Effect of phentolamine mesylate on regression of lidocaine–epinephrine epidural anaesthesia in sheep

ObjectiveTo determine the impact of epidural phentolamine on the duration of anaesthesia following epidural injection of lidocaine–epinephrine.Study designBlinded randomized experimental study.AnimalsA group of 12 adult ewes weighing 25.7 ± 2.3 kg and aged 8–9 months.MethodsAll sheep were administered epidural lidocaine (approximately 4 mg kg^–1) and epinephrine (5 μg mL^–1). Of these, six sheep were randomized into three epidural treatments, separated by 1 week, administered 30 minutes after lidocaine–epinephrine: SAL: normal saline, PHE1: phentolamine (1 mg) and PHE2: phentolamine (2 mg). The other six sheep were administered only epidural lidocaine–epinephrine: treatment LIDEP. Each injection was corrected to 5 mL using 0.9% saline. Noxious stimuli were pinpricks with a hypodermic needle and skin pinch with haemostatic forceps to determine the onset and duration of sensory and motor block. Heart rate, noninvasive mean arterial pressure (MAP), respiratory rate and rectal temperature were recorded.ResultsThe onset times were not different among treatments. Duration of sensory block was significantly shorter in SAL (57.5 ± 6.2 minutes), PHE1 (60.7 ± 9.0 minutes) and PHE2 (62.0 ± 6.7 minutes) than in LIDEP (81.7 ± 13.4 minutes) (p < 0.05). Duration of motor blockade was significantly shorter in PHE1 (59.4 ± 5.4 minutes) and PHE2 (54.3 ± 4.0 minutes) than in SAL (84.8 ± 7.0 minutes) and LIDEP (91.5 ± 18.2 minutes) (p < 0.01). MAP in PHE2 was decreased at 10 minutes after administration of phentolamine (p < 0.05).Conclusion and clinical relevanceEpidural administration of 5 mL normal saline after epidural injection of lidocaine–epinephrine reduced the duration of sensory but not motor block in sheep. Epidural administration of phentolamine diluted to the final volume of 5 mL diminished both the duration of sensory and motor block in sheep administered epidural lidocaine–epinephrine.     

Caudal epidural anti‐nociception using lidocaine,bupivacaine or their combination in cows undergoing reproductive procedures

ObjectiveTo evaluate the anti-nociceptive effects of lidocaine, lidocaine-bupivacaine combination or bupivacaine following caudal epidural administration in cows undergoing reproductive procedures.Study designBlinded, randomized experimental study.AnimalsThirty seven healthy Holstein cows (mean weight ± SD, 633 ± 41 kg).MethodsAnimals were allocated randomly to receive one of four treatments: group LID, 0.2 mg kg^?1 lidocaine 2%; group LID-BUP, lidocaine-bupivacaine mixture in a 1:1 volume ratio (0.1 mg kg^?1 and 0.025 mg kg^?1, respectively); group BUP-LD, 0.05 mg kg^?1 bupivacaine 0.5%; and group BUP-HD, 0.06 mg kg^?1 bupivacaine 0.5%. The onset and duration of perineal anti-nociception were determined using superficial and deep pin pricks and the number of cows with complete perineal anti-nociception was recorded. Parameters were compared using anova followed by Duncan's test where relevant.ResultsMean ± SD time to onset of anti-nociception following epidural administration of BUP-LD was significantly longer than for LID-BUP (p < 0.05). The duration (in minutes) of perineal anti-nociception was significantly longer following epidural administration of BUP-HD (247 ± 31) versus LID-BUP (181 ± 33) and LID (127 ± 25) minutes respectively. The % of cows with complete anti-nociception was increased in the group treated with BUP-HD compared to BUP-LD. Severe ataxia or recumbency did not occur in any groups.Conclusions and clinical relevanceEpidurally administered bupivacaine, at a dose of 0.06 mg kg^?1, may provide satisfactory caudal epidural anti-nociception for longer-duration obstetric and surgical procedures.     

