Comparative study of epidural xylazine or clonidine in horses

OBJECTIVE: To evaluate the cardiorespiratory and behavioural effects of epidural xylazine (XYL) or clonidine (CLO) in horses. STUDY DESIGN: Blinded, randomized experimental study. ANIMALS: Twelve healthy Arabian yearling horses weighing 117-204 kg were randomly allocated into two groups: XYL (n = 6) and CLO (n = 6). METHODS: An epidural catheter was inserted and a facial arterial catheter was placed and the next day the horses were restrained in stocks. Baseline values for heart (HR) and respiratory (RR) rates, arterial pressure and behavioural responses were evaluated before (T0) and 10, 20, 30, 45, 60, 90 and 120 minutes after epidural injection (T10-T120). The horses received 0.2 mg kg(-1) of XYL or 5 microg kg(-1) CLO; adjusted to (3.4 + (body weight in kg x 0.013) mL with saline. Data were analysed by the Kolmogorov-Smirnov test, one-way anova with repeated measures, and one-way anova followed by a Student-Newman-Keuls test or Fisher's exact test, as necessary. Significance was set at p < or = 0.05. RESULTS: Sedation and ataxia were seen at T10, persisting until T120 in four and three horses, respectively, in XYL and all horses in CLO respectively. Two XYL and one CLO horses became recumbent at T45 and T25 respectively. Penile prolapse occurred in four of five males at T30 and T45, in the XYL and CLO groups, respectively, resolving by T120. Tail relaxation was present from T10 to T120 in all horses in XYL and in four horses in CLO. Head drop was observed from T20 to T60 and from T10 to T120 in XYL and CLO respectively. Respiratory rate decreased significantly only at T45 in the CLO group. Heart rate and arterial blood pressure remained stable. CONCLUSIONS AND CLINICAL RELEVANCE: Epidural CLO and XYL produce similar cardiorespiratory and behavioural changes but neither would be safe to use clinically at the doses used in this study.     

Evaluation of electrical nerve stimulation for epidural catheter positioning in the dog

ObjectiveTo evaluate the accuracy of epidural catheter placement at different levels of the spinal cord guided solely by electrical nerve stimulation and resultant segmental muscle contraction.Study designProspective, experiment.AnimalsSix male and two female Beagles, age (1 ± 0.17 years) and weight (12.9 ± 1.1 kg).MethodsAnimals were anesthetized with propofol and maintained with isoflurane. An insulated epidural needle was used to reach the lumbosacral epidural space. A Tsui epidural catheter was inserted and connected to a nerve stimulator (1.0 mA, 0.1 ms, 2 Hz) to assess positioning of the tip at specific spinal cord segments. The catheter was advanced to three different levels of the spinal cord: lumbar (L2–L5), thoracic (T5–T10) and cervical (C4–C6). Subcutaneous needles were previously placed at these spinal levels and the catheter was advanced to match the needle location, guided only by corresponding muscle contractions. Catheter position was verified by fluoroscopy. If catheter tip and needle were at the same vertebral body a score of zero was assigned. When catheter tip was cranial or caudal to the needle, positive or negative numbers, respectively, corresponding to the number of vertebrae between them, were assigned. The mean and standard deviation of the number of vertebrae between catheter tip and needle were calculated to assess accuracy. Results are given as mean ± SD.ResultsThe catheter position in relation to the needle was within 0.3 ± 2.0 vertebral bodies. Positive predictive values (PPV) were 57%, 83% and 71% for lumbar, thoracic and cervical regions respectively. Overall PPV was 70%. No significant difference in PPV among regions was found.Conclusion and clinical relevancePlacement of an epidural catheter at specific spinal levels using electrical nerve stimulation was feasible without radiographic assistance in dogs. Two vertebral bodies difference from the target site may be clinically acceptable when performing segmental epidural regional anesthesia.     

