Objective

To retrospectively compare the efficacy and duration of effect of three commonly used locoregional blocks in dogs undergoing pelvic limb orthopaedic surgery.

Study design

Retrospective clinical study.

Animals

A total of 236 dogs that underwent pelvic limb surgery and were administered a locoregional technique.

Methods

A total of 236 hospital records were reviewed and 230 included in statistical analysis. Dogs were grouped as following: electrostimulation-guided pre-iliac femoral and sciatic nerve block (group PFS, n = 70); ultrasound-guided saphenous and sciatic nerve block (group SS, n = 76); or lumbosacral epidural (group EPI, n = 84). In group EPI, bupivacaine 0.5% or ropivacaine 0.75% was used with morphine. Dogs were pain scored (short form of the Glasgow Composite Measure Pain Scale) hourly following recovery from anaesthesia. Analysed data included: time to first postoperative dose of methadone, pain score at that time, intraoperative rescue analgesia, intraoperative hypotension and ability to walk and urinate overnight. Separate analyses were performed including all pelvic limb surgeries and including only elective stifle surgeries. Kruskal–Wallis and Mann–Whitney tests were performed. A p value < 0.05 was considered significant. The median (range) is reported.

Results

For all pelvic limb surgeries, the time to first postoperative methadone was 530 (110–1337), 440 (140–1030) and 466 (135–1094) minutes in groups EPI, PFS and SS, respectively, and was not significantly different. Postoperatively, 10/84, 15/70 and 12/76 dogs in groups EPI, PFS and SS, respectively, did not require methadone (nonsignificant). Significantly fewer dogs in group EPI (18%) required intraoperative rescue analgesia compared with group SS (38%), but not compared with PFS (30%). Significantly more dogs in group EPI had hypotension intraoperatively (30%) and urinary retention postoperatively (62%).

Conclusions and clinical relevance

Intraoperative analgesia may be superior with EPI than SS for some surgeries of the pelvic limb, but not for stifle surgeries. All three techniques provided similar requirement for postoperative analgesia, but EPI caused higher incidence of intraoperative hypotension and postopertive urinary retention.

中文翻译：

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犬骨盆肢体手术三种局部技术的回顾性比较

客观的

回顾性比较三种常用局部阻滞对接受骨盆肢体骨科手术的犬的疗效和持续时间。

学习规划

回顾性临床研究。

动物

共有 236 只狗接受了骨盆肢体手术并接受了局部区域技术。

方法

共审查了 236 份医院记录，其中 230 份纳入统计分析。犬被分组如下：电刺激引导的髂前股骨和坐骨神经阻滞（PFS 组，n  = 70）；超声引导下隐神经和坐骨神经阻滞（SS 组，n  = 76）；或腰骶部硬膜外（组 EPI，n = 84）。在EPI组中，布比卡因0.5%或罗哌卡因0.75%与吗啡一起使用。从麻醉中恢复后每小时对狗进行疼痛评分（格拉斯哥综合疼痛量表的简写形式）。分析的数据包括：术后第一次美沙酮给药时间、当时的疼痛评分、术中解救镇痛、术中低血压和夜间行走和排尿能力。进行了单独的分析，包括所有骨盆肢体手术和仅包括选择性窒息手术。进行了 Kruskal-Wallis 和 Mann-Whitney 检验。甲p值<0.05被认为显著。报告了中值（范围）。

结果

对于所有盆腔肢体手术，EPI、PFS 和 SS 组的术后首次美沙酮时间分别为 530 (110-1337)、440 (140-1030) 和 466 (135-1094) 分钟，并且没有显着差异。术后，EPI、PFS 和 SS 组中分别有 10/84、15/70 和 12/76 只狗不需要美沙酮（不显着）。与 SS 组 (38%) 相比，EPI 组 (18%) 中需要术中救援镇痛的犬明显更少，但与 PFS (30%) 相比则不然。EPI 组中有更多的狗在术中出现低血压 (30%) 和术后尿潴留 (62%)。

结论和临床相关性

对于某些骨盆肢体手术，EPI 的术中镇痛效果可能优于 SS，但对于窒息手术则不然。这三种技术对术后镇痛的要求相似，但 EPI 导致术中低血压和术后尿潴留的发生率较高。