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Graff SM, Wilson DV, Déjardin LM, Nelson NC. A comparison of the motor effects and analgesic efficacy following lumbar plexus block combined with sciatic nerve block or epidural in dogs undergoing tibial plateau leveling osteotomy. Vet Anaesth Analg 2024; 51:271-278. [PMID: 38102032 DOI: 10.1016/j.vaa.2023.10.034] [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: 04/05/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To compare motor effects and analgesic efficacy following an ultrasound-guided lateral approach to lumbar plexus blockade at L7 and sciatic nerve blockade (LPSNB) against epidural injection in dogs undergoing tibial plateau leveling osteotomy (TPLO). STUDY DESIGN Prospective, randomized, blinded clinical trial. ANIMALS A total of 27 healthy adult dogs undergoing unilateral TPLO surgery. METHODS Dogs were allocated to either LPSNB (bupivacaine 2 mg kg-1, 0.75%) or epidural (morphine PF 0.1 mg kg-1 and bupivacaine 0.5 mg kg-1, 0.75%). Other aspects of clinical management were identical, including anesthetic drug protocol, area of presurgical clipping and bladder care. Time to perform the block, response to surgical stimuli, pain scores, rescue analgesia, time to stand and walk, motor score and time to first urination were recorded. One evaluator, unaware of treatment status, performed all evaluations. Student's t-test or Mann-Whitney U test was used to compare continuous variables between groups, and Fisher's exact test for categorical variables. RESULTS Median (range) times to stand and walk were shorter for LPSNB [60 (40-120) minutes and 90 (60-150) minutes, respectively, p = 0.003] than for epidural [150 (120-240) minutes and 180 (120-360) minutes, respectively, p = 0.006]. Four dogs required rescue intraoperatively (three in epidural group, one in LPSNB group, p = 0.438). Pain scores over the 24 hour evaluation period were similar, and not significantly different, for each group. Time to spontaneous urination [LPSNB, 330 (240-360) minutes; epidural, 300 (120-1440) minutes, p = 1.0] did not differ between groups. CONCLUSIONS AND CLINICAL RELEVANCE An ultrasound-guided lateral paravertebral approach to the lumbar plexus within the psoas compartment at L7, combined with sciatic nerve blockade, allows faster return to normal motor function, with similar pain control and impact on urination when compared with epidural in dogs after TPLO surgery.
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Affiliation(s)
- Sophie M Graff
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Deborah V Wilson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA.
| | - Loic M Déjardin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Nathan C Nelson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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dos-Santos JD, Ginja M, Martins J, Cabral P, Alves-Pimenta S, Ribeiro L, Otero PE, Colaço B. Comparison between Bilateral Ultrasound-Guided Quadratus Lumborum Block and Sacrococcygeal Epidural in Cats Undergoing Ovariectomy. Vet Sci 2024; 11:25. [PMID: 38250931 PMCID: PMC10819764 DOI: 10.3390/vetsci11010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Ultrasound-guided quadratus lumborum block (QLB) and sacrococcygeal epidural anaesthesia (ScE) have been used for neutering cats, providing effective pain relief. OBJECTIVES To compare the effects of the QLB with those of ScE in cats undergoing ovariectomies. METHODS Feral cats undergoing ovariectomy were premedicated with dexmedetomidine (20 μg kg-1) and methadone (0.2 mg kg-1) intramuscularly. Anaesthesia was induced with 2-4 mg kg-1 of propofol intravenously and maintained with isoflurane in oxygen. The cats were randomly allocated to the groups QLB (bilateral QLB with 0.4 mL kg-1 of 0.25% bupivacaine) and ScE (0.3 mL kg-1 of 0.25% bupivacaine). Hemodynamic data and analgesia rescue were collected at four intraoperative periods. The pain scale and motor block were assessed in both groups during the postoperative period. RESULTS The ScE results in increased hypotension, prolonged extubation time, and higher postoperative motor block than the QLB (p < 0.05). The QLB and ScE groups required a similar number of intraoperative rescues and presented the same postoperative pain scale classification. CONCLUSIONS The QLB with 0.25% bupivacaine is a potential alternative to ScE with 0.25% bupivacaine in perioperative pain management in elective cat ovariectomy. The QLB promoted less hypotension and postoperative motor block when compared with the ScE group.
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Affiliation(s)
- José Diogo dos-Santos
- VetOeiras—Veterinary Hospital, 2780-114 Oeiras, Portugal
- Department of Veterinary Science, University Lusófona, 1749-024 Lisbon, Portugal
- CECAV—Animal and Veterinary Research Centre UTAD, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Portugal Department of Veterinary Science, University Lusófona, 1300-477 Lisbon, Portugal
| | - Mário Ginja
- CECAV—Animal and Veterinary Research Centre UTAD, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Portugal Department of Veterinary Science, University Lusófona, 1300-477 Lisbon, Portugal
- CITAB—Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
| | - João Martins
- Department of Veterinary Science, University Lusófona, 1749-024 Lisbon, Portugal
- CECAV—Animal and Veterinary Research Centre UTAD, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Portugal Department of Veterinary Science, University Lusófona, 1300-477 Lisbon, Portugal
- CITAB—Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
| | - Patrícia Cabral
- Department of Veterinary Science, University Lusófona, 1749-024 Lisbon, Portugal
| | - Sofia Alves-Pimenta
- CECAV—Animal and Veterinary Research Centre UTAD, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Portugal Department of Veterinary Science, University Lusófona, 1300-477 Lisbon, Portugal
- CITAB—Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
| | - Lénio Ribeiro
- Department of Veterinary Science, University Lusófona, 1749-024 Lisbon, Portugal
| | - Pablo E. Otero
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427CWN CABA, Argentina
| | - Bruno Colaço
- CECAV—Animal and Veterinary Research Centre UTAD, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Portugal Department of Veterinary Science, University Lusófona, 1300-477 Lisbon, Portugal
- CITAB—Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
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Krystalli A, Sideri A, Kazakos GM, Anatolitou A, Prassinos NN. Contribution to the Study of Perioperative Factors Affecting the Restoration of Dog's Mobility after Femoral Head and Neck Excision: A Clinical Study in 30 Dogs. Animals (Basel) 2023; 13:2295. [PMID: 37508072 PMCID: PMC10376395 DOI: 10.3390/ani13142295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
This study aimed to compare postoperative analgesia and the time of limb weight bearing induced by the intraoperative administration of a local anesthetic at the site of the femoral head and neck excision (FHNE) in dogs, with and without the administration of preoperative epidural anesthesia. Additionally, the impact of postoperative opioid drug administration on weight-bearing time was examined. This randomized, blinded, prospective clinical study included 30 client-owned dogs. The dogs were randomly divided into three groups (A, B, C), each further divided into two subgroups (A1, A2, B1, B2, C1, C2). Group A received epidural anesthesia and ropivacaine at the ostectomy site, Group B received only ropivacaine, and Group C served as the control group. Subgroup 1 received a non-steroidal anti-inflammatory drug postoperatively, while Subgroup 2 had tramadol added to their regimen. Pain assessment was conducted using the University of Melbourne Pain Scale (UMPS) and an algometer. The study concluded that multimodal analgesia, utilizing all the aforementioned analgesic techniques, resulted in faster limb weight bearing for dogs undergoing FHNE.
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Affiliation(s)
- Androniki Krystalli
- Surgery & Obstetrics Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University, 54627 Thessaloniki, Greece
| | - Aikaterini Sideri
- Clinic of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, 43100 Karditsa, Greece
| | - George M Kazakos
- Surgery and Anesthesiology-Intensive Care, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University, 54627 Thessaloniki, Greece
| | - Anthi Anatolitou
- Surgery & Obstetrics Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University, 54627 Thessaloniki, Greece
| | - Nikitas N Prassinos
- Surgery & Obstetrics Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University, 54627 Thessaloniki, Greece
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Torruella X, Potter J, Huuskonen V. Sacrococcygeal epidural administration of 0.5% bupivacaine in seven cats undergoing pelvic or hind limb orthopaedic procedures. Ir Vet J 2023; 76:1. [PMID: 36726137 PMCID: PMC9893688 DOI: 10.1186/s13620-023-00231-2] [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: 01/03/2022] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Epidural administration of local anaesthetic agents provides good intraoperative antinociception for orthopaedic procedures of the pelvis and the pelvic limb. However, in cats the spinal cord extends approximately to the level of the first sacrococcygeal vertebra, and therefore the sacrococcygeal epidural could be a safer alternative to the lumbosacral epidural in cats. This case series describes perioperative analgesia and the haemodynamic status of seven client-owned cats that received sacrococcygeal epidural injection of 0.5% bupivacaine and underwent orthopaedic hind leg or pelvic surgeries under general anaesthesia. CASE PRESENTATION Each cat received either 0.2 or 0.3 mL/kg of 0.5% bupivacaine with or without 0.2 mg/kg of morphine in the sacrococcygeal epidural space. Intraoperative antinociceptive response to surgical stimulus and haemodynamic changes were monitored and reported. CONCLUSION In these seven anaesthetised cats, 0.2 or 0.3 mL/kg of 0.5% bupivacaine, administered alone or in combination with morphine into the sacrococcygeal epidural space, enhanced antinociception so that intraoperative rescue analgesia was unnecessary in all but one cat. It also reduced the anticipated requirement for postoperative opioid use. However, a high incidence of hypotension was observed in the cats in this report, and hence intraoperative blood pressure monitoring should be considered mandatory in anaesthetised cats following epidural injection of local anaesthetic agents, regardless of injection site.
