Research PaperEvaluation of tumescent local anesthesia in cats undergoing 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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