Arnholz Mareike, Hungerbühler Stephan, Weil Clarissa, Schütter Alexandra F, Rohn Karl, Tünsmeyer Julia, Kästner Sabine B R
Mareike Arnholz, Klinik für Kleintiere, Abteilung für Anästhesie, Stiftung Tierärztliche Hochschule Hannover, Bünteweg 9, 30159 Hannover, E-Mail:
Tierarztl Prax Ausg K Kleintiere Heimtiere. 2017 Feb 9;45(1):5-14. doi: 10.15654/TPK-151087. Epub 2016 Sep 27.
Comparison of ultrasound-guided femoral and sciatic nerve block versus epidural anaesthesia with bupivacaine and morphine for orthopaedic surgery of the pelvic limb in dogs with respect to analgesic effectiveness, clinical utility and side effects.
The study included 22 dogs (American Society of Anesthesiologists, ASA grades I and II) undergoing orthopaedic surgery distal to the mid-femoral bone. The study was designed as a randomized, prospective, blinded clinical trial. All dogs were randomly assigned to receive 0.5 mg/kg bupivacaine (0.5%) and 0.1 mg/kg morphine sulphate (1%) either as epidural anaesthesia (group EPI) or by ultrasound-guided femoral and sciatic nerve block (group LA). During surgery, the heart rate, respiratory rate, mean arterial pressure (MAP), end-tidal isoflurane concentrations and dose of rescue analgesia (fentanyl boluses of 5 µg/kg i. v.) were measured. Pain severity was scored (short form of the Glasgow Composite Measure Pain Scale, GCMPS) before surgery and postoperatively at 2, 4, 6, 12 and 24 hours after extubation. Post-operative rescue analgesia consisted of methadone (0.2 mg/kg i. v.), and was applied when the GCMPS > 6. For statistical analysis, the Chi-square, Fisher, and Wilcoxon tests and one- and two-way ANOVA were applied. Differences were considered statistically significant at p < 0.05.
Only the MAP was significantly different between the two treatment groups. Intra- and postoperative MAP of group LA (111.2 ± 11.2 mmHg and 119.3 ± 18.2 mmHg, respectively) was higher than in group EPI (86.6 ± 8.7 mmHg and 95.2 ± 13.1 mmHg, respectively). None of the dogs developed urinary retention or ambulatory deficits when completely recovered from anaesthesia. No other side effects were noted.
In conclusion, femoral and sciatic nerve blocks and epidural anaesthesia ensure comparable analgesic effects in canine patients undergoing orthopaedic surgery of the pelvic limb. The lower mean arterial blood pressure of group EPI was not of clinical relevance.
比较超声引导下股神经和坐骨神经阻滞与布比卡因和吗啡硬膜外麻醉用于犬骨盆四肢骨科手术时的镇痛效果、临床实用性及副作用。
本研究纳入22只美国麻醉医师协会（ASA）分级为I级和II级、接受股骨中段远端骨科手术的犬。本研究设计为一项随机、前瞻性、双盲临床试验。所有犬被随机分配接受0.5mg/kg布比卡因（0.5%）和0.1mg/kg硫酸吗啡（1%），采用硬膜外麻醉（EPI组）或超声引导下股神经和坐骨神经阻滞（LA组）。手术期间，测量心率、呼吸频率、平均动脉压（MAP）、呼气末异氟烷浓度及补救镇痛剂量（静脉注射5μg/kg芬太尼推注）。术前及拔管后2、4、6、12和24小时对疼痛严重程度进行评分（格拉斯哥综合疼痛量表简表，GCMPS）。术后补救镇痛采用美沙酮（静脉注射0.2mg/kg），当GCMPS>6时使用。统计分析采用卡方检验、Fisher检验、Wilcoxon检验以及单因素和双因素方差分析。p<0.05时差异具有统计学意义。
仅两组间MAP有显著差异。LA组术中和术后的MAP（分别为111.2±11.2mmHg和119.3±18.2mmHg）高于EPI组（分别为86.6±8.7mmHg和95.2±13.1mmHg）。麻醉完全恢复后，无一犬出现尿潴留或行走障碍。未观察到其他副作用。
总之，股神经和坐骨神经阻滞与硬膜外麻醉在接受骨盆四肢骨科手术的犬患者中确保了相当的镇痛效果。EPI组较低的平均动脉血压无临床意义。
