Veterinary Anaesthesia and Analgesia, 2010, 37, 460–470 doi:10.1111/j.1467-2995.2010.00560.

RESEARCH PAPER

Ultrasound-guided nerve blocks of the pelvic limb in dogs

Yael Shilo*, Peter J Pascoe , Derek Cissell*, Eric G Johnson , Philip H Kassà & Erik R Wisner 
*Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA, USA
 Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
àDepartment of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA,
USA

Correspondence: Yael Shilo, Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California at Davis,
One-Shields Ave. Davis, CA 95616 USA. E-mail: yshilobenjamini@ucdavis.edu

the three bupivacaine treatments. Success rates of

Abstract
Objectives To evaluate the efficacy of ultrasound-
guidance in nerve blockade of the sciatic and
saphenous nerves in dogs and to determine if this
technique could allow lower anaesthetic doses to be
used with predictable onset and duration of effect.
Study design Prospective randomized (for dose and
leg) blinded experimental crossover trial with
10 day washout period.
Animals Six healthy female Hound dogs aged
12.3 ± 0.5 (mean ± SD) months and weighing
18.7 ± 0.8 (mean ± SD) kg.
Methods An ultrasound-guided, perineural injection
was used with saline at 0.2 mL kg)1 (Sal) or
bupivacaine 0.5% at 0.05 (low dose; LD), 0.1
(medium dose; MD), or 0.2 (high dose; HD) mL kg)1,
divided 2/3 at the sciatic nerve and 1/3 at the
saphenous nerve. Blocks were performed using
dexmedetomidine sedation with atipamezole rever-
sal immediately after completion of the injections.
Motor/proprioceptive and sensory functions were
scored using a 0–8 and a 0–2 scale, respectively.
Clinically relevant blocks were defined as a motor
score ‡2 and sensory score ‡1. Nonparametric
methods were used for statistical analysis.
Results No adverse effects were noted. There was a
significant difference between the treatments with
bupivacaine and the saline control, but not between
clinically relevant sciatic and saphenous blocks
were both 67% (CI 95% 0.22–0.96). Onset and
duration of the blocks were variable; 20–160 and
20–540 minutes, respectively.
Conclusion and clinical relevance None of the
bupivacaine doses was significantly superior,
though there was a tendency for a better block
with the high bupivacaine dose. Either the tech-
nique or the doses used need further modification
before this method will be useful in clinical practice.
Keywords bupivacaine, dog, regional anaesthesia,
sciatic nerve block, saphenous nerve block, ultra-
sound guidance.
Introduction
Local and regional anaesthesia techniques in dogs
increasingly have been used to relieve the pain
related to a variety of medical and surgical proce-
dures. Regional anaesthesia completely blocks
transmission of noxious impulses, decreases the
quantity of opioids and inhalation anaesthetics
required intraoperatively, and thus potentially
decreases their adverse effects (Skarda & Tranquilli
2007a). The basic principle of regional anaesthesia
was stated in an editorial in the British Journal of
Anaesthesia: ‘Regional anaesthesia always works –
provided you put the right dose of the right drug in
the right place’ (Denny & Harrop-Griffiths 2005).
The right place is the hardest one to achieve, and

