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ZAHRA JOL, SEGATTO CZ, ZANELLI GR, BRUNO TDS, NICÁCIO GM, GIUFFRIDA R, CASSU RN. A comparison of intra and postoperative analgesic effects of sacrococcygeal and lumbosacral epidural levobupivacaine in cats undergoing ovariohysterectomy. J Vet Med Sci 2023; 85:1172-1179. [PMID: 37793832 PMCID: PMC10686773 DOI: 10.1292/jvms.23-0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
The aim of this study was to compare the intra and postoperative analgesic effects of sacrococcygeal epidural levobupivacaine with those of lumbosacral levobupivacaine in feline ovariohysterectomy. Thirty-six cats were premedicated with intramuscular acepromazine (0.05 mg/kg) and meperidine (6 mg/kg). Anesthesia was induced with intravenous propofol and maintained with isoflurane in oxygen. The cats were randomly assigned one of the three treatments receiving 0.33% levobupivacaine (0.3 mL/kg) into the sacrococcygeal (S-C group, n=12) or lumbosacral (L-S group, n=12) epidural space, or the same volume of 0.9% saline solution into one of the epidural approaches (Control group, n=12). Intraoperatively, cardiorespiratory variables, end-tidal isoflurane concentration (FE´ISO), and fentanyl requirements were recorded. Postoperative pain was assessed by the UNESP (Universidade Estadual Paulista)-Botucatu multidimensional composite pain scale and the Glasgow feline composite measure pain scale up to 8 hr post-extubation. Morphine was administered as rescue analgesia. Overall FE´ISO and fentanyl requirements were lower in the L-S and S-C compared to the Control (P=0.002-0.048, respectively). There was no significant difference in the cardiorespiratory variables during anesthesia, postoperative pain and rescue analgesia among groups. The time to standing after anesthesia was prolonged in the L-S and S-C groups than in the Control (P<0.001). Lumbosacral and sacrococcygeal epidural levobupivacaine resulted in similar decreases in isoflurane requirements and intraoperative fentanyl supplementation in the cats, with no postoperative benefits.
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Affiliation(s)
- Julia Oliveira Lima ZAHRA
- Department of Veterinary Surgery and Anesthesiology, Faculty of Veterinary Medicine, Universidade do Oeste Paulista, Presidente Prudente, Brazil
| | - Camila Zanetti SEGATTO
- Department of Veterinary Surgery and Anesthesiology, Faculty of Veterinary Medicine, Universidade do Oeste Paulista, Presidente Prudente, Brazil
| | - Gustavo Ricci ZANELLI
- Department of Veterinary Surgery and Anesthesiology, Faculty of Veterinary Medicine, Universidade do Oeste Paulista, Presidente Prudente, Brazil
| | - Tatiane dos Santos BRUNO
- Department of Veterinary Surgery and Anesthesiology, Faculty of Veterinary Medicine, Universidade do Oeste Paulista, Presidente Prudente, Brazil
| | - Gabriel Montoro NICÁCIO
- Department of Veterinary Surgery and Anesthesiology, Faculty of Veterinary Medicine, Universidade do Oeste Paulista, Presidente Prudente, Brazil
| | - Rogerio GIUFFRIDA
- Department of Veterinary Surgery and Anesthesiology, Faculty of Veterinary Medicine, Universidade do Oeste Paulista, Presidente Prudente, Brazil
| | - Renata Navarro CASSU
- Department of Veterinary Surgery and Anesthesiology, Faculty of Veterinary Medicine, Universidade do Oeste Paulista, Presidente Prudente, Brazil
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Salla K, Åhlberg T, Lepajoe J, Kallio-Kujala I, Mölsä S, Casoni D. Efficacy of lumbosacral and sacrococcygeal epidural ropivacaine in dogs undergoing surgery for perineal hernia. Front Vet Sci 2023; 10:1163025. [PMID: 37808102 PMCID: PMC10551457 DOI: 10.3389/fvets.2023.1163025] [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: 02/10/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Epidural anesthesia is commonly administered as part of balanced anesthesia for perioperative analgesia. The main goal of this randomized clinical trial was to compare the efficacy of two epidural approaches in dogs undergoing surgery for a perineal hernia. A secondary aim was to compare motor blockade. Intact ASA 1 and 2 male dogs, weighing ≤25 kg with no previous surgery for perineal hernia were enrolled. After premedication with IM acepromazine 0.02 mg/kg and butorphanol 0.3 mg/kg, general anesthesia was induced with propofol and maintained with sevoflurane in oxygen. Dogs were randomly allocated to receive either a lumbosacral (LS, n = 30) or a sacrococcygeal (SC, n = 26) epidural injection with ropivacaine 1% (0.2 mL/kg) under computed tomography guidance. Successful analgesia was defined as no need of intraoperative rescue analgesia (fentanyl 3 μg/kg IV). Clinical failure was defined as the need of more than two boluses of fentanyl/h each dog received meloxicam 0.2 mg/kg IV at the end of the surgery. The Glasgow Composite Pain Scale short form (GCPS-SF), tactile sensitivity, pressure pain thresholds and motor blockade were assessed at 4, 6, 8, and 24 h after the epidural injection. Methadone (0.2 mg/kg, IV) was administered if the GCPS-SF was ≥6/24 points. Differences between groups were analyzed with the Mann-Whitney U test, Student's t-test or Fisher's Exact test, as appropriate. Success rate was assessed for non-inferiority between groups. The non-inferiority margin was set at -10%. Epidural analgesia was successful in 24 dogs in group LS and 17 dogs in group SC (p = 0.243), resulting in success rates of 80 and 65% in LS and SC groups, respectively. The non-inferiority of group SC versus group LS was confirmed. Clinical failure was recorded in two dogs in group LS and one dog in group SC. No significant differences between groups were detected in the GCPS-SF score, tactile sensitivity, pressure pain thresholds, need of post-operative methadone, or motor blockade. Both epidural techniques are valuable analgesic options for perineal hernia repair in dogs.
