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Upchurch D, Lin KTT, KuKanich B. Two doses of subcutaneous methadone for postoperative analgesia in dogs undergoing tibial plateau levelling osteotomies. J Small Anim Pract 2024; 65:368-375. [PMID: 38594836 DOI: 10.1111/jsap.13728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To evaluate analgesia, sedation and adverse effects of two doses of subcutaneous methadone in dogs undergoing tibial plateau levelling osteotomy. MATERIALS AND METHODS Seventeen client-owned dogs undergoing unilateral tibial plateau levelling osteotomy were randomly allocated to receive either 0.25 mg/kg methadone (eight dogs) or 0.5 mg/kg methadone (nine dogs). All dogs were premedicated with methadone and 2 to 6 mcg/kg dexmedetomidine subcutaneously. They were induced and maintained on a standard protocol. All animals received a second dose of methadone subcutaneously 4 hours after premedication and a 4.4 mg/kg dose of carprofen subcutaneously at 8 hours after premedication. During surgery, blood pressure, heart rate and temperature were assessed every 5 minutes. Postoperatively, sedation scores, temperature, heart rate and Glasgow composite modified pain score - short form were assessed for 12 hours postoperatively. RESULTS One of 17 (5.9%) dogs had intraoperative hypotension, nine of 17 dogs had intra-operative bradyarrhythmias and 17 of 17 dogs had intra-operative hypothermia. No dogs required intra-operative rescue. Composite modified pain score - short form scores were below the threshold for intervention in 16 of 17 (94.1%) animals. Only one of 17 (5.9%) dogs required rescue analgesia. Median sedation score was 0 by the T8 time point. Adverse events were rare in both groups with only vocalisation and hypothermia reported commonly postoperatively. CLINICAL SIGNIFICANCE Two doses of methadone at either 0.25 or 0.5 mg/kg administered via subcutaneous injections pre-operatively and 4 hours later, along with 4.4 mg/kg carprofen subcutaneously 8 hours after the first methadone dose appear to provide sufficient pain control for up to 12 hours in dogs undergoing tibial plateau levelling osteotomy.
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Affiliation(s)
- D Upchurch
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS, 66506, USA
| | - K T T Lin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - B KuKanich
- Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, 66506, USA
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Kalamaras AB, Aarnes TK, Moore SA, Jones SC, Pereira CR, Peng J, Kieves NR. Effects of perioperative saphenous and sciatic nerve blocks, lumbosacral epidural or morphine-lidocaine-ketamine infusion on postoperative pain and sedation in dogs undergoing tibial plateau leveling osteotomy. Vet Anaesth Analg 2021; 48:415-421. [PMID: 33814330 DOI: 10.1016/j.vaa.2021.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 01/29/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the quality of postoperative analgesia and sedation after preoperative saphenous and sciatic nerve blockade, preoperative lumbosacral epidural injection and perioperative intravenous (IV) morphine, lidocaine and ketamine infusions in dogs undergoing stifle arthroscopy and tibial plateau leveling osteotomy (TPLO) under general anesthesia. STUDY DESIGN Prospective, blinded, randomized, clinical comparison study. ANIMALS A total of 45 dogs weighing 33.9 (15.9-56.7) kg and aged 5.2 (1.0-12.0) years, mean (range), undergoing elective unilateral TPLO for spontaneous cranial cruciate ligament rupture. METHODS Client-owned dogs were enrolled. Dogs were randomly assigned to one of three groups: group MLK, perioperative IV morphine, lidocaine and ketamine infusion; group EPID, lumbosacral epidural with ropivacaine and morphine; or group SSNB, saphenous and sciatic nerve blockade with ropivacaine. Routine stifle arthroscopy followed by TPLO surgery was performed. Sedation and pain scores were assessed at 0, 2, 4, 8 and 24 hours following extubation. Rescue analgesia was administered as prescribed by Glasgow composite pain score-short form score >5. RESULTS Sedation scores for MLK were higher than EPID and SSNB. Pain scores for SSNB were lower than those for EPID and MLK. No significant differences were found in anesthesia duration or surgery duration among groups. No dogs required rescue analgesia. CONCLUSIONS AND CLINICAL RELEVANCE Although analgesia was adequate in all groups, the best combination of analgesia without increased sedation was recorded for SSNB.
