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Paolini A, Bucci R, Bianchi A, Del Signore F, Parrillo S, Di Giosia A, Ristori C, Tamburro R, Robbe D, Carluccio A, Rosa V, Vignoli M. Use of Caudal Quadratus Lumborum Block with Ropivacaine as Part of an Opioid-Free Analgesic Protocol in Dogs Undergoing Orchiectomy: A Randomized Trial. Animals (Basel) 2024; 14:1885. [PMID: 38997997 PMCID: PMC11240621 DOI: 10.3390/ani14131885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
In veterinary medicine, the use of loco-regional anesthesia techniques is increasing. The Quadratus Lumborum block (QL) is an interfascial loco-regional technique that involves the release of local anesthetic (LA) between the Quadratus Lumborum and the Small Psoas (Pm) muscle. The study aims to evaluate the effect of the QL block on reducing the total amount of opioids in dogs undergoing pre-scrotal orchiectomy. A group of 36 dogs was enrolled in a randomized blinded study. The animals were divided into two groups: 18 in the experimental group (QL) and 18 in the control group (C). The QL group received 0.4 mL kg-1 of ropivacaine 0.5% for each hemiabdomen (total amount of 3 mg kg-1 of ropivacaine, 1.5 mg kg-1 per side). The C group was brought into the operating room (OR) after receiving the same clipping as the QL group. In the intraoperative period, opioid consumption in the QL group was significantly lower than in the C group. No differences were found in the post-operative phase. No side effects were reported when performing the QL technique. The QL block performed at the level of L6 appears to be a valid approach to reducing opioid use in dogs undergoing orchidectomy with a pre-scrotal surgical approach.
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Affiliation(s)
- Andrea Paolini
- Small Animal Surgery and Anesthesia Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Roberta Bucci
- Obstetrics, Gynecology and Veterinary Andrology Clinic Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Amanda Bianchi
- Small Animal Surgery and Anesthesia Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Francesca Del Signore
- Small Animal Imaging Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Salvatore Parrillo
- Obstetrics, Gynecology and Veterinary Andrology Clinic Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Alessandro Di Giosia
- Obstetrics, Gynecology and Veterinary Andrology Clinic Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Claudia Ristori
- Small Animal Surgery and Anesthesia Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Roberto Tamburro
- Small Animal Surgery and Anesthesia Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Domenico Robbe
- Obstetrics, Gynecology and Veterinary Andrology Clinic Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Augusto Carluccio
- Obstetrics, Gynecology and Veterinary Andrology Clinic Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Valeria Rosa
- Small Animal Surgery and Anesthesia Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Massimo Vignoli
- Small Animal Imaging Service, Department of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
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Feng Y, Chang P, Liu J, Zhang WS. Effects and mechanisms of perioperative medications on the hypothalamic pituitary adrenal response to surgical injury: A narrative review. J Clin Anesth 2024; 94:111367. [PMID: 38232466 DOI: 10.1016/j.jclinane.2023.111367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
The adrenal gland is a vital endocrine organ, and adrenal steroid synthesis and secretion are closely regulated by the hypothalamic-pituitary-adrenal (HPA) axis in response to various stimuli. Surgery or trauma can activate the HPA axis and induce the secretion of cortisol. Different cortisol responses vary with the grade of surgery. Perioperative medications have the potential to decrease the cortisol level in the body, and both excessive and insufficient cortisol levels after surgery are disadvantageous. The effect of perioperative medications on the HPA response to surgery can be divided into three levels: "adrenal insufficiency (AI)", "stress response inhibition", and "uncertainty". The clinical presentation of AI includes fatigue, nausea, vomiting, abdominal pain, muscle cramps, hypotension, hypovolemic shock and prerenal failure, which may result in fatal consequences. Stress response inhibition can reduce postoperative complications, such as pain and cognitive dysfunction. This is protective to patients during perioperative and postoperative periods. The aim of the present review is to shed light on current evidence regarding the exact effects and mechanisms of perioperative medications on the HPA response to surgical injury and provide the applicable guidance on clinical anesthesia.
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Affiliation(s)
- Yan Feng
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, China; Department of Anesthesiology, West China Hospital, Sichuan University, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, China
| | - Pan Chang
- Department of Anesthesiology, West China Hospital, Sichuan University, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, China
| | - Wen-Sheng Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, China.
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Espadas-González L, Usón-Casaús JM, Pastor-Sirvent N, Santella M, Ezquerra-Calvo J, Pérez-Merino EM. The impact of the transversus abdominis plane block (TAP) on stress response measured through the complete blood- derived inflammatory markers. Vet Res Commun 2024; 48:497-506. [PMID: 37840089 PMCID: PMC10810931 DOI: 10.1007/s11259-023-10234-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
This study aims to evaluate the effect of the transversus abdominis plane (TAP) block on the blood cells and the inflammatory markers neutrophil- to- lymphocyte ratio (NLR), platelet- to- lymphocyte ratio (PLR), and systemic immune- inflammation index (SII) after the laparoscopic ovariectomy (LapOV) in dogs. 72 healthy bitches undergoing LapOV were randomly allocated to the no- TAP group of dogs under inhaled anesthesia (IA), the TAP- S group (IA and TAP with saline), and the TAP- B group (IA and TAP with bupivacaine). The NLR, PLR, and SII were calculated 1 h before ovariectomy (T0) and at 2-3 h (T1), 6-8 h (T2), and 20-24 h (T3) post- surgery. The number of dogs requiring postoperative analgesic rescue with buprenorphine and the doses administered in each group were recorded. Significant changes were observed in all groups' postoperative NLR, PLR, and SII over time. Between groups, no differences were observed in any of the ratios at any control point (NLR at T0-T3: p = 0.17, 0.36, 0.80, and 0.95; PLR at T0-T3: p = 0.70, 0.62, 0.21, 0.87; SII at T0-T3: p = 0.29, 0.65, 0.09, and 0.34). A significantly lower number of dogs required analgesic rescue in the TAP-B group (p = 0.0001) and a lower number of doses were administered (p = 0.001). There is no difference in the inflammatory response measured through the complete blood- derived inflammatory markers after the LapOV in dogs when the postoperative pain is managed entirely with opioids or with the TAP block with bupivacaine. The hydrodissection associated with the TAP block technique does not increase the inflammatory response.
