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Stabile M, Lacitignola L, Acquafredda C, Scardia A, Crovace A, Staffieri F. Evaluation of a constant rate intravenous infusion of dexmedetomidine on the duration of a femoral and sciatic nerve block using lidocaine in dogs. Front Vet Sci 2023; 9:1061605. [PMID: 36713886 PMCID: PMC9880291 DOI: 10.3389/fvets.2022.1061605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
Objectives This study investigated the effects of 1 μg/kg/h intravenous constant rate infusion (CRI) of dexmedetomidine on the sensory and motor blockade for femoral and sciatic nerve blocks in dogs undergoing stifle surgery. Materials and methods Client-owned dogs referred for stifle surgery were enrolled in this prospective, randomized, blinded study. Dogs were pre-medicated with acepromazine (0.005-0.01 mg/kg intramuscularly, IM); anesthesia was induced with propofol intravenously and maintained with isoflurane in a mixture of air and oxygen. Electrolocation-guided sciatic and femoral nerve blocks with lidocaine 2% (0.15 mL/kg) were performed using the parasacral and lateral pre-iliac approaches, respectively. After performing local block, a systemic infusion of saline solution (group C) or dexmedetomidine (group D) was started at a CRI at 1 ml/kg/h and continued until the end of surgery. Dexmedetomidine was infused at a dose of 1 μg/kg/h. Respiratory and hemodynamic variables were recorded during surgery. Sensory and motor blockade was evaluated by response to pinching the skin innervated by the sciatic/femoral nerves, with forceps and by observing the dogs' ability to walk and testing proprioception at 30, 60, 120, 180, and 240 min after extubation. Analgesia was monitored with SF-GCPS. Methadone IM was administered as rescue analgesia. Intraoperative data were analyzed by analysis of variance, while postoperative data were analyzed by the independent two-tailed t-test and a Kaplan-Meier test (p < 0.05). Results Twenty dogs were included in this study (10/group). A significant difference in the recovery of sensory nerve function was observed between the groups. The mean durations of the sensory blockade for femoral and sciatic nerves, respectively, was longer (p < 0.001) for group D [168 (146-191, 95% CI), 161 (143-179, 95% CI) min] than in group C [120 (96.1-144, 95% CI), 116 (90.9-142, 95% CI]. No differences in the recovery of patellar and tibial reflexes, proprioceptive function, and ability to walk were found among groups. The overall postoperative rescue analgesia requirement was significantly different (p = 0.019) between groups, with an incidence of 5/10 (50%) dogs in group D and 10/10 (100%) dogs in group C. Conclusion Dexmedetomidine administered as a CRI (1 μg/kg/h) combined with local lidocaine increases the duration of the sensory component of the sciatic and femoral nerve blocks and reduces the requirement for additional analgesia during the immediate postoperative hours.
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Di Bella C, Pennasilico L, Botto R, Salvaggio A, Galosi M, Staffieri F, Piccionello AP. Efficacy of dexmedetomidine as adjuvant to bupivacaine in femoral-sciatic nerve blocks in dogs undergoing tibial plateau levelling osteotomy (TPLO). Res Vet Sci 2023; 154:124-131. [PMID: 36584520 DOI: 10.1016/j.rvsc.2022.12.015] [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: 09/11/2022] [Revised: 12/18/2022] [Accepted: 12/24/2022] [Indexed: 12/28/2022]
Abstract
The aim of this randomized, prospective clinical study was to evaluate the efficacy of dexmedetomidine combined with bupivacaine on sciatic and femoral nerve blocks in dogs. Thirty dogs were selected for elective unilateral tibial plateau levelling osteotomy, and each subject was assigned randomly to receive perineural bupivacaine 0.5% (0.1 mL/kg) and intramuscular dexmedetomidine (0.5 μg/kg) in the BDs group, perineural bupivacaine 0.5% (0.1 mL/kg) plus dexmedetomidine (0.5 μg/kg) in the BDloc group, and perineural bupivacaine 0.5% (0.1 mL/kg) plus intramuscular administration of saline solution the in Bupi group. Nerve blocks were guided by electrolocation. The main intraoperative parameters were registered 10 min before the start of surgery (BASE) and during the skin incision (SKIN), the osteotomy (BONE) and the suture (SUTURE). At 2, 4, 6, 8, 10, 15, 20 and 24 h after blocks, the Glasgow Composite Pain scale (GPCs) was used to identify the degree of pain during