Comparison of the effect of intratesticular lidocaine/bupivacaine vs. saline placebo on pain scores and incision site reactions in dogs undergoing routine castration

Evaluation of Targeted Bupivacaine, Bupivacaine-lidocaine-epinephrine, Dexamethasone, and Meloxicam for Reducing Acute Postoperative Pain in Cats Undergoing Routine Ovariohysterectomy

This study compared bupivacaine (BUP), bupivacaine-lidocaine-epinephrine (BLE), dexamethasone (DEX), and meloxicam (MEL) targeted at specific, potentially painful sites for reducing acute postoperative pain in cats undergoing elective ovariohysterectomy. One hundred fifty-one cats were included in a prospective, randomized, double-blinded clinical trial. Anesthesia consisted of a standardized protocol including buprenorphine, ketamine, dexmedetomidine, and isoflurane. A ventral midline ovariohysterectomy was performed, and cats were administered targeted injections of 0.5% bupivacaine (2 mg/kg); a combined 0.25% bupivacaine (1 mg/kg), 1% lidocaine (2 mg/kg), and 1:100,000 epinephrine (0.005 mg/kg); dexamethasone (0.125 mg/kg); or meloxicam (0.2 mg/kg) intraoperatively at the ovarian suspensory ligaments, uterine body, and incisional subcutaneous tissues. A 0-10 Numeric Pain Rating Scale (NRS) was used to assess cats postoperatively, 1 hour and 3 hours after anesthesia recovery prior to a same day discharge. Pain scores among evaluators were in good agreement with an overall Intraclass Correlation Coefficient (ICC) of 0.7897 (95% Confidence Interval 0.795-0.8313).  In all groups, overall pain scores 1-hour post anesthesia recovery were significantly higher than scores 3 hours post anesthesia recovery (P < .0001). Averaged pain scores compared among treatment groups did not differ at 1 hour post recovery. At 3-hours post anesthesia recovery, MEL group cats had significantly lower pain scores than the BLE group (P = .018). Study results indicate that early postoperative pain scores were similar for cats receiving local infiltrations of BUP, BLE, DEX, and MEL as part of a multimodal pain therapy for routine ovariohysterectomies. MEL showed somewhat better results 3 hours post anesthesia recovery, gaining significance over the BLE group.

Effect of the number of incisions and use of local anesthesia on the physiological indicators of surgically-castrated piglets

The objective of this study was to determine the effect of local anesthesia and the number of incisions performed on the physiological blood profile of piglets after surgical castration. A total of 60 male piglets were divided into five groups of 12 each, based on the surgical method employed and the use, or not, of local anesthesia, as follows: surgical castration using one horizontal incision in both testicles with (C1+L) and without (C1) local anesthesia; surgical castration using two vertical scrotal incisions with and without local anesthesia (C2+L and C2); and control piglets which were removed from their pens and held head-down by their hind limbs for approximately 90 s to simulate castration (SIM). Reference blood samples were drawn 24 h before castration (RV), immediately after surgery or simulated castration (PC), and at 24 and 48 h post-castration, to determine physiological profiles including; pH, hematocrit, glucose, electrolytes, lactate, pCO₂ (mmHg), SO₂ (mmHg), and bicarbonate. Results showed increases in lactate and hematocrit immediately after surgical or simulated castration with decreases in pH, HCO₃- and base excess (BE). Surgical castration produced marked alterations of the physiological profile, detected by reduced pH and HCO₃, higher lactate levels and BE alterations. These changes indicated metabolic acidosis that was greater in the piglets castrated surgically with one horizontal incision than in those castrated with two vertical incisions. More research is needed on the use of lidocaine during surgical castration, as it showed no effect on physiological profile in this study, but did alter hematocrit values.

Local mepivacaine before castration of horses under medetomidine isoflurane balanced anaesthesia is effective to reduce perioperative nociception and cytokine release

Background

In horses castration with primary intention healing is usually performed under balanced inhalation anaesthesia. To optimise analgesia, the use of local anaesthesia was tested.

Objectives

To investigate the effect of local mepivacaine before castration with first intention healing under balanced medetomidine‐isoflurane anaesthesia and flunixin meglumine, morphine analgesia on perioperative cytokine levels and pain in horses.

Study design

Prospective blinded clinical study.

