1
|
Itoh H, Inoue H, Itamoto T, Tani K, Sunahara H, Nemoto Y, Nakaichi M, Iseri T, Itamoto K. The perfusion index as a method of assessing epidural anaesthesia efficacy in healthy dogs. J Vet Res 2024; 68:469-473. [PMID: 39318511 PMCID: PMC11418375 DOI: 10.2478/jvetres-2024-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 09/03/2024] [Indexed: 09/26/2024] Open
Abstract
Introduction Perfusion index (PI) is used as assessment of epidural anaesthesia efficacy in human medicine, but its usefulness in dogs is unknown. The aim of this study was to evaluate the usefulness of PI in determining epidural anaesthesia effectiveness. Material and Methods This is prospective cross-over experimental study. Five healthy adult beagle dogs were anaesthetised and an epidural catheter was inserted in the lumbosacral area and adjusted so that the end of the catheter was placed at the fourth lumbar vertebra. Single-port catheters were used in the control group and multiple-port catheters were used in the treatment group. A PI probe was placed on a hind leg, and the catheter placement was confirmed via computed tomography. The treatment group received a bolus dose of lidocaine, and the control group received saline, via epidural catheter. The PI value was recorded every 5 min until 30 min after lidocaine injection. Results The PIs of the hind limbs were not significantly different over time, nor were they between the control and lidocaine-injected groups at any point in time. Conclusion The PI is not useful in determining the efficacy of epidural anaesthesia in dogs under general anaesthesia. In the future, finding a reliable method to evaluate the success of regional anaesthesia, even in patients under general anaesthesia, will be necessary.
Collapse
Affiliation(s)
- Harumichi Itoh
- Department of Small Animal Clinical Science, Yamaguchi, Japan
| | - Hajime Inoue
- Department of Small Animal Clinical Science, Yamaguchi, Japan
| | - Takuya Itamoto
- Department of Small Animal Clinical Science, Yamaguchi, Japan
| | - Kenji Tani
- Department of Veterinary Surgery, Yamaguchi, Japan
| | | | - Yuki Nemoto
- Department of Veterinary Surgery, Yamaguchi, Japan
| | - Munekazu Nakaichi
- Department of Veterinary Radiology, Joint Faculty of Veterinary Medicine, Yamaguchi University, 1677-1 Yoshida, Yamaguchi753-8515, Japan
| | - Toshie Iseri
- Koganei Animal Medical Emergency Center, Tokyo University of Agriculture and Technology, 2-24-16, Nakamachi, Koganei-shi, Tokyo184-8588, Koganei, Japan
| | | |
Collapse
|
2
|
Sambugaro B, De Gennaro C, Hattersley RD, Vettorato E. Extradural anaesthesia-analgesia in dogs undergoing cholecystectomy: A single centre retrospective study. Front Vet Sci 2022; 9:966183. [PMID: 36157172 PMCID: PMC9500543 DOI: 10.3389/fvets.2022.966183] [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: 06/10/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To assess the effects of extradural anaesthesia-analgesia (EAA) in dogs undergoing cholecystectomy. Materials and methods Medical records of dogs undergoing cholecystectomy between 2011 and 2019 were retrieved and allocated to two groups depending if analgesia was provided systemically (group SA) or extradurally (EAA). Preoperative data, intraoperative antinociceptive medications, postoperative analgesia, perioperative complications, and food intake were compared. Results Overall 41 medical records were included in the study: 19 and 22 dogs were allocated to groups SA and EAA, respectively. In group EAA, an extradural catheter was placed preoperatively in 8 dogs; in the remaining, it was placed postoperatively but an extradural injection was performed preoperatively. The extradural catheter tip was between the 4th lumbar and the 10th thoracic vertebrae. Intraoperatively, nociception was more likely to occur in group SA [OR 55.42 (2.97–1,035.06)]. During the first 24 and 48 h postoperatively, more dogs in group SA required methadone [OR 24 (2.81–268.4) and OR 11.56 (2.37–45.06), respectively] and additional analgesic drugs [OR 25 (3.47–281.9) and OR 35.29 (1.86–668.2), respectively] compared to group EAA. Voluntary postoperative food intake was also significantly higher in group EAA. Clinical significance Compared to systemic analgesia, the use of extradural anaesthesia-analgesia reduced perioperative analgesic requirement and promoted postoperative food intake in dogs undergoing cholecystectomy.
