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Intraperitoneal bupivacaine with or without incisional bupivacaine for postoperative analgesia in dogs undergoing ovariohysterectomy

      Abstract

      Objective

      Intraperitoneal (IP) bupivacaine provides postoperative analgesia in dogs undergoing ovariohysterectomy (OHE) alone or in combination with incisional (INC) bupivacaine. This study investigated whether the combination of INC and IP bupivacaine is superior to IP bupivacaine alone.

      Study design

      Prospective, randomized, blinded clinical study.

      Animals

      Thirty-nine privately owned dogs undergoing OHE, aged 25 ± 23 months and weighing 11.8 ± 5.7 kg.

      Methods

      Dogs were premedicated with acepromazine (0.05 mg kg−1) and morphine (0.5 mg kg−1) intramuscularly (IM); anaesthesia was induced with propofol and maintained with isoflurane in oxygen. Carprofen (4 mg kg−1) was administered subcutaneously (SC) after intubation. Bupivacaine (3 mg kg−1) IP was administered before complete closure of the linea alba to all dogs. Dogs were randomly assigned into two groups: group B received bupivacaine (n = 20; 1 mg kg−1) and group S received saline (n = 19; 0.2 mL kg−1) INC as a subcutaneous ‘splash’ before skin closure. Postoperative analgesia was assessed with a dynamic interactive visual analogue scale, the short form of the Glasgow Composite Pain Scale, and mechanical nociceptive threshold (MNT) measurement at 0.5, 1, 2, 4, 6, 8, 12 and 20 hours after surgery by one blinded observer. Parametric data were tested using t-test; nonparametric data were analysed using the two-sample Wilcoxon test (p < 0.05).

      Results

      There was no significant difference between groups with regard to age, weight, surgical and anaesthetic duration, incision length, sedation and pain scores. MNT values decreased in both groups at all time points as compared with the baseline. No dog required rescue analgesia. No postoperative complications were observed.

      Conclusion and clinical relevance

      Bupivacaine IP and carprofen SC after morphine IM did provide satisfactory postoperative analgesia in dogs undergoing OHE with the anaesthetic protocol used. There appears to be no clinical advantage to adding bupivacaine INC. Neither protocol could prevent the development of primary hyperalgesia.

