A comparison of extradural and intravenous methadone on intraoperative isoflurane and postoperative analgesia requirements in dogs

Objective To compare the effects of intravenous (IV) and extradural (ED) methadone on end‐tidal isoflurane concentration (Fe ′ISO) and postoperative analgesic requirements in dogs undergoing femoro‐tibial joint surgery. Study Design Randomized, blinded, clinical study. Animals Twenty‐four healthy client‐owned dogs undergoing surgical repair of ruptured cruciate ligaments. Methods Dogs were randomly assigned to two groups of 12 animals and received either ED or IV methadone (0.3 mg kg^?1 diluted with saline to 0.2 mL kg^?1). Pre‐anaesthetic medication was IV acepromazine (0.05 mg kg^?1). Anaesthesia was induced with propofol and maintained initially with an Fe ′ISO of 1.0% delivered in oxygen. Methadone was injected with the dogs in sternal recumbency; the observer was unaware of the administration route. At 10 minutes (stimulation 1) and 20 minutes (stimulation 2) after methadone administration pelvic limb reflexes were tested by digit‐clamping. The time at skin incision (stimulation 3), joint‐capsule incision (stimulation 4), tibial tuberosity drilling (stimulation 5), fabellar suturing (stimulation 6) and extracapsular tightening (stimulation 7) were noted. Changes in heart rate (HR) and respiratory rate and arterial blood pressure associated with surgery were recorded along with the corresponding Fe ′ISO. After 20 minutes of anaesthesia, Fe ′ISO was decreased to the minimum required to maintain stable anaesthesia. Immediately after tracheal extubation, 1, 2, 3 and 6 hours postoperatively and on the morning after surgery, the degree of pain present was assessed using a numerical rating scale. The HR, respiratory rates and blood pressure were also recorded at these times. Serum cortisol and blood glucose concentrations were measured before pre‐anaesthetic medication and at each postoperative pain scoring interval except at 1 and 2 hours. Ketoprofen (2 mg kg^?1), carprofen (4 mg kg^?1) or meloxicam (0.2 mg kg^?1) were given by subcutaneous injection whenever pain scoring indicated moderate discomfort was present. Results Controlled ventilation was required in six dogs which stopped breathing after IV methadone. The median Fe ′ISO at stimulus 5 was 1.0% in the IV and 0.83% in the ED group. At stimulus 6, Fe ′ISO was 1.0% in the IV and 0.8% in the ED group; the difference was statistically significant (p ≤ 0.05). There was no significant difference in the duration of postoperative analgesia associated with administration route. Conclusions Extradural methadone significantly reduces the isoflurane requirement compared with IV methadone during femoro‐tibial joint surgery in dogs. Clinical relevance Extradural methadone provides safe and effective pain relief in dogs undergoing cruciate ligament repair.     

Cardiopulmonary arrest and resuscitation following an extradural injection in a normovolemic dog

Objective – To describe general anesthesia and successful resuscitation of a dog developing asystole and apnea during extradural injection of local anesthetic and an opioid. Case Summary – A Beagle with a ruptured cranial cruciate was premedicated with acepromazine and methadone. Anesthesia was induced with propofol and, after endotracheal intubation, maintained using isoflurane in oxygen. During extradural injection of a mixture of lidocaine, bupivacaine, and morphine the dog developed apnea and asystole. Cardiopulmonary cerebral resuscitation was started promptly and the dog was successfully resuscitated. New Information Provided – Asystole and apnea are possible serious side effects of extradural anesthesia in dogs. With adequate monitoring and early detection successful resuscitation is possible.     