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Affiliation(s)
- Kati Salla
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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Freitag FAV, Valverde A, Jensen M, Sanchez A, Gomez DE, Bailey C. Comparison of rostral spread of lumbosacral epidural volume calculated by body weight or length of the vertebral column in small-sized anesthetized dogs. CANADIAN JOURNAL OF VETERINARY RESEARCH = REVUE CANADIENNE DE RECHERCHE VETERINAIRE 2023; 87:208-216. [PMID: 37397637 PMCID: PMC10291696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/29/2023] [Indexed: 07/04/2023]
Abstract
The first objective of this prospective, randomized, crossover experimental trial was to compare the rostral spread of lumbosacral epidural volume calculated by body weight (BW) or vertebral column length (LE) in 6 small, isoflurane-anesthetized female beagle dogs (BW: 7.5 to 10.2 kg; LE measured from the occipital crest to the sacrococcygeal space: 46 to 56 cm). The second objective was to assess the response to a noxious stimulus once the dogs recovered from anesthesia and to determine the effects of the injection on cardiopulmonary variables. While in sternal position, dogs were injected through an epidural catheter with a volume mixture of bupivacaine 0.25% and iopamidol 15% based on BW: 0.2 mL/kg or LE: 0.05 mL/cm (< 50 cm) or 0.07 mL/cm (50 to < 70 cm). Rostral spread was determined by counting the number of vertebrae reached by iopamidol using computed tomography. After anesthesia, cardiopulmonary variables, motor function, and responses to nociceptive stimuli were evaluated. Comparisons were completed with mixed linear models and 2-way analysis of variance (ANOVA) (P < 0.05). The volume of injectate (3.29 ± 0.74 versus 1.81 ± 0.21 mL; mean ± SD) and the number of vertebrae (22 ± 2 versus 19 ± 2 vertebrae) reached by iopamidol were significantly greater for LE than for BW. Response to nociception, time to return of pain sensation, motor function, and cardiopulmonary variables were similar between groups. In conclusion, dosing based on LE resulted in larger rostral spread than when based on BW in dogs of small size.
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Affiliation(s)
- Flavio A V Freitag
- Department of Clinical Studies (Freitag, Valverde, Jensen, Sanchez, Gomez) and Department of Biomedical Sciences (Bailey), Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1
| | - Alexander Valverde
- Department of Clinical Studies (Freitag, Valverde, Jensen, Sanchez, Gomez) and Department of Biomedical Sciences (Bailey), Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1
| | - Monica Jensen
- Department of Clinical Studies (Freitag, Valverde, Jensen, Sanchez, Gomez) and Department of Biomedical Sciences (Bailey), Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1
| | - Andrea Sanchez
- Department of Clinical Studies (Freitag, Valverde, Jensen, Sanchez, Gomez) and Department of Biomedical Sciences (Bailey), Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1
| | - Diego E Gomez
- Department of Clinical Studies (Freitag, Valverde, Jensen, Sanchez, Gomez) and Department of Biomedical Sciences (Bailey), Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1
| | - Craig Bailey
- Department of Clinical Studies (Freitag, Valverde, Jensen, Sanchez, Gomez) and Department of Biomedical Sciences (Bailey), Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1
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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.
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Martin-Flores M, Moy-Trigilio KE, Campoy L, Gleed RD. Retrospective study on the use of lumbosacral epidural analgesia during caesarean section surgery in 182 dogs: Impact on blood pressure, analgesic use and delays. Vet Rec 2021; 188:e134. [PMID: 33646571 DOI: 10.1002/vetr.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/03/2020] [Accepted: 01/26/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND We evaluated the use of lumbosacral epidural anaesthesia (LEA) in dogs undergoing caesarean section over 10 years. METHODS Anaesthetic records were reviewed and divided into two treatment groups: LEA and control. Outcome variables identified a priori as potentially affected by LEA were compared between groups. Results are frequency or median (minimum-maximum). RESULTS Ninety-five dogs received LEA and 87 did not. LEA consisted of 0.2 (0.1-0.3) ml/kg containing bupivacaine (n = 63), ropivacaine (n = 15), or lidocaine (n = 12) at concentrations ranging between 0.06% and 2%. Morphine, fentanyl, or buprenorphine were used as part of LEA. Groups were similar for demographic variables (all p > 0.06). Intravenous opioids were used more often in control than in LEA (p < 0.0005). Incidence of hypotension (MAP < 60 mm Hg) was LEA 68% and control 56% (p = 0.12). Duration of hypotension was longer in LEA (p = 0.03). Use of crystalloids and vasoactive drugs did not differ (all p > 0.1). Time from induction to operating room was 30 (8-75) min for control and 35 (18-65) min for LEA (p = 0.003). DISCUSSION LEA during caesarean section in dogs was associated with lower rates of opioid administration and did not exacerbate the incidence of hypotension.
