Comparison of harmonic blade versus traditional approach in canine patients undergoing spinal decompressive surgery for naturally occurring thoracolumbar disk extrusion

ACVIM consensus statement on diagnosis and management of acute canine thoracolumbar intervertebral disc extrusion

Background

Thoracolumbar intervertebral disc extrusion (TL‐IVDE) is the most common cause of acute paraparesis and paraplegia in dogs; however, guidelines on management of the condition are lacking.

Objectives

To summarize the current literature as it relates to diagnosis and management of acute TL‐IVDE in dogs, and to formulate clinically relevant evidence‐based recommendations.

Animals

None.

Methods

A panel of 8 experts was convened to assess and summarize evidence from the peer‐reviewed literature in order to develop consensus clinical recommendations. Level of evidence available to support each recommendation was assessed and reported.

Results

The majority of available literature described observational studies. Most recommendations made by the panel were supported by a low or moderate level of evidence, and several areas of high need for further study were identified. These include better understanding of the ideal timing for surgical decompression, expected surgical vs medical outcomes for more mildly affected dogs, impact of durotomy on locomotor outcome and development of progressive myelomalacia, and refining of postoperative care, and genetic and preventative care studies.

Conclusions and Clinical Importance

Future efforts should build on current recommendations by conducting prospective studies and randomized controlled trials, where possible, to address identified gaps in knowledge and to develop cost effectiveness and number needed to treat studies supporting various aspects of diagnosis and treatment of TL‐IVDE.

Analgesic effects of intraorbital insertion of an absorbable gelatin hemostatic sponge soaked with 1% ropivacaine solution following enucleation in dogs

OBJECTIVE

To evaluate analgesic effects and complications associated with intraorbital insertion of an absorbable gelatin hemostatic sponge (AGHS) soaked with 1% ropivacaine solution following enucleation in dogs.

ANIMALS

20 client-owned dogs undergoing enucleation.

PROCEDURES

Dogs were randomly assigned to receive an AGHS soaked with 1% ropivacaine solution (n = 10) or saline (0.9% NaCl) solution (control group; 10) inserted intraorbitally prior to skin closure following enucleation. Carprofen (2 mg/kg [0.9 mg/lb]) was administered SC once after orotracheal extubation and then PO twice a day for 5 days. During the postoperative recovery period, apparent pain level was scored at various points with a modified short-form Glasgow Composite Pain Scale (score range, 0 to 19), and methadone was administered for rescue analgesia if any score was ≥ 5. After dogs returned home, owners recorded their behavior and apparent pain level for the first 3 days following enucleation.

RESULTS

At extubation, the median (range) pain score was significantly higher in the control group (8 [2 to 14]) versus the ropivacaine group (3 [1 to 7]). A greater proportion of dogs in the control group received methadone (7/10 vs 1/10) and had crying or attention-seeking behavior on the first day following enucleation (7/10 vs 1/10). No complications were observed in either group.

CONCLUSIONS AND CLINICAL RELEVANCE

Addition of intraorbital insertion of a ropivacaine-soaked AGHS to the analgesic protocol for dogs undergoing enucleation provided better analgesia than was achieved without this treatment as measured immediately and the first day after surgery, with no noted adverse effects.