Surgery Department, The Veterinary Medical Center of Long Island, 75 Sunrise Highway, West Islip, NY, USA.
BMC Vet Res. 2023 Jul 31;19(1):102. doi: 10.1186/s12917-023-03664-7.
OBJECTIVE: To determine the influence of two intraoperative pain management protocols on the need for additional opioids in patients receiving an epidural and periarticular liposomal bupivacaine (PLB) vs. PLB alone in the 12-24 h period after undergoing a TPLO. STUDY DESIGN: Retrospective study. ANIMALS: One hundred seventy-four dogs with cranial cruciate ligament tears presenting for TPLO. METHODS: Medical records of dogs presenting for a unilateral or bilateral cranial cruciate ligament tear who had a TPLO performed were reviewed for signalment, weight, body condition score, and peri-operative pain management protocol. Dogs were divided into two groups: those who received an epidural and PLB, and those who received only PLB. Post-operative opioid administration was recorded for each group. RESULTS: Patients who received an epidural and PLB received fewer postoperative opioids. There were 36% fewer opioid injections administered to dogs who received epidurals compared to dogs who did not receive epidurals (IRR) (95% CI) = 0.64 (0.45-0.92), P = 0.02). BCS was not a significant predictor of the post-operative opioid requirement (IRR (95% CI) = 1.3 (0.75-2.4), P = 0.38). When adjusting for BCS as a possible confounder, there were 39% fewer opioid injections in dogs who received epidurals than dogs without (IRR (95% CI) = 0.61 (0.42-0.88), P = 0.009). CONCLUSIONS: The incidence of postoperative opioid administration was significantly diminished in patients receiving both an epidural and PLB. CLINICAL SIGNIFICANCE: Administration of an epidural in addition to infiltration of PLB significantly decreased the incidence of postoperative opioid administration in dogs undergoing a TPLO.
目的:确定两种术中疼痛管理方案对接受硬膜外和关节周包载布比卡因(PLB)与仅接受 PLB 的患者在接受 TPLO 后 12-24 小时内额外使用阿片类药物的需求的影响。 研究设计:回顾性研究。 动物:174 只患有前十字韧带撕裂的狗,接受 TPLO。 方法:对接受单侧或双侧前十字韧带撕裂并接受 TPLO 的狗的病历进行了回顾,以评估其特征、体重、身体状况评分和围手术期疼痛管理方案。狗被分为两组:接受硬膜外和 PLB 的组和仅接受 PLB 的组。记录每组术后阿片类药物的使用情况。 结果:接受硬膜外和 PLB 的患者术后使用的阿片类药物较少。与未接受硬膜外麻醉的狗相比,接受硬膜外麻醉的狗接受的阿片类药物注射次数减少了 36%(IRR)(95%CI)=0.64(0.45-0.92),P=0.02)。BCS 不是术后阿片类药物需求的显著预测因素(IRR(95%CI)=1.3(0.75-2.4),P=0.38)。当调整 BCS 作为可能的混杂因素时,接受硬膜外麻醉的狗比未接受硬膜外麻醉的狗的阿片类药物注射次数减少了 39%(IRR(95%CI)=0.61(0.42-0.88),P=0.009)。 结论:接受硬膜外和 PLB 联合治疗的患者术后阿片类药物的使用发生率显著降低。 临床意义:在接受 TPLO 的狗中,硬膜外给药加 PLB 浸润显著降低了术后阿片类药物的使用发生率。