Collapse
|
3
|
Epidural Volume of Injectate Using a Dose Regimen Based on Occipito-Coccygeal Spinal Length (OCL): Randomized Clinical Study Comparing Different Ropivacaine Concentrations, with or without Morphine, in Bitches Undergoing Total Unilateral Mastectomy. Animals (Basel) 2022; 12:ani12050587. [PMID: 35268154 PMCID: PMC8909377 DOI: 10.3390/ani12050587] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
A prospective, randomized clinical trial was designed to compare four epidural treatments in dogs undergoing total unilateral mastectomy. The epidural volume of injectate was based on the individual occipito-coccygeal length (OCL) aiming to reach the first thoracic vertebra (T1). The first ten dogs were allocated in a control group (C) and did not receive epidural treatment. Subsequently, forty dogs were randomly allocated in four groups of ten: epidural ropivacaine 0.5% (R0.5%); morphine 0.1 mg kg−1 plus ropivacaine 0.5% (MR0.5%); morphine 0.1 mg kg−1 plus ropivacaine 0.35% (MR0.35%); morphine 0.1 mg kg−1 plus ropivacaine 0.25% (MR0.25%). Intraoperatively, isoflurane requirement (1.3% vs. <1.1% FE’Iso) and fentanyl requirement (9.8 vs. <1.1 µg kg−1 h−1) were significantly higher in C group compared to all epidural groups. Postoperatively, methadone requirement was higher (1.8 mg kg−1 vs. <0.8 mg kg−1) for C group compared to all epidural treatment groups. The ability to walk and to urinate returned 4 h earlier in MR0.35% and MR0.25%. The mean epidural volume of ropivacaine, using a dose regimen based on OCL, to reach T1 was about 0.15 mL cm−1. The addition of morphine further reduced the methadone requirement, without affecting urinary and motor functions.
Collapse
|
4
|
Sarotti D, Ala U, Franci P. Epidural anesthesia in dogs undergoing hindlimb orthopedic surgery: effects of two injection sites. J Vet Med Sci 2022; 84:457-464. [PMID: 35067493 PMCID: PMC8983285 DOI: 10.1292/jvms.21-0289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This prospective clinical trial evaluated the effects of epidural anesthesia (EA) placed at the lumbosacral compared to the L5-L6 junction in dogs undergoing hindlimb orthopedic surgery. In all, 98 dogs were randomly assigned to receive injection at either L7-S1 (LS group) or L5-L6 (LL group) at the same local anesthetic regimen (1 mg/kg bupivacaine 0.5% and 0.1 mg/kg morphine 1%). Fentanyl (1 µg/kg) was the intraoperative rescue analgesia (iRA) administered if mean arterial pressure increased by 30% above pre-stimulation value. Procedural failure, iRA, hypotension, motor block resolution, and postoperative side effects were recorded. There were 7/47 (15%) epidural procedural failures in the LS group and 8/51 (16%) (P=1.00) in the LL group; iRA was administered in 21/40 (52%) LS group dogs and in 13/43 (30%) LL group dogs, respectively (P=0.047). The incidence of hypotension was 10/40 (25%) and 16/43 (37%) in the LS group and the LL group, respectively (P=0.25). Proprioceptive residual deficit at 8 hr after EA was recorded in 3/26 (12%) in group LS dogs and in 13/26 (50%) group LL dogs, respectively (P=0.01). The proprioceptive residual deficit at 24 hr in one dog (LL group) resolved within 36 hr. No episodes of postoperative urinary retention, pruritus or neurological damage were recorded. The L5-L6 EA decreased significantly iRA but delays the proprioceptive recovery time. Further studies are needed to determine whether a lower bupivacaine dose reduces the duration of the residual block retaining the same incidence of iRA.
