Advertisement

Epidural administration of combinations of ropivacaine, morphine and xylazine in bitches undergoing total unilateral mastectomy: a randomized clinical trial

Published:October 12, 2021DOI:https://doi.org/10.1016/j.vaa.2021.10.001

      Abstract

      Objective

      To investigate the epidural administration of combinations of ropivacaine, morphine and xylazine in bitches undergoing unilateral mastectomy.

      Study design

      Prospective, randomized, blinded, clinical study.

      Animals

      A total of 22 bitches scheduled to undergo unilateral mastectomy for mammary tumor excision.

      Methods

      Dogs were anesthetized with acepromazine (0.02 mg kg–1) and morphine (0.3 mg kg–1) intramuscularly, propofol intravenously (IV) and isoflurane. Prior to the beginning of surgery, dogs were randomly administered one of three epidural treatments: ropivacaine (0.75 mg kg–1) with morphine (0.1 mg kg–1) (group RM, n = 7); ropivacaine with xylazine (0.1 mg kg–1) (group RX, n = 8); or ropivacaine with morphine and xylazine (group RMX, n = 7). Cardiopulmonary variables and the expired concentration of isoflurane (Fe′Iso) were recorded intraoperatively. Meloxicam (0.1 mg kg–1) was administered IV during skin closure. Postoperative pain scores were evaluated with the Glasgow composite measure pain scale short form for 24 hours, and rescue analgesia with morphine (0.5 mg kg–1) was administered intramuscularly when pain scores were ≥ 6/24.

      Results

      Fe′Iso was significantly higher in group RM than in groups RX and RMX. Heart rate decreased significantly in groups RX and RMX, but blood pressure remained within acceptable values. The number of dogs administered rescue analgesia within 24 hours was significantly higher in group RX (seven dogs, 87.5%) than in groups RM (one dog, 14.3%; p = 0.01) and RMX (two dogs, 28.6%; p = 0.04). Time to standing was significantly longer in group RX than in group RM.