460

the visualization provided by ultrasound allows
better identification of that right place.
Ultrasound-guided nerve block has been investi-
gated and used in human anaesthesia over the past
15 years. The potential advantages of this method
are many, and include: direct visualization of nerves
and adjacent anatomical structures (blood vessels,
muscles, bones, and tendons), direct visualization of
the spread of local anaesthetic during injection,
with the possibility of repositioning the needle in
cases of maldistribution, and avoidance of intra-
neural or intravascular injections (Marhofer et al.
2005). Reduction of the local anaesthetic dose is
another potential advantage, as it should reduce the
risk of systemic toxicity. This may be important,
especially in patients with renal or hepatic insuffi-
ciency, with autonomic neuropathy, in elderly and
debilitated patients, in infants and young patients,
and when simultaneous local anaesthesia of more
than one region of the body is required (Marhofer
et al. 1998, 2005; Sandhu et al. 2006; Willschke
et al. 2006; Lo et al. 2008). In addition there are
suggestions that accurately placed local anaesthetic
can have a faster onset, a more predictable duration
and overall improvement of block quality (Marhofer
et al. 2005).
The block used most commonly for hind limb
surgeries in dogs is epidural or intrathecal anaes-
thesia (Kona-Boun et al. 2006; Bergmann et al.
2007; Skarda & Tranquilli 2007a; Valverde 2008).
There are conditions in which this procedure is
contraindicated (e.g. hypotension, sepsis, coagulo-
pathy, anatomical disorders, inflammation of the
injection site) (Skarda & Tranquilli 2007a), difficult
to perform (e.g. extremely obese dogs) or of clinical
concern (e.g. myelopathy, pelvic pathology), in
which case as an alternative, animals may benefit
from a saphenous and sciatic blockade. Regional
anaesthesia of the femoral and sciatic nerves has
been reported as being comparable in analgesia to
epidural anaesthesia for knee surgeries in humans
(Davies et al. 2004; Fowler et al. 2008) and in dogs
(Campoy et al. 2009), but to have fewer side effects.
The use of ultrasound-guided nerve block of the
pelvic limb has been studied in dogs, although none
of the studies went beyond a single dose of lidocaine
(Costa-Farre et al. 2009; Echeverry et al. 2009).
The purpose of this study was to evaluate the
efficacy and adverse effects of ultrasound-guided
nerve blockade of the sciatic and saphenous nerves
in dogs at different bupivacaine doses, and to
determine if lower doses, more precisely applied,
 2010 The Authors. Journal compilation
 2010 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists, 37, 460–470
Pelvic limb blockade in dogs Y Shilo et al.
can provide a more predictable onset and duration
of effect.
Materials and methods
Animals
Six healthy female Hound dogs aged 12.3 ± 0.5
(mean ± SD) months and weighing 18.7 ± 0.8
(mean ± SD) kg were used in this study. Health
status of the dogs was assessed by physical exami-
nation, complete blood count, glucometer test and
Azo stick. Husbandry was provided according to the
American College of Laboratory Animal Medicine
guidelines. Animals were allowed to acclimatize for
a week prior to the beginning of the study. Prior to
each study dogs were fasted for 12 hours (with free
access to water) and were weighed. The study pro-
tocol was approved by the Animal Care and Use
Committee of the University of California at Davis.
Experimental protocol
Preliminary work
Preliminary work was performed by the authors
before commencement of the main study in order to
familiarise the research team with the techniques.
Firstly, real time ultrasound with colour-flow
Doppler was used to identify the vessels in proximity
to the nerves in order to refine the landmarks for
injection in three live dogs, following owners’
approval. The dogs were clipped for the ultrasound,
but were not sedated, and injections were not per-
formed. Secondly, in three cadavers of dogs that
died or were euthanized due to terminal illness,
under ultrasound guidance sciatic and saphenous