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Affiliation(s)
- Xavier Torruella
- grid.7886.10000 0001 0768 2743UCD Veterinary Hospital, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, D04 W6F6 Ireland
| | - Joanna Potter
- grid.7886.10000 0001 0768 2743UCD Veterinary Hospital, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, D04 W6F6 Ireland
| | - Vilhelmiina Huuskonen
- grid.7886.10000 0001 0768 2743UCD Veterinary Hospital, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, D04 W6F6 Ireland
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Dourado A, Gomes A, Teixeira P, Lobo L, Azevedo JT, Dias IR, Pinelas R. Antinociceptive Effect of a Sacro-Coccygeal Epidural of Morphine and Lidocaine in Cats Undergoing Ovariohysterectomy. Vet Sci 2022; 9:623. [PMID: 36356100 PMCID: PMC9698262 DOI: 10.3390/vetsci9110623] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND A commonly described analgesic protocol for ovariohysterectomy (OHE) combines systemic opioids, sedatives, and non-steroidal anti-inflammatory drugs. However, systemic analgesia does not fully prevent perioperative visceral and somatic pain triggered by the surgical stimulus. OBJECTIVES To compare the analgesic effects and quality of recovery of systemic analgesia with those of a sacrococcygeal epidural injection of lidocaine and morphine in cats undergoing elective OHE. Methods: Twenty domestic female cats were premedicated with dexmedetomidine (0.01 mg kg-1 IM) and alfaxalone (1.5 mg kg-1 IM) and randomly assigned to one of two analgesic protocols: methadone (0.2 mg kg-1 IM) in the control group CTR (n = 10) and methadone (0.1 mg kg-1 IM) + epidural (lidocaine 2% (0.3 mL kg-1) + morphine 1% (0.1 mg kg-1) diluted with NaCl 0.9% to a total volume of 1.5 mL in the SCC-E group (n = 10). General anaesthesia was induced with alfaxalone (1 mg kg-1 IV) and maintained with sevoflurane in 100% oxygen. Non-invasive blood arterial pressure and cardiorespiratory variables were recorded. The quality of recovery was assessed using a simple descriptive scale. Before surgery and 1, 2, 3, 4, 6, and 8 h post-op pain was assessed using the UNESP-Botucatu multidimensional composite pain scale (MCPS) and mechanical nociception thresholds (MNT). The repeated measures analysis of variance (ANOVA) was used to compare groups over time. Comparison between groups was performed using independent samples t-test if the assumption of normality was verified, or the Mann-Whitney test. The chi-square test of independence and exact Fisher's test were used to compare groups according to recovery quality. RESULTS Heart rate and systolic arterial pressure increased significantly from baseline values in the CTR group and did not change in the SCC-E group. In the CTR group, MNT and UNESP-Botucatu-MCPS scores increased significantly from baseline for all assessment points and the first 3 h, respectively, whereas this did not occur in the SCC-E group. CONCLUSIONS AND CLINICAL RELEVANCE Based on our results, the SCC-E administration of lidocaine 2% with morphine 1% is a reasonable option to provide perioperative analgesia in cats submitted to OHE, compared to a systemic protocol alone.
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Affiliation(s)
- Amândio Dourado
- Veterinary Hospital of Porto, 4250-475 Porto, Portugal
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
| | - Anabela Gomes
- Veterinary Hospital of Porto, 4250-475 Porto, Portugal
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
| | | | - Luís Lobo
- Veterinary Hospital of Porto, 4250-475 Porto, Portugal
- CECA—Center for Animal Science Studies, University of Porto, 4485-661 Vila do Conde, Portugal
- Faculty of Veterinary Medicine, Lusophone University of Humanities and Technology, 1749-024 Lisbon, Portugal
| | - Jorge T. Azevedo
- Department of Animal Science, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
- CECAV—Center for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
- AL4AnimalS—Associate Laboratory for Animal and Veterinary Sciences, 5000-801 Vila Real, Portugal
| | - Isabel R. Dias
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
- CECAV—Center for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
- AL4AnimalS—Associate Laboratory for Animal and Veterinary Sciences, 5000-801 Vila Real, Portugal
| | - Rui Pinelas
- North Downs Specialist Referrals, Bletchingley RH1 4QP, UK
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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.
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Pentsou K, Huuskonen V. Thoracolumbar retrolaminar block in seven dogs undergoing spinal surgery. Ir Vet J 2022; 75:17. [PMID: 35962415 PMCID: PMC9375286 DOI: 10.1186/s13620-022-00224-7] [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: 12/31/2021] [Accepted: 08/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Thoracolumbar intervertebral disc extrusion is a common neurologic complaint in dogs and is associated with debilitating pain that requires careful analgesic management to avoid the transition to a chronic pain state. Recently, there has been an increased effort to incorporate regional anaesthetic techniques whenever possible, both for perioperative analgesia management and for prevention of chronic pain. A novel regional anaesthetic technique named retrolaminar block is a fascial plane block where the local anaesthetic is injected directly on top of the dorsal aspect of the vertebral lamina, in the fascial plane between the lamina and the epaxial muscles. The technique was recently described in humans and it is claimed to provide analgesia in patients undergoing thoracic and lumbar procedures. To the authors’ knowledge, the retrolaminar block has not been previously reported in live dogs. Case presentation Seven dogs presented to our hospital for suspected thoracolumbar intervertebral disc extrusion were anaesthetised using an anaesthetic premedication and induction protocol tailored for each individual animal. Once the suspected diagnosis was confirmed, all seven dogs were placed in sternal recumbency, and the target thoracolumbar vertebral spinous process was identified with palpation. A unilateral retrolaminar block was performed in all dogs with 2 mg/kg of 0.25% bupivacaine. Physiologic parameters, as well as responses to nociceptive stimuli, were monitored throughout the anaesthetic event. Intraoperatively, one dog required a bolus of fentanyl to control nociceptive stimulation while the epaxial muscles were retracted. No further intraoperative rescue analgesia was required in any of the cases. The postoperative pain was assessed using the Short Form of Glasgow Composite Measure Pain Scale for dogs every four hours for the duration of the dogs’ hospitalization. The retrolaminar block reduced the intraoperative requirement for systemic opioids and other adjunct analgesic agents and all dogs were comfortable throughout their hospitalization and up until the time of their discharge. Conclusions This case report presents the performance of the retrolaminar block technique as part of multimodal analgesia management in seven dogs undergoing thoracolumbar spinal surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s13620-022-00224-7.
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Affiliation(s)
- Kyratsoula Pentsou
- UCD Veterinary Hospital, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, D04 W6F6, Ireland.
| | - Vilhelmiina Huuskonen
- UCD Veterinary Hospital, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, D04 W6F6, Ireland
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Santoro F, Castineiras D, Kaartinen J. Intra- and postoperative opioid-sparing analgesia in a cat undergoing pelvic limb amputation. JFMS Open Rep 2022; 8:20551169221116868. [PMID: 36017136 PMCID: PMC9397374 DOI: 10.1177/20551169221116868] [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] [Indexed: 12/03/2022] Open
Abstract
Case summary A combination of preoperative epidurally administered morphine, peripheral nerve blocks and postoperative wound irrigation with ropivacaine is described as an opioid-sparing analgesic protocol for a feline immunodeficiency virus-positive cat with hypertrophic cardiomyopathy undergoing hindlimb amputation. The reported strategy resulted in a lack of intraoperative sympathetic response, haemodynamic stability and adequate postoperative analgesia. No rescue analgesia was needed at any point. Relevance and novel information This report represents an example of how several locoregional techniques can be effectively combined to minimise the perioperative use of systemic opioids and their potential side effects in selected cases.
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Affiliation(s)
- Francesco Santoro
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | - Diego Castineiras
- Willows Veterinary Centre & Referral Service, Solihull, Birmingham, UK
| | - Johanna Kaartinen
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
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Salem M, Rizk A, Mosbah E, Zaghloul A, Karrouf G, Abass M. Antinociceptive effect of lidocaine, tramadol, and their combination for lumbosacral epidural analgesia in rabbits undergoing experimental knee surgery. BMC Vet Res 2022; 18:252. [PMID: 35768810 PMCID: PMC9241259 DOI: 10.1186/s12917-022-03360-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/20/2022] [Indexed: 12/31/2022] Open
Abstract
AIM The current study aimed to evaluate the antinociceptive effect of lidocaine, tramadol, and their combination for lumbosacral epidural analgesia in rabbits undergoing knee surgery. MATERIALS AND METHODS This study was performed on 24 male New Zealand white rabbits weighing 2.8 to 3.0 kg and was allocated into three groups. All groups were anaesthetized by intramuscular (IM) injection of 35 mg/kg ketamine and 5 mg/kg xylazine, 0.1 mg/kg butorphanol. Rabbits in Group A received epidural analgesia of 4 mg/kg lidocaine 2%; Group B rabbits received epidural analgesia of 4 mg/kg tramadol 5%, and Group C rabbits received epidural analgesia of a combination of 4 mg/kg lidocaine and 4 mg/kg tramadol. Prior to and during surgery, the following parameters were recorded in a regular pre-set time interval: onset time of analgesia (OT), duration of flaccid paralysis (DFP), duration of analgesia (DA), onset and duration of sensory blockade, onset and duration of motor blockade, heart rate (HR), respiratory rate (RR), and rectal temperature (RT). RESULTS The mean OT demonstrated a significant decrease (P < 0.05) in Group C (46.5 ± 1.4 sec) compared to Group A and B (61.0 ± 2.4 and 54.5 ± 3.5 sec), respectively. DFP was significantly lower (P < 0.05) in Group C (35.5 ± 2.9 min) than in Group A and B (17.6 ± 1.4 and 21.8 ± 3.6), respectively. DA showed a significant increase (P < 0.05) in group C (45.8 ± 3.3 min) compared to groups A and B, respectively (23.3 ± 1.1 and 31.5 ± 2.3). Heart rate, RR, and RT significantly decreased in Group C compared to the other groups. CONCLUSION According to the current study findings, lumbosacral epidural administration of lidocaine combined with tramadol could be a better choice for potentiating the analgesia than administration of either drug separately and may be safely used in rabbits undergoing knee surgery.
