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.     

Pharmacokinetics of combined intraperitoneal and incisional lidocaine in the dog following ovariohysterectomy

Topical application of local anesthetics provides safe analgesia following abdominal surgery in people. Conservative doses have been utilized to avoid toxicity. Toxic effects are proportional to amount of drug administered and the plasma concentration of the drug, allowing predictions of safety following pharmacokinetic studies. The maximum plasma level, the pharmacokinetics and the safety of lidocaine hydrochloride when administered by the combined intraperitoneal (8 mg/kg i.p. with epinephrine 1:400 000) and incisional (2 mg/kg with epinephrine 1:200 000) routes were studied in six mixed breed dogs following ovariohysterectomy. Rapid uptake of lidocaine produced a peak concentration of 1.45 +/- 0.36 microg/mL (mean +/- SD, range 0.80-1.86 microg/mL) by 0.37 +/- 0.26 h (range 0.11-0.81) after administration. The absorption half-life was 0.13 +/- 0.1 h. Plasma concentrations decreased rapidly and the elimination half-life was 1.17 +/- 0.11 h. No signs of toxicity were observed in these dogs in the 18 h following drug administration. The dose studied generated levels of lidocaine well below toxic.     

Comparison of intraperitoneal ropivacaine and bupivacaine for postoperative analgesia in dogs undergoing ovariohysterectomy

Objective

To compare postoperative analgesia following either intraperitoneal (IP) ropivacaine or bupivacaine in dogs undergoing ovariohysterectomy (OVH) in the scope of multimodal analgesia.

Addition of magnesium sulfate to intraperitoneal ropivacaine for perioperative analgesia in canine ovariohysterectomy

Magnesium may be used as an adjunctive analgesic for perioperative pain management because of its antinociceptive properties. This study investigated the analgesic efficacy of intraperitoneal ropivacaine combined with magnesium sulfate in canine ovariohysterectomy. Forty-five dogs sedated with acepromazine/meperidine and anesthetized with propofol/isoflurane were randomly distributed into three treatments, administered intraperitoneally (n = 15 per group): saline solution (group S), 0.25% ropivacaine (3 mg/kg) alone (group R), or in combination with magnesium sulfate (20 mg/kg, group R-Mg). Intravenous fentanyl was given to control cardiovascular responses to surgical stimulation. Postoperative pain was assessed using an Interactive Visual Analog Scale (IVAS), the short form of the Glasgow Composite Pain Scale, and mechanical nociceptive thresholds. Morphine/meloxicam was administered as rescue analgesia. Intraoperatively, the R-Mg group required less fentanyl (p = .02) and exhibited higher incidence of hypotension (systolic arterial pressure <90 mm Hg, p = .006) compared with the S group. Lower IVAS pain scores were recorded during the first hour in the R-Mg group than the other groups (p = .007–.045). Postoperative rescue analgesia did not differ between groups. Intraperitoneal magnesium sulfate administration, in spite of decreasing intraoperative opioid requirements, increased the incidence of hypotension with minimal evidence of postoperative analgesic benefits.     

Comparison of epidural and systemic tramadol for analgesia following ovariohysterectomy

The objective of the study was to compare epidural and systemic tramadol for postoperative analgesia in bitches undergoing ovariohysterectomy. Twenty animals, randomly divided into two groups, received either epidural (EPI) or intramuscular (IM) tramadol (2 mg/kg) 30 min before anesthetic induction. Analgesia, sedation, cardiorespiratory parameters, end-tidal isoflurane, blood catecholamines and cortisol, and arterial blood gases were measured at different time points up to 24 hr after agent administration. There were no differences between the two groups regarding cardiorespiratory parameters, end-tidal isoflurane, and pain scores. Two dogs in the IM and one in the EPI group required supplemental analgesia. Cortisol was increased (P<0.05) at 120 min (3.59 μg/dL and 3.27μg/dL in the IM and EPI groups, respectively) and 240 min (2.45 μg/dL and 2.54μg/dL in the IM and EPI groups, respectively) compared to baseline. Norepinephrine was also increased (P<0.05) at 120 min in both groups compared to baseline values. Epinephrine values were higher (P<0.05) in the IM group compared with the EPI group at 50 min, 120 min, and 1,440 min after tramadol administration. Epidural tramadol is a safe analgesic, but does not appear to have improved analgesic effects compared with IM administration.     