nerves were injected with 0.2 mL of coloured dye,
and then the nerves dissected in order to confirm
the detection of the nerves and the accuracy of the
injection.
Study protocol
The dogs were assigned randomly to four treat-
ments, using a multiple-dose crossover design with
at least a 10-day washout period between treat-
ments. Treatment side (right or left pelvic limb) also
was randomized. For each treatment, dogs were
sedated with dexmedetomidine hydrochloride (Dex-
domitor; Orion Pharma, Finland) 15–18 lg kg)1
intramuscularly (IM), and the sedation was reversed
461
Pelvic limb blockade in dogs Y Shilo et al.
with atipamezole hydrochloride (Antisedan; Orion
Pharma) 150–180 lg kg)1 IM immediately after
the blocks had been performed. Following sedation,
the dogs were positioned in lateral recumbency.
Hair was clipped at the sacroiliac region from tuber
coxae to tuber ischii and from dorsal midline to mid-
femur. On the medial aspect of the limb, hair was
clipped from the inguinal region to mid-femur. Both
regions were prepared aseptically for injection.
An ultrasound-guided, percutaneous, perineural
injection was applied around the saphenous and
sciatic nerves with saline 0.2 mL kg)1 (Sal) or
bupivacaine hydrochloride 0.5% (Bupivacaine HCl
0.5%; Hospira Inc., IL, USA) at three different doses:
0.05 (low dose; LD), 0.1 (medium dose; MD), or 0.2
(high dose; HD) mL kg)1, divided 2/3 at the sciatic
nerve and 1/3 at the saphenous nerve. Echogenic
needles (Echostim facet tip, 21 gauge · 50 mm;
Havel’s Incorporated, OH, USA) specifically designed
for ultrasound-guided regional anaesthesia were
used. Ultrasonography was performed using a
Philips HDI 5000 ultrasound machine (Philips
Healthcare, WA, USA) with a 5–8 MHz curvilinear
transducer. Sciatic nerve detection was performed
following the guidelines from Benigni et al. (2007).
Briefly, the sciatic nerve was identified in the
transverse and longitudinal planes at the level of
the greater trochanter of the femur, and followed
proximally to the point where it crosses the ilium,
just caudal to the sacroiliac joint, where injections
(a) (b)
Ultrasound
beam
Ilium
Ischium Sacrum
Sciatic
nerve
Femur
Sciatic
nerve
Ischium
Figure 1 Injection technique for ultrasound-guided sciatic (a, b) and saphenous (c) nerve blocks in the dog. (a) Right pelvic
limb, lateral view. (b) Right pelvis, dorsal view. (c) Right pelvic limb, medial view.
462  2010 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists, 37, 460–470
were performed using an in-plane technique (Fig. 1
a,b). After the sciatic nerve was identified and the
needle was in place for injection, a nerve stimulator
(DigiStim 3 PLUS; Neuro Technology Inc., TX, USA)
was used (in 15/24 injections) to test the mA
required to produce a motor response at the
injection site. After recording the mA, the injection
was performed in the longitudinal plane without
moving the needle from the original location. The
region of the saphenous nerve was identified by
locating the femoral artery and vein between the
proximal and the middle thirds of the femur, and
injections were performed with the needle guided
deep to the vessels using an in-plane technique
(Fig. 1c). Local anaesthetic distribution was as-
sessed visually via the ultrasound image in long
axis for all perineural injections of the sciatic nerve
and in short axis for all injections of the saphenous
nerve.
After reversal of sedation the sciatic nerve was
evaluated for sensory and motor function, and the
saphenous nerve was evaluated for sensory function
only, as the cutaneous branch of the femoral nerve
does not have a motor component (Kitchell & Evans
1993). Assessments were performed every 10 min-
utes for the first hour, and then every 20 minutes,
until the animal returned to normal function. Time
to onset and duration of the blocks were recorded.
The quality of sensory block was assessed by
response to pinching with a hemostat in the central
(c)
Cranial
Ilium
Saphenous
nerve
Ultrasound beam
Femur
Ultrasound
beam
Femur
Caudal
 2010 The Authors. Journal compilation