Evaluation of lidocaine for brachial plexus blockade in eastern box turtles (Terrapene carolina carolina)

ObjectiveTo evaluate latency and duration of a brachial plexus block technique in eastern box turtles performed with 2% lidocaine at three dose rates.Study designProspective, randomized, blinded crossover study.AnimalsAdult eastern box turtles, two for drug dose evaluation and a group of six (three male, three female) weighing 432 ± 40 g (mean ± standard deviation) for the main study.MethodsAnimals were randomly assigned to four brachial plexus blocks with lidocaine at 5, 10 and 20 mg kg^–1 or 0.9% saline (treatments LID5, LID10, LID20 and CON, respectively), separated by 1 week. Treatment side was randomized and blocks were performed unilaterally. Baseline observations of mentation, heart rate (HR), respiratory rate (f_R), skin temperature and limb response to manipulation or toe pinch were evaluated. Assessments were made every 10 minutes until 1 hour of normal sensory and motor function to the treated thoracic limb, or for a total of 2 hours if no block was evident.ResultsMotor and sensory blockade was achieved in treatments LID10 and LID20 in one turtle, with a latency of 10 minutes and duration of 50 minutes for both doses. Raising of the ipsilateral lower palpebra occurred with both blocks. Turtles administered lidocaine experienced higher HR compared with CON, and HR decreased over time for all individuals. Mentation and f_R were not changed with any lidocaine dose.ConclusionsThe technique was unreliable in producing brachial plexus motor and sensory blockade at the lidocaine doses evaluated in this study. HR was higher in lidocaine-administered turtles but remained within normal limits for the species. No change in mentation or f_R was observed among treatments.Clinical relevanceGeneral anesthesia with systemic analgesia is recommended for surgical procedures involving the chelonian thoracic limb. Further studies are needed to optimize a brachial plexus block in this species.     

Evaluation of intraperitoneal and incisional lidocaine or bupivacaine for analgesia following ovariohysterectomy in the dog

Objective To determine if intraperitoneal (IP) and incisional (SC) lidocaine or bupivacaine provide analgesia following ovariohysterectomy (OHE). Study Design Prospective, randomized, controlled, blinded clinical trial. Animals Thirty dogs presenting to the Veterinary Teaching Hospital for elective OHE. Methods Dogs were pre‐medicated with acepromazine and butorphanol, induced with thiopental and maintained with isoflurane. They were randomly assigned to three groups: 10 received 8.8 mg kg^?1 2% lidocaine with epinephrine IP (LID); 10 received 4.4 mg kg^?1 0.75% bupivacaine IP (BUP); and 10 received 0.9% saline IP (SAL) upon completion of OHE. All IP doses were standardized to 0.88 mL kg^?1 with saline. An additional 2 mL of undiluted solution was placed SC prior to incisional closure. Dogs were scored at 0.5, 1, 2, 3, 6, 8 and 18 hours post‐extubation by one observer. Dogs were evaluated using a visual analogue scale (VAS) for pain and sedation, and a composite pain scale (CPS) that included physiologic and behavioral variables. Dogs were treated with 0.22 mg kg^?1 butorphanol + acepromazine if their VAS (pain) score was >50. Parametric variables were analyzed using Student's t‐test or repeated measures anova as appropriate. Non‐parametric variables were analyzed by χ²‐test. Results There were no significant differences in age, weight, incision length, surgery time, anesthesia time, or total thiopental dose among groups. Peak post‐surgical pain scores for all groups occurred at 0.5 hours and returned to baseline by 18 hours. Dogs in the BUP group had significantly lower VAS‐pain scores overall than dogs in the SAL group. Seven out of 10 dogs in the SAL group, 4/10 in the LID group and 2/10 in the BUP group were treated with supplemental acepromazine and butorphanol. No differences between groups were detected with the CPS. No adverse side‐effects were observed. Conclusions and clinical relevance Our findings support the use of IP and SC bupivacaine for post‐operative analgesia following OHE in the dog.     

Evaluation of anti-nociceptive effect of epidural tramadol, tramadol-lidocaine and lidocaine in goats