      Conclusions and clinical relevance

      All epidural treatments provided adequate antinociception with minimal cardiovascular adverse effects during mastectomy. The inclusion of morphine (groups RM and RMX) provided the best postoperative analgesia. Owing to the undesirable effect of xylazine on ambulation, the combination ropivacaine–morphine appeared to provide greater benefits in bitches undergoing unilateral mastectomy.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Branson K.R.
        • Ko J.C.H.
        • Tranquilli W.J.
        • et al.
        Duration of analgesia induced by epidurally administered morphine and medetomidine in dogs.
        J Vet Pharmacol Ther. 1993; 16: 369-372
        • Campoy L.
        • Read M.
        • Peralta S.
        Canine and feline local anesthetic and analgesic techniques.
        in: Grimm K.A. Lamont L.A. Tranquilli W.J. Veterinary Anesthesia and Analgesia: The Fifth Edition of Lumb and Jones. Wiley, USA2015: 827-856
        • Credie L.F.G.A.
        • Luna S.P.L.
        • Futema F.
        • et al.
        Perioperative evaluation of tumescent anaesthesia technique in bitches submitted to unilateral mastectomy.
        BMC Vet Res. 2013; 9: 178
        • Crociolli G.C.
        • Cassu R.N.
        • Barbero R.C.
        • et al.
        Gabapentin as an adjuvant for postoperative pain management in dogs undergoing mastectomy.
        J Vet Med Sci. 2015; 77: 1011-1015
        • Duke T.
        • Caulkett N.A.
        • Ball S.D.
        • Remedios A.M.
        Comparative analgesic and cardiopulmonary effects of bupivacaine and ropivacaine in the epidural space of the conscious dog.
        Vet Anaesth Analg. 2000; 27: 13-21
        • Freire C.D.
        • Torres M.L.A.
        • Fantoni D.T.
        • et al.
        Bupivacaine 0.25% and methylene blue spread with epidural anesthesia in dog.
        Vet Anaesth Analg. 2010; 37: 63-69
        • Gasparini S.S.
        • Luna S.P.L.
        • Cassu R.N.
        • et al.
        Anestesia epidural com ropivacaína, lidocaína ou associação de lidocaína e xilazina em cães: efeitos cardiorrespiratório e analgésico. (Epidural anaesthesia using ropivacaine, lidocaine or the combination of lidocaine and xylazine in dogs: cardiorespiratory and analgesic effects).
        Ciência Rural. 2007; 37 (In Portuguese): 418-424
        • Hendrix P.K.
        • Raffe M.R.
        • Robinson E.P.
        • et al.
        Epidural administration of bupivacaine, morphine, or their combination for postoperative analgesia in dogs.
        J Am Vet Med Assoc. 1996; 209: 598-607
        • Herperger L.J.
        Postoperative urinary retention in a dog following morphine with bupivacaine epidural analgesia.
        Can Vet J. 1998; 39: 650-652
        • Jones R.S.
        Epidural analgesia in the dog and cat.
        Vet J. 2001; 161: 123-131
        • Khodwe S.
        • Shukla B.P.
        • Ahmad R.
        Studies on clinicophysiological and haematobiochemical evaluation of bupivacaine, ropivacaine and ropivacaine-xylazine combination as an epidural analgesic in dogs.
        Int J Adv Res. 2013; 1: 31-35
        • Kona-Boun J.J.
        • Cuvelliez S.
        • Troncy E.
        Evaluation of epidural administration of morphine or morphine and bupivacaine for postoperative analgesia after premedication with an opioid analgesic and orthopedic surgery in dogs.
        J Am Vet Med Assoc. 2006; 229: 1103-1112
        • Mathews K.A.
        Pain assessment and general approach to management.
        Vet Clin North Am Small Anim Pract. 2000; 30: 729-755
        • Pohl V.H.
        • Carregaro A.B.
        • Lopes C.
        • et al.
        Epidural anesthesia and postoperatory analgesia with alpha-2 adrenergic agonists and lidocaine for ovariohysterectomy in bitches.
        Can J Vet Res. 2012; 76: 215-220
        • Portela D.A.
        • Romano M.
        • Briganti A.
        Retrospective clinical evaluation of ultrasound guided transverse abdominis plane block in dogs undergoing mastectomy.
        Vet Anaesth Analg. 2014; 41: 319-324
        • Rector E.
        • Kramer S.
        • Kietzmann M.
        • et al.
        Evaluation of the antinociceptive effect of systemic and epidurally applied xylazine in general anesthesia with isoflurane in dogs and the effect of atipamezole injection on postoperative analgesia.
        Berl Munch Tierarztl Wochenschr. 1998; 111 (In German): 438-451
        • Reid J.
        • Nolan A.M.
        • Hughes J.M.L.
        • 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
        • Soares J.H.N.
        • Ascoli F.O.
        • Gremiao I.D.F.
        • et al.
        Isoflurane sparing action of epidurally administered xylazine hydrochloride in anesthetized dogs.
        Am J Vet Res. 2004; 65: 854-859
        • Teixeira L.G.
        • Pujol D.M.
        • Pazzim A.F.
        • et al.
        Combination of transversus abdominis plane block and serratus plane block anesthesia in dogs submitted to mastectomy.
        Pesq Vet Bras. 2018; 38: 315-319
        • Troncy E.
        • Junot S.
        • Keroack S.
        • et al.
        Results of preemptive epidural administration of morphine with or without bupivacaine in dogs and cats undergoing surgery: 265 cases (1997–1999).
        J Am Vet Med Assoc. 2002; 221: 666-672
        • Valverde A.
        • Dyson D.H.
        • McDonell W.N.
        Epidural morphine reduces halothane MAC in the dog.
        Can J Anaesth. 1989; 36: 629-632
        • Vesovski S.
        • Makara M.
        • Martinez-Taboada F.
        Computer tomographic comparison of cranial spread of contrast in lumbosacral and sacrococcygeal epidural injections in dog cadavers.
        Vet Anaesth Analg. 2019; 46: 510-515
        • Wetmore L.A.
        • Glowski M.M.
        Critical care epidural analgesia in veterinary critical care.
        Clin Tech Small Anim Pract. 2000; 15: 177-188