The extradural pressure profile in goats following extradural injection

ObjectiveTo measure the extradural pressures in goats before and after extradural injection, and to investigate the occurrence of extradural pressure waves.Study designProspective experimental trial.AnimalsNine healthy adult goats weighing 59.4 ± 6.4 kg, scheduled for stifle arthroscopy.MethodsThe goats were pre–medicated with midazolam and anaesthesia was induced with propofol and maintained with sevoflurane. The goats were placed in lateral recumbency and extradural puncture was performed via the lumbosacral space. Correct placement of the needle was assessed by lack of resistance to the injection of saline. The needle was connected to an electronic pressure transducer to record extradural pressure. Measurements were taken before and after extradural injection of methadone (0.1 mg kg^?1, diluted to a total volume of 0.2 mL kg^?1) and 10 minutes later. Contrast medium was injected and correct extradural needle placement confirmed by radiography.ResultsLack of resistance to injection of saline occurred in all goats, but there were no pressure waves observed before injection in any animal. Radiography indicated incorrect needle placement in four animals and one had pressure waves synchronous with the arterial pulse after methadone injection. Correct needle placement was confirmed in the remaining five animals which exhibited pressure waves after extradural methadone injection. In the five goats with successful needle placement the baseline extradural pressure ranged from 0.4 to 2.5 kPa (3–19 mmHg), increasing to 4.4–39.9 kPa (33–300 mmHg) after injection. Ten minutes after injection, extradural pressure remained elevated and ranged from 2.5 to 17.3 kPa (19–130 mmHg).Conclusions and clinical relevanceExtradural pressure waves were not useful to confirm correct extradural needle placement in laterally recumbent goats. The presence of such waves after injection of 0.2 mL kg^?1 may be indicative of correct placement but even here we saw one of nine animals with extradural pressure waves where we failed to confirm correct needle placement. Extradural pressure increases after extradural injection.     

Cardiopulmonary and sedative effects of intravenous or epidural methadone in conscious dogs

Cardiopulmonary and sedative effects of intravenous or epidural methadone were compared. Six beagles were randomly assigned to group MIV (methadone 0.5 mg/kg IV + NaCl 0.9% epidurally) or MEP (methadone 0.5 mg/kg epidurally + NaCl 0.9% IV). Cardiopulmonary, blood gas and sedation were assessed at time (T) 0, 15, 30, 60, 120, 240 and 480 min after drug administration. Compared to T0, heart rate decreased at T15–T120 in MIV (p < .001) and T15–T240 in MEP (p < .05); mean arterial pressure was reduced at T15–T60 in MEP (p < .01); respiratory rate was higher at T15 and T30 in both groups (p < .05); pH was lower at T15–T120 in MIV (p < .01) and T15, T30 and T120 in MEP (p < .05); PaCO₂ was higher at T15–T60 in MIV (p < .01) and T15, T30 and T120 in MEP (p < .01); sedation scores were higher at T15 and T30 in MIV and T15–T60 in MEP (p < .05). At T120 and T240, sedation score was higher in group MEP compared with group MIV (p < .01) In conclusion, cardiopulmonary and sedative effects of identical methadone doses are similar when administered IV or epidurally to conscious healthy dogs.     

The effect of recumbency and hindlimb position on the lumbosacral interlaminar distance in dogs: a cadaveric computed tomography study

Objective

To examine the effect of sternal or lateral recumbency, with or without cranial extension of the hindlimbs, on the distance between the dorsal lumbosacral laminae in dogs.

Influence of a preload of hydroxyethylstarch 6% on the cardiovascular effects of epidural administration of ropivacaine 0.75% in anaesthetized dogs

