Ultrasound-Guided Funicular Block: Ropivacaine Injection into the Tissue around the Spermatic Cord to Improve Analgesia during Orchiectomy in Dogs

Premedication with acetazolamide: Is its use for postoperative pain and stress control after laparoscopic ovariectomy in dogs ruled out?

BACKGROUND

Studies in human medicine have concluded that acetazolamide reduces pain associated with carbon dioxide insufflation during laparoscopic surgery. However, there are no published reports regarding the use of acetazolamide for this purpose in companion animals, despite the increasing popularity of laparoscopic techniques in veterinary medicine due to their advantages over open surgeries.

OBJECTIVES

Thirty mixed-breed female dogs were included in the study and randomly assigned to one of three groups: OVE (median celiotomy ovariectomy; n = 10), OVEL (laparoscopic ovariectomy, n = 10) and OVELA (laparoscopic ovariectomy with acetazolamide preoperative administration; n = 10). Experienced surgeons performed all procedures, and the anaesthetic and analgesic protocols were identical for all animals. Acetazolamide was administered orally (at a dose of 25 mg/kg) 2 h prior to induction in the OVELA group. Postoperative pain was evaluated using serum cortisol, salivary cortisol, and the University of Melbourne Pain Scale (UMPS) Score.

RESULTS

Any statistical differences were observed in the UMPS scores when the OVELA group was compared to the OVEL group at 1 h after surgery (p = 0.515), 12 h (p = 0.375) and 24 h (p = 0.242). Animals undergoing open surgery (OVE group) had significantly higher pain scores at all times after surgery when compared with OVEL and OVELA groups. A high positive correlation (r = 0.792; p = 0.01) was found between serum and saliva cortisol concentrations. Mean saliva cortisol concentration was not significantly lower for the OVELA group compared to the other groups.

CONCLUSIONS

This study found evidence that preoperative administration of acetazolamide may be beneficial in managing postoperative pain in dogs after laparoscopic surgeries. However, further research with a larger sample size is needed to confirm this and to determine if acetazolamide should be included in a multimodal postoperative analgesia protocol for laparoscopic ovariectomy in dogs.

Update on canine anorchia: A review

Abnormalities of the external genitals are an important issue in dog breeding because of the unfavourable qualities and characteristics of breeds, resulting in consistent economic losses. Despite their significance, little scientific attention has been given to these problems. Although there are several reviews on cryptorchidism in dogs, none have described anorchia. Testicular agenesis is a rare reproductive disorder with a congenital origin. Moreover, no author has described the diagnostic procedure for making a definitive diagnosis of anorchia in dogs. It is important to have a well-structured diagnostic scheme to help practical veterinarians make a confirmatory diagnosis. This review article aims to provide an update on canine anorchia diagnosis based on the poor research studies published in recent years. We have also contributed to the pathogenesis of this disorder using human medicine studies. Finally, the review includes therapeutic hypotheses that can be expanded in future studies.

Efficacy of dexmedetomidine as adjuvant to bupivacaine in femoral-sciatic nerve blocks in dogs undergoing tibial plateau levelling osteotomy (TPLO)

The aim of this randomized, prospective clinical study was to evaluate the efficacy of dexmedetomidine combined with bupivacaine on sciatic and femoral nerve blocks in dogs. Thirty dogs were selected for elective unilateral tibial plateau levelling osteotomy, and each subject was assigned randomly to receive perineural bupivacaine 0.5% (0.1 mL/kg) and intramuscular dexmedetomidine (0.5 μg/kg) in the BDs group, perineural bupivacaine 0.5% (0.1 mL/kg) plus dexmedetomidine (0.5 μg/kg) in the BDloc group, and perineural bupivacaine 0.5% (0.1 mL/kg) plus intramuscular administration of saline solution the in Bupi group. Nerve blocks were guided by electrolocation. The main intraoperative parameters were registered 10 min before the start of surgery (BASE) and during the skin incision (SKIN), the osteotomy (BONE) and the suture (SUTURE). At 2, 4, 6, 8, 10, 15, 20 and 24 h after blocks, the Glasgow Composite Pain scale (GPCs) was used to identify the degree of pain during the postoperative period. Patients with scores ≥5/20 received rescue analgesia and were excluded. Furthermore, heart rate, mean arterial pressure, footstep capacity, reaction to wound touch and femoral and sciatic skin sensitivity were registered. Parametric data were compared at each time point of the study with the one-way ANOVA for repeated measures and Fisher's test for yes/no variables analysis (p < 0.05). No subject required intraoperative rescue analgesia. In BDloc group, the GCPs score was <5/20 for all dogs at all times of the study, and 70% of dogs did not need systemic analgesia. In the Bupi and BDs groups, 100% of subjects achieved a score ≥ 5/20 between 8 and 10 h after the blocks, and 100% of subjects showed femoral and sciatic skin sensitivity and required rescue analgesia within 10 h. Our results showed that the addition of dexmedetomidine as an adjuvant to bupivacaine in SF blocks may prolong the sensory block and ensure sufficient analgesia for up to 24 h in dogs undergoing TPLO surgery.