Objective To compare the anti‐nociceptive effect of tramadol, a combination of tramadol‐lidocaine, and lidocaine alone when administered in the epidural space. Study design Experimental randomized cross‐over study. Animals Seven healthy male goats, aged 9–11 months, weight 17.5–25.5 kg. Methods Treatments were lidocaine, 2.86 mg kg^?1, tramadol‐lidocaine (1 mg kg^?1 and 2.46 mg kg^?1, respectively) and tramadol (1 mg kg^?1) given into the epidural space. The volume of all treatments was 0.143 mL kg^?1. Nociception was tested by pin prick and by pressure from a haemostat clamp. Times to the onset and duration of anti‐nociception in the perineal region were recorded. Recumbency and ataxia were noted. Rectal temperature, heart rate and respiratory rate were recorded before and at 15 minute intervals for 2 hours after the administration of each treatment. Statistical comparison used one‐way anova with a post hoc Duncan’s test as a post hoc. Significance was taken as p < 0.05. Results Times (mean ± SD) to onset of and duration of loss of sensation, respectively in minutes were; lidocaine, 3 ± 1 and 85 ± 11), tramadol‐lidocaine 4 ± 1 and 140 ± 2; tramadol 12 ± 1 and 235 ± 18. Onset and duration times were significantly longer with tramadol than the other two treatments. Duration was significantly longer with tramadol‐lidocaine than with lidocaine alone. With lidocaine treatment all goats were severely ataxic or recumbent, after tramadol‐lidocaine mildly ataxic, and after tramadol not ataxic. Rectal temperature, heart and respiratory rates did not differ significantly from baseline after any treatment. Conclusions and clinical relevance The combination of tramadol‐lidocaine given by epidural injection produced an anti‐nociceptive effect in the perineal region, which was rapid in onset and had a longer duration of action than lidocaine alone. This combination might prove useful clinically to provide analgesia in goats for long‐duration obstetrical and surgical procedures but surgical stimuli were not investigated in this study.     

Epidural anesthesia in Egyptian water buffalo (Bubalus bubalis): a comparison of lidocaine,xylazine and a combination of lidocaine and xylazine

Objective

To evaluate and compare the analgesic effects of a combination of lidocaine and xylazine to lidocaine or xylazine administered alone for epidural anesthesia in Egyptian water buffalo (Bubalus bubalis).

Comparative analgesic and sedative effects of tramadol,tramadol‐lidocaine and lidocaine for caudal epidural analgesia in donkeys (Equus asinus)

ObjectiveTo compare anti-nociceptive and sedative effects of tramadol, a combination of tramadol-lidocaine, and lidocaine alone for perineal analgesia in donkeys.Study designExperimental ‘blinded’ randomized cross-over study.AnimalsSix healthy adult donkeys.MethodsTreatments were tramadol (TR) (1.0 mg kg⁻¹), tramadol-lidocaine (TRLD) (0.5 and 0.2 mg kg⁻¹ respectively) and lidocaine (LD) (0.4 mg kg⁻¹) given into the epidural space. The volume of all treatments was 0.02 mL kg⁻¹. Nociception was tested at the perineal region by pin prick, followed, if no reaction, by pressure from a haemostat clamp. Times to onset, degree and duration of anti-nociception of the perineal region were recorded. Response was tested immediately after drug administration and at: 2, 5, 10, 15, 30, 45, and 60 minutes post-administration and then at 30 minute intervals thereafter until a response re-occurred. Physiologic data and degree of sedation and ataxia were recorded pre-administration and at intervals for 240 minutes post-administration. Results were analyzed using anova, Kruskal–Wallis tests, and Wilks’ Lambda test as relevant. Significance was taken as p < 0.05.ResultsTimes (minutes, mean ± SD) to onset and duration of anti-nociception, respectively were; TR 13 ± 1.6 and 220 ± 4.6; TRLD 6 ± 0.8 and 180 ± 8.5; LD 4 ± 1.4 and 75 ± 4. Onset and duration times were significantly longer with TR than the other two treatments. TR never produced complete anti-nociception, whereas the TRLD and LD induced complete anti-nociceptive effects. Duration was significantly longer with TRLD than with LD alone. Epidural injections of TR and TRLD induced mild sedation.Conclusions and clinical relevanceEpidural combination of TRLD produced an anti-nociceptive effect in the perineum, which was rapid in onset and had a longer duration of action than LD alone. An epidural single dose of TRLD combination would appear to provide an acceptable analgesic effect in the perineal region of donkeys.     

Evaluation of a regional nerve block with an experimental formulation of encapsulated lidocaine in sheep