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Affiliation(s)
- Mohamed Salem
- grid.10251.370000000103426662Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, 35516 Egypt
| | - Awad Rizk
- grid.10251.370000000103426662Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, 35516 Egypt
| | - Esam Mosbah
- grid.10251.370000000103426662Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, 35516 Egypt
| | - Adel Zaghloul
- grid.10251.370000000103426662Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, 35516 Egypt
| | - Gamal Karrouf
- grid.10251.370000000103426662Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, 35516 Egypt
| | - Marwa Abass
- grid.10251.370000000103426662Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, 35516 Egypt
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Martinez i Ferré B, Corletto F, Shing H, Bhalla R. Epidural catheter misplacement and knot formation within the hypoaxial musculature of a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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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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Steagall PV, Robertson S, Simon B, Warne LN, Shilo-Benjamini Y, Taylor S. 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats. J Feline Med Surg 2022; 24:4-30. [PMID: 34937455 PMCID: PMC10845386 DOI: 10.1177/1098612x211066268] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PRACTICAL RELEVANCE Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. CLINICAL CHALLENGES Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. EVIDENCE BASE These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors' experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.
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Affiliation(s)
- Paulo V Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Universite de Montréal, Saint-Hyacinthe, Canada; and Department of Veterinary Clinical Sciences and Centre for Companion Animal Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
| | | | - Bradley Simon
- Department of Small Animal Clinical Sciences, Texas A&M College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Leon N Warne
- Veterinary Anaesthesia & Pain Management Australia, Perth, Western Australia; and Veterinary Cannabis Medicines Australia, Perth, Western Australia, Australia
| | - Yael Shilo-Benjamini
- Koret School of Veterinary Medicine, The Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
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Fink DM, Ferreira TH, Mans C. Neuraxial administration of morphine combined with lidocaine induces regional antinociception in inland bearded dragons (Pogona vitticeps). Am J Vet Res 2021; 83:212-217. [PMID: 34968185 DOI: 10.2460/ajvr.21.08.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the antinociceptive efficacy and safety of neuraxial morphine in inland bearded dragons (Pogona vitticeps). ANIMALS 10 healthy adult bearded dragons. PROCEDURES Animals were sedated with alfaxalone (15 mg/kg) SC prior to neuraxial injections. In a randomized, blinded, placebo-controlled, crossover design, animals received preservative-free morphine (0.5 mg/kg) combined with lidocaine (2 mg/kg) or lidocaine (2 mg/kg) only (control treatment). For both treatments, saline (0.9% NaCl) solution was used for dilution to a total volume of 0.3 mL/kg. If the initial injection did not result in motor block of the pelvic limbs or cloaca relaxation within 10 minutes, a second injection was performed. Measurements consisted of bilateral mechanical stimulation of the limbs and at 25%, 50%, and 75% of the trunk's length as well as cloacal tone to assess spread and duration of motor block. Pelvic limb withdrawal latencies in response to a thermal noxious stimulus were measured over a 48-hour period to assess antinociception. RESULTS Success rate following the first injection was 90% (18/20 injections) and increased to 100% following a second injection. Motor block occurred within 5 minutes with both treatments. Pelvic limb withdrawal latencies were significantly prolonged following neuraxial morphine versus control treatment for at least 12 hours after injection. By 24 hours, no effect of morphine on pelvic limb latencies was detectable. CLINICAL RELEVANCE These results demonstrated that neuraxial administration of morphine results in regional antinociceptive effects for at least 12 hours and has no clinically relevant adverse effects in healthy bearded dragons. This technique has potential for providing regional analgesia in this species.
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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.
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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
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Viilmann I, Klöppel H, Wringe E, Vettorato E. Success Rate and Perioperative Complications of Lumbosacral Extradural Anaesthesia in Dogs Undergoing Total Hip Replacement: A Double-Centre Retrospective Study. Vet Comp Orthop Traumatol 2021; 35:81-89. [PMID: 34560807 DOI: 10.1055/s-0041-1736194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to retrospectively evaluate the success rate and perioperative complications of lumbosacral extradural anaesthesia in dogs undergoing total hip replacement. STUDY DESIGN Records of dogs undergoing total hip replacement in which lumbosacral extradural anaesthesia with 0.5% levo- or bupivacaine combined with either morphine or buprenorphine were retrieved. Success rate was defined as intraoperative fentanyl consumption <1 μg/kg/h with no intravenous infusion of other analgesic drugs and no additional morphine/methadone within the first 3 hours from premedication. Prevalence of intraoperative anaesthetic and postoperative surgical complications was calculated. RESULTS Overall, 206 dogs were included in the study. Success rate was 88.7%. Hypercapnia (75.2%), hypotension (46.1%), hypothermia (27.7%) and regurgitation (6.3%) were recorded during anaesthesia. Within 24 hours post-surgery, urinary retention (17.8%), vomiting/regurgitation/diarrhea (8.2%) and sciatic neurapraxia of the operated limb (5.8%) were recorded. Luxation of the operated hip occurred at 48 and 72 hours after surgery in two dogs and one dog respectively. One dog had cardiopulmonary arrest at 52 hours after surgery. CONCLUSION While hypercapnia, hypotension and hypothermia might develop intraoperatively, the high success rate and the relatively low prevalence of postoperative surgical complications directly associated with lumbosacral extradural anaesthesia justify its use in dogs undergoing total hip replacement.
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Affiliation(s)
- Inga Viilmann
- Dick White Referrals, Six Mile Bottom, Cambridgeshire, United Kingdom
| | - Heide Klöppel
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, United Kingdom
| | - Elliot Wringe
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, United Kingdom
| | - Enzo Vettorato
- Dick White Referrals, Six Mile Bottom, Cambridgeshire, United Kingdom
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Doyle CR, Riccó Pereira CH, Wanstrath AW, Lerche P, Aarnes TK, Bednarski RM, Werre SR. Evaluation of perfusion index as a noninvasive tool to determine epidural anesthesia effectiveness in dogs. Vet Anaesth Analg 2021; 48:782-788. [PMID: 34362690 DOI: 10.1016/j.vaa.2021.06.011] [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: 03/03/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate perfusion index (PI) as a noninvasive tool to determine effectiveness and onset of epidural anesthesia in dogs. STUDY DESIGN Prospective clinical trial. ANIMALS A total of 21 adult dogs, aged 6.5 ± 3 years and weighing 34.9 ± 6.4 kg, undergoing a tibial plateau leveling osteotomy. METHODS Dogs were premedicated intramuscularly with acepromazine (0.03 mg kg-1) and hydromorphone (0.1 mg kg-1) and anesthetized with intravenous propofol (to effect) and isoflurane in oxygen. A surface transflectance probe was secured to the tail base to monitor PI and a dorsal pedal artery catheter was placed for invasive blood pressure monitoring. A lumbosacral epidural was performed with the dog in sternal recumbency. Dogs were randomly assigned for inclusion of epidural morphine (0.1 mg kg-1) or morphine (0.1 mg kg-1) and lidocaine (4 mg kg-1). PI was recorded following instrumentation of each dog just prior to the epidural (baseline), at 10 minute intervals for 30 minutes, before and after the surgical skin incision and before and after completion of the osteotomy. Physiological variables and end-tidal isoflurane were recorded at the same time points. RESULTS There was no significant difference in PI between the groups at any time point. There was a significant change in end-tidal isoflurane before and after the skin incision in the epidural morphine and epidural morphine-lidocaine groups (p = 0.04, p = 0.05, respectively) and before and after the osteotomy in each group for heart rate (p = 0.001, p = 0.04), diastolic (p = 0.01, p = 0.01) and mean arterial blood pressure (p = 0.03, p = 0.05). CONCLUSIONS AND CLINICAL RELEVANCE PI did not provide an objective means for determining the onset or effectiveness of epidural anesthesia in anesthetized dogs and alternate methods of noninvasive assessment should be investigated.
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Affiliation(s)
- Crystal R Doyle
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Carolina H Riccó Pereira
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
| | - Audrey W Wanstrath
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Phillip Lerche
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Turi K Aarnes
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Richard M Bednarski
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Stephen R Werre
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
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Ferrero C, Borland K, Rioja E. Retrospective comparison of three locoregional techniques for pelvic limb surgery in dogs. Vet Anaesth Analg 2021; 48:554-562. [PMID: 34083139 DOI: 10.1016/j.vaa.2020.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/06/2020] [Accepted: 11/20/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To retrospectively compare the efficacy and duration of effect of three commonly used locoregional blocks in dogs undergoing pelvic limb orthopaedic surgery. STUDY DESIGN Retrospective clinical study. ANIMALS A total of 236 dogs that underwent pelvic limb surgery and were administered a locoregional technique. METHODS A total of 236 hospital records were reviewed and 230 included in statistical analysis. Dogs were grouped as following: electrostimulation-guided pre-iliac femoral and sciatic nerve block (group PFS, n = 70); ultrasound-guided saphenous and sciatic nerve block (group SS, n = 76); or lumbosacral epidural (group EPI, n = 84). In group EPI, bupivacaine 0.5% or ropivacaine 0.75% was used with morphine. Dogs were pain scored (short form of the Glasgow Composite Measure Pain Scale) hourly following recovery from anaesthesia. Analysed data included: time to first postoperative dose of methadone, pain score at that time, intraoperative rescue analgesia, intraoperative hypotension and ability to walk and urinate overnight. Separate analyses were performed including all pelvic limb surgeries and including only elective stifle surgeries. Kruskal-Wallis and Mann-Whitney tests were performed. A p value < 0.05 was considered significant. The median (range) is reported. RESULTS For all pelvic limb surgeries, the time to first postoperative methadone was 530 (110-1337), 440 (140-1030) and 466 (135-1094) minutes in groups EPI, PFS and SS, respectively, and was not significantly different. Postoperatively, 10/84, 15/70 and 12/76 dogs in groups EPI, PFS and SS, respectively, did not require methadone (nonsignificant). Significantly fewer dogs in group EPI (18%) required intraoperative rescue analgesia compared with group SS (38%), but not compared with PFS (30%). Significantly more dogs in group EPI had hypotension intraoperatively (30%) and urinary retention postoperatively (62%). CONCLUSIONS AND CLINICAL RELEVANCE Intraoperative analgesia may be superior with EPI than SS for some surgeries of the pelvic limb, but not for stifle surgeries. All three techniques provided similar requirement for postoperative analgesia, but EPI caused higher incidence of intraoperative hypotension and postopertive urinary retention.
