Peripheral nerve block versus systemic analgesia in dogs undergoing tibial plateau levelling osteotomy: Analgesic efficacy and pharmacoeconomics comparison |
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| Institution: | 1. Department of Anaesthesiology and Pain Therapy, Vetsuisse Faculty, University of Bern, Bern, Switzerland;2. Clinical Pharmacology Laboratory, Institute for Infectious Diseases, University of Bern, Bern, Switzerland;1. Anaesthesia Department Veterinary Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, Hatfield, UK;2. Diagnostic Imaging Department, Veterinary Clinical Science, The Royal Veterinary College, Hawkshead Lane, Hatfield, UK;1. Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA;2. Veterinary Anesthesia Services LLC, Jacksonville, FL, USA;3. Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina;1. Department of Surgery, School of Veterinary Medicine, Metropolitan University of Santos, São Paulo, SP, Brazil;2. Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil;3. Department of Surgery, School of Veterinary Medicine, Paulista University, São Paulo, SP, Brazil |
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| Abstract: | ObjectiveTo compare the perioperative effects and pharmacoeconomics of peripheral nerve blocks (PNBs) versus fentanyl target-controlled infusion (fTCI) in dogs undergoing tibial plateau levelling osteotomy (TPLO).Study designRandomized clinical study.AnimalsA total of 39 dogs undergoing unilateral TPLO.MethodsAfter acepromazine and methadone, anaesthesia was induced with propofol and maintained with isoflurane. Dogs were allocated to group fTCI target plasma concentration (TPC) 1 ng mL–1] or group PNB (nerve stimulator-guided femoral-sciatic block using 0.2 and 0.1 mL kg–1 of levobupivacaine 0.5%, respectively). If nociceptive response occurred, isoflurane was increased by 0.1%, and TPC was increased by 0.5 ng mL–1 in group fTCI; a fentanyl bolus (1 μg kg–1) was administered in group PNB. During the first 24 postoperative hours, methadone (0.2 mg kg–1) was administered intramuscularly according to the Short Form Glasgow Composite Pain Scale, or if pain was equal to 5/24 or 4/20 for two consecutive assessments, or if the dog was non-weight bearing. The area under the curve (AUC) of pain scores, cumulative postoperative methadone requirement, food intake and pharmacoeconomic implications were calculated.ResultsIncidence of bradycardia (p = 0.025), nociceptive response to surgery (p = 0.041) and AUC of pain scores (p < 0.0001) were greater in group fTCI. Postoperatively, 16/19 (84.2%) and eight/20 (40%) dogs in groups fTCI and PNB, respectively, were given at least one dose of methadone (p = 0.0079). Food intake was greater in group PNB (p = 0.049). Although total cost was not different (p = 0.083), PNB was more cost-effective in dogs weighing >15 kg.Conclusions and clinical relevanceCompared with group fTCI, incidence of bradycardia, nociceptive response to surgery, postoperative pain scores, cumulative methadone requirement were lower, and food intake was greater in group PNB, with an economic advantage in dogs weighing >15 kg. |
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| Keywords: | femoral nerve block fentanyl target-controlled infusion regional anaesthesia sciatic nerve block |
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