ObjectiveTo compare the duration of nociceptive and proprioceptive blockade from an experimental encapsulated lidocaine preparation with that of conventional lidocaine.Study designProspective, blinded, randomly assigned, crossover study.AnimalsA total of six adult Dorset ewes, American Society of Anesthesiologists physical status I or II, weighing 60.4 ± 18.0 kg (mean ± standard deviation).MethodsUnder general anesthesia and guided by electrolocation, the common peroneal nerve was blocked unilaterally with encapsulated lidocaine (0.1 mL kg^–1, 200 mg mL^–1) or conventional lidocaine hydrochloride (0.1 mL kg^–1, 20 mg mL^–1). Each sheep was administered both treatments with an interval of 2 weeks between treatments. Nociception and proprioception were scored (scales of 0–3) before anesthesia, at 0.5, 1, 2, 4, 8, 12, 16, 20 and 24 hours after completion of local anesthetic injection, and every 12 hours thereafter for 9 days. Nociceptive and proprioceptive blockade ended the first time each score reached ‘0’; maximum blockade duration was considered and recorded to be the time point immediately prior to this end point. Significance of differences between treatments for duration of blockade was tested with the Wilcoxon rank-sum test. Effects of time and treatment on nociceptive and proprioceptive blockade were evaluated with mixed-effect models. Significance was set at p < 0.05.ResultsCompared with conventional lidocaine, nociceptive blockade lasted 88 hours longer with encapsulated lidocaine (p = 0.008), and proprioceptive blockade lasted 6 hours longer (p = 0.03). Significant effects of time (p < 0.0001), treatment (p = 0.0435) and treatment1time (p < 0.0001) were observed for nociception. Significant effects of time (p < 0.0001) and treatment1time (p = 0.0058) were observed for proprioception.ConclusionEncapsulated lidocaine produced nociceptive blockade with a duration substantially longer than conventional lidocaine.Clinical relevanceSustained-release encapsulated lidocaine alleviates pain and may minimize systemic analgesic use.     

Onset, duration and efficacy of four methods of local anesthesia of the horn bud in calves

ObjectiveTo determine the onset, duration and efficacy of four local anesthetic methods for the horn bud in calves.Study designCrossover study.AnimalsEight, 2 month-old Holstein Friesian bull calves.MethodsCalves were subjected to one of the four following treatments: 1) cornual nerve block (C), 2) ring block (R), 3) cornual nerve block using a percutaneous jet delivery technique (JET) all using 2% lidocaine with epinephrine (0.01 mg mL^?1), and 4) topical eutectic mixture of local anesthetics (EMLA) cream. A peripheral nerve stimulator was used to assess cutaneous sensation over the horn bud using a graded response. Onset, duration and efficacy of anesthesia were determined.ResultsThe efficacy of the blocks was as follows: C 87.5%, R 100%, JET 37.5%, EMLA 0%. The median onset time and duration of anesthesia for C and R were: 2 (range 0.5–5) and 304 (range 107–512), and 3.25 (range 1–9) and 147 (range 62–299) minutes, respectively. Three of eight JET injections had a median onset and duration of 8 (range 0.5–9) and 132 (range 101–155) minutes, respectively. The duration of the C block was significantly longer than the R block (p= 0.047).Conclusions and clinical relevanceThe relatively rapid onset and long duration of anesthesia with C or R blocks using 2% lidocaine with epinephrine validates their practical use in dehorning calves while jet injection and EMLA cream provided insufficient analgesia to be clinically useful. The efficacy of the C block requires further study.     

RESEARCH PAPER: Segmental dorsolumbar epidural analgesia via the caudal approach using multiple port catheters with ketamine or lidocaine or in combination in cattle

ObjectiveTo determine the analgesic and systemic effects of epidural administration of ketamine, lidocaine or a combination of ketamine/lidocaine in standing cattle.Study designProspective, randomized, experimental trial.AnimalsSix healthy male cattle weighing between 335 and 373 kg.MethodsThe animals received 0.5 mg kg^?1 of ketamine (K), 0.2 mg kg^?1 of 2% lidocaine (L) or 0.25 mg kg^?1 ketamine plus 0.1 mg kg^?1 lidocaine (KL). All the drugs were injected into the dorsolumbar epidural space via a caudal approach through a non‐styletted multiple‐port catheter. Each animal received each treatment at random. Evaluations of analgesia, sedation, ataxia, heart rate, arterial pressure, respiratory rate, skin temperature and rectal temperature were obtained at 0 (basal), 5, 10, 15, 30, 45, 60, 75, 90 minutes after epidural injection, and then at 30‐minute intervals until loss of analgesia occurred. Skin temperature was taken at these intervals up to 60 minutes. All the animals received a standard noxious stimulus; a 4‐point scale was used to score the response. A second scale was used to score ataxia and a third for sedation.ResultsThe duration of analgesia in the upper and lower flanks in cattle was 140 ± 15, 50 ± 14 and 80 ± 22 minutes (mean ± SD) after dorsolumbar epidural KL, K or L, respectively. The cardiovascular changes were within acceptable limits in these clinically healthy cattle.ConclusionsDorsolumbar epidural administration of KL to cattle resulted in longer duration of analgesia of the upper and lower flanks in standing conscious cattle, than the administration of K or L alone.Clinical relevanceFurther research is necessary to determine whether this combination using this technique provides sufficient analgesia for flank surgery in standing cattle.     