Collapse
Affiliation(s)
| | - Ugo Ala
- Department of Veterinary Science, University of Turin
| | - Paolo Franci
- Department of Veterinary Science, University of Turin
| |
Collapse
|
5
|
Herrera Becerra JR, Monteiro ER, Martins LG, Baier ME, Santos EA, Bianchi SP. Epidural administration of combinations of ropivacaine, morphine and xylazine in bitches undergoing total unilateral mastectomy: a randomized clinical trial. Vet Anaesth Analg 2021; 49:126-134. [PMID: 34742648 DOI: 10.1016/j.vaa.2021.10.001] [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: 08/12/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the epidural administration of combinations of ropivacaine, morphine and xylazine in bitches undergoing unilateral mastectomy. STUDY DESIGN Prospective, randomized, blinded, clinical study. ANIMALS A total of 22 bitches scheduled to undergo unilateral mastectomy for mammary tumor excision. METHODS Dogs were anesthetized with acepromazine (0.02 mg kg-1) and morphine (0.3 mg kg-1) intramuscularly, propofol intravenously (IV) and isoflurane. Prior to the beginning of surgery, dogs were randomly administered one of three epidural treatments: ropivacaine (0.75 mg kg-1) with morphine (0.1 mg kg-1) (group RM, n = 7); ropivacaine with xylazine (0.1 mg kg-1) (group RX, n = 8); or ropivacaine with morphine and xylazine (group RMX, n = 7). Cardiopulmonary variables and the expired concentration of isoflurane (Fe'Iso) were recorded intraoperatively. Meloxicam (0.1 mg kg-1) was administered IV during skin closure. Postoperative pain scores were evaluated with the Glasgow composite measure pain scale short form for 24 hours, and rescue analgesia with morphine (0.5 mg kg-1) was administered intramuscularly when pain scores were ≥ 6/24. RESULTS Fe'Iso was significantly higher in group RM than in groups RX and RMX. Heart rate decreased significantly in groups RX and RMX, but blood pressure remained within acceptable values. The number of dogs administered rescue analgesia within 24 hours was significantly higher in group RX (seven dogs, 87.5%) than in groups RM (one dog, 14.3%; p = 0.01) and RMX (two dogs, 28.6%; p = 0.04). Time to standing was significantly longer in group RX than in group RM. CONCLUSIONS AND CLINICAL RELEVANCE All epidural treatments provided adequate antinociception with minimal cardiovascular adverse effects during mastectomy. The inclusion of morphine (groups RM and RMX) provided the best postoperative analgesia. Owing to the undesirable effect of xylazine on ambulation, the combination ropivacaine-morphine appeared to provide greater benefits in bitches undergoing unilateral mastectomy.
Collapse
Affiliation(s)
- José R Herrera Becerra
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduardo R Monteiro
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Luiz Gb Martins
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria E Baier
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduardo Ar Santos
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Simone P Bianchi
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| |
Collapse
|
6
|
Tonge M, Robson K, Alderson B. Single thoracic epidural injection for intra‐ and post‐lateral thoracotomy analgesia in a dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mary Tonge
- Department of Small Animal Clinical Science University of Liverpool Neston UK
| | - Katherine Robson
- Department of Small Animal Clinical Science University of Liverpool Neston UK
| | - Briony Alderson
- Department of Small Animal Clinical Science University of Liverpool Neston UK
| |
Collapse
|
7
|
Wilsey AS, Koshman YE, Weisbecker DA, Bird BM, Mirakhur KK, Sadilek S, Ebert PA, Polakowski JS, Foley CM, Medina CL, Mittelstadt SW. Automated Blood Sampling in a Canine Telemetry Cardiovascular Model. Comp Med 2021; 71:133-140. [PMID: 33814031 DOI: 10.30802/aalas-cm-20-000083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Successful implementation of automated blood sampling (ABS) into a telemetry instrumented canine cardiovascular model provides simultaneous cardiovascular assessment of novel compounds while collecting multiple blood samples for analysis of drug level, cytokines, and biomarkers. Purpose-bred male Beagle dogs (n = 36) were instrumented with a dual-pressure telemetry transmitter and vascular access port. Modifications to acclimation practices, surgical procedures, and housing were required for implementation of ABS in our established cardiovascular canine telemetry colony. These modifications have increased the use and reproducibility of the model by combining early pharmacokinetic and cardiovascular studies, thus achieving both refinement and reduction from a 3R perspective. In addition, the modified model can shorten timelines and reduce the compound requirement in early stages of drug development. This telemetry-ABS model provides an efficient means to quickly identify potential effects on key cardiovascular parameters in a large animal species and to obtain a more complete pharmacokinetic-pharmacodynamic profile for discovery compounds.
