Objective Evaluation of the Response to Perineural Analgesia of the Deep Branch of the Lateral Plantar Nerve and Intraarticular Analgesia of the Tarsometatarsal Joint in Horses With Suspected Proximal Metatarsal Pain Using Body-Mounted Inertial Sensors

Abstract

Perineural analgesia of the deep branch of the lateral plantar nerve (DBLPN block) and intraarticular analgesia of the tarsometatarsal joint (TMT block) are commonly used to differentiate pain originating from the distal tarsal and the proximal metatarsal areas in horses. However, both analgesic techniques have recently been subjected to close scrutiny, with questions raised as to their efficacy. The purpose of this study is to undertake an objective assessment of the effect of both diagnostic analgesia techniques on hindlimb lameness using a body-mounted inertial sensor system (Lameness Locator; Equinosis LLC, Columbia, MO). Horses with chronic hindlimb lameness were instrumented with inertial sensors measuring vertical pelvic asymmetry in millimeters and underwent a routine lameness examination including diagnostic analgesia. Twenty-seven horses showing an improvement in lameness after the DBLPN block were selected for the study. These horses underwent the TMT block on the following day. The change in vertical pelvic asymmetry after the DBLPN block was compared to the change following the TMT block. Of 27 horses, 17 showed improvement after the DBLPN block but not after the TMT block (group 1). The other 10 horses showed improvement in lameness after both analgesic techniques (group 2). The DBLPN block and the TMT block desensitized different structures in more than half of the horses. However, the possibility that both analgesic techniques can desensitize the same structures due to either the diffusion of the anesthetic agent or of an inadvertent injection still remains.