Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Top Companion Anim Med. 2023 Jan-Feb;52:100759. doi: 10.1016/j.tcam.2022.100759. Epub 2022 Dec 29.
The aim of this study was to compare the effects of constant rate infusions (CRI) of fentanyl alone or combined with lidocaine and ketamine (FLK), on physiological parameters, isoflurane requirements and the number of postoperative analgesic rescues in dogs undergoing unilateral mastectomy. Twenty-two dogs were premedicated with acepromazine 0.02 mg/kg and morphine 0.5 mg/kg and anesthetized with propofol and isoflurane. Dogs were randomly assigned to 1 of 2 groups: Fentanyl group (fentanyl 5 µg/kg loading dose [LD] and 9 µg/kg/h CRI; n = 11); FLK group (fentanyl [same doses]; lidocaine 2 mg/kg LD and 3 mg/kg/h CRI; ketamine 1.0 mg/kg LD and 0.6 mg/kg/h CRI; = 11). Intraoperative evaluations were performed before the start of surgery and administration of the treatments (T0); three minutes after the LD (T1); during incision and tissue divulsion (T2); during closure of the surgical wound (T3). Meloxicam (0.1 mg/kg) was administered at T3. Blood samples were collected for determination of plasma concentrations of fentanyl, lidocaine and ketamine. Pain scores and the number of postoperative analgesic rescues with morphine (0.5 mg/kg) were evaluated for 24 hours postoperatively using the short form of the Glasgow Composite Measure Pain Scale. Compared to T0, significant decreases in heart rate (from 84 ± 28 to 53 ± 16 bpm in the Fentanyl group and from 93 ± 16 to 63 ± 15 bpm in FLK) and mean arterial pressure (from 61 ± 5 to 49 ± 10 mmHg in Fentanyl and from 59 ± 3 to 38 ± 6 mmHg in FLK) were observed at T1. Arterial hypotension was transient, with normalization of values at T2 and T3. The expired fraction of isoflurane did not differ significantly between the groups. Plasma concentrations of fentanyl, lidocaine and ketamine remained within the therapeutic range. Postoperatively, the number of dogs requiring analgesic rescue was significantly lower in the FLK (0/11, 0%) than in the Fentanyl group (5/11, 45%). In dogs administered morphine and meloxicam as part of the anesthesia protocol, an intraoperative CRI of FLK abolished the requirement for postoperative analgesic rescue for 24 hours in dogs undergoing mastectomy.
本研究旨在比较芬太尼单独持续输注(CRI)或与利多卡因和氯胺酮联合持续输注(FLK)对行单侧乳房切除术犬的生理参数、异氟醚需求和术后镇痛抢救次数的影响。22 只犬接受了乙酰丙嗪 0.02mg/kg 和吗啡 0.5mg/kg 的预处理,并用丙泊酚和异氟醚麻醉。犬随机分为 2 组:芬太尼组(芬太尼 5μg/kg 负荷剂量[LD]和 9μg/kg/h CRI;n=11);FLK 组(芬太尼[相同剂量];利多卡因 2mg/kg LD 和 3mg/kg/h CRI;氯胺酮 1.0mg/kg LD 和 0.6mg/kg/h CRI;n=11)。在手术开始前和治疗给药时(T0)进行术中评估;LD 后 3 分钟(T1);在切开和组织分离时(T2);在缝合手术伤口时(T3)。在 T3 时给予美洛昔康(0.1mg/kg)。采集血样测定血浆中芬太尼、利多卡因和氯胺酮的浓度。术后 24 小时采用格拉斯哥复合疼痛量表的简短形式评估疼痛评分和吗啡(0.5mg/kg)术后镇痛抢救次数。与 T0 相比,芬太尼组心率(从 84±28bpm 降至 53±16bpm)和平均动脉压(从 61±5mmHg 降至 49±10mmHg)在 T1 时显著下降,FLK 组分别从 93±16bpm 和 59±3mmHg 降至 63±15bpm 和 38±6mmHg。动脉低血压是短暂的,在 T2 和 T3 时恢复正常。两组间异氟醚呼气分数无显著差异。芬太尼、利多卡因和氯胺酮的血浆浓度均在治疗范围内。术后,FLK 组(0/11,0%)需要镇痛抢救的犬明显少于芬太尼组(5/11,45%)。在接受吗啡和美洛昔康作为麻醉方案一部分的犬中,术中 FLK 的 CRI 可在 24 小时内消除行乳房切除术犬的术后镇痛抢救需求。