Collapse
Affiliation(s)
- Amanda S Wilsey
- Department of Safety Pharmacology, Abbvie, North Chicago, Illinois;,
| | | | | | - Brandan M Bird
- Department of Safety Pharmacology, Abbvie, North Chicago, Illinois
| | | | - Sabine Sadilek
- Department of Safety Pharmacology, Abbvie, North Chicago, Illinois
| | - Paige A Ebert
- Department of Comparative Medicine, Abbvie, North Chicago, Illinois
| | | | - C Michael Foley
- Department of Safety Pharmacology, Abbvie, North Chicago, Illinois
| | - Chris L Medina
- Department of Comparative Medicine, Abbvie, North Chicago, Illinois
| | | |
Collapse
|
8
|
Boff G, Naspolini B, Marco CD, Andrades J, Caye P, Kalb A, Guim T, Gehrcke M. Dispersão da lidocaína administrada por via epidural em cães posicionados em decúbito lateral ou esternal. ARQ BRAS MED VET ZOO 2020. [DOI: 10.1590/1678-4162-11664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo do estudo foi verificar clinicamente a dispersão da lidocaína no espaço epidural de cães posicionados em diferentes decúbitos. Foram utilizados 16 cães, com peso médio de 17,5 quilogramas. Esses foram tranquilizados com acepromazina, anestesiados com propofol e alocados em dois grupos, conforme o decúbito de posicionamento: decúbito esternal (GE) e decúbito lateral direito (GLD). Ambos os grupos receberam lidocaína a 2%, no volume de 0,25mL/kg, e permaneceram no mesmo decúbito por 20 minutos. Em seguida, avaliou-se o bloqueio dos membros pélvicos e a extensão do bloqueio, a partir da sétima vértebra lombar, por meio de pinçamento interdigital e do panículo paravertebral. Foi, então, realizada cirurgia de orquiectomia. Após tal procedimento, avaliou-se o tempo total de bloqueio dos membros pélvicos. Todos os cães apresentaram bloqueio bilateral, sem diferenças quanto à extensão cranial entre os grupos, sendo a mediana de 7,5 (1-14) vértebras para GE e de 4 (1-14) para GLD. O tempo de bloqueio dos membros direito e esquerdo foi de 123 ± 26 e 130 ± 20 minutos, para GE, e de 120 ± 21 e 121 ± 20 minutos, para GLD, sem diferenças entre os grupos ou entre os membros. Conclui-se que o decúbito não interfere na distribuição da lidocaína administrada por via epidural.
Collapse
Affiliation(s)
- G.A. Boff
- Universidade Federal de Pelotas, Brazil
| | | | | | | | - P. Caye
- Universidade Federal de Pelotas, Brazil
| | - A.C. Kalb
- Universidade Federal de Pelotas, Brazil
| | - T.N. Guim
- Universidade Federal de Pelotas, Brazil
| | | |
Collapse
|
9
|
Evaluation of analgesic, sympathetic and motor effects of 1% and 2% lidocaine administered epidurally in dogs undergoing ovariohysterectomy. Vet Anaesth Analg 2020; 47:797-802. [PMID: 32900618 DOI: 10.1016/j.vaa.2020.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare, versus a control, the sensory, sympathetic and motor blockade of lidocaine 1% and 2% administered epidurally in bitches undergoing ovariohysterectomy. STUDY DESIGN Randomized, blinded, controlled clinical trial. ANIMALS A total of 24 mixed-breed intact female dogs. METHODS All dogs were administered dexmedetomidine, tramadol and meloxicam prior to general anesthesia with midazolam-propofol and isoflurane. Animals were randomly assigned for an epidural injection of lidocaine 1% (0.4 mL kg-1; group L1), lidocaine 2% (0.4 mL kg-1; group L2) or no injection (group CONTROL). Heart rate (HR), respiratory rate (fR), end-tidal partial pressure of carbon dioxide (Pe'CO2), and invasive systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressures were recorded every 5 minutes. Increases in physiological variables were treated with fentanyl (3 μg kg-1) intravenously (IV). Phenylephrine (1 μg kg-1) was administered IV when MAP was <60 mmHg. Postoperative pain [Glasgow Composite Pain Score - Short Form (GCPS-SF)] and return of normal ambulation were recorded at 1, 2, 3, 4 and 6 hours after extubation. RESULTS There were no differences over time or among groups for HR, fR, Pe'CO2 and SAP. MAP and DAP were lower in epidural groups than in CONTROL (p = 0.0146 and 0.0047, respectively). There was no difference in the use of phenylephrine boluses. More fentanyl was administered in CONTROL than in L1 and L2 (p = 0.011). GCPS-SF was lower for L2 than for CONTROL, and lower in L1 than in both other groups (p = 0.001). Time to ambulation was 2 (1-2) hours in L1 and 3 (2-4) hours in L2 (p = 0.004). CONCLUSIONS AND CLINICAL RELEVANCE Epidural administration of lidocaine (0.4 mL kg-1) reduced fentanyl requirements and lowered MAP and DAP. Time to ambulation decreased and postoperative pain scores were improved by use of 1% lidocaine compared with 2% lidocaine.