Evaluation of analgesic and physiologic effects of epidural morphine administered at a thoracic or lumbar level in dogs undergoing thoracotomy

ObjectiveTo evaluate the analgesic and physiological effects of epidural morphine administered at the sixth and seventh lumbar or the fifth and sixth thoracic vertebrae in dogs undergoing thoracotomy.Study designProspective, randomized, blinded trial.AnimalsFourteen mixed-breed dogs, weighing 8.6 ± 1.4 kg.MethodsThe animals received acepromazine (0.1 mg kg^?1) IM and anesthesia was induced with propofol (4 mg kg^?1) IV. The lumbosacral space was punctured and an epidural catheter was inserted up to the region between the sixth and seventh lumbar vertebrae (L, n = 6) or up to the fifth or sixth intercostal space (T, n = 8). The dogs were allowed to recover and after radiographic confirmation of correct catheter position, anesthesia was reinduced with propofol IV and maintained with 1.7% isoflurane. Following stabilization of monitored parameters, animals received morphine (0.1 mg kg^?1) diluted in 0.9% NaCl to a final volume of 0.25 mL kg^?1 via the epidural catheter, and after 40 minutes, thoracotomy was initiated. Heart rate and rhythm, systolic, mean and diastolic arterial pressures, respiratory rate, arterial hemoglobin oxygen saturation, partial pressure of expired CO₂ and body temperature were measured immediately before the epidural administration of morphine (0 minute) and every 10 minutes during the anesthetic period. The Melbourne pain scale and the visual analog scale were used to assess post-operative pain. The evaluation began 3 hours after the epidural administration of morphine and occurred each hour until rescue analgesia.ResultsThere were no important variations in the physiological parameters during the anesthetic period. The post-operative analgesic period differed between the groups, being longer in T (9.9 ± 1.6 hours) compared with L (5.8 ± 0.8 hours).ConclusionsThe use of morphine, at a volume of 0.25 mL kg^?1, administered epidurally over the thoracic vertebrae provided longer lasting analgesia than when deposited over the lumbar vertebrae.Clinical relevanceThe deposition of epidural morphine provided longer lasting analgesia when administered near to the innervation of the injured tissue without increasing side effects.     

FEASIBILITY OF ULTRASOUND‐GUIDED EPIDURAL ACCESS AT THE LUMBO‐SACRAL SPACE IN DOGS

Epidural injections are commonly performed blindly in veterinary medicine. The aims of this study were to describe the lumbosacral ultrasonographic anatomy and to assess the feasibility of an ultrasound‐guided epidural injection technique in dogs. A cross sectional anatomic atlas of the lumbosacral region and ex vivo ultrasound images were obtained in two cadavers to describe the ultrasound anatomy and to identify the landmarks. Sixteen normal weight canine cadavers were used to establish two variations of the technique for direct ultrasound‐guided injection, using spinal needles or epidural catheters. The technique was finally performed in two normal weight cadavers, in two overweight cadavers and in five live dogs with radiographic abnormalities resulting of the lumbosacral spine. Contrast medium was injected and CT was used to assess the success of the injection. The anatomic landmarks to carry out the procedure were the seventh lumbar vertebra, the iliac wings, and the first sacral vertebra. The target for directing the needle was the trapezoid‐shaped echogenic zone between the contiguous articular facets of the lumbosacral vertebral canal visualized in a parasagittal plane. The spinal needle or epidural catheter was inserted in a 45° craniodorsal–caudoventral direction through the subcutaneous tissue and the interarcuate ligament until reaching the epidural space. CT examination confirmed the presence of contrast medium in the epidural space in 25/25 dogs, although a variable contamination of the subarachnoid space was also noted. Findings indicated that this ultrasound‐guided epidural injection technique is feasible for normal weight and overweight dogs, with and without radiographic abnormalities of the spine.     

