Salla Kati, Åhlberg Tuuli, Lepajoe Jaan, Kallio-Kujala Ira, Mölsä Sari, Casoni Daniela
Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland.
Front Vet Sci. 2023 Sep 21;10:1163025. doi: 10.3389/fvets.2023.1163025. eCollection 2023.
Epidural anesthesia is commonly administered as part of balanced anesthesia for perioperative analgesia. The main goal of this randomized clinical trial was to compare the efficacy of two epidural approaches in dogs undergoing surgery for a perineal hernia. A secondary aim was to compare motor blockade. Intact ASA 1 and 2 male dogs, weighing ≤25 kg with no previous surgery for perineal hernia were enrolled. After premedication with IM acepromazine 0.02 mg/kg and butorphanol 0.3 mg/kg, general anesthesia was induced with propofol and maintained with sevoflurane in oxygen. Dogs were randomly allocated to receive either a lumbosacral (LS, = 30) or a sacrococcygeal (SC, = 26) epidural injection with ropivacaine 1% (0.2 mL/kg) under computed tomography guidance. Successful analgesia was defined as no need of intraoperative rescue analgesia (fentanyl 3 μg/kg IV). Clinical failure was defined as the need of more than two boluses of fentanyl/h each dog received meloxicam 0.2 mg/kg IV at the end of the surgery. The Glasgow Composite Pain Scale short form (GCPS-SF), tactile sensitivity, pressure pain thresholds and motor blockade were assessed at 4, 6, 8, and 24 h after the epidural injection. Methadone (0.2 mg/kg, IV) was administered if the GCPS-SF was ≥6/24 points. Differences between groups were analyzed with the Mann-Whitney test, Student's -test or Fisher's Exact test, as appropriate. Success rate was assessed for non-inferiority between groups. The non-inferiority margin was set at -10%. Epidural analgesia was successful in 24 dogs in group LS and 17 dogs in group SC ( = 0.243), resulting in success rates of 80 and 65% in LS and SC groups, respectively. The non-inferiority of group SC versus group LS was confirmed. Clinical failure was recorded in two dogs in group LS and one dog in group SC. No significant differences between groups were detected in the GCPS-SF score, tactile sensitivity, pressure pain thresholds, need of post-operative methadone, or motor blockade. Both epidural techniques are valuable analgesic options for perineal hernia repair in dogs.
硬膜外麻醉通常作为平衡麻醉的一部分用于围手术期镇痛。这项随机临床试验的主要目的是比较两种硬膜外麻醉方法对接受会阴疝手术的犬的疗效。次要目的是比较运动阻滞情况。纳入了ASA 1级和2级、体重≤25 kg且既往未接受过会阴疝手术的雄性犬。在肌肉注射0.02 mg/kg乙酰丙嗪和0.3 mg/kg布托啡诺进行术前用药后，用丙泊酚诱导全身麻醉并用七氟醚在氧气中维持麻醉。在计算机断层扫描引导下，犬被随机分配接受1%罗哌卡因（0.2 mL/kg）的腰骶部（LS，n = 30）或骶尾部（SC，n = 26）硬膜外注射。成功镇痛定义为术中无需急救镇痛（静脉注射3 μg/kg芬太尼）。临床失败定义为每只犬需要超过两次芬太尼推注。在硬膜外注射后4、6、8和24小时评估格拉斯哥综合疼痛量表简表（GCPS-SF）、触觉敏感性、压力痛阈值和运动阻滞情况。如果GCPS-SF≥6/24分，则静脉注射美沙酮（0.2 mg/kg）。根据情况用Mann-Whitney检验、Student's t检验或Fisher精确检验分析组间差异。评估组间非劣效性的成功率。非劣效性界值设定为-10%。LS组24只犬和SC组17只犬硬膜外镇痛成功（P = 0.243），LS组和SC组的成功率分别为80%和65%。证实了SC组相对于LS组的非劣效性。LS组有2只犬和SC组有1只犬记录到临床失败。在GCPS-SF评分、触觉敏感性、压力痛阈值、术后美沙酮需求或运动阻滞方面，两组之间未检测到显著差异。两种硬膜外技术都是犬会阴疝修补术有价值的镇痛选择。