sensory region of the targeted nerve (for the
saphenous) or down to the toes (for the sciatic),
and was compared with the same stimulation in
pre-testing of the same leg prior to sedation and
with the contralateral limb. Landmarks for sensory
regions of both nerves are described elsewhere
(Kitchell & Evans 1993; Adams 2004).
Evaluation of the motor block was assessed by
motor changes, observed by leg position, proprio-
ception, standing and walking patterns (Table 1).
For the sensory block minimum score was 0, when
the animal had normal sensation, and maximum
score was 2, when the animal had complete
blockade. For the motor block minimum score was
0, when the animal had normal function, and
maximum score was 8, when the animal had
complete blockade. Half-point scores were assigned
when it was thought that the observed change was
between the two whole point descriptors. Clinically
relevant blocks were defined as a motor score ‡2
and sensory score ‡1. The assessment of the block
was performed by one person (YS), who did not
know which treatment the animal had received.
The person who performed the injections (DC) also
did not know which treatment the animal had
received and did not take part in the assessment of
the blocks. The person who carried out the injec-
tions was a radiology resident with 2 years experi-
ence performing ultrasound examinations,
ultrasound-guided fine needle aspirates and in
placing ultrasound-guided intra-arterial catheters.
All nerve detection and injections were made under
Table 1 Assessment parameters of the sensory and motor
blocks after ultrasound guided nerve block of the sciatic
and saphenous nerves in dogs*
Scoring 0 1
Sensory block
Response to pinching Normal Decreased
response response
Total sensory scoring Min = 0
Motor block
Weight bearing
Standing Normal Decreased
Walking Normal Decreased
Proprioception Normal Reduced
Leg position Normal Reduced
Total motor scoring Min = 0
*Half-point scores were assigned when it was thought that the
observed change was between the two whole point descriptors.
 2010 The Authors. Journal compilation
 2010 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists, 37, 460–470
Pelvic limb blockade in dogs Y Shilo et al.
the direct supervision of a board-certified radiologist
and a board-certified anaesthesiologist. Dogs were
monitored for several hours post injection of the
local anaesthetic/saline, until complete recovery.
Any adverse effects were recorded.
Statistical analysis
Due to the use of categorical scales, nonparametric
methods were used for all analyses. The Friedman
repeated measures analysis of variance was used to
evaluate changes in dependent variables over time
conditional on treatment, and also treatment
differences conditional on time. Time to onset and
duration of effects were compared between the three
bupivacaine treatments (not including saline con-
trol) using the Friedman test. The Wilcoxon signed
rank test was used to compare onset and duration
between the nerves. Proportion of dogs with
successful blockade is presented with exact 95%
binomial confidence intervals. McNemar’s test was
used to compare sensory versus motor sciatic blocks
and saphenous versus sciatic sensory blocks at each
time point. Results are presented as median and
range. p-values <0.05 were considered significantly
different.
Results
At the preliminary study in cadavers, successful
nerve staining was evident on dissection of the
limbs. Ultrasonographic images with color-flow
Doppler of the sciatic and saphenous nerves in two
live dogs, which were assessed during the pre-
liminary work, are shown in Fig. 2.
No adverse effects were recorded after any of the
injections. There was no resistance to injection and
a negative blood aspiration was obtained for each of
2 the injections. The sciatic nerve was visualized in all
cases in the transverse plane as an oval, hypoechoic
structure with a hyperechoic rim located medial to
No
the ilium and lateral to the caudal gluteal artery
response
Max = 2
(Fig. 2a). The sciatic nerve was then visualized in a
longitudinal plane, in which longitudinal, hyper-
echoic striations were observed within the nerve.
None When the injections were performed at this site, the
None
local anaesthetic/saline spread was observed dis-
Absent
Abnormal
placing the sciatic nerve away from the needle tip,
Max = 8 and did not result in a circumferential spread
(Fig. 3). The sacroiliac joint is approximately in
the same plane as the sciatic nerve when imaging
the nerve in long axis. Depending on the exact plane
463
Pelvic limb blockade in dogs Y Shilo et al.
LT ATL
SCN
CGA
Ilium CGV
Colon
(a)
ATL
CR
Femoral
artery
Femoral
Femur vein
Saphenous nerve
(b)
Figure 2 Ultrasonographic images with color-flow Doppler
in short-axis (transverse) plane of the sciatic (a) and
saphenous (b) nerves in two dogs. Cranial (CR), caudal
(CD), medial (MD), lateral (LT). (a) Sciatic nerve (SCN;
arrow) with the caudal gluteal artery (CGA) and vein
(CGV) in an 8 kg dog. (b) Saphenous nerve (arrow) with
the femoral artery and vein in a 35 kg dog.
of the ultrasound transducer, the sciatic nerve may
be observed coursing ventral to the medial aspect of
the ilium or to lateral aspect of the sacrum
(‘sacroiliac region’, Figs 1b and 3). The saphenous
nerve was observed only in a 35-kg live dog during
the preliminary study (Fig. 2b), and was not
observed directly prior to injection in any of the
research dogs. The location of the saphenous nerve
was inferred from identification of the femoral artery
and vein in the transverse plane. In some dogs, the
saphenous nerve was visualized while observing the
local anaesthetic/saline circumferential spread
around it during injection, as a relatively echogenic
structure surrounded by the hypoechoic injectate.
The sciatic motor block was characterized by
adduction and a mild inner rotation of the affected
limb, lameness (but without complete weight bear-
464  2010 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists, 37, 460–470
MD CR ATL CD
Needle
Sacroiliac
region
SCN
Figure 3 Ultrasonographic image in long-axis (longitudi-
CD nal) plane of the sciatic nerve (SCN, thick arrow) during
injection. The needle is shown by the thin arrows, and the
local spread by an oval dashed line. Cranial (CR), Caudal
(CD).
ing loss), proprioceptive loss and limb dragging. The
sciatic sensory block was characterized by loss of
sensation at the lateral region or the stifle joint and
distally to the tip of the toes, with the plantar area
losing sensation last. The saphenous sensory block
was characterized by loss of sensation at the medial
stifle region.
The median scores and range of the three
bupivacaine treatments are presented in Table 2.
All saline scores were zero, except in two dogs that
had minimal motor changes (motor scoring of 1) at
30 and at 30 and 40 minutes after the saline
injection. There was a significant difference between
the treatments with bupivacaine and the saline
control at times 30–240 minutes (p = 0.013–
0.049), but not between the three bupivacaine
treatments for the sciatic block (p = 0.30–1). For
the saphenous block four time points were signifi-
cantly different between treatments (p = 0.033–
0.043), but when saline was excluded there was no
significant difference between the bupivacaine treat-
ments (p = 0.12–0.19), though there was a ten-
dency for the HD to have a higher score for a longer
time. There was a significant change over time with
the saphenous block and the three bupivacaine
treatments (HD; p < 0.0001, MD; p = 0.033, LD;
p = 0.007), and with the sciatic block and the three
bupivacaine treatments (at all treatments
p < 0.0001), but not with the saline treatment of
both nerves.
Success rates of clinically relevant sciatic and
saphenous blocks were both 67% (CI 95% 0.22–
0.96) (Table 3). There was a great variability
between the dogs in response to the block (Table 3),
 2010 The Authors. Journal compilation
 Pelvic limb blockade in dogs Y Shilo et al.

