Evaluation of preoperative rectus sheath block with bupivacaine for analgesia in cats undergoing ovariohysterectomy: a cadaveric and randomized clinical study.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 100956422 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1467-2995 (Electronic) Linking ISSN: 14672987 NLM ISO Abbreviation: Vet Anaesth Analg Subsets: MEDLINE
    • Publication Information:
      Publication: 2017- : New York, NY : Elsevier
      Original Publication: Oxford, UK : Blackwell Science, c2000-
    • Subject Terms:
      Ovariectomy*/veterinary ; Hysterectomy*/veterinary ; Bupivacaine*/administration & dosage ; Bupivacaine*/pharmacology ; Nerve Block*/veterinary ; Nerve Block*/methods ; Pain, Postoperative*/veterinary ; Pain, Postoperative*/prevention & control ; Anesthetics, Local*/administration & dosage; Animals ; Cats/surgery ; Female ; Cadaver ; Ultrasonography, Interventional/veterinary ; Rectus Abdominis/innervation
    • Abstract:
      Objective: Phase 1: to determine the feasibility of desensitizing ventral branches of spinal nerves within the rectus sheath using an ultrasound-guided rectus sheath block (USRSB). Phase 2: to determine the effect of preoperative USRSB on intraoperative responses to surgical stimulation and postoperative pain.
      Study Design: Cadaveric study and prospective, randomized, blinded, parallel-arm clinical trial.
      Animals: A group of five cat cadavers and 37 shelter-owned cats undergoing ovariohysterectomy.
      Methods: Phase 1: anatomical dissection was performed on one uninjected cadaver. Abdominal walls were dissected in four cadavers (eight hemiabdomens) following bilateral USRSB using 1:1 new methylene blue and 0.5% bupivacaine (0.8 mL kg -1 total). Phase 2: preoperative bilateral USRSB was performed with 0.8 mL kg -1 of 0.25% bupivacaine (RSB) or equivalent volume of 0.9% saline (CONTROL). Intraoperative systolic arterial blood pressure (SAP), heart rate (HR), respiratory rate (f R ) and vaporizer setting (vap%) were recorded before skin incision, during celiotomy and abdominal wall closure. In recovery, cats were administered robenacoxib (2 mg kg -1 ; CONTROL) or 0.9% saline (0.1 mL kg -1 ; RSB) subcutaneously. Postoperative pain was evaluated for 6 hours using the Glasgow Composite Measure Pain Scale.
      Results: Phase 1: spinal nerves T9-L3 were identified within the rectus sheath, and stained in 0%, 40%, 63%, 75%, 100%, 88%, 50% and 13% of hemiabdomens, respectively. Phase 2: 37 cats were included (RSB, n = 17; CONTROL, n = 20). Intraoperatively, SAP, HR and f R were not significantly different between groups. Vap% was significantly lower in RSB during celiotomy (p = 0.036) and closure (p = 0.044). Postoperatively, RSB cats were 5.3 times (95% CI 1.8-8.3) more likely to require rescue analgesia than CONTROL cats.
      Conclusions and Clinical Relevance: During surgery, USRSB with bupivacaine offered minor benefits and provided markedly less postoperative analgesia than robenacoxib, indicating that relying on USRSB provides insufficient postoperative analgesia for ovariohysterectomy in cats.
      (Copyright © 2024 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)
    • Contributed Indexing:
      Keywords: abdomen; feline; locoregional; pain; spay; ultrasound-guided regional anesthesia
    • Accession Number:
      Y8335394RO (Bupivacaine)
      0 (Anesthetics, Local)
    • Publication Date:
      Date Created: 20240829 Date Completed: 20241023 Latest Revision: 20241114
    • Publication Date:
      20241115
    • Accession Number:
      10.1016/j.vaa.2024.07.010
    • Accession Number:
      39209569