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Affiliation(s)
- Alexandra B Kalamaras
- 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
| | - Sarah A Moore
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Stephen C Jones
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Carolina Ricco Pereira
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Juan Peng
- Department of Biomedical Informatics, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Nina R Kieves
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
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Hartnack AK, Niehaus AJ, Lakritz J, Coetzee JF, Kleinhenz MD. Pharmacokinetics of an intravenous constant rate infusion of a morphine-lidocaine-ketamine combination in Holstein calves undergoing umbilical herniorrhaphy. Am J Vet Res 2020; 81:17-24. [PMID: 31887082 DOI: 10.2460/ajvr.81.1.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the pharmacokinetics of morphine, lidocaine, and ketamine associated with IV administration of a constant rate infusion (CRI) of a morphine-lidocaine-ketamine (MLK) combination to calves undergoing umbilical herniorrhaphy. ANIMALS 20 weaned Holstein calves with umbilical hernias. PROCEDURES Calves were randomly assigned to receive a CRI of an MLK solution (0.11 mL/kg/h; morphine, 4.8 μg/kg/h; lidocaine, 2.1 mg/kg/h; and ketamine, 0.42 mg/kg/h) for 24 hours (MLK group) or 2 doses of flunixin meglumine (1.1 mg/kg, IV, q 24 h) and a CRI of saline (0.9% NaCl) solution (0.11 mL/kg/h) for 24 hours (control group). For all calves, the CRI was begun after anesthesia induction. Blood samples were obtained immediately before and at predetermined times for 120 hours after initiation of the assigned treatment. Noncompartmental analysis was used to estimate pharmacokinetic parameters for the MLK group. RESULTS During the CRI, steady-state serum concentrations were achieved for lidocaine and ketamine, but not morphine. Mean terminal half-life was 4.1, 0.98, and 1.55 hours and area under the concentration-time curve was 41, 14,494, and 7,426 h•μg/mL for morphine, lidocaine, and ketamine, respectively. After the CRI, the mean serum drug concentration at steady state was 6.3, 616.7, and 328 ng/mL for morphine, lidocaine, and ketamine, respectively. CONCLUSIONS AND CLINICAL RELEVANCE During the CRI of the MLK solution, steady-state serum concentrations were achieved for lidocaine and ketamine, but not morphine, likely owing to the fairly long half-life of morphine. Kinetic analyses of MLK infusions in cattle are necessary to establish optimal dosing protocols.
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Hartnack AK, Niehaus AJ, Lakritz J, Coetzee JF, Kleinhenz MD. Analgesic efficacy of an intravenous constant rate infusion of a morphine-lidocaine-ketamine combination in Holstein calves undergoing umbilical herniorrhaphy. Am J Vet Res 2020; 81:25-32. [PMID: 31887083 DOI: 10.2460/ajvr.81.1.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the analgesic efficacy of an IV constant rate infusion (CRI) of a morphine-lidocaine-ketamine (MLK) combination in calves undergoing umbilical herniorrhaphy. ANIMALS 20 weaned Holstein calves with umbilical hernias. PROCEDURES Calves were randomly assigned to receive a CRI of an MLK solution (0.11 mL/kg/h; morphine, 4.8 μg/kg/h; lidocaine, 2.1 mg/kg/h; and ketamine, 0.42 mg/kg/h) for 24 hours (MLK group) or 2 doses of flunixin meglumine (1.1 mg/kg, IV, q 24 h) and a CRI of saline (0.9% NaCl) solution (0.11 mL/kg/h) for 24 hours (control group). The assigned CRI was begun after anesthesia induction. A pain-scoring system and incisional algometry were used to assess pain, and blood samples were obtained to measure serum cortisol concentration at predetermined times for 120 hours after CRI initiation. RESULTS Mean pain scores did not differ significantly between the MLK and control groups at any time. Mean algometry score for the MLK group was significantly greater (calves were less responsive to pressure) than that for the control group at 4 hours after CRI initiation. Mean cortisol concentration decreased over time for both groups and was significantly greater for the MLK group than the control group at 1, 4, and 18 hours after CRI initiation. CONCLUSIONS AND CLINICAL RELEVANCE A CRI of MLK provided adequate postoperative analgesia to calves that underwent umbilical herniorrhaphy. However, the technical support required for CRI administration limits its use to hospital settings. Kinetic analyses of MLK infusions in cattle are necessary to establish optimal dosing protocols and withdrawal intervals.