Table 2 Median (range) scores of saphenous and sciatic motor and sensory blocks at the high dose (HD; 0.2 mL kg)1),
medium dose (MD; 0.1 mL kg)1), or low dose (LD; 0.05 mL kg)1) of bupivacaine 0.5%

Saphenous Sciatic sensory Sciatic motor

Time
(minutes) HD MD LD HD MD LD HD MD LD

30 0 (0–2) 0 (0) 0 (0–1) 0 (0–1) 0 (0–1) 0 (0–1) 4.3 (0–6) 2.3 (0–6) 1.5 (0–5)
40 0.8 (0–2) 0 (0–0.5) 0 (0–1.5) 0.5 (0–2) 0 (0–1) 0 (0–1) 4.3 (0–6) 2.5 (0–5.5) 1.8 (0–5)
50 1 (0–2) 0 (0–1) 0.3 (0–2) 0.8 (0–2) 0 (0–2) 0.5 (0–1) 4 (0–6) 2.8 (0–6) 2 (0–5)
60 1.5 (0–2) 0 (0–2) 0.3 (0–1.5) 1 (0–2) 0.3 (0–2) 0 (0–1) 4 (0–5.5) 3.3 (0–5) 2 (0–5.5)
100 1 (0–2) 0 (0–2) 0 (0–1) 1 (0–2) 0.8 (0–1.5) 0 (0–1.5) 3 (1–6) 3.5 (0–5.5) 3.3 (0–6)
140 1 (0–2) 0 (0–1) 0 (0–1) 1.3 (0–2) 0.5 (0–2) 0.3 (0–2) 3.3 (1–5.5) 3 (0–6) 4 (0–6)
180 0 (0–2) 0 (0–1) 0 (0–2) 0.5 (0–2) 0.5 (0–2) 1.3 (0–2) 3.3 (1–6) 2.5 (0–7) 5.5 (0–6)
220 0 (0–2) 0 (0–1) 0 (0–0.5) 0.5 (0–1.5) 0.3 (0–2) 0.5 (0–2) 3 (0.5–6.5) 1.5 (0–6) 3.8 (0–6.5)
260 0 (0–2) 0 (0–0.5) 0 (0) 0.5 (0–1.5) 0 (0–1) 0.5 (0–2) 2 (0–6.5) 1 (0–6) 3.8 (0–6)
300 0 (0–1.5) 0 (0) – 0.5 (0–2) 0 (0–1) 0.5 (0–2) 1.5 (0–6.5) 0.8 (0–5.5) 3 (0–6)
340 0 (0–1) – – 0.3 (0–1) 0 (0–0.5) 0.3 (0–2) 0.5 (0–6) 0.5 (0–3.5) 0.8 (0–6)
380 0 (0–0.5) – – 0 (0–1) 0 (0–0.5) 0 (0–0.5) 0.3 (0–6) 0.3 (0–3) 0.5 (0–5)
420 0 (0) – – 0 (0–1) 0 (0) 0 (0–0.5) 0 (0–6) 0 (0–3) 0 (0–4.5)
460 – – – 0 (0–1) – 0 (0) 0 (0–5) 0 (0–3) 0 (0–2.5)
500 – – – 0 (0–1) – – 0 (0–5) 0 (0–3) 0 (0–1)
540 – – – 0 (0) – – 0 (0–3) 0 (0–1.5) 0 (0)
580 – – – – – – 0 (0–1.5) 0 (0–1) –
620 – – – – – – 0 (0) 0 (0) –

For scoring system refer to Table 1. There were no significant differences between treatments.

Table 3 Success rate; the dogs that were blocked (+) or not ()) after ultrasound-guided nerve block of the sciatic and
saphenous nerves, at the high dose (HD; 0.2 mL kg)1), medium dose (MD; 0.1 mL kg)1), or low dose (LD; 0.05 mL kg)1) of
bupivacaine 0.5%

Saphenous Sciatic sensory Sciatic motor

Dog number HD MD LD HD MD LD HD MD LD

1 + + + + + + + + +
2 ) ) ) ) + + ) + +
3 + ) ) + ) ) + ) )
4 + ) ) + + + + + +
5 + + + + + + + + +
6 + ) ) ) ) ) + ) )
Total (%) 5 (83%) 2 (33%) 2 (33%) 4 (67%) 4 (67%) 4 (67%) 5 (83%) 4 (67%) 4 (67%)

Successful blocks were defined as a motor score ‡2 and sensory score ‡1. There were no significant differences between treatments.

for example, one of the dogs did not have a
successful sciatic block at any dose (only mild motor
changes; score of 2.5 at the HD).
The first assessment was performed when the
dogs recovered from the sedation, which was
typically 20–30 minutes after injection. Onset and
duration of the blocks were variable: 20–160 and
20–510 minutes, respectively, and there were no
 2010 The Authors. Journal compilation
 2010 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists, 37, 460–470
significant differences between treatments of both
nerves or between the nerves (Fig. 4). The durations
of sciatic motor and sensory blocks were not
significantly different, though motor changes lasted
usually 20–40 minutes longer than sensory
changes. The duration of the saphenous block was
shorter than that of the sciatic block (not signifi-
cant) in all dogs, with one exception: the dog that
465
Pelvic limb blockade in dogs Y Shilo et al.

