Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA.
J Vet Intern Med. 2022 Sep;36(5):1742-1751. doi: 10.1111/jvim.16514. Epub 2022 Aug 13.
Opioids are widely used for perioperative pain control in dogs undergoing spinal surgery, but alternatives may be required because data suggest that opioids exacerbate inflammation in the injured spinal cord and veterinary access to opioids may become more restricted in the future.
To compare recovery of ambulation and other functions between spinal cord-injured dogs receiving peri-operative fentanyl and those receiving a ketamine-dexmedetomidine combination.
A total of 102 client-owned dogs undergoing decompressive surgery for thoracolumbar intervertebral disc herniation.
Randomized clinical trial. Dogs were randomized 1:1 to fentanyl or a ketamine-dexmedetomidine combination for intra and postoperative analgesia. Primary outcome was time to recovery of ambulation; secondary outcomes were the postoperative Colorado Acute Pain Scale, the short-form Glasgow Composite Measure Pain Scale, time to recovery of voluntary urination and time to unassisted eating.
No difference was found in time to recovery of ambulation between groups (adjusted sub-hazard ratio, 0.83; 95% confidence interval [CI], 0.55-1.24; P = .36) or in pain scores (Colorado: χ = 14.74; P = .32; Glasgow: χ = 6.61; P = .76). Differences in time to recovery of eating and urination were small but favored ketamine-dexmedetomidine (adjusted odds ratios, 3.31; 95% CI, 1.53-7.16; P = .002 and 2.43; 95% CI, 1.00-5.96; P = .05, respectively).
There was no evidence that, at the doses used, fentanyl impaired ambulatory outcome after surgery for thoracolumbar intervertebral disc herniation in dogs. Pain control appeared similar between groups. Secondary outcomes suggested minor benefits associated with ketamine-dexmedetomidine. The ketamine-dexmedetomidine combination appears to be a reasonable alternative to peri-operative opioids.
阿片类药物在接受脊柱手术的犬中被广泛用于围手术期疼痛控制，但可能需要替代药物，因为数据表明阿片类药物会加重受伤脊髓的炎症，并且兽医将来可能会更难获得阿片类药物。
比较接受围手术期芬太尼和接受氯胺酮-右美托咪定联合用药的脊髓损伤犬的运动和其他功能恢复情况。
102 只接受胸腰椎椎间盘突出减压手术的患犬。
随机临床试验。犬随机 1:1 分为芬太尼或氯胺酮-右美托咪定联合用于围手术期镇痛。主要结局是运动恢复时间；次要结局是术后科罗拉多急性疼痛量表、短格式格拉斯哥综合疼痛量表、自愿排尿恢复时间和自主进食恢复时间。
两组间运动恢复时间无差异（调整后的亚危险比，0.83；95%置信区间[CI]，0.55-1.24；P = 0.36）或疼痛评分（科罗拉多：χ ²= 14.74；P = 0.32；格拉斯哥：χ ²= 6.61；P = 0.76）。进食和排尿恢复时间的差异较小，但氯胺酮-右美托咪定更有利（调整后的优势比，3.31；95%CI，1.53-7.16；P = 0.002 和 2.43；95%CI，1.00-5.96；P = 0.05）。
在使用的剂量下，芬太尼没有证据表明会损害犬胸腰椎椎间盘突出症手术后的运动预后。两组的疼痛控制效果相似。次要结局表明氯胺酮-右美托咪定联合用药具有轻微的优势。氯胺酮-右美托咪定联合用药似乎是围手术期阿片类药物的合理替代品。