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Affiliation(s)
- Camilla Ferrero
- Anaesthesia Department, Anderson Moores Veterinary Specialists, Winchester, Hampshire, UK.
| | - Karla Borland
- Anaesthesia Department, Anderson Moores Veterinary Specialists, Winchester, Hampshire, UK
| | - Eva Rioja
- Anaesthesia Department, Anderson Moores Veterinary Specialists, Winchester, Hampshire, UK
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Marolf V, Spadavecchia C, Müller N, Sandersen C, Rohrbach H. Opioid requirements after locoregional anaesthesia in dogs undergoing tibial plateau levelling osteotomy: a pilot study. Vet Anaesth Analg 2021; 48:398-406. [PMID: 33714620 DOI: 10.1016/j.vaa.2020.10.010] [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: 06/13/2020] [Revised: 08/16/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the intraoperative and early postoperative opioid requirement after ultrasound-guided sciatic and/or femoral nerve block or epidural anaesthesia in dogs undergoing tibial plateau levelling osteotomy (TPLO). STUDY DESIGN Prospective, masked, pilot, randomized, clinical trial. ANIMALS A total of 40 client-owned dogs undergoing TPLO. METHODS Each dog was randomly assigned to group SF (combined sciatic and femoral nerve block), group S (sciatic nerve block), group F (femoral nerve block) or group E (epidural anaesthesia). A total of 0.3 mL kg-1 of ropivacaine 0.5% was administered to each nerve or in the epidural space. Intraoperatively, fentanyl (2 μg kg-1) was administered intravenously when heart rate, mean arterial pressure or respiratory rate increased by >30% compared with baseline values. Postoperatively, a visual analogue scale (VAS) and a modified German version of the French pain scale (4AVet) were used to assess pain every 30 minutes for 150 minutes and again once the morning after surgery. Methadone (0.1 mg kg-1) was administered intravenously if the VAS was ≥ 4 cm [maximal value 10 cm; median (interquartile range)] or the composite pain score was ≥5 [maximal value 15; median (interquartile range)]. Significance was defined as p ≤ 0.05. RESULTS Groups SF and E required less total intraoperative and early postoperative opioid doses compared with groups S and F (p = 0.031). No dogs in group SF had a block failure or required postoperative methadone. A reduced methadone requirement was found in group SF compared with all the other groups up to 150 minutes after recovery (p = 0.041). CONCLUSIONS AND CLINICAL RELEVANCE Combined sciatic and femoral nerve block and epidural anaesthesia lead to less cumulative consumption of perioperative opioids than single nerve blockade. Sciatic or femoral nerve block alone might be insufficient to control nociception and early postoperative pain in dogs undergoing TPLO.
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Affiliation(s)
- Vincent Marolf
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium.
| | - Claudia Spadavecchia
- Vetsuisse Faculty, Department of Clinical Veterinary Medicine, Bern, Switzerland
| | - Nicole Müller
- Vetsuisse Faculty, Department of Clinical Veterinary Medicine, Bern, Switzerland
| | - Charlotte Sandersen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Helene Rohrbach
- Vetsuisse Faculty, Department of Clinical Veterinary Medicine, Bern, Switzerland
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Louro LF, Milner PI, Bardell D. Epidural administration of opioid analgesics improves quality of recovery in horses anaesthetised for treatment of hindlimb synovial sepsis. Equine Vet J 2020; 53:682-689. [PMID: 32852063 DOI: 10.1111/evj.13338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/17/2020] [Accepted: 08/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Opioid epidural analgesia has been shown to provide effective analgesia in horses. There is a lack of evidence regarding the effect of opioid epidural analgesia on quality of recovery in horses. OBJECTIVES Identify whether opioid epidural analgesia influences quality of recovery in horses undergoing general anaesthesia required for management of hindlimb synovial sepsis. STUDY DESIGN Single-centre retrospective cross-sectional study. METHODS Data were obtained from the clinical records of horses which had undergone arthroscopic or tenoscopic surgery for management of hindlimb synovial sepsis over a 9-year period in a referral hospital population. Multivariable logistic regression analysis was used to identify the perioperative factors that impact on quality of recovery. RESULTS Records from 149 horses, undergoing 170 general anaesthetics were included. Multivariable logistic regression analysis showed that opioid epidural analgesia (OR 3.0, 95% CI 1.2 to 7.2, P = .02) was associated with good quality of recovery, whereas Cob breeds (OR 0.16, 95% CI 0.06 to 0.46, P = .001), age (in years) (OR 0.90, 95% CI 0.83 to 0.97, P = .004) increasing intraoperative dosages (in mg/kg) of thiopental (OR 0.64, 95% CI 0.46 to 0.90, P = .01) or ketamine (OR 0.42, 95% CI 0.18 to 0.98, P = .04) were associated with poor quality of recovery. MAIN LIMITATIONS Certain variables that may influence quality of recovery, such as patient temperament and hindlimb orthopaedic co-morbidities were not recorded. The clinical prediction model obtained is only applicable to the specific facilities, population and perianaesthetic management practiced at our institution. CONCLUSIONS Opioid epidural analgesia is significantly associated with good quality of recovery in horses undergoing general anaesthesia required for management of hindlimb synovial sepsis. Other risk factors, such as increasing age, cob breed, use of higher intraoperative dosages (in mg/kg) of ketamine and/or thiopental, were associated with poor quality of recovery.
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Affiliation(s)
- Luís F Louro
- Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Peter I Milner
- Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - David Bardell
- Institute of Veterinary Science, University of Liverpool, Neston, UK.,Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, Liverpool, UK
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LaTourette PC, David EM, Pacharinsak C, Jampachaisri K, Smith JC, Marx JO. Effects of Standard and Sustained-release Buprenorphine on the Minimum Alveolar Concentration of Isoflurane in C57BL/6 Mice. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE 2020; 59:298-304. [PMID: 32268932 DOI: 10.30802/aalas-jaalas-19-000106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Both standard and sustained-release injectable formulations of buprenorphine (Bup and BupSR, respectively) are used as preemptive analgesics, potentially affecting gas anesthetic requirements. This study tested the effects of Bup and BupSR on isoflurane requirements and confirmed that buprenorphine could reduce isoflurane requirements during a laparotomy in mice. We hypothesized that both Bup and BupSR would significantly decrease the required minimum alveolar concentration (MAC) of isoflurane. C57BL/6 mice received either isotonic crystalloid fluid (control), Bup (0.1 mg/kg), or BupSR (1.2 mg/kg) subcutaneously 10 min prior to the induction of anesthesia. Each anesthetized mouse was tested at 2 isoflurane concentrations. A 300-g noxious stimulus was applied at each isoflurane concentration, alternating between hindfeet. In addition, a subset of mice underwent terminal laparotomy or 60 min of anesthesia after injection with Bup, BupSR, or saline to ensure an appropriate surgical plane of anesthesia. Mice were maintained at the lowest isoflurane concentration that resulted in 100% of mice at a surgical plane from the aforementioned MAC experiments (control, 2.0%; Bup and BupSR, 1.7%). Analysis showed that both Bup and BupSR significantly decreased isoflurane requirements by 25.5% and 14.4%, respectively. The isoflurane MAC for the control injection was 1.80% ± 0.09%; whereas Bup and BupSR decreased MAC to 1.34% ± 0.08% and 1.54% ± 0.09%, respectively. Sex was not a significantly different between the injection groups during MAC determination. All of the mice that underwent surgery achieved a surgical plane of anesthesia on the prescribed regimen and recovered normally after discontinuation of isoflurane. Lastly, heart and respiratory rates did not differ between mice that underwent surgery and those that were anesthetized only. Bup and BupSR are MAC-sparing in male and female C57BL/6 mice and can be used for effective multimodal anesthesia.
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Affiliation(s)
- Philip C LaTourette
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania
| | - Emily M David
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania
| | | | | | - Jennifer C Smith
- Bioresources Department, Henry Ford Health System, Detroit, Michigan
| | - James O Marx
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania;,
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Pratt CL, Balakrishnan A, McGowan E, Drobatz KJ, Reineke EL. A prospective randomized, double-blinded clinical study evaluating the efficacy and safety of bupivacaine versus morphine-bupivacaine in caudal epidurals in cats with urethral obstruction. J Vet Emerg Crit Care (San Antonio) 2020; 30:170-178. [PMID: 32100466 DOI: 10.1111/vec.12944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/21/2018] [Accepted: 10/31/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of the caudal epidural technique in cats with urethral obstruction (UO). DESIGN Prospective, double-blinded, randomized, sham-controlled study. ANIMALS Eighty-eight male cats with UO. INTERVENTIONS Thirty cats randomized to bupivacaine epidural (BUP), 28 cats to bupivacaine-morphine epidural (BUP/MOR), and 30 cats to sham epidural (SHAM). MEASUREMENTS AND MAIN RESULTS Time to perform the epidural and efficacy of the epidural was assessed by evaluation of tail and perineal responses. The amount of propofol for urinary catheterization and time to administration of rescue analgesia (buprenorphine) was recorded. Cats were monitored for epidural complications. The median time to perform the epidural was 2 min (range, 0.2-13 min and range, 0.5-13 min), with an epidural success rate of 70%. The median amount of propofol administered for urinary catheterization was significantly less in the BUP (2.1 mg/kg; range, 0-7.5 mg/kg) and MOR/BUP cats (1.85 mg/kg; range, 0-8.6 mg/kg) as compared to SHAM cats (4 mg/kg; range, 0-12.7 mg/kg) (P = 0.006, P = 0.0008, respectively). The median time to administration of rescue analgesia was also significantly longer in the BUP (10 h; range, 2-32 h) and MOR/BUP cats (10 h; range, 4-45 h) as compared to SHAM cats (4 h; range, 2-36 h) (P = 0.0026, P = 0.0004, respectively). There were no recognized complications related to the epidural. CONCLUSION Caudal epidural appears to be safe, may reduce the amount of IV anesthesia needed to facilitate urinary catheterization, and can be used to provide long-term analgesia in the hospital.