(a) 4
40 H
HD
Saphenous 70
50 MD
4
40 L
LD Figure 4 Median onset (a) and dura-
SciaƟc sensory 55
95
tion (b) of ultrasound-guided sciatic
30
30 and saphenous nerve blocks at three
SciaƟc motor 35 bupivacaine doses* in six dogs. Val-
0 20 40 60 80 100 120 140 160 180 ues for onset and duration of effect
Onset Ɵme (minutes) are presented only for dogs that were
blocked. Error bars present the range.
(b) 100
1
Saphenous 180
1 H
HD There were no significant differences
20
2
MD between treatments. *HD (high dose;
SciaƟc sensory
330
3
145
1 LD 0.2 mL kg)1), MD (medium dose; 0.1
255
2
mL kg)1), or LD (low dose; 0.05 mL
270
2
275
2 kg)1) of bupivacaine 0.5%.
SciaƟc motor 320
3
0 100 200 300 400 500 600
DuraƟon Ɵme (minutes)

was refractory to the sciatic block, with the HD
treatment.
Motor response to nerve stimulation of the sciatic
nerve was elicited in all dogs that were monitored
(15/15). The mean ± SD (range) mA values
recorded from the nerve stimulator that resulted in
motor response was 0.23 ± 0.12 (0.1–0.4) mA.
Discussion
In this study, ultrasound guidance was useful in
detecting the sciatic nerve, in avoidance of inad-
vertent intravascular or intraneural injections in
both sciatic and saphenous perineural injections,
and in partial-to-complete blockade of these nerves
in 67% of the bupivacaine injections.
Bupivacaine was chosen to be used in this study
due to its long duration of effect, wide use in
veterinary medicine, market availability, low cost,
and safety at recommended doses. The clinical dose
of bupivacaine 0.5% commonly used in practice for
regional anaesthesia in dogs is 0.4 mL kg)1
(2 mg kg)1) (Rasmussen et al. 2006b; Skarda &
Tranquilli 2007a). The volumes of bupivacaine in
this study were chosen to be equivalent to half,
quarter, and an eighth of that dose, in order to
evaluate the efficacy of this method at lower
volumes, as was described in humans (Marhofer
et al. 1998; Sandhu et al. 2006; Willschke et al.
2006). Saline treatment was included for control to
ensure that the methods of assessment were accu-
rate. Nerve blockade in animals most frequently is
carried out blindly (Mihelic et al. 1995; Rasmussen
et al. 2006b; Skarda & Tranquilli 2007a). The use
466  2010 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists, 37, 460–470
of nerve stimulators to guide correct needle place-
ment in regional anaesthesia in dogs has been
described (Moens & Caulkett 2000; Wenger et al.
2005; Lamont & Lemke 2008; Mahler & Adogwa
2008), but this is still a ‘blind’ technique. ‘Blind’
blocks that rely solely on anatomical landmarks
are known to produce complications in humans
(Marhofer et al. 2005) and in dogs (Mihelic et al.
1995), although one of the approaches to the
femoral nerve block in that canine study was very
close to the spine, and this probably contributed to
the complications. Even the technique of nerve
stimulation, which has been recommended as the
gold standard for nerve identification in regional
anaesthesia, fails to ensure an adequate level of
nerve block, and carries the risk of inflicting damage
to the nerve by direct puncture (Marhofer et al.
2005).
One of the advantages of ultrasound guidance in
regional anaesthesia is the ability to identify impor-
tant anatomical structures, and to avoid intraneural
or intravascular injections (Marhofer et al. 2005).
In two studies which detected the sciatic nerve in
dogs via nerve stimulation, long-term adverse
effects were not reported as the dogs were eutha-
nized immediately after injections (Campoy et al.
2008; Rigaud et al. 2008). In one of these studies
there was no evidence of intraneural injection in
any of the dissections (Campoy et al. 2008), but in
the other study nerve histopathology revealed that
there was an intraneural injection in 7/24 cases
(Rigaud et al. 2008). In two studies that looked
at saphenous-tibial-common peroneal ‘blind’ block-
ade there was a high incidence of dermatome
 2010 The Authors. Journal compilation

