus cranialis, n. caudalis and n. cutaneus femoris caudalis as well was performed within foramen ischiadicus majus.