Collapse
|
10
|
Cole J, Hughey S. Bolus epidural infusion improves spread compared with continuous infusion in a cadaveric porcine spine model. Reg Anesth Pain Med 2019:rapm-2019-100818. [PMID: 31563882 DOI: 10.1136/rapm-2019-100818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/27/2019] [Accepted: 09/18/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The administration of epidural anesthesia during labor is a common technique used to reduce the pain of childbirth. We sought to compare standard infusion strategies of continuous epidural infusions (CEI) with programmed intermittent epidural bolus (PIEB) to assess the length of spread in terms of vertebral body length. Based on previous clinical data in humans, the PIEB was associated with improved pain control and decreased total dose of local anesthetic. We hypothesized that the PIEB was associated with increased spread when compared with CEI. METHODS Thirty female Yorkshire-cross swine cadavers were used to compare three infusion strategies, continuous infusion (CEI) 10 mL/hour programmed continuously, multiple bolus (MB) 2 mL given every 12 min for 10 mL total and 10 mL delivered in a single bolus (SB). Radiographs were used to identify the spread of the radiopaque contrast dye, and a number of vertebral bodies covered were measured to assess spread. RESULTS Overall, the CEI had an average spread of 5.6 levels, MB 7.9 and SB 10.4. The differences between SB and MB (p=0.011), SB and CEI (p<0.001) and MB and CEI (p=0.028) were all found to be significant. CONCLUSIONS We demonstrated increased spread of epidural contrast with programmed intermittent bolus strategies. This supports previous evidence of improved patient outcomes with PIEB strategy compared with CEI, and encourages the use of PIEB in the appropriate patient population.
Collapse
Affiliation(s)
- Jacob Cole
- Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Scott Hughey
- Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| |
Collapse
|
11
|
Abstract
Epidural and spinal anesthesia with a combination of local anesthetics and opioids (when available) is a commonly used technique in veterinary medicine and a safe one when practiced under strict guidelines. It is a valuable tool in the analgesic armamentarium and can greatly extend the ability to provide analgesia and reduce postoperative opioid requirements. As with all regional anesthetic techniques, clinical experience should be gained in order to practice it efficiently, and care should be taken to minimize the risks and complications associated with its use.
Collapse
Affiliation(s)
- Manuel Martin-Flores
- Section of Anesthesiology and Pain Medicine, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14850, USA.
| |
Collapse
|
12
|
Floriano D, Sahagian MJ, Chiavaccini L. Impact of epidural bupivacaine on perioperative opioid requirements, recovery characteristics, and duration of hospitalization in dogs undergoing cystotomy: A retrospective study of 56 cases. Vet Surg 2019; 48:1330-1337. [PMID: 31328291 DOI: 10.1111/vsu.13290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/03/2019] [Accepted: 06/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare perioperative opioid consumption and duration of hospitalization (DOH) in anesthetized dogs receiving opioid-based analgesia (OBA) vs those receiving bupivacaine epidural-based analgesia (EPID) during cystotomy. STUDY DESIGN Retrospective cross-sectional study. ANIMALS Fifty-six client-owned dogs undergoing cystotomy. METHODS Clinical records of dogs undergoing cystotomy between January 2015 and December 2017 were reviewed. Demographic data, duration of anesthesia and surgery, anesthetic management, perioperative opioid consumption expressed in morphine equivalents (ME), perioperative use of adjuvant analgesics, time to first micturition, time to eat, time to ambulate, and DOH were recorded. Opioid consumption and DOH were compared with a Wilcoxon rank-sum test, followed by linear regression analysis as appropriate. Time to first micturition, time to eat, and time to walk unassisted were modeled with Cox-proportional hazard models. RESULTS Dogs treated with EPID during surgery required 1.5 mg/kg ME less compared with those treated with OBA (P = .04) during surgery. Three of 19 dogs treated with EPID vs 15 of 37 dogs receiving OBA required intraoperative adjuvant analgesics (P = .06). Dogs treated with EPID regained motor function slower than dogs treated with OBA (P = .01); however, there was no difference in time to urinate, time to eat, or DOH between treatments. CONCLUSION Perioperative lumbosacral epidural with bupivacaine reduced intraoperative opioid consumption in dogs anesthetized for cystotomy. CLINICAL SIGNIFICANCE The use of epidural bupivacaine in dogs undergoing cystotomy may reduce intraoperative opioid requirements without affecting return of bladder function or DOH.