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Affiliation(s)
- Chap L Pratt
- Department of Clinical Sciences and Advanced Medicine-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anusha Balakrishnan
- Department of Clinical Sciences and Advanced Medicine-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erin McGowan
- Department of Clinical Sciences and Advanced Medicine-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth J Drobatz
- Department of Clinical Sciences and Advanced Medicine-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica L Reineke
- Department of Clinical Sciences and Advanced Medicine-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Grubb T, Lobprise H. Local and regional anaesthesia in dogs and cats: Descriptions of specific local and regional techniques (Part 2). Vet Med Sci 2020; 6:218-234. [PMID: 31965749 PMCID: PMC7196680 DOI: 10.1002/vms3.218] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 07/27/2019] [Accepted: 10/27/2019] [Indexed: 11/30/2022] Open
Abstract
Pain management in veterinary patients is a crucial component of appropriate patient care. Local anaesthetic drugs used in local and regional blockade can completely block the transmission of nociceptive impulses, decreasing both intra‐operative nociception and postoperative pain, while decreasing the potential incidence of adverse effects that can be associated with systemic boluses of drugs. For efficacy and safety, this class of drugs is recommended as part of the analgesic protocol in the majority of surgical procedures and traumatic injuries. Numerous local and regional blocks are proven effective in dogs and cats, thus providing the clinician with ample opportunity to include these blocks in practice. This manuscript, Part 2 of a two‐part instalment, focuses on brief descriptions of select commonly used local/regional anaesthesia techniques for dogs and cats that cover a multitude of painful surgeries/injuries and that can be implemented in any practice. In Part 1 of this topic, detailed information on local anaesthetic drugs commonly used in small animal practice was reviewed (Grubb & Lobprise, 2020).
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The effect of neuraxial morphine on postoperative pain in dogs after extrahepatic portosystemic shunt attenuation. Vet Anaesth Analg 2019; 47:111-118. [PMID: 31718938 DOI: 10.1016/j.vaa.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the analgesic effect of epidural morphine after surgical extrahepatic portosystemic shunt (EHPSS) attenuation. STUDY DESIGN Randomized clinical trial. ANIMALS A total of 20 dogs with a congenital EHPSS. METHODS Dogs were randomly allocated to be given either a single epidural dose of 0.2 mg kg-1 preservative-free morphine (group M) or not (group C) before surgery. All dogs were administered 0.3 mg kg-1 methadone intravenously (IV) as preanaesthetic medication. Pain scores were determined every 2 hours for the first 24 hours postoperatively using the short-form Glasgow Composite Measure Pain Scale (GCMPS-SF). Dogs with a GCMPS-SF pain score >4/20 or >5/24 received 0.1 mg kg-1 methadone IV as rescue analgesia and were reassessed 30 minutes later. If more than three doses of methadone were administered in a 2 hour period, alternative pain relief was provided and a treatment failure recorded. The GCMPS-SF pain scores and number of rescue analgesia injections were analysed over 24 hours. The last observation carried forward method was applied in case of treatment failure. Food consumption and time to first urination were recorded. Data were analysed using a Mann-Whitney U test and presented as median (minimum-maximum range), with significance set at p < 0.05. RESULTS Group M showed lower GCMPS-SF pain scores [15 (11-41) versus 31 (11-86); p = 0.023] and lower postoperative methadone requirements [0 (0-0.2) versus 0.25 (0-0.5) mg kg-1; p = 0.029] than group C. There were three treatment failures in group C only. Food consumption and time to first urination did not differ between groups. CONCLUSIONS AND CLINICAL RELEVANCE Epidural morphine reduced the requirement for postoperative analgesia in this study population.
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Dancker C, MacFarlane P, Love EJ. Pruritus and myoclonus following five consecutive doses of morphine administered through an epidural catheter in a dog. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2019-000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Emma J Love
- Bristol Veterinary SchoolUniversity of BristolLangfordUK
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Goich M, Bascuñán A, Faúndez P, Valdés A. Multimodal analgesia for treatment of allodynia and hyperalgesia after major trauma in a cat. JFMS Open Rep 2019; 5:2055116919855809. [PMID: 31245022 PMCID: PMC6582303 DOI: 10.1177/2055116919855809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Case summary A 2-year-old polytraumatized male cat was admitted to a teaching hospital for correction of a defective inguinal herniorrhaphy. Upon arrival, the cat showed signs of neuropathic pain, including allodynia and hyperalgesia. Analgesic therapy was initiated with methadone and metamizole; however, 24 h later, the signs of pain continued. Reparative surgery was performed, and a multimodal analgesic regimen was administered (methadone, ketamine, wound catheter and epidural anesthesia). Postoperatively, the cat showed signs of severe pain, assessed using the UNESP-Botucatu multidimensional composite pain scale. Rescue analgesia was initiated, which included methadone, bupivacaine (subcutaneous wound-diffusion catheter) and transversus abdominis plane block. Because the response was incomplete, co-adjuvant therapy (pregabalin and electroacupuncture) was then implemented. Fourteen days after admission, the patient was discharged with oral tramadol and pregabalin for at-home treatment. Relevance and novel information Neuropathic pain is caused by a primary lesion or dysfunction in the nervous system and is a well-described complication following trauma, surgical procedures such as hernia repair, and inadequate analgesia. The aims of this report are to: (1) describe a presentation of neuropathic pain to highlight the recognition of clinical signs such as allodynia and hyperalgesia in cats; and (2) describe treatment of multi-origin, severe, long-standing, ‘mixed’ pain (acute inflammatory with a neuropathic component). The patient was managed using multiple analgesic strategies (multimodal analgesia), including opioids, non-steroidal anti-inflammatory drugs, locoregional anesthesia, co-adjuvant drugs and non-pharmacological therapy (electroacupuncture).
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Affiliation(s)
- Mariela Goich
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la vida, Universidad Andres Bello
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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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Panti A, Greenhalgh SN, Longo M, Liuti T. The effect of recumbency and hindlimb position on the lumbosacral interlaminar distance in dogs: a cadaveric computed tomography study. Vet Anaesth Analg 2018; 45:802-810. [DOI: 10.1016/j.vaa.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/29/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
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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.
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Affiliation(s)
- F Garcia-Pereira
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL, 32610 USA.
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Yoon JH, Son JY, Kim MJ, Kang SH, Ju JS, Bae YC, Ahn DK. Preemptive application of QX-314 attenuates trigeminal neuropathic mechanical allodynia in rats. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2018; 22:331-341. [PMID: 29719455 PMCID: PMC5928346 DOI: 10.4196/kjpp.2018.22.3.331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/09/2018] [Accepted: 02/19/2018] [Indexed: 12/19/2022]
Abstract
The aim of the present study was to examine the effects of preemptive analgesia on the development of trigeminal neuropathic pain. For this purpose, mechanical allodynia was evaluated in male Sprague-Dawley rats using chronic constriction injury of the infraorbital nerve (CCI-ION) and perineural application of 2% QX-314 to the infraorbital nerve. CCI-ION produced severe mechanical allodynia, which was maintained until postoperative day (POD) 30. An immediate single application of 2% QX-314 to the infraorbital nerve following CCI-ION significantly reduced neuropathic mechanical allodynia. Immediate double application of QX-314 produced a greater attenuation of mechanical allodynia than a single application of QX-314. Immediate double application of 2% QX-314 reduced the CCI-ION-induced upregulation of GFAP and p-p38 expression in the trigeminal ganglion. The upregulated p-p38 expression was co-localized with NeuN, a neuronal cell marker. We also investigated the role of voltage-gated sodium channels (Navs) in the antinociception produced by preemptive application of QX-314 through analysis of the changes in Nav expression in the trigeminal ganglion following CCI-ION. Preemptive application of QX-314 significantly reduced the upregulation of Nav1.3, 1.7, and 1.9 produced by CCI-ION. These results suggest that long-lasting blockade of the transmission of pain signaling inhibits the development of neuropathic pain through the regulation of Nav isoform expression in the trigeminal ganglion. Importantly, these results provide a potential preemptive therapeutic strategy for the treatment of neuropathic pain after nerve injury.
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Affiliation(s)
- Jeong-Ho Yoon
- Department of Oral Physiology School of Dentistry, Kyungpook National University, Daegu 41940, Korea
| | - Jo-Young Son
- Department of Oral Physiology School of Dentistry, Kyungpook National University, Daegu 41940, Korea
| | - Min-Ji Kim
- Department of Oral Physiology School of Dentistry, Kyungpook National University, Daegu 41940, Korea
| | - Song-Hee Kang
- Department of Oral Physiology School of Dentistry, Kyungpook National University, Daegu 41940, Korea
| | - Jin-Sook Ju
- Department of Oral Physiology School of Dentistry, Kyungpook National University, Daegu 41940, Korea
| | - Yong-Chul Bae
- Department of Oral Anatomy, School of Dentistry, Kyungpook National University, Daegu 41940, Korea
| | - Dong-Kuk Ahn
- Department of Oral Physiology School of Dentistry, Kyungpook National University, Daegu 41940, Korea
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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.