Assessment of brachial plexus blockade in chickens by an axillary approach

ObjectiveTo assess the brachial plexus block in chickens by an axillary approach and using a peripheral nerve stimulator.Study designProspective, randomized, double-blinded study.AnimalsSix, 84-week old, female chickens.MethodsMidazolam (1 mg kg⁻¹) and butorphanol (1 mg kg⁻¹) were administered into the pectoralis muscle. Fifteen minutes later, the birds were positioned in lateral recumbency and following palpation of the anatomic landmarks, a catheter was inserted using an axillary approach to the brachial plexus. Lidocaine or bupivacaine (1 mL kg⁻¹) was injected after plexus localization by the nerve stimulator. Sensory function was tested before and after blockade (carpus, radius/ulna, humerus and pectoralis muscle) in the blocked and unblocked wings. The latency to onset of motor and sensory block and the duration of sensory block were recorded. A Friedman nonparametric one-way repeated-measures anova was used to compare scores from baseline values over time and to compare the differences between wings at each time point.ResultsA total of 18 blocks were performed with a success rate of 66.6% (12/18). The latency for motor block was 2.8 ± 1.1 and 3.2 ± 0.4 minutes for lidocaine and bupivacaine, respectively. The latencies for and durations of the sensory block were 6.0 ± 2.5 and 64.0 ± 18.0 and 7.8 ± 5.8 and 91.6 ± 61.7 minutes for lidocaine and bupivacaine, respectively. There was no statistical difference between these times for lidocaine or bupivacaine. Sensory function was not abolished in nonblocked wings.Conclusions and clinical relevanceThe brachial plexus block was an easy technique to perform but had a high failure rate. It might be useful for providing anesthesia or postoperative analgesia of the wing in chickens and exotic avian species that have similar wing anatomy.     

Effects of transdermal lidocaine or lidocaine with prilocaine or tetracaine on mechanical superficial sensation and nociceptive thermal thresholds in horses

Objective

To evaluate the transdermal local anaesthetic effect of lidocaine or lidocaine combined with prilocaine or tetracaine in horses.

Comparison of the cytotoxic effects of bupivacaine, lidocaine, and mepivacaine in equine articular chondrocytes

Objective To compare the chondrotoxicity of bupivacaine, lidocaine, and mepivacaine in equine articular chondrocytes in vitro. Study design Prospective, experimental study. Study material Equine articular chondrocytes. Methods Primary cultured equine chondrocytes were exposed to 0.5% bupivacaine, 2% lidocaine, or 2% mepivacaine for 30 or 60 minutes. After treatment, cell viability was evaluated by trypan blue exclusion and the 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide (MTT) colorimetric assay in a dose dependent manner. Apoptosis and necrosis of chondrocytes were analyzed with the double staining of Hoechst 33258 and propidium iodide using fluorescence microscopy, and the results were confirmed using flow cytometry. Results After 30‐minute exposure, trypan blue exclusion assay revealed that cell viability of 0.5% bupivacaine group was 28.73 ± 8.44%, and those of 2% lidocaine and 2% mepivacaine were 66.85 ± 6.03% and 86.27 ± 2.00%, respectively. The viability of chondrocytes after saline treatment was 95.95 ± 2.75%. The results of MTT assay and fluorescence microscopy had similar tendency with trypan blue assay. Each result showed that bupivacaine was the most toxic of the three local anaesthetics. Mepivacaine was less toxic than lidocaine. The results of the viability test suggest that bupivacaine and lidocaine exhibit a marked chondrotoxicity, and that this is mainly due to necrosis rather than apoptosis. Conclusions and clinical relevance Bupivacaine may induce detrimental chondrotoxicity when administered intra‐articularly, especially in patients with joint disease, and we suggest that it should be used cautiously in equine practice. Mepivacaine may be an alternative to both bupivacaine and lidocaine.     

