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L. N. Rønnow Kjærulff N. J. Dorch Lauritsen C. Thorn Ekstrøm S. Østergaard E. Olsen S. Hyldahl Laursen C. Lindegaard 《Equine Veterinary Education》2021,33(7):360-367
Caudal epidural analgesia is a well-established therapeutic modality for pain alleviation in horses. Additionally, epidural analgesia could potentially be a complementary diagnostic tool for confirmation of pain-related conditions in horses presenting with nonspecific signs of poor performance or rideability issues. To use the epidural as a diagnostic tool, the administered medications should provide efficient analgesia without accompanying adverse effects. Therefore, the objectives of the current study were to evaluate the analgesic properties and effects on locomotor function, mentation and physical examination parameters of caudal epidural co-administration of methadone and morphine in horses. Five mares received a caudal epidural injection of 0.1 mg/kg bwt methadone and 0.1 mg/kg bwt morphine diluted to a total volume of 4.4 mL/100 kg. Before and several times thereafter, horses were subjected to mechanical nociceptive threshold evaluation, physical examination, assessment of mentation and locomotor function examination. Horses were assigned ataxia scores (0–4) by a group of inexperienced raters (three senior-year veterinary students) and a group of experienced raters (two board-certified internal medicine specialists) that assessed the locomotor examinations either live or video-based. The epidural co-administration of methadone and morphine resulted in clinically relevant and statistically significant increases of horses’ tolerance to mechanical noxious stimuli at the coccygeal, perineal, sacral, lumbar and thoracic regions. Analgesia was evident after 4.4 h and lasted at least 5 h. Regional differences in the onset of analgesia reflected a cranial spread of the analgesic solution. No horses showed signs of gait disturbances; the overall median ataxia score was 0 at all times; and the average difference in scores between two randomly selected raters for a random horse at a random time point was 0.377 indicating high inter-rater agreement. There were no adverse changes of mentation and physical examination parameters. Observed side effects included signs of decreased frequency of defaecation, generalised sweating, and pruritus. 相似文献
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Alexandra B. Kalamaras Turi K. Aarnes Sarah A. Moore Stephen C. Jones Carolina Ricco Pereira Juan Peng Nina R. Kieves 《Veterinary anaesthesia and analgesia》2021,48(3):415-421
ObjectiveTo compare the quality of postoperative analgesia and sedation after preoperative saphenous and sciatic nerve blockade, preoperative lumbosacral epidural injection and perioperative intravenous (IV) morphine, lidocaine and ketamine infusions in dogs undergoing stifle arthroscopy and tibial plateau leveling osteotomy (TPLO) under general anesthesia.Study designProspective, blinded, randomized, clinical comparison study.AnimalsA total of 45 dogs weighing 33.9 (15.9–56.7) kg and aged 5.2 (1.0–12.0) years, mean (range), undergoing elective unilateral TPLO for spontaneous cranial cruciate ligament rupture.MethodsClient-owned dogs were enrolled. Dogs were randomly assigned to one of three groups: group MLK, perioperative IV morphine, lidocaine and ketamine infusion; group EPID, lumbosacral epidural with ropivacaine and morphine; or group SSNB, saphenous and sciatic nerve blockade with ropivacaine. Routine stifle arthroscopy followed by TPLO surgery was performed. Sedation and pain scores were assessed at 0, 2, 4, 8 and 24 hours following extubation. Rescue analgesia was administered as prescribed by Glasgow composite pain score–short form score >5.ResultsSedation scores for MLK were higher than EPID and SSNB. Pain scores for SSNB were lower than those for EPID and MLK. No significant differences were found in anesthesia duration or surgery duration among groups. No dogs required rescue analgesia.Conclusions and clinical relevanceAlthough analgesia was adequate in all groups, the best combination of analgesia without increased sedation was recorded for SSNB. 相似文献
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TECHNIQUE,DIFFICULTY, AND ACCURACY OF COMPUTED TOMOGRAPHY‐GUIDED TRANSLAMINAR AND TRANSFORAMINAL LUMBOSACRAL EPIDURAL AND INTRAARTICULAR LUMBAR FACET JOINT INJECTIONS IN DOGS 
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下载免费PDF全文 Annalisa Liotta Charlotte Sandersen Thierry Couvreur Géraldine Bolen 《Veterinary radiology & ultrasound》2016,57(2):191-198