IMAGING DIAGNOSIS—SPINAL EPIDURAL HEMANGIOSARCOMA IN A DOG

An 8‐year‐old, male Boxer was examined for an acute onset of ambulatory paraparesis. Neurologic examination was consistent with a T3‐L3 myelopathy. Myelography revealed an extradural spinal cord compression in the region of the T10‐T13 vertebrae. On magnetic resonance (MR) imaging, a well‐defined epidural mass lesion was detected. The mass was mildly hyperintense on T1‐weighted, hyperintense on T2‐weighted and STIR images compared to normal spinal cord and enhanced strongly and homogenously. Postmortem examination confirmed a primary epidural hemangiosarcoma. Findings indicated that the MRI characteristics of spinal epidural hemangiosarcoma may mimic other lesions including meningioma and epidural hemorrhages/hematomas of non‐neoplastic etiology.     

Eliminating the effect of epidural fat during dorsolumbar epidural analgesia in cattle

Objective To compare the distribution of new methylene blue (NMB) solution injected into either the subperiosteal space or under the epidural fat at the first and second lumbar vertebral interspace in cattle. Study design Prospective experimental study. Sample population Nine nonpregnant cows. Methods Needles were advanced towards the first interlumbar epidural space using a dorsal mid‐line approach. Upon confirmation of successful penetration of the ligamentum flavum, group 1 received 5 mL of 0.12% NMB in 0.9% saline. In group 2, the needle was slowly advanced a further 7–10 mm to ensure injection under the epidural fat; the same dose was injected. The extent of cranial and caudal migration of dye, as indicated by staining of epidural fat and the dura mater was measured. Results In group 1 (n = 4), NMB solution migrated only between the periosteum and the epidural fat. There was unilateral distribution in two cows. In contrast, there was no difference between left‐ and right‐sided distribution in group 2 (n = 5), and the NMB solution migrated only between epidural fat and the dura mater. Although the dura mater was not penetrated in any animal of group 2, the dorsal roots were slightly stained and the overlying dura mater was heavily stained in these animals. Conclusions and clinical relevance Variation in distribution of local anaesthetic solution can probably be overcome by deeper needle penetration of the epidural fat.     

Analgesic, hemodynamic and respiratory effects of caudal epidurally administered ropivacaine hydrochloride in mares

Objective To determine the analgesic, hemodynamic and respiratory effects, sedation and ataxia in mares of caudal epidural administration of ropivacaine hydrochloride solution. Study design Prospective, single‐dose trial. Animals Ten healthy mares weighing from 475 to 565 kg. Methods Intravascular catheters and an epidural needle were placed after infiltration of the skin and subcutaneous tissues with 2% lidocaine. Ropivacaine (0.5%, 8 or 9 mL) was then injected epidurally at the fifth sacral or sacrococcygeal vertebrae, respectively. Analgesia was determined by lack of sensory perception to electrical stimulation (> 40 milliamps) and absence of response to needle pricks extending from coccyx to S2 dermatomes. Electrocardiogram, heart and respiratory rates, rectal temperature, arterial blood pressure, arterial acid‐base (pH, standard bicarbonate and base excess), gas tensions (PO₂, PCO₂), PCV, oxyhemoglobin and total solids concentrations, and numerical scores of perineal analgesia, sedation (head drop), and ataxia (position of pelvic limbs) were determined before and during a 5‐hour testing period. Analysis of variance (anova ) with repeated measures was used to detect significant (p < 0.05) differences of mean values from baseline. Results Epidurally administered ropivacaine induced variable analgesia extending bilaterally from coccyx to S2 (three mares), coccyx to S3 (four mares), and coccyx to S4 (three mares), with minimal sedation, ataxia, and cardiovascular and respiratory disturbances of mares. Perineal analgesia was attained at 10 ± 4 minutes and lasted for 196 ±42 minutes (mean ± SD). Five mares demonstrated inadequate perineal analgesia, probably attributable to deviation of the spinal needle from the midline. They were successfully blocked with ropivacaine on another occasion. Epidural ropivacaine significantly reduced repiratory rates of mares and did not change other variables from baseline. Conclusions and clinical relevance Ropivacaine (0.5%, 8 mL 500 kg^?1) can be administered caudal epidurally to produce prolonged (> 2.5 hours) bilateral perineal analgesia with minimal sedation, ataxia, and circulatory and respiratory disturbances in standing mares.     