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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
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Bustamante R, Aguado D, Cediel R, Gómez de Segura I, Canfrán S. Clinical comparison of the effects of isoflurane or propofol anaesthesia on mean arterial blood pressure and ventilation in dogs undergoing orthopaedic surgery receiving epidural anaesthesia. Vet J 2018; 233:49-54. [DOI: 10.1016/j.tvjl.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
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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: 21] [Impact Index Per Article: 3.0] [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.
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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
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Küls N, Blissitt KJ, Shaw DJ, Schöffmann G, Clutton RE. Thermography as an early predictive measurement for evaluating epidural and femoral-sciatic block success in dogs. Vet Anaesth Analg 2017; 44:1198-1207. [PMID: 29037799 DOI: 10.1016/j.vaa.2016.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/04/2016] [Accepted: 11/19/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate skin temperature increase as an early predictive measure for evaluating epidural and femoral-sciatic block success in dogs. STUDY DESIGN Prospective clinical trial. ANIMALS A total of 29 dogs undergoing orthopaedic surgery on one hindlimb. METHODS Dogs were anaesthetized and placed into lateral recumbency with the affected limb uppermost and the coat was clipped. Baseline infrared thermographic images (T0) of the affected limb, of the paw pad of the affected leg and of the ipsilateral paw pad were taken. Subsequently, dogs were administered either an epidural (EPI; n=11) or a femoral-sciatic block (FS; n=18) using bupivacaine 1 mg kg-1. Then, 2 minutes after placement of the block, thermographic images were obtained every 3 minutes for a total of four measurements (T1-T4) and surgery was commenced. Rescue analgesia consisting of fentanyl 1 μg kg-1 was administered if needed. A regional block was considered successful if the dose of fentanyl administered was less than the lower 95% confidence interval of the geometric mean of the total fentanyl used in each group. A ≥ 1 °C increase of skin temperature was considered as the minimum increase required for detection of a successful block. RESULTS A total of 12 out of 18 blocks in the FS and eight of 11 in the EPI group were considered successful based on fentanyl consumption. Out of these, only four of 12 in the FS and one of eight in the EPI group developed an increase in temperature of ≥ 1 °C. Contrarily, four of six of the nonsuccessful cases in the FS and three of three in the EPI group developed an increase in temperature of ≥ 1 °C. CONCLUSIONS AND CLINICAL RELEVANCE Contrary to reports in humans, thermography did not indicate regional block success prior to surgery in dogs. However further studies under more controlled conditions are needed to determine whether thermography can be used to indicate failure of regional blockade.
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Affiliation(s)
- Nina Küls
- Department for Anaesthesiology and Perioperative Care, The Veterinary University of Vienna, Vienna, Austria.
| | - Karen J Blissitt
- Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, Midlothian, UK
| | - Darren J Shaw
- Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, Midlothian, UK
| | - Gudrun Schöffmann
- Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, Midlothian, UK
| | - Richard E Clutton
- Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, Midlothian, UK
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Fernandez-Parra R, Zilberstein L, Fontaine C, Adami C. Comparison of intratesticular lidocaine, sacrococcygeal epidural lidocaine and intravenous methadone in cats undergoing castration: a prospective, randomized, investigator-blind clinical trial. Vet Anaesth Analg 2017; 44:356-363. [PMID: 28455211 DOI: 10.1016/j.vaa.2016.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 02/01/2016] [Accepted: 03/04/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to compare three analgesic protocols for feline castration. STUDY DESIGN Prospective, randomized clinical study. ANIMALS Forty-nine client-owned cats. METHODS Cats were injected with intramuscular (IM) dexmedetomidine (15 μg kg-1) and alfaxalone (3 mg kg-1) and assigned randomly to one of three treatment groups. Group ITL (n = 15) were administered intratesticular 2% lidocaine (0.05 mL each testicle), group SCL (n = 15) a sacrococcygeal epidural injection of 2% lidocaine (0.1 mL kg-1) and group IVM (n = 19) intravenous (IV) methadone (0.3 mg kg-1), before surgery. Cardiorespiratory variables were recorded. In case of autonomic nociceptive response, IV fentanyl (2 μg kg-1) was administered. During recovery, time from IM atipamezole (75 μg kg-1, administered at the end of surgery) to sternal recumbency and to active interaction was recorded. Quality of recovery was assessed using a simple descriptive scale. Postoperative analgesia was evaluated using a visual analogue scale and the UNESP-Botucatu multidimensional composite pain scale (MCPS) at return of active interaction and then 1, 2 and 3 hours later. RESULTS The three analgesic protocols were comparable in terms of intraoperative fentanyl and propofol requirement. Cardiorespiratory variables stayed within normal ranges in the majority of the cases, although group IVM had the lowest intraoperative respiratory rate (p = 0.0009). No differences were detected between groups in UNESP-Botucatu MCPS scores (p = 0.21). However, group ITL showed higher visual analogue scale score than group IVM (p = 0.001). Four cats enrolled in group ITL, as well as three of group SCL and one of group IVM, required rescue analgesics before the completion of pain assessment. CONCLUSIONS AND CLINICAL RELEVANCE Intratesticular and sacrococcygeal epidural lidocaine injections could be regarded as good alternatives to systemic opioids in cats undergoing castration, although the benefits of these techniques seem to be of shorter duration than IV methadone.
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Affiliation(s)
- Rocio Fernandez-Parra
- Department of Veterinary Anesthesiology and Critical Care, Ecole Nationale Vétérinaire d'Alfort, Paris, France.
| | - Luca Zilberstein
- Department of Veterinary Anesthesiology and Critical Care, Ecole Nationale Vétérinaire d'Alfort, Paris, France
| | - Cyril Fontaine
- Department of Veterinary Anesthesiology and Critical Care, Ecole Nationale Vétérinaire d'Alfort, Paris, France
| | - Chiara Adami
- Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, UK
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Cerasoli I, Tutunaru A, Cenani A, Ramirez J, Detilleux J, Balligand M, Sandersen C. Comparison of clinical effects of epidural levobupivacaine morphine versus bupivacaine morphine in dogs undergoing elective pelvic limb surgery. Vet Anaesth Analg 2017; 44:337-345. [DOI: 10.1016/j.vaa.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 11/27/2015] [Accepted: 01/29/2016] [Indexed: 11/25/2022]
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Arnholz M, Hungerbühler S, Weil C, Schütter AF, Rohn K, Tünsmeyer J, Kästner SBR. [Comparison of ultrasound guided femoral and sciatic nerve block versus epidural anaesthesia for orthopaedic surgery in dogs]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2017; 45:5-14. [PMID: 27677086 DOI: 10.15654/tpk-151087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/09/2016] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Comparison of ultrasound-guided femoral and sciatic nerve block versus epidural anaesthesia with bupivacaine and morphine for orthopaedic surgery of the pelvic limb in dogs with respect to analgesic effectiveness, clinical utility and side effects. MATERIAL AND METHODS The study included 22 dogs (American Society of Anesthesiologists, ASA grades I and II) undergoing orthopaedic surgery distal to the mid-femoral bone. The study was designed as a randomized, prospective, blinded clinical trial. All dogs were randomly assigned to receive 0.5 mg/kg bupivacaine (0.5%) and 0.1 mg/kg morphine sulphate (1%) either as epidural anaesthesia (group EPI) or by ultrasound-guided femoral and sciatic nerve block (group LA). During surgery, the heart rate, respiratory rate, mean arterial pressure (MAP), end-tidal isoflurane concentrations and dose of rescue analgesia (fentanyl boluses of 5 µg/kg i. v.) were measured. Pain severity was scored (short form of the Glasgow Composite Measure Pain Scale, GCMPS) before surgery and postoperatively at 2, 4, 6, 12 and 24 hours after extubation. Post-operative rescue analgesia consisted of methadone (0.2 mg/kg i. v.), and was applied when the GCMPS > 6. For statistical analysis, the Chi-square, Fisher, and Wilcoxon tests and one- and two-way ANOVA were applied. Differences were considered statistically significant at p < 0.05. RESULTS Only the MAP was significantly different between the two treatment groups. Intra- and postoperative MAP of group LA (111.2 ± 11.2 mmHg and 119.3 ± 18.2 mmHg, respectively) was higher than in group EPI (86.6 ± 8.7 mmHg and 95.2 ± 13.1 mmHg, respectively). None of the dogs developed urinary retention or ambulatory deficits when completely recovered from anaesthesia. No other side effects were noted. CLINICAL RELEVANCE In conclusion, femoral and sciatic nerve blocks and epidural anaesthesia ensure comparable analgesic effects in canine patients undergoing orthopaedic surgery of the pelvic limb. The lower mean arterial blood pressure of group EPI was not of clinical relevance.
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Affiliation(s)
- Mareike Arnholz
- Mareike Arnholz, Klinik für Kleintiere, Abteilung für Anästhesie, Stiftung Tierärztliche Hochschule Hannover, Bünteweg 9, 30159 Hannover, E-Mail:
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Adami C, Gendron K. What is the evidence? The issue of verifying correct needle position during epidural anaesthesia in dogs. Vet Anaesth Analg 2017; 44:212-218. [PMID: 28215814 DOI: 10.1016/j.vaa.2016.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 02/23/2016] [Accepted: 03/04/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To review the methods for verifying the needle position while performing epidural anaesthesia in dogs, and to discuss the advantages, disadvantages, usefulness and reliability of each technique in the experimental and clinical research setting. DATABASES USED PubMed, Scopus, Google Scholar and the Basel University Library online catalogues; the latter, which was provided by the University of Berne, were used as databases. The results were filtered manually based on the titles and abstracts in order to narrow the field. CONCLUSIONS Besides some drawbacks, including the potential side effects of contrast medium injection, which may limit its routine use in clinical patients, epidurography should still be regarded as one of the most reliable techniques to verify needle position in dogs. Ultrasonography, electrical nerve stimulation, loss of resistance and the hanging drop technique are regarded as less invasive than epidurography and, for this reason, their use may be more applicable to clinical patients. However, these methods have been described in only a few published reports, all of which involved a limited number of dogs. Finally, the detection of epidural pressure waves has been investigated more extensively in dogs, and the findings of these studies suggest that this technique may be used to verify epidural needle placement for experimental and clinical research, on condition that all the negative subjects are excluded from the study.