Collapse
Affiliation(s)
- Dario Floriano
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael J Sahagian
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ludovica Chiavaccini
- Department of Molecular and Biomedical Sciences, North Carolina State University, Raleigh, North Carolina
| |
Collapse
|
13
|
Comparison of calculated lumbosacral epidural volumes of injectate using a dose regimen based on body weight versus length of the vertebral column in dogs. Vet Anaesth Analg 2019; 46:135-140. [DOI: 10.1016/j.vaa.2018.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 11/17/2022]
|
14
|
Garcia-Pereira F. Epidural anesthesia and analgesia in small animal practice: An update. Vet J 2018; 242:24-32. [PMID: 30503540 DOI: 10.1016/j.tvjl.2018.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 11/15/2022]
Abstract
Epidural anesthesia is a commonly performed technique in both human and veterinary medicine. The technique is relatively simple following appropriate training and provides anesthesia and analgesia for acute and chronic pain. Several drug combinations have been administered by this route with variable success and duration. Multiple techniques to guide or confirm correct epidural needle placement are discussed in this article, as well as anatomical features of the epidural space, effect of drug volume and concentration, and adverse effects of the technique in small animal practice. This article is not an exhaustive review of the literature, but an update of some new findings over the last decade.
Collapse
Affiliation(s)
- F Garcia-Pereira
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL, 32610 USA.
| |
Collapse
|
15
|
Dias RSG, Soares JHN, Castro DDSE, Gress MAKDA, Machado ML, Otero PE, Ascoli FO. Cardiovascular and respiratory effects of lumbosacral epidural bupivacaine in isoflurane-anesthetized dogs: The effects of two volumes of 0.25% solution. PLoS One 2018; 13:e0195867. [PMID: 29668768 PMCID: PMC5906007 DOI: 10.1371/journal.pone.0195867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 03/30/2018] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to compare cardiovascular and respiratory effects of two volumes of bupivacaine 0.25% (0.2 mL kg-1-treatment BUP02-and 0.4 mL kg-1 -treatment BUP04) administered epidurally at the lumbosacral intervertebral space in dogs anesthetized with isoflurane. This experimental prospective randomized crossover design trial used six mixed breed adult dogs, four neutered males and two spayed females. Each dog was anesthetized on three different occasions: the first for isoflurane minimum alveolar concentration (MAC) measurement, and the following two assigned treatments (BUP02 or BUP04). On the two treatment days, anesthesia was induced and maintained with isoflurane at 1.3 MAC during the experiments. Cardiovascular and respiratory measurements were recorded before (T0) and 5, 15, 30, 60 and 90 minutes after the epidural administration of bupivacaine. Comparisons between and within groups were performed by a mixed-model ANOVA and Friedman's test when appropriate followed by Bonferroni post-hoc test or Dunnet's test to compare time points within each treatment with T0 (p < 0.05). Mean arterial pressure decreased significantly from 15 to 90 minutes after the administration of BUP02 and from 5 to 60 minutes in BUP04, with lower values in BUP04 than in BUP02 lasting up to 30 minutes after bupivacaine administration. No significant changes in cardiac output and systemic vascular resistance were observed in either treatment. Hypoventilation was only detected in BUP04. Hemoglobin concentration and arterial oxygen content decreased after both treatment of bupivacaine with no significant decrease in oxygen delivery. Two dogs in BUP04 developed Horner's syndrome. The epidural administration of 0.4 mL.kg-1 of bupivacaine to dogs in sternal recumbency anesthetized with isoflurane 1.3 MAC caused more cardiovascular and respiratory depression than 0.2 mL.kg-1.