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Barnes K, Faludi A, Takawira C, Aulakh K, Rademacher N, Liu CC, Lopez MJ. Extracorporeal shock wave therapy improves short-term limb use after canine tibial plateau leveling osteotomy. Vet Surg 2019; 48:1382-1390. [PMID: 31469432 DOI: 10.1111/vsu.13320] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 06/19/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the influence of postoperative extracorporeal shock wave therapy (ESWT) on hind limb use after tibial plateau leveling osteotomy (TPLO). STUDY DESIGN Randomized, prospective clinical trial. ANIMALS Sixteen client-owned dogs, 2 to 10 years old weighing 18 to 75 kg. METHODS Dogs were randomly assigned to treatment cohorts, TPLO with ESWT (ESWT, n = 9) or TPLO without ESWT (control, n = 7). Treatment consisted of 1000 pulses at 0.15 mJ/mm2 immediately and 2 weeks after surgery. Subjective pain, stifle goniometry, stifle circumference, peak vertical force (PVF) and vertical impulse (VI) were measured before surgery, prior to ESWT, and 2 and 8 weeks after surgery. Measures were compared between treatments at each time point and among time points for each treatment (P < .05). RESULTS The PVF (5.5 ± 1.0 N/kg, mean ± SD) and VI (0.67 ± 0.14 N-s/kg) of surgically treated limbs in the ESWT cohort were higher 8 weeks after surgery compared with preoperative (3.8 ± 1.1 N/kg, P < .0001 and 0.47 ± 0.21 N-s/kg, P = .0012, respectively) values. In the control cohort, PVF (2.9 ± 1.3 N/kg, P = .0001) and VI (0.33 ± 0.20 N-s/kg, P = .0003) 2 weeks after surgery and VI (0.42 ± 0.2 N-s/kg, P = .0012) 8 weeks after surgery were lower (4.59 ± 2.33 N/kg and 0.592 ± 0.35 N-s/kg, respectively) than before surgery. Other parameters did not differ between groups. CONCLUSION Weight bearing increased faster after TPLO in dogs treated with postoperative ESWT. CLINICAL SIGNIFICANCE This study provides evidence to consider adjunct ESWT after TPLO.
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Affiliation(s)
- Kate Barnes
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Alex Faludi
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Catherine Takawira
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Karanvir Aulakh
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Nathalie Rademacher
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Chin-Chi Liu
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Mandi J Lopez
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana
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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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Kushnir Y, Marwitz GS, Shilo-Benjamini Y, Milgram J. Description of a regional anaesthesia technique for the dorsal cranium in the dog: a cadaveric study. Vet Anaesth Analg 2018; 45:684-694. [PMID: 30093320 DOI: 10.1016/j.vaa.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 04/14/2018] [Accepted: 05/02/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To identify landmarks and to describe a technique for nerve blockade of the dorsal cranium in dogs. STUDY DESIGN Anatomic cadaveric study. ANIMALS A total of 39 dog cadavers, weighing 18.0 ± 9.7 kg (mean ± standard deviation). METHODS The study was performed in three parts. In the initial part, cadavers were dissected to determine the location of the frontal, zygomaticotemporal, and major occipital nerves, and to identify prominent landmarks for their blockade. In the second part, one technique was developed to block each of the frontal and zygomaticotemporal nerves, and two techniques, rostral and caudal, were developed to block the major occipital nerve. Injection solution was 0.05% methylene blue in 0.5% bupivacaine. In the third part, cadavers were used to test the techniques developed in the second part with 0.04 mL kg-1 of the same injectate administered at each site (maximal volume 0.5 mL per site). The length of nerve stained was measured, with a length ≥6 mm considered successful. Confidence intervals were calculated using Fisher's exact test. RESULTS Success rates (95% confidence interval) for the frontal, zygomaticotemporal, and rostral and caudal locations for the major occipital nerve were 94% (80-99%), 91% (76-98%), 74% (58-86%) and 77% (59-89%), respectively. With a combination of both locations, the success rate for the major occipital nerve was 100% (90-100%). CONCLUSION AND CLINICAL RELEVANCE This study describes a simple regional anaesthesia technique using palpable anatomical landmarks that may provide analgesia for dogs undergoing craniotomy.