the postoperative period. Patients with scores ≥5/20 received rescue analgesia and were excluded. Furthermore, heart rate, mean arterial pressure, footstep capacity, reaction to wound touch and femoral and sciatic skin sensitivity were registered. Parametric data were compared at each time point of the study with the one-way ANOVA for repeated measures and Fisher's test for yes/no variables analysis (p < 0.05). No subject required intraoperative rescue analgesia. In BDloc group, the GCPs score was <5/20 for all dogs at all times of the study, and 70% of dogs did not need systemic analgesia. In the Bupi and BDs groups, 100% of subjects achieved a score ≥ 5/20 between 8 and 10 h after the blocks, and 100% of subjects showed femoral and sciatic skin sensitivity and required rescue analgesia within 10 h. Our results showed that the addition of dexmedetomidine as an adjuvant to bupivacaine in SF blocks may prolong the sensory block and ensure sufficient analgesia for up to 24 h in dogs undergoing TPLO surgery.
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Affiliation(s)
- Caterina Di Bella
- School of Bioscience and Veterinary Medicine, University of Camerino, Camerino, Italy.
| | - Luca Pennasilico
- School of Bioscience and Veterinary Medicine, University of Camerino, Camerino, Italy.
| | - Riccardo Botto
- School of Bioscience and Veterinary Medicine, University of Camerino, Camerino, Italy.
| | - Alberto Salvaggio
- School of Bioscience and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Margherita Galosi
- School of Bioscience and Veterinary Medicine, University of Camerino, Camerino, Italy.
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy.
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Clark TP. The history and pharmacology of buprenorphine: New advances in cats. J Vet Pharmacol Ther 2022; 45 Suppl 1:S1-S30. [DOI: 10.1111/jvp.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/19/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
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Acquafredda C, Stabile M, Lacitignola L, Centonze P, Di Bella C, Crovace A, Fiorentino M, Staffieri F. Clinical efficacy of dexmedetomidine combined with lidocaine for femoral and sciatic nerve blocks in dogs undergoing stifle surgery. Vet Anaesth Analg 2021; 48:962-971. [PMID: 34607765 DOI: 10.1016/j.vaa.2021.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/28/2021] [Accepted: 05/12/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the effects of dexmedetomidine administered perineurally or intramuscularly (IM) on sensory, motor function and postoperative analgesia produced by lidocaine for sciatic and femoral nerve blocks in dogs undergoing unilateral tibial tuberosity advancement surgery. STUDY DESIGN Prospective, blinded, clinical study. ANIMALS A group of 30 dogs. METHODS Dogs were anaesthetized with acepromazine, propofol and isoflurane in oxygen/air. Electrolocation-guided femoral and sciatic nerve blocks were performed: group L, 0.15 mL kg-1 2% lidocaine (n = 10); group LDloc, lidocaine and 0.15 μg kg-1 dexmedetomidine perineurally (n = 10); group LDsys, lidocaine and 0.3 μg kg-1 dexmedetomidine IM (n = 10). After anaesthesia, sensory blockade was evaluated by response to forceps pinch on skin innervated by the saphenous/femoral, common fibular and tibial nerves. Motor blockade was evaluated by observing the ability to walk and proprioception. Analgesia was monitored with Short Form of Glasgow Composite Pain Scale for up to 4 hours after extubation. Methadone IM was administered as rescue analgesia. Data were analysed by linear mixed effect models and Kaplan-Meier test (p < 0.05). RESULTS Median duration of the sensory blockade for all nerves was longer (p < 0.001) for group LDloc than for groups L and LDsys and was longer (p = 0.0011) for group LDsys than for group L. Proprioception returned later (p < 0.001) for group LDloc [285 (221-328) minutes] compared with group L [160 (134-179) minutes] or LDsys [195 (162-257) minutes]. Return of the ability to walk was similar among all groups. Dogs in group LDloc required postoperative rescue analgesia later (p = 0.001) than dogs in groups LDsys and L. CONCLUSIONS AND CLINICAL RELEVANCE Dexmedetomidine administered perineurally with lidocaine prolonged sensory blockade and analgesia during the immediate postoperative period. Systemic dexmedetomidine also prolonged the sensory blockade of perineural lidocaine.
