Lewis Kerrie A, Bednarski Richard M, Aarnes Turi K, Dyce Jonathan, Hubbell John A E
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
J Am Vet Med Assoc. 2014 May 1;244(9):1041-6. doi: 10.2460/javma.244.9.1041.
To compare 4 analgesic protocols in dogs undergoing stifle joint surgery.
Randomized, blinded, prospective clinical trial. Animals-48 client-owned dogs that underwent stifle joint surgery.
Dogs undergoing tibial plateau leveling osteotomy were randomly assigned to receive a constant rate infusion of a combination of morphine, lidocaine, and ketamine; a lumbosacral epidural with morphine and ropivacaine; both treatments (ie, constant rate infusion and lumbosacral epidural); or only IM premedication with morphine. Indices of cardiorespiratory function and isoflurane requirement were recorded at 5-minute intervals during anesthesia. A validated sedation scoring system and the modified Glasgow composite measure pain score were used to assess comfort and sedation after surgery and anesthesia once the swallowing reflex returned and a body temperature of ≥ 36.7°C (98.1°F) was attained. Pain and sedation scores were acquired at 60-minute intervals for 4 hours, then at 4-hour intervals for 24 hours. Dogs with a postoperative pain score > 5 of 24 were given morphine as rescue analgesia.
No differences in heart rate, respiratory rate, systolic arterial blood pressure, end-tidal Pco2, end-tidal isoflurane concentration, and vaporizer setting were detected among groups. No differences in pain score, sedation score, rescue analgesia requirement, or time to first rescue analgesia after surgery were detected.
Pain scores were similar among groups, and all 4 groups had similar rescue analgesia requirements and similar times to first administration of rescue analgesia. All 4 analgesic protocols provided acceptable analgesia for 24 hours after stifle joint surgery.
比较接受 stifle 关节手术的犬的 4 种镇痛方案。
随机、盲法、前瞻性临床试验。动物——48 只接受 stifle 关节手术的客户拥有的犬。
接受胫骨平台水平截骨术的犬被随机分配接受吗啡、利多卡因和氯胺酮组合的持续静脉输注；腰荐部硬膜外注射吗啡和罗哌卡因；两种治疗（即持续静脉输注和腰荐部硬膜外注射）；或仅用吗啡进行肌肉注射术前用药。在麻醉期间每隔 5 分钟记录心肺功能指标和异氟烷需求量。一旦吞咽反射恢复且体温≥36.7°C（98.1°F），使用经过验证的镇静评分系统和改良的格拉斯哥综合疼痛评分来评估术后和麻醉后的舒适度和镇静程度。疼痛和镇静评分在 4 小时内每隔 60 分钟获取一次，然后在 24 小时内每隔 4 小时获取一次。术后疼痛评分>24 分中 5 分的犬给予吗啡作为解救镇痛。
各组之间在心率、呼吸频率、收缩期动脉血压、呼气末二氧化碳分压、呼气末异氟烷浓度和蒸发器设置方面未检测到差异。在疼痛评分、镇静评分、解救镇痛需求或术后首次解救镇痛时间方面未检测到差异。
各组之间疼痛评分相似，所有 4 组的解救镇痛需求相似，首次给予解救镇痛的时间相似。所有 4 种镇痛方案在 stifle 关节手术后 24 小时内均提供了可接受的镇痛效果。