Cranial versus caudal thoracic epidural anesthesia using three volumes of lidocaine in conscious Beagle dogs

Objective

To compare the effects of epidural injection of three volumes of lidocaine injected at the third (T3) or eleventh thoracic vertebra (T11) in conscious dogs to induce thoracic epidural anesthesia (TEA) and to measure the epidural dispersion of iohexol under similar conditions.

Practical tips for modified dorsolumbar epidural anesthesia in cattle

Segmental dorsolumbar epidural anesthesia has been considered difficult to perform. The purpose of this study was to determine whether or not it is difficult for beginners to learn how to do modified dorsolumbar epidural anesthesia of cattle. Thirty cattle were divided into two groups, young (n = 8) and adult (n = 22), according to their age and body weight, and 0.12% new methylene blue (NMB) was injected into the first interlumbar (L1-L2) epidural space by four fifth-year veterinary school students who had never performed this method. After a 1 hour lecture on the modified dorsolumbar epidural anesthesia procedure which included basic anatomy and skills, each student successfully performed the procedure. In the young group, the NMB solution was distributed between the periosteum and the epidural fat (BPF) in one half and between the epidural fat and the dura mater (BFD) in the other half of the cattle. In about 60% (13/22) of the adult group, the NMB solution distributed as BFD type. This study showed that the modified dorsolumbar epidural anesthesia procedure is easy for beginners to perform if they overcome their fear about the deeper insertion of the epidural needle with basic anatomical knowledge and a little experience.     

中国黄牛脑硬膜外异网结构特征观察

采集甘肃省广河县成年黄牛的头部标本，采用管道铸型腐蚀技术，制作了黄牛脑动脉系统整体铸型标本，选取脑硬膜外异网血管铸型开展解剖学研究。结果发现，中国黄牛脑硬膜外异网主要由4部分组成：脑硬膜外前异网、脑硬膜外后异网、前V形扩展部及基一枕动脉丛。供应黄牛脑硬膜外异网的主要动脉有上颌动脉、枕动脉、椎动脉、眼外动脉及髁动脉，同时这些血管也是向脑组织供血的间接来源。研究认为，中国黄牛脑硬膜外异网的体积大小、异网吻合支数目、前V形扩展结构、基枕动脉丛等形态学特性与国外报道的普通牛相似；基枕动脉丛是连通黄牛脑硬膜外异网多条供血管道的枢纽结构，该枢纽将后异网、椎动脉、枕动脉及髁动脉贯通，成为向脑硬膜外异网供血的主要结构保障。     

The use of a nerve stimulation test to confirm sacrococcygeal epidural needle placement in cats

ObjectiveTo determine if a nerve stimulation test (NST) could act as a monitoring technique to confirm sacrococcygeal epidural needle placement in cats.Study designProspective experimental trial in a clinical setting.AnimalsTwenty-four adult cats, scheduled for a therapeutic procedure where epidural anesthesia was indicated.MethodsUnder general anesthesia, an insulated needle was inserted through the S₃-Cd₁ intervertebral space guided by the application of a fixed electrical current (0.7 mA) until a motor response was obtained. The NST was considered positive when the epidural nerve stimulation produced a motor response of the muscles of the tail, whereas it was considered negative when no motor response was evoked. In the NST positive cases, 0.3 mL kg⁻¹ of 0.5% bupivacaine was administrated before needle withdrawal. Ten minutes after injection, epidural blockade was confirmed by the loss of perineal (anal), and pelvic limbs reflexes (patellar and withdrawal).ResultsThe use of a fixed electrical stimulation current of 0.7 mA resulted in correct prediction of sacrococcygeal epidural injection, corroborated by post bupivacaine loss of perineal and pelvic limb reflexes, in 95.8% of the cases.Conclusion and clinical relevanceThis study demonstrates the feasibility of using, in a clinical setting, an electrical stimulation test as an objective and in real-time method to confirm sacrococcygeal epidural needle placement in cats.     