insensitivity for extended periods of time (1–4
hours) in the control saline groups (Rasmussen
et al. 2006a,b). The authors explained this obser-
vation by noting that the dogs had residual seda-
tion, anaesthesia and/or analgesia. In two studies
which looked at ultrasound-guided nerve block of
the pelvic limb in dogs no adverse effects were
observed, though only a small number of injections
were performed in each study (Costa-Farre et al.
2009; Echeverry et al. 2009). In the present study
no functional deficits were detected after any of the
24 perineural injections, and all dogs regained
complete sensory and motor function at maximum
10 hours post injections. However, a larger popu-
lation is needed in order to determine the safety of
this technique. The two saline injections that caused
minimal motor changes for approximately 30 min-
utes can probably be attributed to residual ataxia
from the sedation, since, in these two cases, it was
hard to determine which leg was affected. It is not
likely that this was due to sciatic nerve compression
or damage because of the rapid recovery to normal
function.
Human studies showed that the success rates of
ultrasound guided techniques are higher when
compared to blind or nerve-stimulating techniques
(Kapral et al. 2008; Lo et al. 2008; Perlas et al.
2008; Weintraud et al. 2008). Moreover, combin-
ing nerve-stimulating and ultrasound guided tech-
niques did not change the success (Beach et al.
2006; Sinha et al. 2007). The success rate reported
for ultrasound-guided sciatic block in humans is
89–100% (Domingo-Triado et al. 2007; Oberndor-
fer et al. 2007; Perlas et al. 2008; Danelli et al.
2009). The higher success rate in humans in
comparison to this study could be attributed to the
advanced experience in human ultrasound-guided
regional anaesthesia, to the multiple attempts done
in human clinical cases, and to the higher volumes
per kg used .
In two studies by Rasmussen et al. (2006a,b) a
blind method was used to block the saphenous
nerve and the distal region (mid thigh) of the sciatic
nerve in dogs. The block success rate of the divisions
of the sciatic, the common peroneal and tibial
nerves, was 80% (Rasmussen et al. 2006a) and
50% (Rasmussen et al. 2006b), and the success rate
of the saphenous nerve block was 75% (Rasmussen
et al. 2006b), and 15% (Rasmussen et al. 2006a).
However, these results may be biased due to
residual sedation as mentioned above. In one of
these studies (Rasmussen et al. 2006b), performed
 2010 The Authors. Journal compilation
 2010 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists, 37, 460–470
Pelvic limb blockade in dogs Y Shilo et al.
in cadavers, there was a very low success rate in
chondrodystrophic dogs (0/5 in saphenous nerve
and 1/5 in common peroneal and tibial nerves) in
comparison to nonchondrodystrophic dogs (97–
100% success). Ultrasound guidance in chondro-
dystrophic breeds might provide better guidance for
these blocks. The success rate in a study using
ultrasound-guided sciatic block in five dogs was
100% for sciatic and superficial peroneal, but only
partial block was observed at the tibial nerve in all
dogs (Costa-Farre et al. 2009). It should be noted
that in that study butorphanol 0.3 mg kg)1 was
administered as part of the sedation protocol, and
might have caused some bias in the assessment of
the sensory blocks.
Several factors may have influenced the success
rate in the present study. First, the ability to identify
the saphenous nerve. The saphenous nerve was not
identified in this study prior to injection. It was
identified in the preliminary study only in a 35 kg
dog (Fig. 2b). An important reason, which could
have decreased our ability to observe the nerve, was
the use of a mid-frequency ultrasound transducer
(5–8 MHz). Costa-Farre et al. (2009) described rea-
sonable observation of the saphenous nerve when a
high-frequency transducer (10–12 MHz) was used.
Although Echeverry et al. (2009) used a higher
frequency transducer as well (3–14 MHz), the
authors described difficulty in identifying the fem-
oral nerve (the saphenous is its cutaneous branch).
The second factor relates to the sciatic injection
location. The sciatic nerve can be approached at
different locations as it is well observed via ultra-
sound along its course from its origin caudally to
the sacroiliac joint (Fig. 1b) to the distal thigh
(Benigni et al. 2007). The location in the present
study was selected to be as proximal as possible, in
order to have a better blockade. However, the local
anaesthetic accumulated only on one side of the
nerve (Fig. 3). This could be due to the nerve fascia,
which may be thicker at this location. This factor
has been described as a possible cause for unsuc-
cessful sciatic blockade in humans (Benzon et al.
1997). Campoy (Campoy 2006; Campoy et al.
2008) described a sciatic blockade by injecting the
local anaesthetic between the greater trochanter
and the ischiatic tuberosity, which is distal to the
injection location in the present study, with good
nerve staining results. Costa-Farre et al. (2009)
described the sciatic injections at the same location
as Campoy, but had the same problem regarding the
uneven local anaesthetic spread around the nerve,
467
Pelvic limb blockade in dogs Y Shilo et al.
as in the present study, with only partial block of the
tibial branch of the sciatic. Echeverry et al. (2009)
described the sciatic injections at a more distal
location (mid-thigh) similar to Rasmussen et al.
(2006a,b), and had circumferential spread of the
local anaesthetic around the nerve (the ‘donut
sign’), however, assessment of the block was not
performed.
A third possible explanation for the lower success
rate in both nerves in the present study is the low
volumes used. Campoy et al. (2008) concluded that
0.05 mL kg)1 injected around the sciatic nerve,
detected by nerve stimulation, had sufficient distri-
bution based on nerve staining in postmortem
examination. However, evaluation of nerve block-