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Affiliation(s)
- Lorena Espadas-González
- Unidad de Cirugía, Departamento de Medicina Animal, Facultad de Veterinaria UEx, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain
| | - Jesús M Usón-Casaús
- Unidad de Cirugía, Departamento de Medicina Animal, Facultad de Veterinaria UEx, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain
| | - Nieves Pastor-Sirvent
- Unidad de Cirugía, Departamento de Medicina Animal, Facultad de Veterinaria UEx, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain
| | - Massimo Santella
- Veterinary Teaching Hospital, Facultad de Veterinaria, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain
| | - Javier Ezquerra-Calvo
- Unidad de Cirugía, Departamento de Medicina Animal, Facultad de Veterinaria UEx, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain
| | - Eva M Pérez-Merino
- Unidad de Cirugía, Departamento de Medicina Animal, Facultad de Veterinaria UEx, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain.
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Clinical Assessment of Introducing Locoregional Anaesthesia Techniques as Part as the Intraoperative Analgesia Management for Canine Ovariohysterectomy in a Veterinary Teaching Hospital. Animals (Basel) 2022; 12:ani12151939. [PMID: 35953928 PMCID: PMC9367294 DOI: 10.3390/ani12151939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 01/01/2023] Open
Abstract
This study compared four methods to provide intraoperative analgesia during canine ovariohysterectomy in a veterinary teaching hospital. A retrospective study was designed to assess the nociceptive response, cardiorespiratory stability, quality of recovery and complications of four analgesic protocols: epidural analgesia (EPIDURAL group), Quadratus Lumborum block (QLB group), Transversus Abdominis Plane block (TAP group), and just systemic analgesia (GENERAL group). Undergraduate students carried out all the loco-regional techniques under the direct supervision of a qualified anaesthetist. A total of 120 cases met the inclusion criteria and were included in the study and were distributed as follows: 22, 27, 32 and 39 cases with EPIDURAL, GENERAL, QLB and TAP groups, respectively. Data were analysed with statistical software R using different statistical methods. Significant differences among groups were defined as p < 0.05. Based on our results, all the groups needed the same number of rescue analgesia during the intra-operative period. The use of loco-regional techniques anticipated a better quality of recovery compared with the general group. The EPIDURAL group showed a statistically lower expired fraction of sevoflurane. No differences were found regarding complications. In conclusion, these four analgesic methods are suitable and safe to be performed for canine ovariohysterectomy, although loco-regional techniques might have some advantages.
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Sylvain L, Jerneja S, Karine P. Respiratory response to finger clamping in dogs under general anesthesia: A descriptive pilot study. Front Vet Sci 2022; 9:843956. [PMID: 35928110 PMCID: PMC9343778 DOI: 10.3389/fvets.2022.843956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Aim of the studyThe aim of this study was to assess the effects of a nociceptive stimulus on respiratory variables in anesthetized dogs.Material and methodEleven dogs received acepromazine administered intramuscularly (IM) at a dose of 0.04 mg kg−1 45 mins before induction of anesthesia. Loss of consciousness was obtained with midazolam at 0.2 mg kg−1 and propofol administered at a dose of 2 mg kg−1 intravenously (IV). Orotracheal intubation was performed and anesthesia was maintained with isoflurane in 100% oxygen. Inspired (VTi) and expired (VTe) tidal volume (VT), minute volume (VM), inspiratory and expiratory time (Ti; Te) were measured and recorded twice a second by a spirometer. The Drive (VT/Ti) and Timing [Ti/(Ti+ Te)] were calculated.After stabilizing the depth of anesthesia the variables measured by the spirometer were recorded for 5 mins [T0−5-T0]. Then (T0) interdigital clamping of the hind leg was performed until a withdrawal movement was observed. If no reaction occurred, the clamp was left in place for 60s. After removal of the clamp, respiratory variables were measured continuously for another 5 mins [T0-T0+5]. At T0+5 morphine (0.2 mg kg−1 IV) was administered. Five minutes later (T0+10), a second clamp test was performed, using the same procedure. At T0+15 the data recording was stopped.ResultThe results showed a large variation in the individual values of Drive and Timing and are presented in a descriptive manner. The observation of Drive values over time showed variations following nociceptive stimuli. Drive appears to have increased only for those dogs that did not move during the stimulus, and were therefore pinched for a full 60 s. In contrast, the study of the Timing values revealed no difference between the data before and after nociceptive stimulation. However Timing seems to increase after morphine administration.ConclusionDrive remains a parameter that needs to be studied in depth to determine its sensitivity and precocity to monitor acute nociception.
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Affiliation(s)
- Lepape Sylvain
- University Lyon, VetAgro Sup (Veterinary Campus of Lyon), 69280, Marcy l'Etoile, France
| | - Sredensek Jerneja
- University Lyon, VetAgro Sup (Veterinary Campus of Lyon), 69280, Marcy l'Etoile, France
| | - Portier Karine
- University Lyon, VetAgro Sup (Veterinary Campus of Lyon), 69280, Marcy l'Etoile, France
- University Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon, Bron, France
- *Correspondence: Portier Karine
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