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Affiliation(s)
- Chiara Adami
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK.
| | - Karine Gendron
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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Simon BT, Steagall PV. The present and future of opioid analgesics in small animal practice. J Vet Pharmacol Ther 2016; 40:315-326. [DOI: 10.1111/jvp.12377] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 09/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- B. T. Simon
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
| | - P. V. Steagall
- Department of Clinical Sciences; Faculty of Veterinary Medicine; Université de Montréal; Saint-Hyacinthe QC Canada
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Gatson BJ, Garcia‐Pereira FL, James M, Carrera‐Justiz S, Lewis DD. Use of a perfusion index to confirm the presence of sciatic nerve blockade in dogs. Vet Anaesth Analg 2016; 43:662-669. [DOI: 10.1111/vaa.12378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/06/2016] [Indexed: 11/28/2022]
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DeRossi R, Hermeto LC, Jardim PHA, de Andrade Bicudo N, de Assis KT. Postoperative pain control in cats: clinical trials with pre-emptive lidocaine epidural co-administered with morphine or methadone. J Feline Med Surg 2016; 18:882-888. [PMID: 26310819 PMCID: PMC11132221 DOI: 10.1177/1098612x15602738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Objectives The aim of the study was to evaluate the effectiveness of epidural lidocaine in combination with either methadone or morphine for postoperative analgesia in cats undergoing ovariohysterectomy. Methods Under general anesthesia, 24 cats that underwent ovariohysterectomy were randomly allocated into three treatment groups of eight each. Treatment 1 included 2% lidocaine (4.0 mg/kg); treatment 2 included lidocaine and methadone (4.0 mg/kg and 0.3 mg/kg, respectively); and treatment 3 included lidocaine and morphine (4.0 mg/kg and 0.1 mg/kg, respectively). All drugs were injected in a total volume of 0.25 ml/kg via the lumbosacral route in all cats. During the anesthetic and surgical periods, the physiologic variables (respiratory and heart rate, arterial blood pressure and rectal temperature) were measured at intervals of time zero, 10 mins, 20 mins, 30 mins, 60 mins and 120 mins. After cats had recovered from anesthesia, a multidimensional composite pain scale was used to assess postoperative analgesia 2, 4, 8, 12, 18 and 24 h after epidural. Results The time to first rescue analgesic was significantly ( P <0.05) prolonged in cats that received both lidocaine and methadone or lidocaine and morphine treatments compared with those that received lidocaine treatment alone. All cats that received lidocaine treatment alone required rescue analgesic within 2 h of epidural injections. All treatments produced significant cardiovascular and respiratory changes but they were within an acceptable range for healthy animals during the surgical period. Conclusions and relevance The two combinations administered via epidural allowed ovariohysterectomy with sufficient analgesia in cats, and both induced prolonged postoperative analgesia.
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Affiliation(s)
- Rafael DeRossi
- Department of Veterinary Medicine – Surgery and Anesthesiology, Faculty of Veterinary Medicine and Animal Science, Federal University of Mato Grosso do Sul, MS, Brazil
| | - Larissa Correa Hermeto
- Postgraduate Program in Veterinary Surgery, School of Agrarian and Veterinary Sciences, UNESP, Jaboticabal, SP, Brazil
| | | | - Natalia de Andrade Bicudo
- Department of Veterinary Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Klebs Tavares de Assis
- Department of Veterinary Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
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Littlewood KE, Mellor DJ. Changes in the Welfare of an Injured Working Farm Dog Assessed Using the Five Domains Model. Animals (Basel) 2016; 6:ani6090058. [PMID: 27657140 PMCID: PMC5035953 DOI: 10.3390/ani6090058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/07/2016] [Accepted: 09/14/2016] [Indexed: 02/03/2023] Open
Abstract
Simple Summary The Five Domains Model is now increasingly used to assess the welfare status of a wide range of species in markedly different circumstances. Particular strengths are that the Model facilitates structured, systematic and comprehensive evaluations of animals’ negative and positive mental experiences, the overall balance of which underlies their welfare status or quality of life. Importantly, the Model also clarifies the specific internal and external factors that give rise to those experiences. The welfare evaluation published here is the first to use the most up-to-date version of the Model, and stands as a detailed example that may assist others undertaking such welfare evaluations in other species and contexts. Moreover, it is the first such evaluation of a companion animal. It employs a fictitious scenario involving a working farm dog before, during and after it sustains a serious hind leg injury requiring amputation and its subsequent rehoming as a pet. A wide range of negative and positive experiences are graded, interactions between them are revealed, and the balance between negative and positive states at different stages of the scenario is described. Such Model evaluations can highlight current practices that merit re-evaluation. More generally, when major welfare issues are identified, use of the Model could enhance expert witness participation in related prosecutions by highlighting scientifically supported connections between indicative physical/functional states and behaviours and their associated negative experiences in ill-treated animals. Five Domains Model evaluations can also facilitate quality of life assessments and end-of-life decisions. Abstract The present structured, systematic and comprehensive welfare evaluation of an injured working farm dog using the Five Domains Model is of interest in its own right. It is also an example for others wanting to apply the Model to welfare evaluations in different species and contexts. Six stages of a fictitious scenario involving the dog are considered: (1) its on-farm circumstances before one hind leg is injured; (2) its entanglement in barbed wire, cutting it free and transporting it to a veterinary clinic; (3) the initial veterinary examination and overnight stay; (4) amputation of the limb and immediate post-operative recovery; (5) its first four weeks after rehoming to a lifestyle block; and (6) its subsequent life as an amputee and pet. Not all features of the scenario represent average-to-good practice; indeed, some have been selected to indicate poor practice. It is shown how the Model can draw attention to areas of animal welfare concern and, importantly, to how welfare enhancement may be impeded or facilitated. Also illustrated is how the welfare implications of a sequence of events can be traced and evaluated, and, in relation to specific situations, how the degrees of welfare compromise and enhancement may be graded. In addition, the choice of a companion animal, contrasting its welfare status as a working dog and pet, and considering its treatment in a veterinary clinical setting, help to highlight various welfare impacts of some practices. By focussing attention on welfare problems, the Model can guide the implementation of remedies, including ways of promoting positive welfare states. Finally, wider applications of the Five Domains Model are noted: by enabling both negative and positive welfare-relevant experiences to be graded, the Model can be applied to quality of life assessments and end-of-life decisions and, with particular regard to negative experiences, the Model can also help to strengthen expert witness testimony during prosecutions for serious ill treatment of animals.
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Affiliation(s)
- Katherine E Littlewood
- Animal Welfare Science and Bioethics Centre, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North 4442, New Zealand.
| | - David J Mellor
- Animal Welfare Science and Bioethics Centre, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North 4442, New Zealand.
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Bartel AKG, Campoy L, Martin-Flores M, Gleed RD, Walker KJ, Scanapico CE, Reichard AB. Comparison of bupivacaine and dexmedetomidine femoral and sciatic nerve blocks with bupivacaine and buprenorphine epidural injection for stifle arthroplasty in dogs. Vet Anaesth Analg 2016; 43:435-43. [DOI: 10.1111/vaa.12318] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
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Robertson SA, Taylor PM. Pain management in cats—past, present and future. Part 2. Treatment of pain—clinical pharmacology. J Feline Med Surg 2016; 6:321-33. [PMID: 15363764 DOI: 10.1016/j.jfms.2003.10.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/13/2003] [Accepted: 10/20/2003] [Indexed: 10/26/2022]
Abstract
Opioids have an unjustified reputation for causing mania in cats, but with refinements in dosing they are now used successfully in this species. The mu-opioid agonists are generally considered the best analgesics. Morphine (0.1–0.3 mg/kg) is effective in a clinical setting. Methadone (up to 0.5 mg/kg) has a similar profile to morphine. Pethidine (Demerol, meperidine; 2–5 mg/kg) is a useful analgesic with a faster onset but shorter duration of action than morphine. Oxymorphone and hydromorphone (0.05–0.1 mg/kg) are widely used in the USA. These opioids are more potent (up to 10 times), and longer acting than morphine in cats. Butorphanol (0.1–0.4 mg/kg) is a mu-opioid antagonist that produces its analgesic actions through kappa agonist activity. It rapidly reaches a ceiling effect, is short acting and is a weaker analgesic than pure mu opioids. Buprenorphine (0.01–0.02 mg/kg), a partial mu-agonist, is the most popular opioid used in small animal practice in the UK, other parts of Europe, Australia and South Africa. In clinical studies it has produced better analgesia than several other opioids and appears to be highly suitable for perioperative pain management in cats. NSAIDs are also used in cats for pain management, although cats metabolise these differently from other species. With appropriate dosing, carprofen (1–4 mg/kg) and meloxicam (0.3 mg/kg) have proved highly effective with few side effects. The use of ketoprofen (2 mg/kg), tolfenamic acid (4 mg/kg) and vedaprofen (0.5 mg/kg) has been reported in cats. Other less traditional analgesics such as ketamine, medetomidine and local anaesthetics are also used for clinical pain management. The transmucosal, transdermal and epidural routes offer novel methods for administration of analgesic drugs and have considerable potential for improving techniques in feline pain management.