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Affiliation(s)
- Yishai Kushnir
- Koret School of Veterinary Medicine, Robert H Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, Rehovot, Israel.
| | - Gal S Marwitz
- Koret School of Veterinary Medicine, Robert H Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, Rehovot, Israel
| | - Yael Shilo-Benjamini
- Koret School of Veterinary Medicine, Robert H Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, Rehovot, Israel
| | - Joshua Milgram
- Koret School of Veterinary Medicine, Robert H Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, Rehovot, Israel
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Bradbrook C, Clark L. State of the art analgesia-Recent developments pharmacological approaches to acute pain management in dogs and cats: Part 2. Vet J 2018; 236:62-67. [PMID: 29871752 DOI: 10.1016/j.tvjl.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
There has been considerable interest in the area of acute pain management over recent years, focusing on pain assessment, pharmacological and non-pharmacological interventions. The evidence base for our clinical decision making and treatment of patients is ever increasing and becoming more robust. There is still a tendency to base some aspects of pain management on poor quality evidence and this requires further input in years to come. With new literature come new ideas and this review will detail the current knowledge base behind pharmacological management of acute pain in dogs and cats. The known mechanisms of action of each analgesic and its evidence will be considered. The second part of this review will consider the non-traditional analgesics, describing their component drugs individually, thereby focusing on their mechanisms of action and the current evidence for their use in acute pain management.
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Affiliation(s)
| | - L Clark
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Herts, SG5 3HR, UK
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Chiavaccini L, Claude AK, Meyer RE. Comparison of Morphine, Morphine-Lidocaine, and Morphine-Lidocaine-Ketamine Infusions in Dogs Using an Incision-Induced Pain Model. J Am Anim Hosp Assoc 2017; 53:65-72. [PMID: 28282236 DOI: 10.5326/jaaha-ms-6442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We aimed to compare antinociceptive effects of IV infusions of morphine (M), morphine-lidocaine (ML), or morphine-lidocaine-ketamine (MLK) combined, in a mild-to-moderate pain model in dogs. Eighteen adult hounds were heavily sedated with IV morphine (0.2 mg/kg) and dexmedetomidine to undergo thoracic skin incisions. After reversal, dogs were randomly assigned to receive loading doses of lidocaine and ketamine (MLK), lidocaine and saline (ML), or equivalent volume of saline (M), followed by 18 hr constant infusions of morphine (0.12 mg/kg/hr), lidocaine (3 mg/kg/hr) and ketamine (0.6 mg/kg/hr); morphine (0.12 mg/kg/hr) and lidocaine (3 mg/kg/hr); or morphine (0.12 mg/kg/hr), respectively. Pain was assessed with Short Form Glasgow Composite Measure Pain Scale and mechanical nociception with von Frey filaments (VFFS). Data were analyzed with linear mixed model on ranks. Independently of treatment, Short Form Glasgow Composite Measure Pain Scale was significantly higher than baseline for 24 hr (p < .0001), while VFFS was significantly lower than baseline for 48 hr post-recovery (p < .0001), with no difference between MLK and M groups. The ML group recorded significantly lower VFFS (p = .02) than the M group for the entire study. In conclusion, there was no significant analgesic difference between MLK and M alone.
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Affiliation(s)
| | - Andrew K Claude
- From the Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California (L.C.); and College of Veterinary Medicine, Department of Clinical Sciences, Mississippi State, Starkville, Mississippi (A.K.C., R.E.M.)
| | - Robert E Meyer
- From the Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California (L.C.); and College of Veterinary Medicine, Department of Clinical Sciences, Mississippi State, Starkville, Mississippi (A.K.C., R.E.M.)
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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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