Horses are excitable animals by nature and are often particularly sensitive to and intolerant of palpation around their head and ears. However, it is frequently necessary to perform procedures around the head, during routine veterinary examination and treatments, and prophylactic dental procedures. Such procedures are often poorly tolerated by the horse and may result in potentially violent avoidance behaviour, preventing safe completion of the procedure. In addition, due to the high cost of general anaesthesia, and its reported risks of morbidity and mortality, and due to the high demands on time and personnel, the ability to perform many investigative, surgical and dental procedures safely in the conscious, sedated horse is attractive. Regional and local nerve blocks are commonly used to enhance the analgesia achieved under general anaesthesia, for oral surgical procedures in other species, including dogs (Beckman and Legende 2002; Lantz 2003) and man (Reiter 1980; Johnson 1982; Lefevre 1991), and for surgical procedures on the distal limbs in horses. Traditionally, restraint of horses for procedures on the head has been achieved with the assistance of an experienced handler, nose twitches and administration of sedatives, especially α-2 agonist drugs. The α-2 agonists produce a satisfactory level of sedation and analgesia, particularly when used in combination with opiates including butorphanol (Torbugesic)1, methadone (Physeptone)2 and morphine (Morphine Sulphate)3. Although adequate, chemically-assisted restraint can be achieved using these techniques in many horses and for many minor procedures, the horse undoubtedly still experiences considerable pain, which is both noxious and undesirable. Therefore, from a welfare perspective, with respect to the horse, and from an efficacy and safety perspective with respect to the veterinarian, it is highly desirable to achieve a greater degree of regional analgesia and muscle relaxation than is possible using sedatives alone, particularly when doing invasive procedures requiring a high degree of precision. The use of regional or local anaesthetic techniques produces superior analgesia resulting in better compliance, safer restraint, reduced doses of sedative drugs and greater duration of sedation, and consequently facilitates shorter operating times. In addition, head-shy behaviour, which can be learned as a consequence of noxious veterinary procedures on the head, is less likely to be reinforced.
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