Collapse
Affiliation(s)
- Raquel Sartori Gonçalves Dias
- Graduate Program in Cardiovascular Sciences, College of Medicine, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - João Henrique Neves Soares
- Department of Small Animal Clinical Sciences, Virginia–Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Douglas dos Santos e Castro
- Department of Large Animal Clinical Sciences, Anesthesia and Pain Management Service, University of Florida, Gainesville, Florida, United States of America
| | | | - Marcela Lemos Machado
- Graduate Program in Cardiovascular Sciences, College of Medicine, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Pablo E. Otero
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Buenos Aires, Argentina
| | - Fabio Otero Ascoli
- Graduate Program in Cardiovascular Sciences, College of Medicine, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
- Department of Physiology and Pharmacology, Biomedical Institute, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| |
Collapse
|
16
|
Steagall PVM, Simon BT, Teixeira Neto FJ, Luna SPL. An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs. Front Vet Sci 2017; 4:68. [PMID: 28553642 PMCID: PMC5427076 DOI: 10.3389/fvets.2017.00068] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/20/2017] [Indexed: 12/20/2022] Open
Abstract
This review aims to report an update on drugs administered into the epidural space for anesthesia and analgesia in dogs, describing their potential advantages and disadvantages in the clinical setting. Databases searched include Pubmed, Google scholar, and CAB abstracts. Benefits of administering local anesthetics, opioids, and alpha2 agonists into the epidural space include the use of lower doses of general anesthetics (anesthetic “sparing” effect), perioperative analgesia, and reduced side effects associated with systemic administration of drugs. However, the potential for cardiorespiratory compromise, neurotoxicity, and other adverse effects should be considered when using the epidural route of administration. When these variables are considered, the epidural technique is useful as a complementary method of anesthesia for preventive and postoperative analgesia and/or as part of a balanced anesthesia technique.
Collapse
Affiliation(s)
- Paulo V M Steagall
- Faculty of Veterinary Medicine, Department of Clinical Sciences, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Bradley T Simon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Francisco J Teixeira Neto
- Faculty of Veterinary Medicine and Animal Science, Department of Veterinary Surgery and Anaesthesiology, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Stelio P L Luna
- Faculty of Veterinary Medicine and Animal Science, Department of Veterinary Surgery and Anaesthesiology, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| |
Collapse
|
17
|
Boscan P, Wennogle S. Evaluating Femoral-Sciatic Nerve Blocks, Epidural Analgesia, and No Use of Regional Analgesia in Dogs Undergoing Tibia-Plateau-Leveling-Osteotomy. J Am Anim Hosp Assoc 2016; 52:102-8. [PMID: 26808436 DOI: 10.5326/jaaha-ms-6278] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This is a retrospective study evaluating femoral-sciatic nerve blocks (FSBs), epidural analgesia, and non-regional analgesia (NRA) in dogs undergoing tibia-plateau-leveling-osteotomy surgery. Thirty-five records met the criteria for each of the FSB and epidural analgesia groups. Seventeen anesthesia records met the criteria for the NRA or control group. The parameters reported were: isoflurane vaporizer setting, rescue analgesia/anesthesia drugs received, heart rate, systolic blood pressure, and recovery quality (0-4, with 0 being poor and 4 being good). Rescue analgesia-anesthesia during surgery was performed with either fentanyl, ketamine, or propofol. A larger percentage of dogs in the NRA group required rescue analgesia during surgery. The FSB group had a higher recovery quality with median (95% confidence interval of four (±0.3) when compared to two (±0.8) in NRA (p < 0.01). No difference between groups was observed on any other parameter reported. As part of a multimodal analgesia approach for tibia-plateau-leveling-osteotomy surgery, the use of femoral and sciatic nerves blocks with bupivacaine appears to be an alternative technique to help with analgesia and anesthesia during surgery.
Collapse
Affiliation(s)
- Pedro Boscan
- From the Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO
| | - Sara Wennogle
- From the Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO
| |
Collapse
|
18
|
Castro DS, Soares JHN, Gress MAKA, Otero PE, Marostica E, Ascoli FO. Hypoventilation exacerbates the cardiovascular depression caused by a high volume of lumbosacral epidural bupivacaine in two isoflurane-anesthetized dogs. Vet Anaesth Analg 2015; 43:235-7. [PMID: 26577992 DOI: 10.1111/vaa.12320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Douglas S Castro
- Department of Physiology and Pharmacology, College of Veterinary Medicine, Fluminense Federal University, Niterói, RJ, Brazil.