Tissue sealing versus suture ligation in open canine ovariectomy: Surgical times, intraoperative nociceptive response and frequency of complications

BACKGROUND

In this study, we compared two different techniques currently used for open canine ovariectomy: traditional method utilising absorbable suture and vessel sealing device (ENSEAL^® Ethicon Endo-Surgery, Cincinnati, OH).

OBJECTIVES

The aim of this study was to compare the surgical times, intraoperative nociceptive response and the frequency of intraoperative complications in the canine ovariectomy procedure using these two techniques.

METHODS

Forty bitches were randomly divided into two groups. The Control Group (C) will use a classic open surgery approach using ligatures with absorbable suture and ovarian resection with a scalpel blade. In the Group E, resection of ovarian structures was performed with ENSEAL^® tissue sealer device. For each dog the surgical times, the intraoperative nociceptive response (measuring heart rate, respiratory rate and non-invasive blood pressure) and the intraoperative complications were measured to compare the effectiveness of the two techniques.

RESULTS

The results of this study showed that the procedures performed using ENSEAL^® were faster than the traditional techniques using surgical suture. Instead, the results regarding the nociception and the safety of the two procedures are similar.

CONCLUSIONS

The present study shows that the use of ENSEAL^® significantly shortened the surgical time. Meanwhile, its use was found to be similarly safe and efficient in terms of intra-operative nociception, as the classical techniques with absorbable suture. Canine ovariectomy using ENSEAL^® device is more practical and faster than the traditional technique; the routine use of this device is considered a useful alternative for the canine neutering.

Local and Regional Anaesthetic Techniques in Canine Ovariectomy: A Review of the Literature and Technique Description

Simple Summary

This review stems from a general trend of increasing attention toward surgical nociception in the veterinary field. Indeed, veterinarian anaesthetists are becoming more careful in relieving perioperative nociception, improving the analgesic protocols and therefore optimising surgical outcomes. Canine ovariectomy is a common surgical procedure with a moderate level of pain. Therefore, intraoperative analgesia is very important because pain causes various systemic inflammatory effects that slow patient recovery. This review aims to collect all recent information about local and regional anaesthetic/analgesic techniques in a review of the literature describing the technique utilised. In addition, the present review aims to provide practical guidelines for veterinary practitioners to improve the anaesthetic techniques in canine neutering through an overview of the available literature. In fact, the methods described, considering the relative simplicity of execution, can be used in daily routine practice.

Abstract

Canine ovariectomy is an elective surgery with a moderate level of pain. Despite its relative simplicity, it requires surgical pain management. This study aimed to collect all recent information about local and regional anaesthetic/analgesic techniques in a review of the literature describing the technique utilised. The various procedures described in this review use local anaesthetics to improve analgesia in the routine systemic anaesthetic protocol. The approach described in this paper is called multimodal analgesia and is used in addition to the normal standard anaesthetic protocol. These techniques proved effective in minimising responses to the surgical stimulus and ensured adequate intraoperative and postoperative analgesia. The routine use of multimodal analgesia is considered a useful alternative for pain management in canine ovariectomy, in that it minimises patient suffering, improves the recovery of rescue analgesia, increases drug savings, and improves animal outcomes. In addition, the use of these local and regional techniques ensures satisfactory analgesic coverage that lasts for the first hours postoperatively.