Intratesticular lidocaine reduces the response to surgical castration in dogs

ObjectiveTo investigate whether intratesticular injection of lidocaine pre-surgery would reduce the intraoperative responses to elective castration in dogs.Study designDouble-blinded, randomized, controlled, prospective clinical study.AnimalsForty-two client-owned dogs weighing 2.2–38.4 kg and aged between 4.5 and 56 months.MethodsGroup L dogs received an intratesticular injection of 2% lidocaine (2 mg kg^?1) and Group S an identical volume of saline prior to surgery. Premedication was with acepromazine and morphine intramuscularly. Anaesthesia was induced with propofol intravenously and maintained with isoflurane vaporized in oxygen. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (f_R), end-tidal isoflurane (Fe′ISO) and carbon dioxide concentrations, oxygen saturation and ECG were monitored during surgery. Fe′ISO was maintained at 1.0 ± 0.1%. Supplemental propofol was given in response to gross movement.ResultsGroup L had significantly lower maximum values for both HR and MAP. Group L displayed significantly smaller increases in HR during exteriorization of the first testis than Group S. There was an overall significant difference in MAP between groups during all surgical events (p = 0.041) and time points (p = 0.002). In univariate analysis, Group L showed significantly less changes in MAP during skin incision, exteriorization of the first testis and clamping of both spermatic cords. Group S reached its highest f_R significantly earlier. Group L (eight dogs) required additional propofol 33 ± 18 minutes after the start of surgery and Group S (seven dogs) at 19 ± 17 minutes; this difference was not statistically significant. Seven dogs in Group L and 12 dogs in Group S required rescue analgesia with morphine (GCMPS-SF score ≥6); this difference was not statistically significant. No adverse effects were reported postoperatively.Conclusions and clinical relevanceBased on this study, the authors recommend the use of intratesticular lidocaine for surgical castration in dogs.     

RESEARCH PAPER: Ultrasound‐guided nerve blocks of the pelvic limb in dogs

ObjectivesTo evaluate the efficacy of ultrasound‐guidance in nerve blockade of the sciatic and saphenous nerves in dogs and to determine if this technique could allow lower anaesthetic doses to be used with predictable onset and duration of effect.Study designProspective randomized (for dose and leg) blinded experimental crossover trial with 10 day washout period.AnimalsSix healthy female Hound dogs aged 12.3 ± 0.5 (mean ± SD) months and weighing 18.7 ± 0.8 (mean ± SD) kg.MethodsAn ultrasound‐guided, perineural injection was used with saline at 0.2 mL kg^?1 (Sal) or bupivacaine 0.5% at 0.05 (low dose; LD), 0.1 (medium dose; MD), or 0.2 (high dose; HD) mL kg^?1, divided 2/3 at the sciatic nerve and 1/3 at the saphenous nerve. Blocks were performed using dexmedetomidine sedation with atipamezole reversal immediately after completion of the injections. Motor/proprioceptive and sensory functions were scored using a 0–8 and a 0–2 scale, respectively. Clinically relevant blocks were defined as a motor score ≥2 and sensory score ≥1. Nonparametric methods were used for statistical analysis.ResultsNo adverse effects were noted. There was a significant difference between the treatments with bupivacaine and the saline control, but not between the three bupivacaine treatments. Success rates of clinically relevant sciatic and saphenous blocks were both 67% (CI 95% 0.22–0.96). Onset and duration of the blocks were variable; 20–160 and 20–540 minutes, respectively.Conclusion and clinical relevanceNone of the bupivacaine doses was significantly superior, though there was a tendency for a better block with the high bupivacaine dose. Either the technique or the doses used need further modification before this method will be useful in clinical practice.     

Clinical evaluation of ketamine and lidocaine intravenous infusions to reduce isoflurane requirements in horses under general anaesthesia

ObjectiveTo compare isoflurane alone or in combination with systemic ketamine and lidocaine for general anaesthesia in horses.Study designProspective, randomized, blinded clinical trial.AnimalsForty horses (ASA I-III) undergoing elective surgery.MethodsHorses were assigned to receive isoflurane anaesthesia alone (ISO) or with ketamine and lidocaine (LKI). After receiving romifidine, diazepam, and ketamine, the isoflurane end-tidal concentration was set at 1.3% and subsequently adjusted by the anaesthetist (unaware of treatments) to maintain a light plane of surgical anaesthesia. Animals in the LKI group received lidocaine (1.5 mg kg⁻¹ over 10 minutes, followed by 40 μg kg⁻¹ minute⁻¹) and ketamine (60 μg kg⁻¹ minute⁻¹), both reduced to 65% of the initial dose after 50 minutes, and stopped 15 minutes before the end of anaesthesia. Standard clinical cardiovascular and respiratory parameters were monitored. Recovery quality was scored from one (very good) to five (very poor). Differences between ISO and LKI groups were analysed with a two-sample t-test for parametric data or a Fischer's exact test for proportions (p < 0.05 for significance). Results are mean ± SD.ResultsHeart rate was lower (p = 0.001) for LKI (29 ± 4) than for ISO (34 ± 6). End-tidal concentrations of isoflurane (ISO: 1.57% ± 0.22; LKI: 0.97% ± 0.33), the number of horses requiring thiopental (ISO: 10; LKI: 2) or dobutamine (ISO:8; LKI:3), and dobutamine infusion rates (ISO:0.26 ± 0.09; LKI:0.18 ± 0.06 μg kg⁻¹ minute⁻¹) were significantly lower in LKI compared to the ISO group (p < 0.001). No other significant differences were found, including recovery scores.Conclusions and clinical relevanceThese results support the use of lidocaine and ketamine to improve anaesthetic and cardiovascular stability during isoflurane anaesthesia lasting up to 2 hours in mechanically ventilated horses, with comparable quality of recovery.     