Effect of intraperitoneal or incisional bupivacaine on pain and the analgesic requirement after ovariohysterectomy in dogs

ObjectiveTo compare the effect of intraperitoneal (IP) or incisional (INC) bupivacaine on pain and the analgesic requirement after ovariohysterectomy in dogs.Study designProspective, randomized clinical study.AnimalsThirty female dogs undergoing ovariohysterectomy (OHE).MethodsDogs admitted for elective OHE were anesthetized with acepromazine, butorphanol, thiopental and halothane. Animals were randomly assigned to one of three groups (n = 10 per group). The treatments consisted of preincisional infiltration with saline solution (NaCl 0.9%) or bupivacaine with epinephrine and/or IP administration of the same solutions, as follows: INC and IP 0.9% NaCl (control group); INC 0.9% NaCl and IP bupivacaine (5 mg kg^?1, IP group); INC bupivacaine (1 mg kg^?1) and IP 0.9% NaCl (INC group). Postoperative pain was evaluated by a blinded observer for 24 hours after extubation by means of a visual analog scale (VAS) and a numeric rating scale (NRS). Rescue analgesia (morphine, 0.5 mg kg^?1, IM) was administered if the VAS was >5/10 or the NRS >10/29.ResultsAt 1 hour after anesthesia, VAS pain scores were [medians (interquartile range)]: 6.4 (3.1–7.9), 0.3 (0.0–2.6) and 0.0 (0.0–7.0) in control, IP and INC groups, respectively. VAS pain scores were lower in the IP compared to the control group. Over the first 24 hours, rescue analgesia was administered to 7/10, 5/10 and 3/10 dogs of the control, INC and IP groups, respectively. Total number of dogs given rescue analgesia over the first 24 hours did not differ significantly among groups.Conclusions and clinical relevanceIntraperitoneal bupivacaine resulted in lower pain scores during the first hour of the postoperative period and there was a trend towards a decreased need for rescue analgesia after OHE in dogs.     

Postoperative urinary retention in a dog following morphine with bupivacaine epidural analgesia.

Urinary retention, overflow incontinence, and subsequent detrusor atony were observed following surgery in which a morphine with bupivacaine epidural injection was used for perioperative analgesia. The premise that the urinary retention may have been due to the effects of the morphine component of the epidural is discussed, along with other possible causes.     

Epidural anesthesia and postoperatory analgesia with alpha-2 adrenergic agonists and lidocaine for ovariohysterectomy in bitches

The aim of this study was to determine the viability and cardiorespiratory effects of the association of epidural alpha-2 adrenergic agonists and lidocaine for ovariohysterectomy (OH) in bitches. Forty-two bitches were spayed under epidural anesthesia with 2.5 mg/kg body weight (BW) of 1% lidocaine with adrenaline (CON) or in association with 0.25 mg/kg BW of xylazine (XYL), 10 μg/kg BW of romifidine (ROM), 30 μg/kg BW of detomidine (DET), 2 μg/kg BW of dexmedetomidine (DEX), or 5 μg/kg BW of clonidine (CLO). Heart rate (HR), respiratory rate (f_R) and arterial pressures were monitored immediately before and every 10 min after the epidural procedure. Blood gas and pH analysis were done before, and at 30 and 60 min after the epidural procedure. Animals were submitted to isoflurane anesthesia if they presented a slightest sign of discomfort during the procedure. Time of sensory epidural block and postoperative analgesia were evaluated. All animals in CON and DEX, 5 animals in ROM and CLO, 4 animals in XYL, and 3 in DET required supplementary isoflurane. All groups, except CLO, showed a decrease in HR. There was an increase in arterial pressures in all groups. Postoperative analgesia lasted the longest in XYL. None of the protocols were totally efficient to perform the complete procedure of OH; however, xylazine provided longer postoperative analgesia than the others.     