Laparoscopic versus Open Ovariectomy in Bitches: Changes in Cardiorespiratory Values, Blood Parameters, and Sevoflurane Requirements Associated with the Surgical Technique

The aim of this study was to examine the cardiorespiratory and blood changes associated with pneumoperitoneum (PNP) in laparoscopic ovariectomy (LAP Ove), as well as sevoflurane requirements, comparing them to those determined in open surgery (LPT Ove). The study was performed in 16 bitches submitted to LAP or LPT Ove. The cardiorespiratory and end-tidal sevoflurane concentration values were recorded as follows: at the beginning of surgery (T1), after the right ovary resection (T2), after the left ovary resection (T3), and after surgical closure (T4). Blood samples were taken before and after PNP. Among the cardiorespiratory parameters, no differences were observed in the values of end-tidal CO2, minute volume, and heart rate. In the LAP Ove group, a significant increase in inspiratory pressures and a decreased compliance were identified at T2 and T3. Significant higher arterial pressure values were observed in both groups at T2 and T3, with this increase especially marked at T2 in the LPT Ove group. Sevoflurane requirements were significantly higher in the LPT group during ovarian resection. Finally, in terms of the hematochemical parameters, statistical differences were recorded between pre- and post-operative assessments, but not between both surgical groups. The pathophysiological effects associated with PNP seemed to be transient and well-tolerated by healthy dogs.

Effect of Pinus taeda Hydrolyzed Lignin on Biochemical Profile, Oxidative Status, and Semen Quality of Healthy Dogs

Sub-fertility represents a frequent challenge in canine reproduction. The use of micronutrients and/or additives was investigated as an approach to improve sperm quality, which are the main constraints on reproduction in canine species. Although some information is available about the effect of daily supplementation with substances presenting antioxidant/antioxidative activity on semen quality, this study aimed to observe the effect of a polyphenolic mix of substances derived from hydroxylation of Pinus taeda lignin (PTHL). For the trial, 40 male dogs were involved, 20 received PTHL for 90 days and 20 were left untreated, serving as a control group. Every 30 days, blood and semen samples were collected and analyzed. The biochemical profile of both groups was not affected by treatment and time (p > 0.05). Differently, dogs that received PTHL showed higher blood superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activity (p < 0.01). Moreover, the dietary addition of PTHL can significantly increase the semen volume, concentration, and spermatozoa motility (p < 0.01) in healthy dogs. PTHL supplementation represents a good way to enhance the semen quality of dogs and improve the antioxidant status of animals.

Analgesic comparison between topical irrigation (splash block) versus injection of lidocaine on the ovarian pedicle in canine ovariectomy

Objectives

The aim of this study was to compare the analgesic efficacy of topical irrigation versus injection of lidocaine on the ovarian pedicle to provide analgesia in bitches ovariectomy. In the current study were monitored: increased blood pressure, heart rate and respiratory rate to identify an acute intraoperative nociceptive response. These parameters were registered at six times during the surgical procedure: grasping of the ovary (time 1), dissection of the mesosalpinx (time 2), tightening of the first loop ligature (time 3), tightening of the second loop ligature (time 4), transection of the ovarian pedicle (time 5) and release of the ovary (time 6).

Material and Methods

Forty healthy bitches were randomly assigned in two groups (n = 20) to receive topical irrigation (splash block) of 2% lidocaine (C group) on both ovarian pedicle (2 mg/kg each), or an equal volume of lidocaine was injected at the same sites (R group).

Results

The results of the present study suggest that splash block may provide intraoperative analgesic effects equivalent to injection in the ovarian pedicle in dogs that have undergone ovariectomy. The lidocaine improved surgical analgesia during canine ovariectomy in both groups, and this action is not affected by the inoculation technique.

Clinical significance

Pain management in veterinary patients is a crucial component of appropriate patient care. Therefore, the need for achieving safer anaesthesia for surgical intervention is gaining much attention. Ovariectomy is a common surgical procedure in bitches with medium level of pain. This study concluded that considering its relative simplicity, low cost, and safety, both techniques could be used in daily clinical practice.