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Affiliation(s)
- S A Robertson
- Department of Large Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
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DeRossi R, Jardim PHA, Hermeto LC, Pagliosa RC. Comparison of analgesic and systemic effects of bupivacaine, methadone, or bupivacaine/methadone administered epidurally in conscious sheep. Aust Vet J 2016; 93:164-9. [PMID: 25939263 DOI: 10.1111/avj.12313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/05/2014] [Accepted: 08/28/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the combination of bupivacaine and methadone administered epidurally in sheep. METHODS Six healthy female mixed-breed sheep weighing 35-46 kg and aged 12-18 months were included. Each sheep was assigned to receive three treatments: 0.5 mg/kg 0.25% bupivacaine (BP), 0.3 mg/kg 1% methadone (MT) or 0.25 mg/kg bupivacaine and 0.15 mg/kg methadone (BPMT). All drugs were injected into the lumbosacral space through an epidural catheter. Each animal received each treatment at random. Heart rate, arterial blood pressure (systolic, diastolic and mean), respiratory rate, rectal temperature, analgesia, sedation and motor block were determined before treatment and at predetermined intervals. RESULTS The duration of analgesia was 240, 220, and 180 min for BP, MT and BPMT, respectively (P < 0.05). Motor block for all agents was mild to moderate. None or the treatments significantly altered the heart rate, blood pressure or respiratory rate. CONCLUSION Our findings suggest that lumbosacral epidural administration of bupivacaine, methadone or a combination of the two drugs can provide perioperative analgesia in sheep as part of their management for surgical procedures in the flank and hindlimbs.
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Affiliation(s)
- R DeRossi
- Department of Veterinary Medicine-Surgery and Anesthesiology, Faculty of Veterinary Medicine and Animal Science, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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Evangelista MC, Steagall P, Garofalo NA, Rodrigues JC, Teixeira-Neto F. Morphine-induced pruritus after epidural administration followed by treatment with naloxone in a cat. JFMS Open Rep 2016; 2:2055116916634105. [PMID: 28491414 PMCID: PMC5388069 DOI: 10.1177/2055116916634105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2016] [Indexed: 11/16/2022] Open
Abstract
Case summary A young male domestic shorthair cat weighing 1.6 kg was admitted to a veterinary teaching hospital for elective orchiectomy. A lumbosacral epidural injection of preservative-free morphine (0.1 mg/kg) and lidocaine (0.25 ml/kg) was performed under general anesthesia. One hour after extubation, the cat became agitated. Severe licking and biting of the hindlimbs, tail and lumbar area were observed. Pruritus was suspected and likely to be caused by epidural morphine. Acepromazine (0.02 mg/kg IM) was administered but clinical signs did not cease. Naloxone (2 µg/kg IV) was administered and clinical signs resolved within 20 mins. Relevance and novel information Different therapeutic approaches are available for the treatment of morphine-induced pruritus. This case describes an additional treatment option using opioid antagonism with naloxone.
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Affiliation(s)
- Marina C Evangelista
- Department of Veterinary Anesthesia and Surgery, Faculty of Veterinary Medicine and Animal Sciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Paulo Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Natache A Garofalo
- Department of Veterinary Anesthesia and Surgery, Faculty of Veterinary Medicine and Animal Sciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Jessica C Rodrigues
- Department of Veterinary Anesthesia and Surgery, Faculty of Veterinary Medicine and Animal Sciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Francisco Teixeira-Neto
- Department of Veterinary Anesthesia and Surgery, Faculty of Veterinary Medicine and Animal Sciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
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Santos L, Fernandes L, Sepulveda R, Pereira V, Eleotério R, Favarato L. Eletroacupuntura na analgesia trans e pós-operatória de cadelas submetidas à ovariosalpingohisterectomia. ARQ BRAS MED VET ZOO 2015. [DOI: 10.1590/1678-4162-7987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivou-se com este estudo avaliar o efeito analgésico trans e pós-operatório da eletroacupuntura em onda denso-dispersa e frequências 3 e 200Hz, nos pontos E44, R3 e BP4, compará-lo com a analgesia promovida pelos pontos BP6, E36 e VB 34, e pela morfina, em cadelas submetidas à ovariosalpingohisterectomia (OSH). Teve-se como hipótese que a eletroacupuntura nos pontos E44, R3 e BP4 resultaria em controle da dor trans e pós-operatória melhor ou igual àquele promovido pela eletroacupuntura nos pontos BP6, E36 e VB34 e pela morfina. Trinta e seis cadelas submetidas à cirurgia eletiva de OSH foram distribuídas em blocos ao acaso em três grupos com 12 animais. Em dois grupos foi realizada eletroacupuntura denso-dispersa, com frequência de 3 e 200Hz, sendo que, no primeiro grupo (GEA), foram estimulados os pontos BP4, E44, R3 e, no segundo grupo (GEB), os pontos BP6, E36, VB34. Nesses dois grupos, foram administrados 1,5mL de solução fisiológica por via IM. No terceiro grupo (GF), foi realizada acupuntura em três pontos falsos e o aparelho de eletroacupuntura foi acoplado, mas não foi ligado, e administrou-se morfina na dose de 0,5mg/kg, diluída em solução fisiológica de modo que o volume total foi de 1,5mL por via IM. Foram avaliados os parâmetros cardiovasculares e respiratórios durante o período pré e transoperatório. A avaliação de dor pós-operatória foi realizada durante 12 horas, e a analgesia suplementar com morfina foi realizada quando o escore de dor alcançou valores iguais ou superiores a nove pontos (total de 27) de acordo com a "Escala de dor da Universidade de Melbourne" (EDUM). O grupo GEB apresentou pressão arterial estável, menor variação da Etiso e menor requerimento analgésico no pós-operatório. Nos grupos GEA e GF houve aumento da Etiso e da pressão arterial nos momentos de maior manipulação cirúrgica. Os maiores escores de dor foram obtidos em MP0 (momento da extubação) no GEA (8) e em MP1(1h após a extubação) no GF (9). O GF apresentou o maior requerimento analgésico no pós-operatório e foram realizados 17 resgates em 6 animais. Os acupontos R3, E44 e BP4, utilizados na eletroacupuntura com a frequência de 3 e 200Hz, não são capazes de promover ação antinociceptiva satisfatória no período transoperatório. O efeito analgésico pós-operatório promovido pela eletroestimulação nos acupontos R3, E44 e BP4 é inferior ao proporcionado pelos acupontos E36, BP6 e VB34 e superior ao obtido com a morfina.
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Albuquerque V, Araújo M, Ferreira G, Fonseca M, Abimussi C, Ferreira J, Oliva V. Epidural levobupivacaine alone or combined with different morphine doses in bitches under continuous propofol infusion. ARQ BRAS MED VET ZOO 2015. [DOI: 10.1590/1678-4162-7661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to assess the cardiopulmonary, analgesic, adverse effects, serum concentration of cortisol and plasma levels of levobupivacaine and morphine in bitches undergoing propofol anesthesia and epidural analgesia with levobupivacaine alone or combined with morphine. This was a randomized 'blinded' prospective clinical study using 32 adult bitches weighing 9.8±4.1kg that were admitted for elective ovariohysterectomy. Twenty minutes after administration of acepromazine and midazolam, anesthesia was induced with propofol (4mg kg-1) and maintained by a continuous rate infusion (CRI). Each animal was randomly assigned to one of four epidural groups: GL = levobupivacaine alone (0.33mg kg-1); GLM0.1 = levobupivacaine and morphine (0.1mg kg-1); GLM0.15 = levobupivacaine and morphine (0.15mg kg-1); and GLM0.2 = levobupivacaine and morphine (0.2mg kg-1). Variables obtained during anesthesia were heart rate, respiratory rate, systolic, mean and diastolic arterial blood pressures, oxyhemoglobin saturation, inspired oxygen fraction, end-tidal carbon dioxide tension, blood gases, serum cortisol, and plasma levels of levobupivacaine and morphine. The onset and duration times of the blockade were recorded. Arterial pressures were significantly increased in all groups at the times of ovarian pedicle clamping. There was a decrease in pH, together with an increase in both PaO2and PaCO2 over time. Serum cortisol levels were increased in TESu compared to TB, T30 and TR. Limb spasticity, muscle tremors, opisthotonos and diarrhea were observed in some animals during propofol infusion and ceased with the end of CRI. Reactions happened at different moments and lasted for different periods of time in each individual. Epidural with levobupivacaine alone or combined with morphine allowed for ovariohysterectomy to be performed under low propofol infusion rates, with minimal changes in cardiovascular variables and in serum cortisol levels. Adverse effects were observed in very few animals in each group.
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Sarotti D, Rabozzi R, Franci P. Comparison of epidural versus intrathecal anaesthesia in dogs undergoing pelvic limb orthopaedic surgery. Vet Anaesth Analg 2015; 42:405-13. [DOI: 10.1111/vaa.12229] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 07/17/2014] [Indexed: 11/27/2022]
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Abstract
Untreated or undermanaged perioperative pain has systemic effects that may negatively impact a patient's welfare and return to function. A consistent analgesic plan that assesses a patient's pain and comfort at regular intervals during the perioperative period should be incorporated into practice. Validated pain assessment tools are available for use in dogs and cats. Multimodal analgesic plans should be created for individual patients and modified according to pain assessments. These plans, based on a thorough history, physical examination, and knowledge of the expected pain, should be combinations of an opioid, a nonsteroidal anti-inflammatory drug, a local anesthetic, and nonpharmacologic analgesic techniques.
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Bahrenberg A, Dzikiti BT, Fosgate GT, Stegmann FG, Tacke SP, Rioja E. Antinociceptive effects of epidural magnesium sulphate alone and in combination with morphine in dogs. Vet Anaesth Analg 2015; 42:319-28. [DOI: 10.1111/vaa.12211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 01/29/2014] [Indexed: 01/28/2023]
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