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Affiliation(s)
- Claudia Acquafredda
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy; PhD Course in Organs and Tissues Transplantation and Celluar Therapies, Department of Emergency and Organ Transplantations, Aldo Moro University, Bari, Italy
| | - Marzia Stabile
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy; PhD Course in Organs and Tissues Transplantation and Celluar Therapies, Department of Emergency and Organ Transplantations, Aldo Moro University, Bari, Italy
| | - Luca Lacitignola
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Paola Centonze
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Caterina Di Bella
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy; PhD Course in Organs and Tissues Transplantation and Celluar Therapies, Department of Emergency and Organ Transplantations, Aldo Moro University, Bari, Italy
| | - Antonio Crovace
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Marco Fiorentino
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy.
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Shen QH, Li HF, Zhou XY, Yuan XZ, Lu YP. Dexmedetomidine as an adjuvant for single spinal anesthesia in patients undergoing cesarean section: a system review and meta-analysis. J Int Med Res 2020; 48:300060520913423. [PMID: 32466699 PMCID: PMC7263150 DOI: 10.1177/0300060520913423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Previous studies reported the effect of dexmedetomidine on intrathecal anesthesia. In this review, we explored the impact of dexmedetomidine as an adjunct for lumbar anesthesia in patients undergoing cesarean section. METHODS Two authors searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, the Chinese BioMedical database, Chinese Scientific Journal Database, and the Wanfang database. RESULTS Ten trials comprising 970 patients were included in this review. Intrathecal dexmedetomidine significantly reduced the onset time of sensory block (standardized mean difference (SMD), -1.50, 95% confidence interval (CI) -2.15, -0.85, I2 = 92%) and motor block (SMD -0.77, 95% CI -1.50, -0.49, I2 = 60%) and prolonged the block duration time (sensory block: SMD 2.02, 95% CI 1.29, 2.74, I2 = 93%; motor block: SMD 1.90, 95% CI 1.07, 2.74, I2 = 94%). Patients who received dexmedetomidine showed a lower incidence of shivering. No significant difference was reported for the neonatal Apgar score and other complications. CONCLUSION The use of intrathecal dexmedetomidine during cesarean section can shorten the onset time of spinal anesthesia and enhance the effect of local anesthetic. It has no significant impact on neonates and there were no other adverse events.
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Affiliation(s)
- Qi-Hong Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Hui-Fang Li
- Department of Gynecology, Tongxiang Maternal and Child Health Care Hospital, Tongxiang, Zhejiang, China
| | - Xu-Yan Zhou
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Xiao-Zong Yuan
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Ya-Ping Lu
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
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Benito J, Evangelista MC, Doodnaught GM, Watanabe R, Beauchamp G, Monteiro BP, Steagall P. Analgesic Efficacy of Bupivacaine or Bupivacaine-Dexmedetomidine After Intraperitoneal Administration in Cats: A Randomized, Blinded, Clinical Trial. Front Vet Sci 2019; 6:307. [PMID: 31572740 PMCID: PMC6753169 DOI: 10.3389/fvets.2019.00307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/29/2019] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to compare the analgesic efficacy of intraperitoneal bupivacaine vs. bupivacaine-dexmedetomidine in combination with intramuscular buprenorphine in cats undergoing ovariohysterectomy. Sixty healthy adult cats (2.8 ± 0.7 kg; n = 30/group) were included in a randomized, prospective, blinded, clinical trial after owners' written consent. After premedication with acepromazine (0.02 mg/kg) and buprenorphine (0.02 mg/kg) intramuscularly, anesthesia was induced with propofol to effect (6.2 ± 1.4 mg/kg) and maintained with isoflurane. Bupivacaine 0.25% alone (BG; 2 mg/kg) or bupivacaine (same dose) with dexmedetomidine (BDG; 1 μg/kg) were instilled/splashed over the ovarian pedicles and caudal aspect of uterus before ovariohysterectomy. Final injectate volume was standardized between groups. Sedation was evaluated using a five-point simple descriptive scale. Pain was evaluated using the short-form UNESP-Botucatu composite pain scale (SF-CPS) before, and at 0.5, 1, 2, 3, 4, 6, 8, 12, and 24 h after surgery. Rescue analgesia was provided with buprenorphine (0.02 mg/kg intravenously) and meloxicam (0.2 mg/kg subcutaneously) when SF-CPS ≥ 4. The Mantel-Haenszel chi-square test was used for analyzing ordinal variables (e.g., SF-CPS pain scores). The effect of time in SF-CPS scores was assessed with the Cochran-Mantel-Haenszel test for repeated measures. The alpha level for each contrast was adjusted downward with the sequential Benjamini-Hochberg procedure. The number of cats receiving rescue analgesia was analyzed using χ2 test (p < 0.05). The prevalence of rescue analgesia was the same for the two treatments (p = 1.000) [BG, n = 6, 20%; BDG, n = 6, 20%] and similar for timing of rescue analgesia (p = 0.16). The SF-CPS scores were significantly increased between 1 and 12 h in BG, and between 0.5 and 8 h in BDG when compared with baseline values. Median (interquartile range) pain scores were higher in BG [1 (1-2)] than BDG [1 (0-1)] at 12 h (p = 0.023). Sedation scores were not significantly different between groups throughout the study. In terms of prevalence of rescue analgesia, but not duration of action, the analgesic efficacy of bupivacaine-dexmedetomidine was similar to bupivacaine alone after intraperitoneal administration in cats receiving buprenorphine.
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Affiliation(s)
- Javier Benito
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Marina C Evangelista
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Graeme M Doodnaught
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Ryota Watanabe
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Guy Beauchamp
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Beatriz P Monteiro
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Paulo Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
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Valverde A, Skelding AM. Alternatives to Opioid Analgesia in Small Animal Anesthesia: Alpha-2 Agonists. Vet Clin North Am Small Anim Pract 2019; 49:1013-1027. [PMID: 31481257 DOI: 10.1016/j.cvsm.2019.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Alpha-2 agonists have potent analgesic effects, in addition to their sedative actions. Alpha-2 agonists provide analgesia through any of several routes of administration, including parenteral, oral, epidural or intrathecal and intraarticular, because of spinal and supraspinal actions. Systemic doses are short acting, whereas local administration at the site of action result in longer analgesic effects. The potent cardiovascular and respiratory effects of alpha-2 agonists should be considered when used as analgesics.
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Affiliation(s)
- Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - Alicia M Skelding
- Toronto Animal Health Partners Emergency and Specialty Hospital, Toronto, Ontario M3B 2R2, Canada
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Portela DA, Verdier N, Otero PE. Regional anesthetic techniques for the pelvic limb and abdominal wall in small animals: A review of the literature and technique description. Vet J 2018; 238:27-40. [PMID: 30103913 DOI: 10.1016/j.tvjl.2018.07.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/24/2018] [Accepted: 07/13/2018] [Indexed: 11/17/2022]
Abstract
Increasing interest in using peripheral nerve blocks in small animals is evident, given the numerous studies published recently on this topic in important veterinary journals. Initially, research was focused on intraoperative analgesia to the pelvic limb, and several descriptions of lumbosacral plexus, femoral and sciatic nerve blocks have been described in studies. There is recent interest in developing techniques for somatosensory blockade of the abdominal wall. This article is the second part of a two-part review of regional anesthesia (RA) in small animals, and its aim is to discuss the most relevant studies in the veterinary literature, where objective methods of nerve location have been used, and to illustrate in pictures the currently used techniques for providing RA to the abdominal wall and the pelvic limb in small animals.
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Affiliation(s)
- D A Portela
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
| | - N Verdier
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Buenos Aires, Argentina
| | - P E Otero
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Buenos Aires, Argentina
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