In human medicine, spinal pain and radiculopathy are commonly managed by computed tomography (CT)‐guided facet joint injections and by transforaminal or translaminar epidural injections. In dogs, CT‐guided lumbosacral epidural or lumbar facet joint injections have not been described. The aim of this experimental, ex vivo, feasibility study was to develop techniques and to assess their difficulty and accuracy. Two canine cadavers were used to establish the techniques and eight cadavers to assess difficulty and accuracy. Contrast medium was injected and a CT scan was performed after each injection. Accuracy was assessed according to epidural or joint space contrast opacification. Difficulty was classified as easy, moderately difficult, or difficult, based on the number of CT scans needed to guide insertion of the needle. A total of six translaminar and five transforaminal epidural and 53 joint injections were performed. Translaminar injections had a high success rate (100%), were highly accurate (75%), and easy to perform (100%). Transforaminal injections had an moderately high success rate (75%), were accurate (75%), and moderately difficult to perform (100%). Success rate of facet joint injections was 62% and was higher for larger facet joints, such as L7‐S1. Accuracy of facet joint injections ranged from accurate (37–62%) to highly accurate (25%) depending on the volume injected. In 77% of cases, injections were moderately difficult to perform. Possible complications of epidural and facet joint injections were subarachnoid and vertebral venous plexus puncture and periarticular spread, respectively. Further studies are suggested to evaluate in vivo feasibility and safety of these techniques. 相似文献
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Comparison of bupivacaine and dexmedetomidine femoral and sciatic nerve blocks with bupivacaine and buprenorphine epidural injection for stifle arthroplasty in dogs 下载免费PDF全文
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Alexander Valverde DVM DVSc DACVA Cornelia I. Gunkel Dr. med. vet. MRCVS 《Journal of Veterinary Emergency and Critical Care》2005,15(4):295-307
Objective: This review discusses the different analgesic drugs and routes of administration used in large animals for acute pain management. General guidelines and doses are given to assist in choosing techniques that provide effective analgesia. Etiology: Noxious stimuli are perceived, recognized, and localized by specialized sensory systems located at spinal and supraspinal levels. Diagnosis: Localizing the source of the noxious stimulus as well as understanding the behavioral aspects and physiological changes that result from such insult is important to adequately diagnose and treat pain. Pain assessment is far from being definite and objective; not only are there species differences, but also individual variation. In addition, the behavioral and physiological manifestations vary with the acute or chronic nature of pain. Therapy: Pain management should include (1) selecting drugs that better control the type of pain elicited by the insult; (2) selecting techniques of analgesic drug administration that act on pathways or anatomical locations where the nociceptive information is being processed or originating from; (3) combining analgesic drugs that act on different pain pathways; and (4) provide the best possible comfort for the animal. Prognosis: Providing pain relief improves the animal's well being and outcome; however, interpreting and diagnosing pain remains difficult. Continuing research in pain management will contribute to the evaluation of the pathophysiology of pain, pain assessment, and newer analgesic drugs and techniques. 相似文献
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The use of a nerve stimulation test to confirm sacrococcygeal epidural needle placement in cats 下载免费PDF全文
下载免费PDF全文 Pablo E Otero Natali Verdier Andrea S Zaccagnini Santiago E Fuensalida Lisa Tarragona Diego A Portela 《Veterinary anaesthesia and analgesia》2015,42(1):115-118
ObjectiveTo determine if a nerve stimulation test (NST) could act as a monitoring technique to confirm sacrococcygeal epidural needle placement in cats.Study designProspective experimental trial in a clinical setting.AnimalsTwenty-four adult cats, scheduled for a therapeutic procedure where epidural anesthesia was indicated.MethodsUnder general anesthesia, an insulated needle was inserted through the S3-Cd1 intervertebral space guided by the application of a fixed electrical current (0.7 mA) until a motor response was obtained. The NST was considered positive when the epidural nerve stimulation produced a motor response of the muscles of the tail, whereas it was considered negative when no motor response was evoked. In the NST positive cases, 0.3 mL kg−1 of 0.5% bupivacaine was administrated before needle withdrawal. Ten minutes after injection, epidural blockade was confirmed by the loss of perineal (anal), and pelvic limbs reflexes (patellar and withdrawal).ResultsThe use of a fixed electrical stimulation current of 0.7 mA resulted in correct prediction of sacrococcygeal epidural injection, corroborated by post bupivacaine loss of perineal and pelvic limb reflexes, in 95.8% of the cases.Conclusion and clinical relevanceThis study demonstrates the feasibility of using, in a clinical setting, an electrical stimulation test as an objective and in real-time method to confirm sacrococcygeal epidural needle placement in cats. 相似文献