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Affiliation(s)
- Manuel Martin-Flores
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | | | - Luis Campoy
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Robin D Gleed
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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Cima DS, Credie LDFGA, Futema F, Luna SPL. Lumbar Epidural: Anatomical and Clinical Study in Dogs Submitted to Ovariohysterectomy. Front Vet Sci 2020; 7:527812. [PMID: 33240944 PMCID: PMC7669829 DOI: 10.3389/fvets.2020.527812] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 10/08/2020] [Indexed: 12/02/2022] Open
Abstract
Epidural anesthesia minimizes perioperative pain in dogs. It is considered that epidural solution dispersion in cadavers is similar to alive dogs. The objective of the anatomical study was to compare the dispersion of 0.2 mL/kg 0.25% bupivacaine and iohexol via lumbar epidural (L1–L2) under fluoroscopic guidance in 10 thawed cadavers (GC) and 13 female dogs (G0.25) (5–15 kg; body score 4/5). The objective of the clinical study was to evaluate postoperative analgesic consumption and sedation for 6 h after extubation of dogs submitted to ovariohysterectomy when using 0.25% (G0.25; n = 10) bupivacaine with the intraoperative use of fentanyl (GF; n = 10). Parametric data were compared by the t-test and non-parametric data by the Mann Whitney test. Pain and sedation scores were evaluated over time by the Friedman test, followed by the Dunn test. Alive dogs presented greater epidural dispersion (17 ± 3 vertebrae) than thawed cadavers (11 ± 4 vertebrae; p = 0.002). All dogs treated with fentanyl and only one dog treated with 0.25% epidural bupivacaine presented pain scores above the cut-off point of the Glasgow Composite Measure Pain Scale Short-Form (GCMPS-SF) and required postoperative rescue analgesia up to 6 h after extubation. The sedation score was higher at all postoperative moments compared to preoperative moments in the G0.25 and GF, except for evaluations performed at 5 and 6 h after extubation in the GF. Greater sedation was observed immediately after extubation in the GF compared to the G0.25, and there was greater sedation in the G0.25 compared to the GF from 3 to 6 h after extubation. The conclusion of the anatomical study was that L1–L2 epidural bupivacaine dispersion is lower in canine thawed cadavers than in alive dogs. Conclusion of the clinical study was that lumbar epidural anesthesia improved postoperative analgesia and produced longer postoperative sedation when compared to fentanyl.
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Affiliation(s)
- Daniela Santilli Cima
- Department of Anesthesiology, Medical School, São Paulo State University (Unesp), Botucatu, Brazil
| | | | - Fábio Futema
- School of Veterinary Medicine, São Judas Tadeu University, São Paulo, Brazil
| | - Stelio Pacca Loureiro Luna
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu, Brazil
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Martin-Flores M, Anderson JC, Sakai DM, Campoy L, Cheong SH, Romano M, Gleed RD. A retrospective analysis of the epidural use of bupivacaine 0.0625-0.125% with opioids in bitches undergoing cesarean section. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2019; 60:1349-1352. [PMID: 31814643 PMCID: PMC6855299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Epidural anesthesia, often used during cesarean surgery, can exacerbate hypotension from general anesthesia and delay discharge due to motor block. Decreasing the local anesthetic dose might reduce those complications. Cases of dogs undergoing cesarean section that were anesthetized without epidural (n = 29) (control) and dogs with low-dose epidural bupivacaine with fentanyl or buprenorphine (n = 37) were reviewed. The incidence of hypotension was equal between groups. Intraoperative opioids were administered more to control (93%) than to treated dogs (18%; P < 0.0001). Epidural bupivacaine 0.0625-0.125% combined with an opioid reduced the use of intraoperative opioids and did not exacerbate arterial hypotension during cesarean section in anesthetized dogs.
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Affiliation(s)
- Manuel Martin-Flores
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Justine C Anderson
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Daniel M Sakai
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Luis Campoy
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Soon Hon Cheong
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Marta Romano
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Robin D Gleed
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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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]
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Ferreira JP. Epidural anaesthesia–analgesia in the dog and cat: considerations, technique and complications. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/coan.2018.23.11.628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jacques P Ferreira
- European and RCVS specialist in Veterinary Anaesthesia and Analgesia, Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, West Midlands B90 4NH
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