Research Paper
Evaluation of tumescent local anesthesia in cats undergoing unilateral mastectomy

https://doi.org/10.1016/j.vaa.2020.08.006Get rights and content

Abstract

Objective

To evaluate the analgesic efficacy and safety of tumescent local anesthesia (TLA) in cats undergoing unilateral mastectomy.

Study design

Prospective clinical trial.

Animals

A total of 12 ovariohysterectomized female cats.

Methods

All animals were premedicated with pethidine (4 mg kg–1) intramuscularly (IM), followed by induction of anesthesia with propofol (5 mg kg–1) intravenously and maintenance with isoflurane in oxygen. A refrigerated TLA solution (15 mL kg–1, 8 °C) was injected using a Klein cannula. The solution was composed of 0.5 mL of epinephrine (1 mg mL–1) and 40 mL of 2% lidocaine added to 210 mL lactated Ringer’s solution (final lidocaine concentration 0.32%). Heart and respiratory rates, systolic arterial blood pressure, temperature and oxygen saturation were measured during anesthesia. Blood samples were collected from the jugular vein for measurement of plasma lidocaine concentration using high performance liquid chromatography. Postoperative pain scores were evaluated hourly for 6 hours. Analgesic rescue was performed with tramadol (2 mg kg–1) IM and meloxicam (0.15 mg kg–1) subcutaneously.

Results

Plasma lidocaine concentration peaked at 90 minutes after injection of TLA, but no concentration considered toxic for the species was measured. The median postoperative analgesia time was 6 hours after injection of TLA.

Conclusions

This study found that TLA prevented sympathetic response to noxious stimuli during anesthesia and provided satisfactory postoperative analgesia in cats submitted to total unilateral mastectomy, with no apparent signs of toxicity.

Clinical relevance

TLA can prevent sympathetic stimulation resulting from noxious stimuli during anesthesia, promoting good intraoperative conditions, proving to be a viable addition to analgesia in cats submitted to a total unilateral mastectomy.

Introduction

Mammary tumors are the third most common tumor in cats, of which approximately 90% are malignant and the highest prevalence is in cats aged 10–12 years. Mastectomy is the treatment of choice (Amorim et al. 2006); however, mastectomies involve extensive tissue resection and require appropriate analgesic protocols (Couceiro et al. 2009).

Tumescent local anesthesia (TLA) uses a large volume of diluted local anesthetic, with a vasoconstrictor included, for extensive subcutaneous tissue infiltration (Bussolin et al. 2003). The composition of the TLA solution minimizes systemic drug absorption and risk of toxicity (Klein 1999), reduces bleeding during surgery, provides long-term postoperative analgesia (Jones & Grover 2004) and prevents surgical site infection (Johnson et al. 2008). In humans, TLA is indicated for mastectomy in elderly women and is used for liposuction (Do & Kelley 2007), sentinel lymph node removal (Eichhorn et al. 2004), general dermatological surgery (Davila & Garcia-Doval 2012), vascular surgery (Mizukami & Hamamoto 2007), abdominoplasty, burn repair surgeries in pediatric patients (Bussolin et al. 2003) and plastic surgery (Gutowski 2014). In veterinary medicine, TLA has been used for mastectomy in bitches, providing effective analgesia during surgery and in the immediate postoperative period (Abimussi et al. 2014).

The risk of local anesthetic toxicity is greater in cats than in dogs (Chadwick 1985). A literature search found no reports of TLA use in cats; therefore, this study was conceived to evaluate the behavior of cats administered TLA. We hypothesized that TLA would provide antinociception in cats during mastectomy and analgesia in the immediate postoperative period with no adverse effects.

Section snippets

Materials and methods

The study was approved by the Universidade Federal Rural do Rio de Janeiro (UFRRJ) Animal Care and Use Committee (no. 011/2015).

A total of 12 cats were enrolled in the study with no weight and age restriction after owners’ written consent. Inclusion criteria were based on a complete physical examination and hematologic evaluation, thoracic radiography, echocardiography and abdominal ultrasonography. Exclusion criteria were presence of mammary gland inflammation, tumors >5 cm in diameter,

Results

All 12 cats were successfully enrolled in the study (Table 1). The cats were 11 ± 3 years old and weighed 3.7 ± 1.2 kg [mean ± standard deviation (SD)]. Time for instrumentation, from anesthetic induction to start of TLA infiltration, was 19 ± 7 minutes, and 16 ± 2 minutes were allowed between TLA infiltration and the beginning of the surgery. All cats underwent total unilateral mastectomy with surgery lasting 54 ± 7 minutes (mean ± SD). In the 12 cats, seromas and hematomas were present at the

Discussion

The main findings of this study were that TLA prevented sympathetic response to noxious stimuli during anesthesia and provided satisfactory postoperative analgesia in cats submitted to total unilateral mastectomy. This study was undertaken to evaluate the use of TLA with lidocaine in cats as the technique was already established in humans and dogs. Previous reports on dogs support the intra- and postoperative analgesic effects of TLA as the sole analgesic for mastectomies (Abimussi et al. 2013;

Conclusion

This study found that TLA, 15 mL kg–1 of 0.32% lidocaine with epinephrine at 8–12 °C, infiltrated subcutaneously could prevent sympathetic stimulation from noxious stimuli during anesthesia for unilateral mastectomy surgery in cats. TLA also provided satisfactory postoperative analgesia for several hours, with no apparent signs of toxicity. Therefore, TLA appears to be viable for clinical use as an alternative to intraoperative opioid use for mastectomies in cats.

Acknowledgements

CMRM received a scholarship from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and RLSO received a scholarship from CAPES/PDSE/Process number 88881.188458/2018-01.

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