Methods

Twenty stallions were randomly assigned to control or mepivacaine groups. Flunixin meglumine was administered before sedation with medetomidine and followed by ketamine/diazepam intravenously (i.v.). Anaesthesia was maintained with isoflurane and 3.5 μg/kg per hour medetomidine. Mepivacaine horses were given mepivacaine 2% (3.5 mL SC, 1 mL/100 kg intrafunicularly, 2 mL/100 kg intratesticularly) on each side. For recovery, horses were given 2 μg/kg medetomidine i.v. and 0.1 mg/kg morphine i.m. and oral phenylbutazone (0.02 mg/kg q12h) for post‐operative analgesia. One hour before premedication and 4, 8 and 24 h post‐incision, pain was scored with three different pain scales (Equine Utrecht University Scale for Facial Assessment of Pain, Horse Grimace Scale, Equine Utrecht University Scale for Composite Pain Assessment) and plasma cytokines (interleukin‐6 and tumour necrosis factor alpha) were measured. Data were analysed using repeated measures ANOVA, linear regression and unpaired t‐test, significance level P≤0.05.

Results

Horses in both groups showed a significant increase in pain scores and cytokines compared to baseline. Post‐operatively the mepivacaine group exhibited significantly lower pain scores and cytokine levels. Mean heart rate during anaesthesia was significantly lower in the mepivacaine group compared to control group (28.8 ± 1 and 33.2 ± 1.7 respectively). Otherwise there were no differences between the groups.

Main limitations

The decision to provide additional analgesia was based on the attending surgeon's assessment rather than a standardised rescue analgesia plan based on pain scores. The study was only conducted for 24 h post‐castration and complications were not recorded.

Conclusion

Local mepivacaine before castration with primary wound closure improved anaesthesia quality, attenuated post‐operative increases in cytokines and reduced post‐operative pain despite balanced anaesthesia with multimodal analgesia in control horses.

Acute physiological responses to castration-related pain in piglets: the effect of two local anesthetics with or without meloxicam

Methods to reduce castration-related pain in piglets are still issues of concern and interest for authorities and producers. Our objectives were to estimate the effectiveness of two protocols of local anesthesia (lidocaine and the combination of lidocaine+bupivacaine) as well as the use of meloxicam as a postoperative analgesic in alleviating castration-related pain, measured by acute physiological responses. Eight groups (15 piglets/group) were included in the study: (1) castration without anesthesia or analgesia, without meloxicam (TRAD WITHOUT), (2) castration without anesthesia or analgesia, but with meloxicam (TRAD WITH), (3) handling without meloxicam (SHAM WITHOUT), (4) handling with meloxicam (SHAM WITH), (5) castration after local anesthesia with lidocaine but without meloxicam (LIDO WITHOUT), (6) castration after local anesthesia with lidocaine and meloxicam (LIDO WITH), (7) castration after local anesthesia with lidocaine+bupivacaine without meloxicam (LIDO+BUPI WITHOUT), (8) castration after local anesthesia with lidocaine+bupivacaine and meloxicam (LIDO+BUPI WITH). Acute physiological responses measured included skin surface temperature and serum glucose and cortisol concentrations. On days 4 and 11 post-castration BW was recorded and average daily gain was calculated over this period. Furthermore, piglet mortality was recorded over the 11-day post-castration period. Administration of local anesthetic or meloxicam did not prevent the decrease in skin surface temperature associated with castration. Lidocaine reduced the increase in glucose concentration associated with castration. For castrated pigs, the joint use of lidocaine and meloxicam caused a significant decrease in cortisol concentration; the combination of intratesticular lidocaine and bupivacaine did not seem to be more effective than lidocaine alone. No effect of treatments on mortality and growth were detected.

Coelioscopic and Endoscope-Assisted Sterilization of Chelonians

Elective sterilization is a safe and well-established surgical procedure performed in dogs and cats worldwide. Conversely, chelonian sterilization has been mostly performed therapeutically, because of the intricate anatomy and difficult access to the reproductive organs, and consequently, reproductive problems and diseases remain common. With the advance of veterinary endoscopy, novel techniques of soft tissue prefemoral coelioscopic and endoscope-assisted sterilization have been published, and preventative chelonian sterilization is now a reality. Nevertheless, extrapolations between species should be carefully considered, and further studies are warranted. This article summarizes and describes the current coelioscopic and coelioscope-assisted sterilization techniques for chelonia.