      Keywords

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      References

        • Anil SS
        • Anil L
        • Deen J
        Challenges of pain assessment in domestic animals.
        J Am Vet Med Assoc. 2002; 220: 313-319
        • Barnhart MD
        • Hubbell JA
        • Muir WW
        • et al.
        Pharmacokinetics, pharmacodynamics, and analgesic effects of morphine after rectal, intramuscular, and intravenous administration in dogs.
        Am J Vet Res. 2000; 61: 24-28
        • Berde CB
        • Strichartz GR
        Local anesthetics.
        in: Miller RE 8th edn. Miller's Anesthesia. vol. 1. Churchill Livinsgston, USA2014: 1028-1054
        • Borer‐Weir K
        Analgesia.
        in: Clarke KW Trim CM Hall LW Veterinary Anaesthesia. 11th edn. Saunders Elsevier, UK2014: 115-123
        • Brondani J
        • Luna SP
        • Mama KR
        • et al.
        Cut‐off point for rescue analgesia of uni‐dimensional scales used to assess postoperative pain in cats.
        in: Proceedings of the AVA Autumn Meeting. 2013 (London, UK)
        • Bubalo V
        • Moens YP
        • Holzmann A
        • et al.
        Anaesthetic sparing effect of local anaesthesia of the ovarian pedicle during ovariohysterectomy in dogs.
        Vet Anaesth Analg. 2008; 35: 537-542
        • Campagnol D
        • Teixeira‐Neto FJ
        • Monteiro ER
        • et al.
        Effect of intraperitoneal or incisional bupivacaine on pain and the analgesic requirement after ovariohysterectomy in dogs.
        Vet Anaesth Analg. 2012; 39: 426-430
        • Carpenter RE
        • Wilson DV
        • Evans AT
        Evaluation of intraperitoneal and incisional lidocaine or bupivacaine for analgesia following ovariohysterectomy in the dog.
        Vet Anaesth Analg. 2004; 31: 46-52
        • Conzemius MG
        • Hill CM
        • Sammarco JL
        • et al.
        Correlation between subjective and objective measures used to determine severity of postoperative pain in dogs.
        J Am Vet Med Assoc. 1997; 210: 1619-1622
        • Feldman HS
        • Arthur GR
        • Covino BG
        Comparative systemic toxicity of convulsant and supraconvulsant doses of intravenous ropivacaine, bupivacaine, and lidocaine in the conscious dog.
        Anesth Analg. 1989; 69: 794-801
        • Fitzpatrick CL
        • Weir HL
        • Monnet E
        Effects of infiltration of the incision site with bupivacaine on postoperative pain and incisional healing in dogs undergoing ovariohysterectomy.
        J Am Vet Med Assoc. 2010; 237: 395-401
        • Fujita Y
        • Endoh S
        • Yasukawa T
        • et al.
        Lidocaine increases the ventricular fibrillation threshold during bupivacaine‐induced cardiotoxicity in pigs.
        Br J Anaesth. 1998; 80: 218-222
        • Gaynor JS
        • Muir WWI
        Acute pain management: a case‐based approach.
        in: Gaynor JS Muir WWI Handbook of Veterinary Pain Management. 3rd edn. Elsevier, USA2014: 444-446
        • Gurney MA
        Pharmacological options for intra‐operative and early postoperative analgesia: an update.
        J Small Anim Pract. 2012; 53: 377-386
        • Hannibal K
        • Galatius H
        • Hansen A
        • et al.
        Preoperative wound infiltration with bupivacaine reduces early and late opioid requirement after hysterectomy.
        Anesth Analg. 1996; 83: 376-381
        • Kukanich B
        • Lascelles BD
        • Papich MG
        Pharmacokinetics of morphine and plasma concentrations of morphine‐6‐glucuronide following morphine administration to dogs.
        J Vet Pharmacol Ther. 2005; 28: 371-376
        • Lascelles BD
        • Cripps PJ
        • Jones A
        • et al.
        Efficacy and kinetics of carprofen, administered preoperatively or postoperatively, for the prevention of pain in dogs undergoing ovariohysterectomy.
        Vet Surg. 1998; 27: 568-582
        • Marx GF
        Cardiotoxicity of local anesthetics – the plot thickens.
        Anesthesiology. 1984; 60: 3-5
        • McKune CM
        • Pascoe PJ
        • Lascelles BD
        • et al.
        The challenge of evaluating pain and a pre‐incisional local anesthetic block.
        PeerJ. 2014; 2: e341
        • Michelsen J
        • Heller J
        • Wills F
        • et al.
        Effect of surgeon experience on postoperative plasma cortisol and C‐reactive protein concentrations after ovariohysterectomy in the dog: a randomised trial.
        Aust Vet J. 2012; 90: 474-478
        • Moiniche S
        • Mikkelsen S
        • Wetterslev J
        • et al.
        A qualitative systematic review of incisional local anaesthesia for postoperative pain relief after abdominal operations.
        Br J Anaesth. 1998; 81: 377-383
        • Morton CM
        • Reid J
        • Scott EM
        • et al.
        Application of a scaling model to establish and validate an interval level pain scale for assessment of acute pain in dogs.
        Am J Vet Res. 2005; 66: 2154-2166
        • Ng A
        • Smith G
        I: Intraperitoneal administration of analgesia: is this practice of any utility?.
        Br J Anaesth. 2002; 89: 535-537
        • Ng A
        • Swami A
        • Smith G
        • et al.
        The analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine after total abdominal hysterectomy.
        Anesth Analg. 2002; 95: 158-162
        • Reid J
        • Nolan AM
        • Hughes JML
        • et al.
        Development of the short‐form Glasgow Composite Measure Pain Scale (CMPS‐SF) and derivation of an analgesic intervention score.
        Anim Welf. 2007; 16: 97-104
        • Schulte‐Steinberg H
        • Weninger E
        • Jokisch D
        • et al.
        Intraperitoneal versus interpleural morphine or bupivacaine for pain after laparoscopic cholecystectomy.
        Anesthesiology. 1995; 82: 634-640
        • Shih AC
        • Robertson S
        • Isaza N
        • et al.
        Comparison between analgesic effects of buprenorphine, carprofen, and buprenorphine with carprofen for canine ovariohysterectomy.
        Vet Anaesth Analg. 2008; 35: 69-79
        • Slingsby L
        Multimodal analgesia for postoperative pain relief.
        In Pract. 2008; 30: 208-212
        • Zohar E
        • Fredman B
        • Phillipov A
        • et al.
        The analgesic efficacy of patient‐controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo‐oophorectomy.
        Anesth Analg. 2001; 93: 482-487