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与生理盐水相比,在接受卵巢子宫切除术的犬中,腹腔内和切口处注射罗哌卡因在多模式麻醉后并未改善术后镇痛效果。

Intraperitoneal and incisional ropivacaine did not improve postoperative analgesia after multimodal anaesthesia compared with saline in dogs undergoing ovariohysterectomy.

作者信息

Kazmir-Lysak K, Steblaj B, Torgerson P R, Kutter A P N, Restitutti F, Henze I S

机构信息

Section Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich.

Department for Clinical Diagnostics and Services, Section of Anaesthesiology, Vetsuisse Faculty, University of Zurich.

出版信息

Schweiz Arch Tierheilkd. 2023 Oct;165(10):634-643. doi: 10.17236/sat00405.

Abstract

Intraperitoneal administration of local anaesthetics may reduce postoperative pain after ovariohysterectomy in dogs. The aim of this prospective, randomised, blinded, placebo-controlled clinical trial was to compare postoperative analgesia and opioid requirements after intraperitoneal and incisional administration of ropivacaine versus 0,9 % NaCl (saline). Forty-three client-owned dogs were enrolled in the study and anaesthetised using a standardized protocol that included premedication with acepromazine (0,03-0,05 mg/kg) and dexmedetomidine (0,01 mg/kg) intramuscularly. Anaesthesia was induced with propofol titrated to effect and ketamine (1 mg/kg) intravenously and maintained with isoflurane in oxygen. The analgesic regimen included carprofen (4 mg/kg) subcutaneously and morphine (0,2 mg/kg) intravenously. Depending on group assignment, each dog received either an intraperitoneal and incisional splash with ropivacaine (2 mg/kg and 1 mg/kg, respectively) (group R), or an equal volume of saline (group S). Buprenorphine (0,02 mg/kg) was administered intramuscularly once the uterus was removed. Sedation and pain were assessed 0,5, 1, 2, 4, 6 and 8 hours after extubation using a sedation scale, the short form of the Glasgow Composite Pain Scale (CMPS-SF) and a dynamic interactive visual analogue scale (DIVAS). Postoperatively, buprenorphine (0,01 mg/kg) was administered intravenously if dogs scored 6/24 on CMPS-SF. The ordinal mixed model showed no difference in pain scores between groups. Fisher's exact test showed no significant difference in postoperative buprenorphine requirements between group S (3/22 dogs) and group R (1/21 dogs) at the doses used. In addition, lower sedation scores were associated with higher DIVAS scores. In this multimodal analgesic protocol, ropivacaine could not improve analgesia compared to saline.

摘要

腹腔内注射局部麻醉药可能会减轻犬卵巢子宫切除术后的疼痛。这项前瞻性、随机、双盲、安慰剂对照临床试验的目的是比较罗哌卡因腹腔内注射和切口注射与0.9%氯化钠(生理盐水)相比的术后镇痛效果和阿片类药物需求量。43只客户拥有的犬被纳入研究,并采用标准化方案进行麻醉,该方案包括肌肉注射乙酰丙嗪(0.03 - 0.05 mg/kg)和右美托咪定(0.01 mg/kg)进行术前用药。静脉注射丙泊酚至起效剂量和氯胺酮(1 mg/kg)诱导麻醉,并用异氟醚和氧气维持麻醉。镇痛方案包括皮下注射卡洛芬(4 mg/kg)和静脉注射吗啡(0.2 mg/kg)。根据分组情况,每只犬分别接受罗哌卡因腹腔内和切口浸润注射(分别为2 mg/kg和1 mg/kg)(R组),或等体积的生理盐水(S组)。子宫切除后肌肉注射丁丙诺啡(0.02 mg/kg)。拔管后0、5、1、2、4、6和8小时,使用镇静评分量表、格拉斯哥综合疼痛量表简表(CMPS - SF)和动态交互式视觉模拟量表(DIVAS)评估镇静和疼痛情况。术后,如果犬在CMPS - SF上的评分为6/24,则静脉注射丁丙诺啡(0.01 mg/kg)。有序混合模型显示两组之间的疼痛评分没有差异。Fisher精确检验显示,在所用剂量下,S组(22只犬中的3只)和R组(21只犬中的1只)术后丁丙诺啡需求量没有显著差异。此外,较低的镇静评分与较高的DIVAS评分相关。在这种多模式镇痛方案中,与生理盐水相比,罗哌卡因并不能改善镇痛效果。

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