| | - João H N Soares
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Maria A K A Gress
- Department of Physiology and Pharmacology, College of Veterinary Medicine, Fluminense Federal University, Niterói, RJ, Brazil
| | - Pablo E Otero
- Department of Anesthesiology, College of Veterinary Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Elizabeth Marostica
- Department of Physiology and Pharmacology, College of Veterinary Medicine, Fluminense Federal University, Niterói, RJ, Brazil
| | - Fabio O Ascoli
- Department of Physiology and Pharmacology, College of Veterinary Medicine, Fluminense Federal University, Niterói, RJ, Brazil
| |
Collapse
|
19
|
Kawalilak LT, Tucker RL, Greene SA. USE OF CONTRAST-ENHANCED COMPUTED TOMOGRAPHY TO STUDY THE CRANIAL MIGRATION OF A LUMBOSACRAL INJECTATE IN CADAVER DOGS. Vet Radiol Ultrasound 2015; 56:570-4. [DOI: 10.1111/vru.12264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/19/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lukas T. Kawalilak
- Veterinary Clinical Sciences; Washington State University; Pullman WA 99164-6610
| | - Russell L. Tucker
- Veterinary Clinical Sciences; Washington State University; Pullman WA 99164-6610
| | - Stephen A. Greene
- Veterinary Clinical Sciences; Washington State University; Pullman WA 99164-6610
| |
Collapse
|
20
|
Son WG, Jang M, Yoon J, Lee LY, Lee I. The effect of epidural injection speed on epidural pressure and distribution of solution in anesthetized dogs. Vet Anaesth Analg 2014; 41:526-33. [DOI: 10.1111/vaa.12147] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 11/03/2013] [Indexed: 11/30/2022]
|
21
|
Moll X, García F, Ferrer RI, Santos L, Aguilar A, Andaluz A. Distribution of methylene blue after injection into the epidural space of anaesthetized pregnant and non-pregnant sheep. PLoS One 2014; 9:e92860. [PMID: 24709655 PMCID: PMC3977856 DOI: 10.1371/journal.pone.0092860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/26/2014] [Indexed: 11/19/2022] Open
Abstract
The aim of the study was to determine the distribution of different volumes of methylene blue solution injected into the epidural space in anaesthetized pregnant and non-pregnant sheep, to evaluate its cranial distribution and to compare between them. Fifteen pregnant and fifteen non-pregnant sheep were included in the study. Sheep were anaesthetized and received 0.05, 0.1, or 0.2 mL/kg of a lumbosacral epidural solution containing 0.12% methylene blue in 0.9% saline. Thirty minutes after the epidural injection, the ewes were euthanized. The extension of the dye within the epidural space was measured, and the correlation between the volume of the dye injected and the number of stained vertebrae was evaluated. The cranial migration of the dye between pregnant and non-pregnant sheep was also compared. The results show that the volume of methylene blue injected epidurally into pregnant and non-pregnant sheep correlated directly with its cephalic distribution into the epidural space; and a volume of 0.1 mL/kg or 0.2 mL/kg stained up to the first lumbar segment in pregnant and non-pregnant sheep, respectively. Also, the results suggest that the volume of drugs administered into the epidural space of pregnant sheep should be half the volume that would be used in non-pregnant sheep.
Collapse
Affiliation(s)
- Xavier Moll
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
- * E-mail:
| | - Felix García
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rosa Isabel Ferrer
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Laura Santos
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Adrià Aguilar
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Anna Andaluz
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
| |
Collapse
|
22
|
Adami C, Veres-Nyéki K, Spadavecchia C, Rytz U, Bergadano A. Evaluation of peri-operative epidural analgesia with ropivacaine, ropivacaine and sufentanil, and ropivacaine, sufentanil and epinephrine in isoflurane anesthetized dogs undergoing tibial plateau levelling osteotomy. Vet J 2012; 194:229-34. [PMID: 22658249 DOI: 10.1016/j.tvjl.2012.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 04/17/2012] [Accepted: 04/18/2012] [Indexed: 11/19/2022]
Affiliation(s)
- C Adami
- Department of Veterinary Clinical Science, Anaesthesiology and Pain Therapy Division, Vetsuisse-Faculty, University of Berne, 3012 Berne, Switzerland.
| | | | | | | | | |
Collapse
|
23
|
Son WG, Kim J, Seo JP, Yoon J, Choi M, Lee LY, Lee I. Cranial epidural spread of contrast medium and new methylene blue dye in sternally recumbent anaesthetized dogs. Vet Anaesth Analg 2011; 38:510-5. [DOI: 10.1111/j.1467-2995.2011.00643.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|