Bupivacaine 0.25% and methylene blue spread with epidural anesthesia in dog

ObjectiveTo evaluate the extent sensory and motor blocks produced by the epidural injection of different volumes of 0.25% bupivacaine (Bu) with methylene blue (MB), in dogs.Study designProspective experimental trial.AnimalsTwenty healthy adult mongrel dogs, weighing 9.9 ± 1.9 kg.MethodsDogs were randomly allocated into one of four groups that received 0.2, 0.4, 0.6 or 0.8 mL kg^?1 of an epidural solution containing 0.25% Bu and MB. Sensory block was evaluated against time by pinching the tail, hind limb interdigital web, toenail bases and the skin over the vertebral dermatomes. Motor block was assessed by ataxia, hind limb weight-bearing ability and by loss of muscle tone of the tail and pelvic limbs. Data were collected at 2, 5, 10, 15 and 30 minutes after the end of epidural injection. After the final time point, dogs were euthanatized and laminectomies were conducted to expose the extent of the dural dye staining.ResultsThe volumes 0.2, 0.4, 0.6 and 0.8 mL kg^?1 of 0.25% Bu and MB blocked a mean of 5, 14.2, 20.2 and 21 dermatomes, respectively. The extent of the senory block increased up to a volume of 0.6 mL kg^?1. Motor block was longer-lasting and more intense than sensory block. Complete dyeing of the spinal cord with MB was achieved in some dogs at 0.4 mL kg^?1 and all dogs at 0.6 mL kg^?1.ConclusionsThe volume of anesthetic injected into the epidural space plays an important role in the quality of the epidural anesthesia. At 0.25%, bupivacaine provided an efficient sensory block at 0.6 mL kg^?1.Clinical relevanceRelatively high volumes (0.6 mL kg^?1) of 0.25%, BU and MB were needed to produce an effective sensory and motor block caudal to the umbilicus, but all spinal cord segments were reached by MB at this dose.     

Cardiovascular effects following epidural injection of romifidine in isoflurane‐anaesthetized dogs

ObjectiveTo investigate the cardiovascular effects of epidural romifidine in isoflurane-anaesthetized dogs.Study designProspective, randomized, blinded experiment.AnimalsA total of six healthy adult female Beagles aged 1.25 ± 0.08 years and weighing 12.46 ± 1.48 (10.25–14.50) kg.MethodsAnaesthesia was induced with propofol (6–9 mg kg^?1) and maintained with 1.8–1.9% end-tidal isoflurane in oxygen. End-tidal CO₂ was kept between 35 and 45 mmHg (4.7–6.0 kPa) using intermittent positive pressure ventilation. Heart rate (HR), arterial blood pressure and cardiac output (CO) were monitored. Cardiac output was determined using a LiDCO monitor and the derived parameters were calculated. After baseline measurements, either 10 μg kg^?1 romifidine or saline (total volume 1 mL 4.5 kg^?1) was injected into the lumbosacral epidural space. Data were recorded for 1 hour after epidural injection. A minimum of 1 week elapsed between treatments.ResultsAfter epidural injection, the overall means (± standard deviation, SD) of HR (95 ± 20 bpm), mean arterial blood pressure (MAP) (81 ± 19 mmHg), CO (1.63 ± 0.66 L minute^?1), cardiac index (CI) (2.97 ± 1.1 L minute^?1 m^?2) and stroke volume index (SI) (1.38 ± 0.21 mL beat^?1 kg^?1) were significantly lower in the romifidine treatment compared with the overall means in the saline treatment [HR (129 ± 24 bpm), MAP (89 ± 17 mmHg), CO (3.35 ± 0.86 L minute^?1), CI (6.17 ± 1.4 L minute^?1 m^?2) and SI (2.21 ± 0.21 mL beat^?1 kg^?1)]. The overall mean of systemic vascular resistance index (SVRI) (7202 ± 2656 dynes seconds cm^?5 m^?2) after epidural romifidine injection was significantly higher than the overall mean of SVRI (3315 ± 1167 dynes seconds cm^?5 m^?2) after epidural saline injection.ConclusionEpidural romifidine in isoflurane-anaesthetized dogs caused significant cardiovascular effects similar to those reportedly produced by systemic romifidine administration.Clinical relevanceSimilar cardiovascular monitoring is required after epidural and systemically administered romifidine. Further studies are required to evaluate the analgesic effects of epidural romifidine.     

