EVALUATION OF THE ANALGESIC EFFECT OF A POSOPERATIVE CONTINUOUS RATE INFUSION OF MORPHINE, LIDOCAINE AND KETAMINE IN SIX DOGS UNDERGOING ORTHOPEDIC SURGERY Diego A Ospina1; Diego F Echeverry1; Edwin F Buritica1. 1 Small Animal’s Medicine and Surgery Research Group, Faculty of Veterinary Medicine, University of Tolima, Colombia contact mail:
[email protected]
Introduction The current approach to the management of perioperative pain is based on the use of preventive multimodal analgesia protocols.1 Continuous rate infusions (CRI) as part of multimodal anaesthesia protocols are an effective and safe alternative for the control of postoperative pain associated with orthopedic surgery in dogs.2
Objective To describe the use of a CRI of morphine (M), lidocaine (L) and ketamine (K) for the control of postoperative pain in 6 dogs undergoing orthopedic surgery. Bred
Diagnosis
Surgical procedures
Rottweiler Chow Chow Mongrel dog Mongrel dog Schnauzer Mongrel dog
Distal metaphyseal fracture of the right tibia Right hip dislocation Right mandibular body fracture Severe osteomyelitis of the femur Osteosarcoma of the right tarsus Supracondylar fracture of the left femur
Plate osteosynthesis Femoral head and neck excision External fixation Femoral shaft amputation Amputation at the level of the femoral shaft Cross fixation nails
Anaesthetic protocol
Postoperative pain management
Premedication: acepromazine (0.01 mg kg-1) IV or xilacine (0,5 mg Kg-1) IM, morphine (0,3 mg kg-1) IV, meloxicam (0.3 mg kg-1) IM. Induction: propofol (5 mg kg-1) IV, ketamine (5 mg Kg-1) IV or Thiopental (8mg Kg-1) IV. Manteinance: Isofluorane in oxygen 100%.
Upon completion of the last suture each patient received a loading dose of 0.25, 1 and 0.5 mg kg-1 IV of M, L and K respectively, in a period of 2 minutes, followed by the CRI of 0.12, 1 and 0.12 mg kg-1/h of M, L and K respectively. The infusion rate employed was 1 mL kg-1/h during 24 hours. (fig. 1- 2)
Posoperative pain evaluation The postoperative pain evaluation was performed every 60 minutes using the Short-Form Glasgow Composite Measure Pain Score (CMPS-SF) during 24 hours. Values greater than 5 in this score were considered indicative of insufficient analgesic coverage. A
B
C
B.
A.
Fig 1. A) Medicaments employed. B) The medicaments were introduced into a 500 mL saline bag which was covered by an aluminum foil to avoid the pharmacological alteration of the medicaments employed. C. During the evaluated postoperative period the CMPS-SF was between 1-3 in all the cases.
Throughout the postoperative period the CMPS-SF was between 1-3
Two to 8 hours after the start of the CRI, in 2 patients was observed an episode of dysphoria wich was effectively treated with 0,01 mg Kg-1 of acepromazine
No additional analgesia was employed in the evaluated dogs during the 24 hours of the CRI infusion
Results & conclusions • • • •
During the evaluated postoperative period the results of the CMPS-SF were between 1-3 in all the cases. It was observed in some patients episodes of dysphoria (n=2) and bradycardia (n=2) associated with the drugs used in the CRI. No additional analgesic therapy was administer during the posoperative period. The use of a CRI with M, L and K was effective for the postoperative pain management associated with orthopedic surgery in the evaluated patients and under the conditions described in this study.
• The use of this CRI could be considered as an adequate, safe and inexpensive analgesic protocol to provide postoperative analgesia in dogs undergoing orthopedic surgery. References
1. Lamont LA: Adjunc0ve analgesic therapy in veterinary medicine. Vet Clin North Am Small Anim Pract 2008; 38(6):1187-‐1203. 2. West E, Andreoni V, Keeley B, Self Ia, Jones B: Analgesic management of an eight-‐year-‐old Springer Spaniel aRer amputa0on of a thoracic limb. Ir Vet J 2009; 62(2):111-‐118.
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