School of Veterinary Sciences, University of Bristol, Bristol, Somerset, UK.
School of Veterinary Sciences, University of Bristol, Bristol, Somerset, UK.
Vet J. 2021 Apr;270:105622. doi: 10.1016/j.tvjl.2021.105622. Epub 2021 Jan 22.
This study investigated the influence of bupivacaine infiltration before or after hemilaminectomy on peri-operative opioid requirement in dogs. Thirty dogs undergoing T3-L3 hemilaminectomy were randomly assigned to receive peri-incisional infiltration of bupivacaine 2 mg/kg into the epaxial muscles before surgery (Group A), at wound closure (Group B), or no infiltration (Group C). Anaesthesia comprised dexmedetomidine 4 mcg/kg and methadone 0.3 mg/kg IV (premedication), alfaxalone IV (induction), and isoflurane in oxygen (maintenance). All dogs received meloxicam SC/PO prior to induction of general anaesthesia. Response to surgery, defined as a change in autonomic physiological variables >20% above baseline, was treated with fentanyl 2.5 mcg/kg boluses, followed by a continuous rate infusion of fentanyl at 5 mcg/kg/h. The Glasgow Composite Pain Score-Short Form (GCPS-SF) was performed before premedication and at regular intervals until 24 h postoperatively. Methadone 0.2 mg/kg analgesia was given IV if GCPS-SF was ≥5/20. Number of intraoperative, postoperative and total analgesic interventions were recorded. Analgesic interventions were analysed using a chi-squared test using a Pocock approach and statistical significance was set at P < 0.029. The number of intra-operative analgesic interventions in Group A (median, 0; range, 0-2), was significantly lower than in Group B (median, 3; range, 0-5) and Group C (median, 3; range, 0-5; P = 0.019). Regarding postoperative interventions, there were significantly fewer in Group A (median, 0; range, 0-1) and Group B (median, 0; range, 0-1) than in Group C (median, 1; range, 0-2; P = 0.047). Group A (median, 0; range, 0-3), had significantly fewer total analgesic interventions than Group B (median, 3; range, 0-6) and Group C (median, 4; range, 1-7; P = 0.014). Bupivacaine reduced peri-operative opioid administration and pre-surgical peri-incisional infiltration yielded the greatest benefit.
本研究旨在探讨在半椎板切除术前或术后浸润布比卡因对犬围手术期阿片类药物需求的影响。30 只接受 T3-L3 半椎板切除术的犬随机分为三组：手术前（A 组）、缝合时（B 组）或不浸润（C 组）于椎旁肌内注射 2mg/kg 布比卡因。麻醉包括右美托咪定 4μg/kg 和甲泼尼龙 0.3mg/kg 静脉注射（术前）、阿法沙龙静脉注射（诱导）和异氟烷氧气（维持）。所有犬在全身麻醉诱导前均接受美洛昔康 SC/PO。手术反应定义为自主生理变量变化超过基线 20%，用芬太尼 2.5μg/kg 进行冲击治疗，然后以 5μg/kg/h 的速度持续输注芬太尼。在术前和术后每隔一段时间进行格拉斯哥复合疼痛评分-短期形式（GCPS-SF）。如果 GCPS-SF≥5/20，则静脉给予甲泼尼龙 0.2mg/kg 镇痛。记录术中、术后和总镇痛干预次数。采用泊松法卡方检验分析镇痛干预，统计学意义设为 P<0.029。A 组（中位数，0；范围，0-2）术中镇痛干预次数明显低于 B 组（中位数，3；范围，0-5）和 C 组（中位数，3；范围，0-5；P=0.019）。A 组（中位数，0；范围，0-1）和 B 组（中位数，0；范围，0-1）术后干预次数明显少于 C 组（中位数，1；范围，0-2；P=0.047）。A 组（中位数，0；范围，0-3）的总镇痛干预次数明显少于 B 组（中位数，3；范围，0-6）和 C 组（中位数，4；范围，1-7；P=0.014）。布比卡因减少了围手术期阿片类药物的使用，术前椎旁浸润效果最佳。