What is the evidence? The issue of verifying correct needle position during epidural anaesthesia in dogs

Objectives

To review the methods for verifying the needle position while performing epidural anaesthesia in dogs, and to discuss the advantages, disadvantages, usefulness and reliability of each technique in the experimental and clinical research setting.

A comparison of epidural morphine with low dose bupivacaine versus epidural morphine alone on motor and respiratory function in dogs following splenectomy

ObjectiveTo compare post-operative motor function in dogs that received epidural morphine and low dose bupivacaine versus epidural morphine alone following splenectomy.Study designProspective, randomized study.Animals16 client owned dogs undergoing routine splenectomy.MethodsFollowing splenectomy dogs were randomly allocated into one of two groups. The morphine group (MOR) was administered epidural morphine (0.1 mg kg^?1); the morphine-bupivacaine group (MORB) received epidural morphine (0.1 mg kg^?1) and low dose bupivacaine [0.25 mg kg^?1, (0.167%)]. The adjusted final volume was 0.15 mL kg^?1 in both groups. Motor function and pain assessment were performed at pre-determined times using a simple numerical motor score and the University of Melbourne Pain Scale (UMPS) respectively. An arterial blood gas was performed 2 hours following epidural administration to check for respiratory compromise. If patients scored >7 on the UMPS or were deemed painful by the observer they were administered hydromorphone intravenously and dose and time of rescue analgesia were recorded.ResultsThere were no statistically significant differences in motor scores, pain scores, amount of rescue analgesia administered or PaCO₂ between treatment groups. No dogs demonstrated respiratory depression or profound motor dysfunction at any time point during the study. 9/16 (56%) dogs did not require rescue analgesia during the first 18 hours following splenectomy.Conclusions and clinical relevanceThe combination of low dose bupivacaine (0.25 mg kg^?1) and morphine (0.1 mg kg^?1) when administered epidurally has little effect on post-operative motor function. This combination can be used without concern of motor paralysis in healthy animals.     

Lignocaine versus bupivacaine for flank anaesthesia using multiport catheters via a caudal epidural approach in cattle

Objective To determine the anaesthetic and systemic effects of dorsolumbar epidural anaesthesia using non-stylet multiport catheters via the caudal approach to administer hypertonic 5% lignocaine (HL) or hypertonic 0.5% bupivacaine (HB) to the flank in standing cattle. Materials and methods Six healthy adult cattle weighing 310–455 kg received 0.2 mg/kg HL or 0.025 mg/kg of HB; control animals received 0.9% saline solution. All drugs were injected into the dorsolumbar epidural space via a caudal approach through a non-stylet multiport catheter. Each animal received each treatment at random. Evaluations of anaesthesia, ataxia, heart rate, arterial pressures, respiratory rate and rectal temperature were obtained at 0 (basal), 5, 10, 15, 30, 45, 60, 75, and 90 min after epidural injection and then at 30-min intervals until loss of anaesthesia. All animals received a standard noxious stimulus and a 4-point scale was used to score the response. A second scale was used to score ataxia. Results The duration of anaesthesia in the upper and lower flanks in cattle was 68 ± 12 and 110 ± 15 min (mean ± SD) after dorsolumbar epidural HL or HB, respectively. Both hypertonic local anaesthetics produced a mild ataxia. The systemic changes were within acceptable limits in these clinically healthy cattle. Conclusion In standing cattle the dorsolumbar epidural injection of hypertonic lignocaine provided faster onset of anaesthesia and fewer cardiovascular effects, but had a shorter duration of anaesthesia than hypertonic bupivacaine.