The ultrasound-guided funicular block in cats undergoing orchiectomy: ropivacaine injection into the spermatic cord to improve intra and postoperative analgesia

BACKGROUND

The orchiectomy in cats is a common surgical procedure with medium level of pain and for this reason requires intra and postoperative analgesia management. The aim of this study was to compare intra and postoperative pain in two groups of cats undergoing orchiectomy. Sixty healthy cats were randomly assigned in two groups (n = 30) to receive pre surgery ropivacaine hydrochloride (0.2 mL/kg at 0.5%) (R Group) or NaCl 0.9% (C group) into the spermatic cord. The intraoperative evaluation was carried out using the cardiorespiratory stability parameters and eventually administration of rescue analgesia. A rescue analgesia (fentanyl 2 µg/kg) was administered during orchiectomy in case of considerable increase of blood pressure, heart rate or respiratory rate. The postoperative evaluation was been done using scores following a UNESP-Botucatu multimodal scale for 6 h post-surgery.

RESULTS

As result, cats in R group responded better to surgical procedure, maintaining lower postoperative pain scores than C group.

CONCLUSIONS

The ultrasound-guided funicular block used in this study, as already demonstrated in dogs, is a good method to protect the cats from surgical pain and ensure a good level of surgical analgesia.

Cardiopulmonary Effects and Pharmacokinetics of Dexmedetomidine Used as an Adjunctive Analgesic to Regional Anesthesia of the Oral Cavity with Levobupivacaine in Dogs

This study investigated the cardiopulmonary effects and pharmacokinetics of dexmedetomidine (DEX) used as an adjunctive analgesic for regional anesthesia of the oral cavity with levobupivacaine in anesthetized dogs. Forty dogs were randomly assigned to four groups of 10 dogs. All dogs received levobupivacaine (4 blocks) with DEX IO (infraorbital block, n = 10) or IA (inferior alveolar block, n = 10) or placebo (PLC; n = 10) or DEX (n = 10) was injected intravenously (IV) after administration of levobupivacaine. The dose of DEX was always 0.5 µg/kg. Cardiopulmonary parameters were recorded, and blood was drawn for the quantification of DEX in plasma using LC-MS/MS. Heart rate was lower in all LB + DEX groups, while mean arterial pressure (MAP) was higher in the LB + DEX IV and LB + DEX IA groups compared to the LB + PLC IV group. Compared to DEX IV, IO and IA administration resulted in lower MAP up to 2 min after application. Absorption of DEX was faster at IO administration (Cmax and Tmax were 0.47 ± 0.08 ng/mL and 7.22 ± 1.28 min and 0.76 ± 0.09 ng/mL and 7.50 ± 1.63 min for the IO and IA block, respectively). The IA administration resulted in better bioavailability and faster elimination (t1/2 was 63.44 ± 24.15 min and 23.78 ± 3.78 min for the IO and IA block, respectively). Perineural administration of DEX may be preferable because of the less pronounced cardiovascular response compared to IV administration.

Use of 'Aminogam Gel' to fast the wound healing in dogs after the surgical curettage of injured penis

Background

Aminogam gel is used in human patients to accelerate the post‐surgical wound healing process of soft oral tissues (e.g. after teeth extraction or oral laser surgery). For this reason and because of the histological affinity between oral and genital mucosa, Aminogam Gel was applied on the dog's penile mucosa to evaluate wound healing after traumatic lesion.

Objectives

This study aimed to compare conventional therapy (using only oral medications) to topic application of ‘Aminogam Gel’ in order to determine which is better to accelerate the healing process of canine penis injuries.

Methods

For this study, 12 male dogs with an injured penis and traumatic paraphimosis were selected. All patients had traumatic penis injuries due to unsuccessful mating attempts and consequent trauma (continuous licking). The dogs underwent surgical curettage of necrotic areas. The animals were randomly divided into two groups: a control group treated with routine therapy and a group treated with Aminogam Gel as an adjuvant for the scarring process. We assessed wound status and tracked healing using the Bates‐Jensen Wound Assessment Tool.

Results

Dogs treated with Aminogam Gel therapy healed faster than dogs treated with traditional therapy alone.

Discussion

Aminogam Gel is a valid auxiliary drug to accelerate wound healing after penis surgery. This is especially important for breeding dogs, for whom rapid and complete healing of the penis is important for returning to normal reproductive activities.