Comparison of oral and subcutaneous administration of buprenorphine and meloxicam for preemptive analgesia in cats undergoing ovariohysterectomy

OBJECTIVE: To compare the effectiveness of preoperative PO and SC administration of buprenorphine and meloxicam for prevention of postoperative pain-associated behaviors in cats undergoing ovariohysterectomy. DESIGN: Randomized controlled study. ANIMALS: 51 female cats (4 to 60 months old; weight range, 1.41 to 4.73 kg [3.1 to 10.4 lb]). PROCEDURE: Cats received 1 of 5 treatments at the time of anesthetic induction: buprenorphine PO (0.01 mg/kg [0.0045 mg/lb]; n = 10), buprenorphine SC (0.01 mg/kg; 10), meloxicam SC (0.3 mg/kg 10.14 mg/lb]; 10), meloxicam PO (0.3 mg/kg; 10), or 0.3 mL of sterile saline (0.9% NaCI) solution SC (control group; 11). Sedation scores and visual analog scale and interactive visual analog scale (IVAS) pain-associated behavior scores were assigned to each cat 2 hours before and at intervals until 20 hours after surgery. RESULTS: Cats receiving meloxicam PO or SC had significantly lower IVAS scores (2.91 and 2.02, respectively), compared with IVAS scores for cats receiving buprenorphine PO (755). Pain-associated behavior scores for cats administered buprenorphine or meloxicam PO or SC preoperatively did not differ significantly from control group scores. Rescue analgesia was not required by any of the cats receiving meloxicam, whereas 3 of 10 cats receiving buprenorphine PO, 2 of 10 cats receiving buprenorphine SC, and 1 of 11 cats receiving the control treatment required rescue analgesia. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of pain-associated behavior scores, cats receiving meloxicam PO or SC before ovariohysterectomy appeared to have less pain after surgery than those receiving buprenorphine PO preoperatively.     

A comparison of four methods of analgesia in cats following ovariohysterectomy

OBJECTIVE: To evaluate the effectiveness of preoperative administration of oral carprofen, subcutaneous ketoprofen, and local nerve block with bupivacaine in preventing postoperative pain-associated behavior in cats after ovariohysterectomy. ANIMALS: Fifty-two female intact cats. Materials and methods Cats received butorphanol (0.44 mg kg(-1) IM), carprofen (2.2 mg kg(-1) PO), ketoprofen (2.2 mg kg(-1) SQ), or bupivacaine infiltration block (1.1 mg kg(-1) SQ) before surgery. Cortisol and drug concentrations and visual analog scale (VAS) and interactive visual analog scale (IVAS) pain-associated behavior scores were measured 2 hours before and 0, 1, 2, 4, 8, 12, and 24 hours after ovariohysterectomy. RESULTS: Cats receiving butorphanol had significantly increased IVAS scores 2 hours after surgery compared with baseline measurements. Cats receiving carprofen, ketoprofen, and bupivacaine had significant increases from baseline in VAS and IVAS scores 1 and 2 hours after surgery. VAS and IVAS scores for cats receiving bupivacaine were significantly greater 1 and 2 hours after surgery than for cats that received butorphanol. Cats receiving carprofen had significant increases in cortisol 1 hour after surgery and significant decreases 24 hours after surgery compared with baseline measurements. CONCLUSIONS AND CLINICAL RELEVANCE: Preoperative carprofen and ketoprofen have effects on pain-associated behavior similar to butorphanol in cats undergoing ovariohysterectomy. Cats receiving bupivacaine blocks may require additional analgesics immediately after surgery.     

Sprayed intraperitoneal bupivacaine reduces early postoperative pain behavior and biochemical stress response after laparoscopic ovariohysterectomy in dogs

This study investigated the use of sprayed intraperitoneal bupivacaine to relieve postoperative pain behavior and biochemical stress response after laparoscopic ovariohysterectomy (LOVH) in dogs. Sixteen sexually intact female dogs were randomly assigned to two groups. The sprayed intraperitoneal bupivacaine (SIB) group received 4.4 mg/kg of sprayed intraperitoneal bupivacaine diluted to 0.25% with an equivalent volume of saline after pneumoperitoneum. The control group received 1.76 mL/kg of saline in a similar fashion. Both groups received preoperative periportal 5% bupivacaine (1 mL) before incision. Postoperative pain was measured using the short form of the Glasgow composite measures pain scale (CMPS-SF, 0-24). Serum cortisol and glucose concentrations were measured preoperatively and 0.5, 1, 2, 4, 6, 12, and 24h postoperatively. The SIB group had significantly lower CMPS-SF compared to the control group 1, 2, 4, 6, and 12h after the operation. Cortisol concentrations were significantly increased from preoperative concentrations in the control group at 0.5, 1, 2, and 4h post operation and at 0.5 and 1h post operation in the SIB group. No significant differences were seen in serum glucose within each group. This report suggests that the use of sprayed intraperitoneal bupivacaine can be used as part of a multimodal approach for pain management after LOVH in dogs.     

