Marolf Vincent, Luyet Cédric, Spadavecchia Claudia, Eichenberger Urs, Rytz Ulrich, Rohrbach Helene
Department of Clinical Veterinary MedicineVetsuisse FacultyBernSwitzerland.
Department of AnaesthesiologyLindenhof HospitalBernSwitzerland.
Vet Med Sci. 2015 Sep 7;1(2):39-50. doi: 10.1002/vms3.7. eCollection 2015 Oct.
The analgesic effects of peripheral nerve blocks can be prolonged with the placement of perineural catheters allowing repeated injections of local anaesthetics in humans. The objectives of this study were to evaluate the clinical suitability of a perineural coiled catheter (PCC) at the sciatic nerve and to evaluate pain during the early post-operative period in dogs after tibial plateau levelling osteotomy. Pre-operatively, a combined block of the sciatic and the femoral nerves was performed under sonographic guidance (ropivacaine 0.5%; 0.3 mL kg per nerve). Thereafter, a PCC was placed near the sciatic nerve. Carprofen (4 mg kg intravenously) was administered at the end of anaesthesia. After surgery, all dogs were randomly assigned to receive four injections of ropivacaine (group R; 0.25%, 0.3 mL kg) or NaCl 0.9% (group C; 0.3 mL kg) every 6 h through the PCC. Pain was assessed by use of a visual analogue scale (VAS) and a multi-dimensional pain score (4Avet) before surgery (T-1), for 390 min (T0, T30, T60, T120, T180, T240, T300, T360 and T390) as well as 1 day after surgery (Day 1). Methadone (0.1 mg kg) was administered each time the VAS was ≥40 mm or the 4Avet was ≥5. At T390 dogs received buprenorphine (0.02 mg kg). Data were compared using Mann-Whitney rank sum tests and repeated measures analysis of variance. Regardless of group allocation, 55% of dogs required methadone. VAS was significantly lower at T390 (=0.003), and at Day 1 (=0.002) and so was 4Avet at Day 1 (=0.012) in group R than in group C. Bleeding occurred in one dog at PCC placement and PCC dislodged six times of 47 PCCs placed. Minor complications occurred with PCC but allowed four repeated administrations of ropivacaine or saline over 24 h in 91.5% of the cases.
通过放置神经周围导管，可延长局部神经阻滞的镇痛效果，从而允许在人体中重复注射局部麻醉剂。本研究的目的是评估坐骨神经周围螺旋导管（PCC）的临床适用性，并评估犬胫骨平台水平截骨术后早期的疼痛情况。术前，在超声引导下对坐骨神经和股神经进行联合阻滞（罗哌卡因0.5%；每根神经0.3 mL/kg）。此后，在坐骨神经附近放置PCC。麻醉结束时静脉注射卡洛芬（4 mg/kg）。术后，所有犬随机分为两组，通过PCC每6小时接受4次罗哌卡因注射（R组；0.25%，0.3 mL/kg）或0.9%氯化钠注射（C组；0.3 mL/kg）。在手术前（T-1）、390分钟内（T0、T30、T60、T120、T180、T240、T300、T360和T390）以及术后1天（第1天），使用视觉模拟评分法（VAS）和多维疼痛评分（4Avet）评估疼痛。每次VAS≥40 mm或4Avet≥5时，给予美沙酮（0.1 mg/kg）。在T390时，犬接受丁丙诺啡（0.02 mg/kg）。使用曼-惠特尼秩和检验和重复测量方差分析比较数据。无论分组如何，55%的犬需要美沙酮。与C组相比，R组在T390时VAS显著降低（=0.003），在第1天时VAS也显著降低（=0.002），第1天时4Avet也显著降低（=0.012）。在放置PCC时，有1只犬出现出血，在放置的47根PCC中有6根发生移位。PCC出现了轻微并发症，但在91.5%的病例中允许在24小时内重复4次注射罗哌卡因或生理盐水。