ade with this volume was not performed. A clinical
study in dogs by Campoy et al. (2009) reported the
use of 0.2 mL kg)1 bupivacaine 0.5% divided
equally between the femoral and sciatic nerves,
which produced comparable analgesia to epidural
injection. Costa-Farre et al. (2009) used 0.1 mL
kg)1 of lidocaine 2% at each nerve, and Echeverry
et al. (2009) used 0.3 mL kg)1 of lidocaine 1%
at each nerve. The higher volume used in the
Echeverry et al. (2009) study might explain the
better results in the circumferential spread of local
anaesthetic around the sciatic nerve.
The onset of blocks at all nerves and doses was
variable (Fig. 4). The minimal onset time defined by
this study protocol was 20 minutes, because it took
the dogs 20–30 minutes to recover from the sedation
and have their first assessment. In the Costa-Farre
et al. (2009) study, evaluations were performed at
15 minutes after injections, and the dogs were
blocked at that time. Factors that can affect the
onset of a local anaesthetic include: lipid solubility,
concentration, dose/volume, and location (proximity
to the nerve) (Skarda & Tranquilli 2007b). There
were three dogs that had a very long sciatic sensory
onset time; 100 (MD), 140 and 160 (LD) minutes.
This might be caused by an inaccurate deposition of
the local anaesthetic or a long diffusion time through
a thick fascia covering the nerve (Benzon et al.
1997). Though not statistically significant, the HD
seemed to have a shorter onset (Fig. 4).
Human studies suggest that the reduction of the
dose of the local anaesthetic through ultrasound
guidance can decrease the duration of the block and
permit rapid recovery and discharge (Sandhu et al.
2006; Koscielniak-Nielsen 2008; Riazi et al. 2008).
High variability in the duration of saphenous
blockade (1–20 hours) and of common peroneal
468  2010 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists, 37, 460–470
and tibial blockade (1–24 hours) in dogs also was
described in both Rasmussen studies (Rasmussen
et al. 2006a,b). In these studies the dose of bupiva-
caine injected was double the high dose used in this
study, and this may explain the longer duration in
those studies. In the Costa-Farre et al. (2009) study
all five dogs were completely normal at 2 hours
after injections, but lidocaine is known to be a
shorter acting drug in comparison to bupivacaine
(Skarda & Tranquilli 2007b). A block will last as
long as there is enough local anaesthetic surround-
ing the nerve and appropriate conditions for action
of the drug. The duration of a block can be
influenced by: drug protein binding, concentration,
dose/volume, pH of the tissue, and blood flow to the
tissue (Skarda & Tranquilli 2007b). The dogs in the
present study were similar in regard to signalment,
body size, structure and condition, and received the
same three dose treatments. Theoretically, the high
variance between the dogs could be explained by an
individual variance in fascia thickness, which we
could not assess, or differences in bupivacaine
deposition, though performed by the same person.
The shorter duration of the saphenous block in
comparison to the sciatic block may be explained by
a higher blood flow in that region. The shorter
duration of the sciatic sensory block in comparison
to the motor block was also described in humans
(Triado et al. 2004; Domingo-Triado et al. 2007),
and might be related to the organization of the
different nerve fibres within the nerve. In large
nerve trunks motor fibres are usually located in the
outer portion of the bundle and are more accessible
to local anaesthetics. Thus, motor fibres may be
blocked before sensory fibres in large mixed nerves
(Hadzic & Volka 2004).
With motor nerve stimulation, the most com-
monly accepted end point for evidence that an
insulated, stimulating needle is close enough to the
target nerve to result in reliable anaesthesia is a
motor response at or below 0.5 mA (Sinha et al.
2007; Rigaud et al. 2008). The current recorded in
this present study by the nerve stimulator at the
location of injection (0.1–0.4 mA) is considered
low, and indicated that the needle was in close
proximity to the sciatic nerve. The minimum
threshold stimulating current in the Costa-Farre
et al. (2009) study was also 0.2–0.4 mA.
Although there are many advantages for the use
of ultrasound guidance in regional anaesthesia,
there are also disadvantages to this method in
veterinary medicine: expense and availability of
 2010 The Authors. Journal compilation

ultrasound equipment, greater complexity requiring
a learning process in ultrasound management, and
the smaller nerves that are harder to detect via
ultrasound in small animal patients.
Limitations to this study include the small num-
ber of dogs, the lack of a preliminary in vivo study to
determine the local anaesthetic doses, and the best
location for the perineural injections. Other limita-
tions are the subjectivity of the block assessments,
and the temperament of two of the dogs (one
hyperactive and the other non-reactive) that might
have biased the results.
In conclusion, none of the bupivacaine doses was
significantly superior, though there was a tendency
for a better block with the high bupivacaine dose.
Dogs may benefit from ultrasound-guided regional
anaesthesia of the pelvic limb, however, either the
technique, or the doses used, need further modifi-
cation before this method will be useful in clinical
practice.
Acknowledgements
This study was supported by the Center for Com-
panion Animal Health, School of Veterinary Medi-
cine, University of California, Davis, and by the
Veterinary Medical Teaching Hospital Resident
Research Grant, School of Veterinary Medicine, Uni-
versity of California, Davis. The authors would also
like to acknowledge Havel’s Incorporated for dona-
tion of the Echogenic needles that were used in this
study, John Doval for the Injection technique figures,
and to thank Kristine Siao for her help with the dogs.
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