Use of Contrast-Enhanced Ultrasound of the Testes after Non-Surgical Sterilization of Male Dogs with CaCl2 in Alcohol

Sterilization by intratesticular injection of chemical agents is a non-surgical alternative to neutering male companion animals. We used contrast-enhanced ultrasound (CEUS) to monitor vascular alterations to testes immediately after the intratesticular injection of CaCL2 in alcohol. We evaluated the CEUS features of normal and damaged testes in 20 dogs after the intratesticular injection of CaCl2. The CEUS evaluation was performed at the site of the chemical agent inoculation. In treated testes, qualitative CEUS showed a lower intensity enhancement of the parenchyma than pre-treatment normal testes with a predominantly anechoic pattern and only a few hyperechoic vascular focal spots. Quantitative CEUS showed significantly lower values of time-intensity curve (TIC) parameters, including signal intensity (Peak: 4.72 ± 2.1), regional blood volume (RBV: 134.3 ± 63.7), and regional blood flow (RBF: 4.36 ± 2.18) than normal testes (p < 0.001). Sonographic findings from CEUS showed hypovascularization of the canine testicular parenchyma caused by the hardening agent. This diagnostic technique helps clinicians define testicular vascular alterations achieved by chemical castration more efficiently. Nevertheless, more studies are required to apply this methodology to more subjects with a broader weight range and stray dogs.

Immediate Postoperative Analgesia of Nalbuphine-Ketamine Combination Compared with Ketamine Alone in Xylazine-Sedated Goats Undergoing Left Flank Laparotomy

Goats have been used as animal models in research, and the need for achieving safer anesthesia for research or surgical intervention is gaining much attention. The objective of this study was to evaluate intraoperative effects and the immediate postoperative analgesia of nalbuphine–ketamine regimen in goats. Twenty clinically healthy adult female crossbred goats weighing 14 ± 2 kg were allocated randomly into each of two equally sized groups. All animals were sedated with intramuscular (IM) xylazine (0.07 mg/kg), then anesthesia was intravenously (IV) induced with ketamine alone (10 mg/kg) (XK group), or a combination of nalbuphine (0.5 mg/kg) and ketamine (5 mg/kg) (XNK group). Following induction, left flank laparotomy was performed and then sutured. The quality of anesthesia and immediate postoperative analgesia was evaluated. Immediate postoperative analgesia was assessed up to 5 h after standing, using a modified Unesp–Botucatu acute composite pain scale (USAPS). Serum cortisol, glucose, insulin, and C-reactive protein (CRP) were measured at ½, 1, 2, 4, 6, 12, and 24 h, postoperatively (PO). The USAPS pain scores were significantly lower in the XNK compared to the XK group (p < 0.05). The XNK group exhibited a statistically significant difference in the level of serum cortisol at ½ and 1 h PO (p = 0.018 and 0.045, respectively) compared to the XK group. At 2, 4, 6 h PO, CRP significantly decreased (p = 0.023, 0.040 and 0.005, respectively) in the XNK compared to the XK group. Nalbuphine–ketamine produced an acceptable induction of anesthesia and recovery compared to ketamine. Recovery with nalbuphine–ketamine was faster and better quality. The USAPS pain scores were lower in nalbuphine–ketamine, indicating that this novel combination produces better postoperative pain control than ketamine alone.

Testicular torsions in veterinary medicine

The purpose of this review is to provide a comprehensive comparison of spermatic cord torsion in domestic animals. Spermatic cord torsion leads to occlusion of testicular blood flow resulting in ischemia and tissue hypoxia. Spermatic cord torsion has been reported in all domestic mammals but dogs and horses are overrepresented. Abdominal pain (colic), anorexia, vomiting, lameness, and stiff gait are the most common clinical signs reported. The condition may be asymptomatic in cases of a low degree of spermatic cord torsion. In dogs, spermatic cord torsion is most commonly reported in undescended testes, which in some cases are neoplastic. However, in horses, spermatic cord torsion occurs more commonly in scrotal testes. Surgical treatment for spermatic cord torsion depends upon the degree and duration of torsion. If the affected testis is located within the scrotum and determined to still be viable, detorsion with orchidopexy can be performed. Orchiopexy of the unaffected scrotal testis is also recommended in stallions. If the affected testis cannot be salvaged, unilateral or bilateral orchidectomy is recommended. In all cases of spermatic cord torsion of an undescended testis, orchidectomy is recommended. Veterinarians should be aware of the clinical signs and treatment options for spermatic cord torsion in domestic mammals.