Evaluation of corneal anaesthesia after the application of topical 0.5% bupivacaine, 2% lidocaine and 0.4% oxybuprocaine in normal horses

ObjectiveTo compare the corneal anaesthetic effect of 0.5% bupivacaine, 2% lidocaine and 0.4% oxybuprocaine on normal equine eyes.Study designProspective, blinded crossover study.AnimalsA group of 10 clinically healthy horses.MethodsCorneal sensitivity was determined in each eye by measuring corneal touch threshold (CTT). The study had three phases. Each subject was randomly given one of the three treatments followed by a 72 hour washout period. Every horse received all treatments. Baseline CTT was recorded prior to anaesthetic instillation (T0) then CTT was measured 5 and 10 minutes after (T1 and T2, respectively), then 20 to 90 minutes (T3 to T10) at 10 minute intervals. CTT data were compared among treatments at each time point using the Friedman test p < 0.05.ResultsMedian (range) baseline CTT was 51.3 (25.0–60.0) mm for bupivacaine, 50.0 (40.0–55.0) mm for oxybuprocaine and 55.0 (30.0–60.0) mm for lidocaine. All treatments caused a significant decrease in CTT at T1. The lowest CTT was observed at T3 with bupivacaine and oxybuprocaine treatments. Median CTTs at this time point were 18.7 (5.0–25.0) mm and 28.7 (25.0–40.0) mm, respectively. The lowest CTT with lidocaine treatment was 28.7 (20.0–50.0) mm at T6 (50 minutes). At T3, CTT was significantly lower with the bupivacaine treatment compared with oxybuprocaine and lidocaine treatments (p < 0.0074). There was no significant difference in CTT values between T1 and T6 for bupivacaine, between T1 and T7 for lidocaine, and between T1 and T8 for oxybuprocaine. Duration of the maximum effect was 45 minutes for the bupivacaine, 55 minutes for the lidocaine and 65 minutes for the oxybuprocaine treatment.Conclusions and clinical relevanceAdministration of a 0.5% injectable solution of bupivacaine or a 2% lidocaine had similar anaesthetic effect to the commonly used oxybuprocaine. Therefore, they might be used as alternatives for corneal anaesthesia.     

Cardiopulmonary and isoflurane‐sparing effects of epidural or intravenous infusion of dexmedetomidine in cats undergoing surgery with epidural lidocaine

ObjectiveTo compare the cardiorespiratory, anesthetic-sparing effects and quality of anesthetic recovery after epidural and constant rate intravenous (IV) infusion of dexmedetomidine (DEX) in cats given a low dose of epidural lidocaine under propofol-isoflurane anesthesia and submitted to elective ovariohysterectomy.Study designRandomized, blinded clinical trial.AnimalsTwenty-one adult female cats (mean body weight: 3.1 ± 0.4 kg).MethodsCats received DEX (4 μg kg^?1, IM). Fifteen minutes later, anesthesia was induced with propofol and maintained with isoflurane. Cats were divided into three groups. In GI cats received epidural lidocaine (1 mg kg^?1, n = 7), in GII cats were given epidural lidocaine (1 mg kg^?1) + DEX (4 μg kg^?1, n = 7), and in GIII cats were given epidural lidocaine (1 mg kg^?1) + IV constant rate infusion (CRI) of DEX (0.25 μg kg^?1 minute^?1, n = 7). Variables evaluated included heart rate (HR), respiratory rate (f_R), systemic arterial pressures, rectal temperature (RT), end-tidal CO₂, end-tidal isoflurane concentration (e′ISO), arterial blood gases, and muscle tone. Anesthetic recovery was compared among groups by evaluation of times to recovery, HR, f_R, RT, and degree of analgesia. A paired t-test was used to evaluate pre-medication variables and blood gases within groups. anova was used to compare parametric data, whereas Friedman test was used to compare muscle relaxation.ResultsEpidural and CRI of DEX reduced HR during anesthesia maintenance. Mean ± SD e′ISO ranged from 0.86 ± 0.28% to 1.91 ± 0.63% in GI, from 0.70 ± 0.12% to 0.97 ± 0.20% in GII, and from 0.69 ± 0.12% to 1.17 ± 0.25% in GIII. Cats in GII and GIII had longer recovery periods than in GI.Conclusions and clinical relevanceEpidural and CRI of DEX significantly decreased isoflurane consumption and resulted in recovery of better quality and longer duration, despite bradycardia, without changes in systemic blood pressure.     