The development of multiple cutaneous inverted papilloma following ovariohysterectomy in a dog

Abstract

CASE HISTORY: Ovariohysterectomy was performed on an adult Cavalier King Charles Spaniel. The skin that had been clipped for surgery was noticed to be erythematous 8 days later.

CLINICAL AND PATHOLOGICAL FINDINGS: Poorly defined patches containing multiple papules were visible bilaterally within the clipped skin. These became larger over the following 2 weeks, and samples were collected for histology. Seven days later, the lesions were multiple raised masses, up to 5 cm in diameter. Histology revealed numerous cup-shaped epidermal proliferations extending into the dermis. The presence of keratinocytes with increased quantities of blue-grey cytoplasm, and koilocytosis suggested papillomavirul infection; Canis familiaris papillomavirus (CfPV-2) DNA was amplified from two separate samples. Complete regression was observed 8 weeks after the lesions had been initially observed.

DIAGNOSIS: Multiple inverted papilloma confined to skin that had been clipped for surgery.

CLINICAL RELEVANCE: This is the first time that the development of canine cutaneous papillomas has been associated with surgery. The nature of the association between surgery and development of the papillomas is uncertain. However, it is possible that damage to superficial skin could promote the formation of papillomas. This is the first identification of CfPV-2 in New Zealand.     

Epidural anesthesia with bupivacaine, bupivacaine and fentanyl, or bupivacaine and sufentanil during intravenous administration of propofol for ovariohysterectomy in dogs

OBJECTIVE: To compare cardiovascular and systemic effects and analgesia during the postoperative period of epidural anesthesia performed with bupivacaine alone or with fentanyl or sufentanil in bitches maintained at a light plane of anesthesia with continuous infusion of propofol. STUDY DESIGN: Prospective randomized masked clinical trial. ANIMALS: 30 female dogs of various breeds. PROCEDURES: Dogs were allocated into 3 groups of 10 each. One group received fentanyl (2 microg/kg [0.91 microg/lb]) and bupivacaine (1 mg/kg [0.45 mg/lb]), 1 group received sufentanil (1 microg/kg) and bupivacaine (1 mg/kg), and 1 group received bupivacaine (1 mg/kg). All dogs received acepromazine (0.1 mg/kg [0.045 mg/lb]) and continuous infusion of propofol for sedation. The agents were administered into the lumbosacral space and diluted in saline (0.9% NaCl) solution to a total volume of 0.36 mL/kg (0.164 mL/lb). Cardiac and respiratory rates, arterial blood pressures, pH, and blood gases were evaluated. Analgesia, sedation level, serum cortisol concentrations, and plasma catecholamine concentrations were measured regularly for 6 hours. RESULTS: No important changes in cardiovascular, respiratory, or sedation variables were observed. Degree of analgesia in the postoperative period was higher in the sufentanil group, although use of fentanyl and bupivacaine also resulted in a sufficient level of analgesia. CONCLUSIONS AND CLINICAL RELEVANCE: Use of the 3 anesthetic techniques permitted ovariohysterectomy with sufficient analgesia and acceptable neuroendocrine modulation of pain with minimal adverse effects.     

Comparison between meloxicam and carprofen for postoperative analgesia after feline ovariohysterectomy

Eighty female cats presented for ovariohysterectomy were randomly allocated to one of two treatment groups in this assessor-blinded trial. After pre-anaesthetic assessment, the cats were premedicated with acepromazine (0.1 mg/kg). Anaesthesia was induced with thiopentone and maintained with halothane in oxygen. Forty cats received carprofen (4 mg/kg subcutaneously) and 40 received meloxicam (0.3 mg/kg subcutaneously) after anaesthetic induction. Following routine flank ovariohysterectomy the cats were assessed using visual analogue scale scores for pain and sedation over a 20-hour study period. Blood samples were taken before sedation and at 20 hours for serum biochemistry (urea, creatinine, alanine aminotransferase and aspartate aminotransferase). There were no significant differences between the groups for pain and sedation scores. Serum biochemistry values were similar between the groups, with some differences within groups between the pre-sedation and 20-hour values. One cat in the carprofen group and two cats in the meloxicam group required rescue analgesia with intramuscular morphine (0.2 mg/kg).     