Fentanyl patch versus tramadol for the control of postoperative pain in canine ovariectomy and mastectomy

OBJECTIVES

The purpose of the present study was to evaluate the postoperative analgesic efficacy of fentanyl patches versus subcutaneous tramadol after canine ovariectomy, with and without unilateral mastectomy.

MATERIALS AND METHODS

A total of 40 female dogs were included in the present study, all of which were domesticated, healthy and 4-12 years of age. The animals were divided into four groups (n = 10 per group) based on the surgery and the analgesic protocol used: the TO group only underwent ovariectomy, and received postoperative tramadol; the TM group underwent both ovariectomy and mastectomy, and received postoperative tramadol; the FO group only underwent ovariectomy, and received fentanyl patches; and the FM group underwent both ovariectomy and mastectomy, and received fentanyl patches. Postoperative pain was evaluated every 4 h for 24 h using a numeric analogue scale (NAS) and a modified Glasgow Composite Measure Pain Scale Short Form (CMPS-SF).

RESULTS

The results of the present study showed that patients in all four groups tolerated postoperative surgical stress well. Analysis of variance for repeated measures did not show significant differences in the NAS scores and in Glasgow CMPS-SF between groups in terms of pain scores or rescue analgesia.

CLINICAL SIGNIFICANCE

These results indicated that the analgesic effect of the fentanyl patch was similar to that of subcutaneous (SC) tramadol in female dogs after ovariectomy, with and without unilateral mastectomy, suggesting that the fentanyl patch may represent a valid supplementary tool for the control of postoperative pain in animals after surgery.

The effect of splash block on the need for analgesia in dogs subjected to video-assisted ovariectomy

Objectives

The present study aimed to demonstrate the efficacy of splash block using lidocaine to provide additional analgesia during ovariectomy in bitches. To identify an acute intraoperative nociceptive response, three clinical parameters were used: increased blood pressure, heart rate and respiratory rate.

Material and Methods

Forty healthy bitches were randomly assigned to receive 2% lidocaine (L group) topical application (splash block) on both ovaries (2 mg/kg each), or an equal volume of NaCl 0.9% at the same sites (C group). A fentanyl bolus (2 µg/kg) was administered intraoperatively in response to an increase in blood pressure, heart rate or respiratory rate during surgery (> 30% compared with the pre‐incisional values).

Results

Local lidocaine administration significantly reduced the need for supplementary fentanyl. Dogs in the L group showed greater intraoperative hemodynamic stability and lower surgical pain than those in the C group. In addition to the routine anaesthetic protocol, the local anaesthesia used in the present study was safe and caused no cardiopulmonary suppression. In addition, it significantly reduced the need for mandatory systemic or rescue analgesia.

Clinical Significance

Ovariectomy is a common surgical procedure in bitches. Analgesia during this procedure is important because intraoperative pain can cause negative effects that prevent patient recovery. This study aimed to demonstrate the analgesic efficacy of lidocaine splash block in video‐assisted ovariectomy in dogs. The results showed that splash block improved surgical analgesia during canine laparoscopic ovariectomy. Considering its relative simplicity, low cost, and safety, splash block could be used in daily clinical practice.

Case of Anorchia in a Mixed-Breed Dog

Anorchia is a rare and often poorly understood disorder of sexual development. In the present case report, we used a multidisciplinary approach to diagnose a case of anorchia in a 30-month old dog. The diagnostic process began with gathering the dog medical history followed by a clinical visit with the patient, which included a general wellness examination as well as an examination of the genital system. As suggested in the relevant literature, the dog underwent an ultrasound and then computed tomography (CT) of the genital system, which confirmed the diagnosis of testicular agenesis. Genetic testing confirmed the male XY karyotype. Hormone testing also supported the diagnosis: testosterone and anti-Müllerian hormone levels were below their reference ranges, and luteinizing hormone (LH) was above 1 ng/mL. Following the diagnostic procedures suggested in the relevant literature, the present study confirms anorchia in the dog and describes a case of testicular agenesis in the canine species.