Constant Rate Infusion of Lidocaine, Tumescent Anesthesia and Their Combination in Dogs Undergoing Unilateral Mastectomy.

Cecilia Vullo,Annastella Falcone,Gabriele Marino,Adolfo Maria Tambella,Giuseppe Catone

doi:10.3390/ani11051280

Abstract

Simple SummaryAppropriate pain management, particularly when large tissue is removed, allows for better recovery during the postoperative period. The analgesic effects of regional tumescent anesthesia (TUM) combined with constant rate infusion (CRI) of lidocaine were evaluated in dogs submitted to unilateral mastectomy. The purpose of this study was to evaluate if the addition of TUM to lidocaine CRI influenced cardiopulmonary function in dogs undergoing unilateral mastectomy and provided adequate postoperative analgesia. The authors concluded that the combination of the two technique decreases pain and requirement for rescue analgesia than with lidocaine CRI or TUM alone.Tumescent anesthesia (TUM) is a technique that was initially used to perform liposuction under local anesthesia, which consists of the injection of such large volumes of local anesthetic until to produce swelling and firmness (tumescence) of the surgical area. The aim of this study was to compare the intraoperative analgesic efficacy of lidocaine (LID) constant rate infusion (CRI), of TUM, or their combination (LID/TUM) and the postoperative pain and analgesic requirement in dogs undergoing unilateral mastectomy. Twenty-four dogs were premedicated with dexmedetomidine (3 μg/kg) and methadone (0.2 mg/kg) intravenously (IV). After induction with propofol IV to effect, dogs were randomly allocated to receive a loading dose of lidocaine (2 mg/kg) followed by a CRI of 100 μg/kg/min (Group LID) in addition to an equivalent volume of lactated Ringer’s solution instead of local TUM; a loading dose of lactated Ringer’s solution followed by a CRI of Ringer’s solution in addition to TUM (Group TUM); a loading dose of lidocaine (2 mg/kg) followed by a CRI of 100 μg/kg/min in addition to TUM (Group LID/TUM). Anesthesia was maintained with isoflurane in oxygen. Postoperative pain scores were assessed once the dogs had fully recovered from the sedative effects, and following 15, 30, 45 and 60 min. The results of the current study allow us to assert that all three treatments provided satisfactory intraoperative antinociceptive effects but administration of LID/TUM induced greater inhibition on sympathetic stimulating effect up to 60 min from recovery, thus, providing better early postoperative pain relief in dogs undergoing mastectomy.

Highlights

The mammary gland is a modified apocrine sweat gland, and it is the most common site for the development of benign and malignant tumors in intact female dogs [1]
The intravenous (IV) use or constant rate infusion (CRI) of lidocaine as a supplement to general anesthesia has been reported in dogs [8,9,10,11,12,13,14,15,16,17,18], and has been used for surgical procedures, as delineated in recent veterinary pain management guidelines because it plays an important role in the control of peri and postoperative sympathetic response [19,20]
There was no significant difference between the groups for age, weight, Tadbulera1t.ioMneoafnsvuarlgueersy,anandessttahnedsaiar,dtidmeveitaotioennsdootfraagceheaanldewxteuibgahttioinn,thaendthrreeceogvreoruyptsi.mLeID(T: aLbidleoc1aine graonudp;FTigUuMre: T1u).mescent anesthesia group; LID/TUM: Lidocaine/Tumescent anesthesia group

Summary

Introduction

The mammary gland is a modified apocrine sweat gland, and it is the most common site for the development of benign and malignant tumors in intact female dogs [1]. Postoperative pain followed the surgery may consist of inflammatory, neurogenic, and visceral components [4]. To minimize perioperative patients’ distress, especially after major surgery, as mastectomy, requires multimodal pre-emptive analgesia that includes both systematical and local or regional administration of analgesics [5,6]. The intravenous (IV) use or constant rate infusion (CRI) of lidocaine as a supplement to general anesthesia has been reported in dogs [8,9,10,11,12,13,14,15,16,17,18], and has been used for surgical procedures, as delineated in recent veterinary pain management guidelines because it plays an important role in the control of peri and postoperative sympathetic response [19,20]

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