Use of intravenous lidocaine to treat dexmedetomidine-induced bradycardia in sedated and anesthetized dogs

ObjectiveTo assess cardiopulmonary function in sedated and anesthetized dogs administered intravenous (IV) dexmedetomidine and subsequently administered IV lidocaine to treat dexmedetomidine-induced bradycardia.Study designProspective, randomized, crossover experimental trial.AnimalsA total of six purpose-bred female Beagle dogs, weighing 9.1 ± 0.6 kg (mean ± standard deviation).MethodsDogs were randomly assigned to one of three treatments: dexmedetomidine (10 μg kg^–1 IV) administered to conscious (treatments SED1 and SED2) or isoflurane-anesthetized dogs (end-tidal isoflurane concentration 1.19 ± 0.04%; treatment ISO). After 30 minutes, a lidocaine bolus (2 mg kg^–1) IV was administered in treatments SED1 and ISO, followed 20 minutes later by a second bolus (2 mg kg^–1) and a 30 minute lidocaine constant rate infusion (L-CRI) at 50 (SED1) or 100 μg kg^–1 minute^–1 (ISO). In SED2, lidocaine bolus and L-CRI (50 μg kg^–1 minute^–1) were administered 5 minutes after dexmedetomidine. Cardiopulmonary measurements were obtained after dexmedetomidine, after lidocaine bolus, during L-CRI and 30 minutes after discontinuing L-CRI. A mixed linear model was used for comparisons within treatments (p < 0.05).ResultsWhen administered after a bolus of dexmedetomidine, lidocaine bolus and L-CRI significantly increased heart rate and cardiac index, decreased mean blood pressure, systemic vascular resistance index and oxygen extraction ratio, and did not affect stroke volume index in all treatments.Conclusion and clinical relevanceLidocaine was an effective treatment for dexmedetomidine-induced bradycardia in healthy research dogs.     

Clinical comparison of two regimens of lidocaine infusion in horses undergoing laparotomy for colic

ObjectiveTo compare, in horses undergoing laparotomy for colic, the effects of administering or not administering a loading intravenous (IV) bolus of lidocaine prior to its constant rate infusion (CRI). Effects investigated during isoflurane anaesthesia were end-tidal isoflurane concentration (Fe’ISO), cardiovascular function, anaesthetic stability and the quality of recovery.Study designProspective, randomized clinical study.AnimalsThirty-six client-owned horses.MethodsHorses were assigned randomly to receive lidocaine as a CRI (50 μg kg⁻¹ minute⁻¹) either preceded (LB) or not preceded (L) by a loading dose (1.5 mg kg⁻¹ IV over 15 minutes). Lidocaine infusion (LInf) was started (T0) within 20 minutes after induction of general anaesthesia and discontinued approximately 30 minutes before the end of surgery. Anaesthetic depth, Fe’ISO, intra-operative physiological parameters and quality of recovery were assessed or measured. Data were analysed using one-way anova, t-test, Fisher test, Wilcoxon and Kruskal–Wallis tests as appropriate (p < 0.05).ResultsMean ± SD Fe’ISO was 1.21 ± 0.08% in group LB and 1.23 ± 0.06% in group L. Heart rate was significantly higher in group L than in group LB at times T5-T15, T25, T35 and T95. No difference was found between groups in other measured physiological values, nor in any measure taken to improve these parameters. Recovery phase was comparable and satisfactory in all but one full term pregnant horse in group L which fractured a femur during recovery.ConclusionPreloading with a lidocaine bolus prior to a CRI of lidocaine did not influence isoflurane requirements, cardiopulmonary effects (other than a reduction in heart rate at some time points) or recovery compared to no preloading bolus.Clinical relevanceA loading dose of lidocaine prior to CRI does not confer any advantage in horses undergoing laparotomy for colic.