Bergmann Hannes M, Nolte Ingo, Kramer Sabine
Small Animal Clinic, School of Veterinary Medicine, Bischofsholer Damm 15, Hannover, Germany.
Vet Surg. 2007 Oct;36(7):623-32. doi: 10.1111/j.1532-950X.2007.00314.x.
To compare analgesic efficacy of preoperative versus postoperative administration of carprofen and to determine, if preincisional mepivacaine epidural anesthesia improves postoperative analgesia in dogs treated with carprofen.
Blind, randomized clinical study.
Dogs with femoral (n=18) or pelvic (27) fractures.
Dogs were grouped by restricted randomization into 4 groups: group 1 = carprofen (4 mg/kg subcutaneously) immediately before induction of anesthesia, no epidural anesthesia; group 2 = carprofen immediately after extubation, no epidural anesthesia; group 3 = carprofen immediately before induction, mepivacaine epidural block 15 minutes before surgical incision; and group 4 = mepivacaine epidural block 15 minutes before surgical incision, carprofen after extubation. All dogs were administered carprofen (4 mg/kg, subcutaneously, once daily) for 4 days after surgery. Physiologic variables, nociceptive threshold, lameness score, pain, and sedation (numerical rating scale [NRS], visual analog scale [VAS]), plasma glucose and cortisol concentration, renal function, and hemostatic variables were measured preoperatively and at various times after surgery. Dogs with VAS pain scores >30 were administered rescue analgesia.
Group 3 and 4 dogs had significantly lower pain scores and amount of rescue analgesia compared with groups 1 and 2. VAS and NRS pain scores were not significantly different among groups 1 and 2 or among groups 3 and 4. There was no treatment effect on renal function and hemostatic variables.
Preoperative carprofen combined with mepivacaine epidural anesthesia had superior postoperative analgesia compared with preoperative carprofen alone. When preoperative epidural anesthesia was performed, preoperative administration of carprofen did not improve postoperative analgesia compared with postoperative administration of carprofen.
Preoperative administration of systemic opioid agonists in combination with regional anesthesia and postoperative administration of carprofen provides safe and effective pain relieve in canine fracture repair.
比较卡洛芬术前与术后给药的镇痛效果，并确定切口前甲哌卡因硬膜外麻醉是否能改善接受卡洛芬治疗的犬的术后镇痛效果。
盲法随机临床研究。
股骨骨折（n = 18）或骨盆骨折（27）的犬。
通过受限随机化将犬分为4组：第1组 = 在麻醉诱导前立即皮下注射卡洛芬（4 mg/kg），未进行硬膜外麻醉；第2组 = 拔管后立即皮下注射卡洛芬，未进行硬膜外麻醉；第3组 = 在麻醉诱导前立即皮下注射卡洛芬，在手术切口前15分钟进行甲哌卡因硬膜外阻滞；第4组 = 在手术切口前15分钟进行甲哌卡因硬膜外阻滞，拔管后皮下注射卡洛芬。所有犬在术后4天每天皮下注射一次卡洛芬（4 mg/kg）。在术前和术后不同时间测量生理变量、痛觉阈值、跛行评分、疼痛和镇静情况（数字评分量表[NRS]、视觉模拟评分量表[VAS]）、血糖和皮质醇浓度、肾功能及止血变量。VAS疼痛评分>30的犬给予补救性镇痛。
与第1组和第2组相比，第3组和第4组犬的疼痛评分和补救性镇痛量显著更低。第1组和第2组之间或第3组和第4组之间的VAS和NRS疼痛评分无显著差异。对肾功能和止血变量无治疗效果。
与单独术前使用卡洛芬相比，术前使用卡洛芬联合甲哌卡因硬膜外麻醉具有更好的术后镇痛效果。当进行术前硬膜外麻醉时，与术后使用卡洛芬相比，术前使用卡洛芬并未改善术后镇痛效果。
术前给予全身性阿片类激动剂联合区域麻醉以及术后给予卡洛芬可为犬骨折修复提供安全有效的疼痛缓解。
