Objective

To determine the intraoperative and early postoperative opioid requirement after ultrasound-guided sciatic and/or femoral nerve block or epidural anaesthesia in dogs undergoing tibial plateau levelling osteotomy (TPLO).

Study design

Prospective, masked, pilot, randomized, clinical trial.

Animals

A total of 40 client-owned dogs undergoing TPLO.

Methods

Each dog was randomly assigned to group SF (combined sciatic and femoral nerve block), group S (sciatic nerve block), group F (femoral nerve block) or group E (epidural anaesthesia). A total of 0.3 mL kg^–1 of ropivacaine 0.5% was administered to each nerve or in the epidural space. Intraoperatively, fentanyl (2 μg kg^–1) was administered intravenously when heart rate, mean arterial pressure or respiratory rate increased by >30% compared with baseline values. Postoperatively, a visual analogue scale (VAS) and a modified German version of the French pain scale (4AVet) were used to assess pain every 30 minutes for 150 minutes and again once the morning after surgery. Methadone (0.1 mg kg^–1) was administered intravenously if the VAS was ≥ 4 cm [maximal value 10 cm; median (interquartile range)] or the composite pain score was ≥5 [maximal value 15; median (interquartile range)]. Significance was defined as p ≤ 0.05.

Results

Groups SF and E required less total intraoperative and early postoperative opioid doses compared with groups S and F (p = 0.031). No dogs in group SF had a block failure or required postoperative methadone. A reduced methadone requirement was found in group SF compared with all the other groups up to 150 minutes after recovery (p = 0.041).

Conclusions and clinical relevance

Combined sciatic and femoral nerve block and epidural anaesthesia lead to less cumulative consumption of perioperative opioids than single nerve blockade. Sciatic or femoral nerve block alone might be insufficient to control nociception and early postoperative pain in dogs undergoing TPLO.

中文翻译：

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犬胫骨平台整平截骨术局部麻醉后对阿片类药物的需求：一项初步研究

客观的

确定接受胫骨平台水平截骨术 (TPLO) 的犬在超声引导下坐骨神经和/或股神经阻滞或硬膜外麻醉后术中和术后早期阿片类药物的需求。

学习规划

前瞻性、隐蔽、试点、随机、临床试验。

动物

共有 40 只客户拥有的狗正在接受 TPLO。

方法

每只狗被随机分配到SF组（坐骨神经和股神经联合阻滞）、S组（坐骨神经阻滞）、F组（股神经阻滞）或E组（硬膜外麻醉）。向每条神经或硬膜外腔注射总共 0.3 mL kg ^–1的 0.5% 罗哌卡因。术中，当心率、平均动脉压或呼吸频率与基线值相比增加 > 30% 时，静脉注射芬太尼 (2 μg kg ^–1 )。术后，使用视觉模拟量表 (VAS) 和改良的德国版法国疼痛量表 (4AVet) 评估疼痛，​​每 30 分钟评估一次，持续 150 分钟，并在手术后第二天早上评估一次。美沙酮 (0.1 mg kg ^–1) 如果 VAS ≥ 4 cm [最大值 10 cm; 中位数（四分位距）]或复合疼痛评分≥5[最大值15；中位数（四分位距）]。显着性定义为p ≤ 0.05。

结果

与 S 和 F 组相比，SF 和 E 组需要较少的术中和术后早期阿片类药物总剂量（p  = 0.031）。SF 组中没有狗出现阻滞失败或需要术后美沙酮。与所有其他组相比，SF 组在恢复后 150 分钟内发现美沙酮需求减少（p  = 0.041）。

结论和临床相关性

与单一神经阻滞相比，联合坐骨神经和股神经阻滞以及硬膜外麻醉导致围手术期阿片类药物的累积消耗量更少。单独的坐骨神经或股神经阻滞可能不足以控制接受 TPLO 的狗的伤害感受和术后早期疼痛。