ObjectiveTo evaluate the cardiovascular effects of a preload of hydroxyethylstarch 6% (HES), preceding an epidural administration of ropivacaine 0.75% in isoflurane anaesthetized dogs.AnimalsSix female, neutered Beagle dogs (mean 13.3 ± SD 1.0 kg; 3.6 ± 0.1 years).Study designRandomized experimental cross-over study (washout of 1 month).MethodsAnaesthesia was induced with propofol and maintained with isoflurane in oxygen/air. All dogs were anaesthetized twice to receive either treatment HESR (continuous rate infusion [CRI] of 7 mL kg^?1 HES started 30 minutes [T-30] prior to epidural administration of ropivacaine 0.75% 1.65 mg kg^?1 at T0) or treatment R (no HES preload and similar dose and timing of epidural ropivacaine administration). Baseline measurements were obtained at T-5. Heart rate (HR), mean (MAP), diastolic (DAP) and systolic (SAP) invasive arterial pressures, cardiac output (Lithium dilution and pulse contour analysis) and derived parameters were recorded every 5 minutes for 60 minutes. Statistical analysis was performed on five dogs, due to the death of one dog.ResultsClinically relevant decreases in MAP (<60 mmHg) were observed for 20 and 40 minutes following epidural administration in treatments HESR and R respectively. Significant decreases in MAP and DAP were present after treatment HESR for up to 20 minutes following epidural administration. No significant within-treatment and overall differences were observed for other cardiovascular parameters. A transient unilateral Horner's syndrome occurred in two dogs (one in each treatment). One dog died after severe hypotension, associated with epidural anaesthesia.Conclusions and clinical relevanceA CRI of 7 mL kg^?1 HES administered over 30 minutes before epidural treatment did not prevent hypotension induced by epidural ropivacaine 0.75%. Epidural administration of ropivacaine 0.75% in isoflurane anaesthetized dogs was associated with a high incidence of adverse effects in this study.     

IMAGING DIAGNOSIS‐INFILTRATIVE LIPOMA CAUSING SPINAL CORD AND LUMBAR NERVE ROOT COMPRESSION IN A DOG

A 12‐year‐old, male, fox terrier dog presented with an abnormal gait of the left pelvic limb. Computed tomography revealed a large, homogeneous, hypoattenuating, noncontrast enhancing mass within the left epaxial muscles that invaded the L5–6 vertebral canal and caused spinal cord compression. Imaging findings were consistent with an infiltrative lipoma. The mass was removed and a left hemilaminectomy was performed in the affected area. Histopathology confirmed the mass to be an infiltrative lipoma. The dog recovered and regained neurologic function within 2 weeks. Computed tomography assisted preoperative planning by characterizing the shape, size, and location of the mass.     

Continuous extradural analgesia in a cow with complex regional pain syndrome

A chronic pain syndrome, similar to the complex regional pain syndrome (CRPS) described in human beings, was diagnosed in a cow with persisting severe pelvic limb lameness. Diagnosis was based on the disproportionate relationship between the severity and duration of pain and the lesion, the failure of conventional analgesic and surgical therapy and the presence of characteristic clinical features. Multimodal therapy, i.e. a mixture of methadone, ketamine and bupivacaine was administered continuously for 17 days via an extradural catheter to counteract nociceptive hypersensitization. Doses were adjusted daily after assessing the effect, using a composite pain score. Physiotherapy was also performed. The diagnosis of CRPS in cattle is unusual. In this case, treatment was successful and the cow was discharged mildly lame and in improving physical condition. Long-term extradural analgesia proved to be safe and effective in the treatment of this syndrome, which was nonresponsive to conventional therapy.     

Successful resuscitation from cardiac arrest associated with extradural lidocaine in a dog

BACKGROUND: Extradural lidocaine exerts several adverse effects which are seldom fatal. While cardiac arrest following extradural lidocaine injection has been reported in human beings, it has not hitherto been reported in dogs. OBSERVATIONS: The emergency management of a dog with complete urethral obstruction is described. We intended to perform vaginoscopy and cystostomy under extradural lidocaine anaesthesia, but cardiac asystole occurred a few minutes after injection. Resuscitation was successful. About 20 minutes later cardiac arrest recurred, and was treated successfully. The dog remained hypothermic for approximately 7 hours. Complete recovery without neurological deficit occurred the next day and the dog remained normal for at least 3 months. The probable cause of the problem was cranial lidocaine dispersion causing a drop in cardiac preload and cardiac arrest. The successful neurological outcome was attributed to early diagnosis and effective treatment. Hypothermia may have conferred cerebral protection during ischemia. CONCLUSIONS: Extradural local anaesthetic administration is not without risk and the technique should be tailored to individual animals. Constant monitoring is required to detect potentially fatal complications and increase the likelihood of successful outcome.