Comparison of xylazine and lidocaine effects for analgesia and cardiopulmonary functions following lumbosacral epidural injection in goats

The present study was carried out in order to compare the effects of xylazine and lidocaine on analgesia and cardiopulmonary parameters following epidural injection in goats. Twelve healthy Small East African goats of both sexes (mean +/- SD; 15.6 +/- 1.9 kg body weight) were used. The goats were randomly assigned to two groups of five and seven animals. The first group (n = 5) was given 2% lidocaine-HCl at 4400 micrograms/kg body weight. The second group (n = 7) was administered 2% xylazine-HCl at 150 micrograms/kg body weight. All drugs were diluted in 5 ml of sterile water and were injected epidurally through the lumbosacral interspace with the injection taking over 20 s. Both drugs induced analgesia within 5 min. Signs of sedation, cardiopulmonary changes and lateral recumbency developed within 5-7 min after administration of epidural xylazine. Tail flaccidity and hind limb paralysis developed 3 min after epidural administration of lidocaine. The time from recumbency to regaining normal stance was 60 and 158 min for xylazine- and lidocaine-treated animals respectively. Xylazine induced adequate analgesia of the flank and perineum, which extended to the head and forelimbs. In contrast, lidocaine induced adequate bilateral flank and perineal analgesia extending up to the third thoracic vertebra. For both drugs, analgesia of the flank and perineum persisted for the entire 180-min observational period. Epidural injection of xylazine and lidocaine caused variable depression effects on the cardiopulmonary values but was not so low as to cause concern. It is concluded that lumbosacral epidural injection of xylazine at 150 micrograms/kg body weight in 5 ml of water for injection offers the most desirable sedation and analgesia of the flank and perineum. The longer duration of analgesia may be useful for postoperative analgesia and relief of continuous straining in goats.     

Comparison of lidocaine, lidocaine/epinephrine or bupivacaine for thoracolumbar paravertebral anaesthesia in fat-tailed sheep

ObjectiveTo evaluate the speed of onset and duration of loss of sensation in the flank following paravertebral administration of lidocaine (with or without epinephrine) or bupivacaine.Study designBlinded, randomized experimental study.AnimalsNine healthy fat-tailed male lambs (mean weight ± SD, 22.9 ± 3 kg). Each animal was used twice.MethodsAnimals were allocated randomly to receive two of three treatments: lidocaine 2% (LID, n = 6), lidocaine with epinephrine 5 μg mL^?1 (LIDEP, n = 6) or bupivacaine 0.5% (BUP, n = 6). The sheep received a total volume of 9 mL (3 mL for each paravertebral nerve) of anaesthetic. Onset and duration of loss of sensation on the flank were evaluated using nociceptive stimuli (superficial and deep pin-prick and clamping with a haemostat). Values for heart (HR) and respiratory (f_R) rates, rectal and skin temperatures were recorded before and at predetermined intervals after paravertebral injection. Parameters were compared using anova followed by Duncan’s test where relevant.ResultsMean ± SD times to onset of loss of flank sensation following paravertebral administration of LID, LIDEP or BUP were 1.8 ± 1.2, 2.0 ± 0.9 and 3.6 ± 1.3 minutes, respectively. Durations of action in minutes were 65 ± 18, 95 ± 46 and 303 ± 98, respectively. Onset and duration of effects after BUP treatment were significantly longer than after LID or LIDEP (p < 0.05), but did not differ significantly between LID and LIDEP. No clinical signs of local anaesthetic toxicity were noticed and HR and f_R remained stable with all protocols.Conclusions and clinical relevanceParavertebral administration of bupivacaine produces a longer duration of anaesthesia when compared to lidocaine with or without epinephrine and is indicated when prolonged flank surgery is to be performed.