Abstract
The aim of this study was to compare the analgesic efficacy of intraperitoneal bupivacaine vs. bupivacaine-dexmedetomidine in combination with intramuscular buprenorphine in cats undergoing ovariohysterectomy. Sixty healthy adult cats (2.8 ± 0.7 kg; n = 30/group) were included in a randomized, prospective, blinded, clinical trial after owners' written consent. After premedication with acepromazine (0.02 mg/kg) and buprenorphine (0.02 mg/kg) intramuscularly, anesthesia was induced with propofol to effect (6.2 ± 1.4 mg/kg) and maintained with isoflurane. Bupivacaine 0.25% alone (BG; 2 mg/kg) or bupivacaine (same dose) with dexmedetomidine (BDG; 1 μg/kg) were instilled/splashed over the ovarian pedicles and caudal aspect of uterus before ovariohysterectomy. Final injectate volume was standardized between groups. Sedation was evaluated using a five-point simple descriptive scale. Pain was evaluated using the short-form UNESP-Botucatu composite pain scale (SF-CPS) before, and at 0.5, 1, 2, 3, 4, 6, 8, 12, and 24 h after surgery. Rescue analgesia was provided with buprenorphine (0.02 mg/kg intravenously) and meloxicam (0.2 mg/kg subcutaneously) when SF-CPS ≥ 4. The Mantel-Haenszel chi-square test was used for analyzing ordinal variables (e.g., SF-CPS pain scores). The effect of time in SF-CPS scores was assessed with the Cochran-Mantel-Haenszel test for repeated measures. The alpha level for each contrast was adjusted downward with the sequential Benjamini-Hochberg procedure. The number of cats receiving rescue analgesia was analyzed using χ2 test (p < 0.05). The prevalence of rescue analgesia was the same for the two treatments (p = 1.000) [BG, n = 6, 20%; BDG, n = 6, 20%] and similar for timing of rescue analgesia (p = 0.16). The SF-CPS scores were significantly increased between 1 and 12 h in BG, and between 0.5 and 8 h in BDG when compared with baseline values. Median (interquartile range) pain scores were higher in BG [1 (1–2)] than BDG [1 (0–1)] at 12 h (p = 0.023). Sedation scores were not significantly different between groups throughout the study. In terms of prevalence of rescue analgesia, but not duration of action, the analgesic efficacy of bupivacaine-dexmedetomidine was similar to bupivacaine alone after intraperitoneal administration in cats receiving buprenorphine.
Highlights
The World Small Animal Veterinary Association Global Pain Council has recommended the use of incisional and intraperitoneal administration of local anesthetics for canine and feline pain management in a multimodal analgesic approach
Local anesthetic drugs are often combined with adjuvant drugs in human and veterinary medicine to prolong analgesia after peripheral nerve blocks [2, 3]
Dexmedetomidine has been used in combination with bupivacaine to improve antinociception and duration of action after sciatic and femoral nerve blocks [3]
Summary
The World Small Animal Veterinary Association Global Pain Council has recommended the use of incisional and intraperitoneal administration of local anesthetics for canine and feline pain management in a multimodal analgesic approach. These are simple, safe and cost-effective methods to reduce pain after ovariohysterectomy in small animals [1]. Local anesthetic drugs are often combined with adjuvant drugs (i.e., opioids, vasoactive agents, agonists of α-adrenergic receptors, etc.) in human and veterinary medicine to prolong analgesia after peripheral nerve blocks [2, 3]. Dexmedetomidine has been used in combination with bupivacaine to improve antinociception and duration of action after sciatic and femoral nerve blocks [3]
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