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Adriano B Carregaro Gabrielle C Freitas Carlize Lopes Rafael Lukarsewski Fernanda S Tamiozzo Rogério R Santos 《Veterinary anaesthesia and analgesia》2014,41(2):205-211
ObjectiveTo evaluate the analgesic and physiological effects of epidural morphine administered at the sixth and seventh lumbar or the fifth and sixth thoracic vertebrae in dogs undergoing thoracotomy.Study designProspective, randomized, blinded trial.AnimalsFourteen mixed-breed dogs, weighing 8.6 ± 1.4 kg.MethodsThe animals received acepromazine (0.1 mg kg?1) IM and anesthesia was induced with propofol (4 mg kg?1) IV. The lumbosacral space was punctured and an epidural catheter was inserted up to the region between the sixth and seventh lumbar vertebrae (L, n = 6) or up to the fifth or sixth intercostal space (T, n = 8). The dogs were allowed to recover and after radiographic confirmation of correct catheter position, anesthesia was reinduced with propofol IV and maintained with 1.7% isoflurane. Following stabilization of monitored parameters, animals received morphine (0.1 mg kg?1) diluted in 0.9% NaCl to a final volume of 0.25 mL kg?1 via the epidural catheter, and after 40 minutes, thoracotomy was initiated. Heart rate and rhythm, systolic, mean and diastolic arterial pressures, respiratory rate, arterial hemoglobin oxygen saturation, partial pressure of expired CO2 and body temperature were measured immediately before the epidural administration of morphine (0 minute) and every 10 minutes during the anesthetic period. The Melbourne pain scale and the visual analog scale were used to assess post-operative pain. The evaluation began 3 hours after the epidural administration of morphine and occurred each hour until rescue analgesia.ResultsThere were no important variations in the physiological parameters during the anesthetic period. The post-operative analgesic period differed between the groups, being longer in T (9.9 ± 1.6 hours) compared with L (5.8 ± 0.8 hours).ConclusionsThe use of morphine, at a volume of 0.25 mL kg?1, administered epidurally over the thoracic vertebrae provided longer lasting analgesia than when deposited over the lumbar vertebrae.Clinical relevanceThe deposition of epidural morphine provided longer lasting analgesia when administered near to the innervation of the injured tissue without increasing side effects. 相似文献
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Singh K Kinjavdekar P Amarpal Aithal HP Gopinathan A Singh GR Pawde AM Pratap K 《Veterinary research communications》2007,31(2):133-142
Xylazine–ketamine combination was evaluated for its efficacy and safety after epidural administration in uraemic and healthy
goats. The combination (xylazine 0.025 mg/kg and ketamine 2.5 mg/kg) was administered to uraemic (n = 6) and healthy (n = 6) animals in the lumbosacral epidural space. The combination was evaluated in terms of clinical, physiological, haematological
and biochemical parameters. The onset of analgesia was faster in healthy animals than in uraemic animals. Xylazine and ketamine
produced complete analgesia of tail, perineum, inguinal and thigh regions in all animals of both groups. However, healthy
animals showed longer duration of complete analgesia than did uraemic animals. Greater ataxia was recorded in healthy animals
than in uraemic animals. The heart rate showed a significant decrease in both groups; however, respiratory rate and rectal
temperature did not show any significant changes. Haemoglobin, packed cell volume and total leukocyte count decreased non-significantly
in both groups. Total leukocyte count was significantly higher in uraemic animals. A significantly higher value of urea nitrogen
and creatinine was recorded in uraemic animals. The blood electrolytes (Na+, K+ and Cl−) and blood gases (P
o
2 and P
co
2) did not show any significant changes in both groups; however, base excess was significantly higher in uraemic animals. The
effects produced by the combination on different systems were transient and values normal as the effect of the drugs wore
off. The results suggest that the combination when used epidurally in uraemic goats produced effective and safe surgical analgesia. 相似文献