Postoperative Analgesia Time in Dogs Submitted to Mastectomy and Anesthetized with Tumescent Solutions of Lidocaine or Ropivacaine

Fabiana Del Lama Rocha, Newton Nunes, Paula Chiconi Dacunto dos Santos, Cléber Kazuo Ido, Paloma do Espírito Santo Silva, Eveline Simões Azenha Aidar, Helen Roberta Amaral da Silva, Tiago Carmagnani Prada

Abstract


Background: Mastectomy, a procedure with high pain stimulation, is the treatment of choice for bitches with breast cancer. Tumescent anaesthesia is widely used for transoperative and postoperative analgesia in bitches submitted to mastectomy, because facilitates tissue divulsion, also contributing significantly for the rapid recovery of patients. Although, there is no consensus as to which local anesthetic to use and at what concentration it should be used. Herein was investigated which local anesthetics, lidocaine or ropivacaine, when used in tumescent solutions, could provide a more lasting analgesic effect in the postoperative period in bitches submitted to radical unilateral mastectomy.

Materials, Methods & Results: Sixteen bitches were sedated with chlorpromazine (0.3 mg/kg) and meperidine (3 mg/kg) followed by anesthesia with propofol and isofluorane. Then, bitches were randomly assigned to two groups (n= 8 each): LG group, infused with 15 mL/kg of tumescence solution containing 0.1% lidocaine; and RG group, infused with 15 mL/kg of tumescence solution with 0.1% ropivacaine. The study was conducted in a double-blind fashion. Control group did not include, because the patients would be submitted to severe or unbearable pain, according to the short-form of the Glasgow pain Scale (CMPS-SF). The heart (HR) and respiratory (ƒ) rates, and systolic blood pressure (SBP) were measured in the pre-operative period and immediately after extubation (Mextub) and at 0.5 h, 1 h, 2 h, 4 h, 8 h, and 12 h after the extubation. Analgesic efficacy was assessed using the CMPS-SF and von Frey filaments. Both groups showed higher means for HR at 0.5 h (167 ± 7 in LG; 170 ± 7 in RG) than at 4 h (117 ± 7 in LG; 120 ± 7 in RG). CMPS-SF revealed higher medians (P= 0.038) at the Mextub and 12 h time points for the LG [5 (3-6) and 1 (0-2)] than for the RG [5 (2-5) and 0 (0-1)].

Discussion: Pain was excluded as a possible explanation for the difference presented for HR in both groups because, moderate pain is considered when more than two cardiorespiratory parameters show an increase of at least 20% in relation to baseline values, which did not occur in this study. Indeed, most animals were walking at 0.5 h after extubation and, in many cases, this occurred before the collection of data for the postoperative period. This may have influenced the results since exercise releases catecholamines and increases HR. Moreover at 4 h after extubation, most animals were asleep. As metabolism decreases during sleep, expected that HR would also decrease and that was indeed the case. Regarding CMPS-SF, the way the patients walks was the item that most contributed to the high score found for the Mextub time point because it's impossible to be performed seconds after extubation. As the reluctance to move occurred only immediately after extubation, the values obtained at the Mextub time point are more likely to be due to an anesthetic residual effect and not to the pain stimulus itself. When the groups were compared, the median values obtained at the LG were greater than RG at the Mextub and 12 h postoperative time points.  There was no need for analgesic rescue differing from those in literature that reported the need for analgesic rescue in 50% of the animals. Those study established a CMPS-SF score of 3.3 as indicative for analgesic rescue whereas our research established a score of 7. Tumescence solutions with lidocaine or ropivacaine provide equivalent postoperative analgesia for at least 12 h.


Full Text:

PDF

References


Abimussi C.J.X. 2012. Anestesia por tumescência com lidocaína ou ropivacaína em diferentes concentrações em cadelas submetidas à mastectomia. 75f. Botucatu, SP. Dissertação (Mestrado em Anestesiologia) - Programa de Pós-Graduação em Anestesiologia, Universidade Estadual Paulista “Julio de Mesquita Filho”, Campus Botucatu.

Abimussi C.J.X., Menegheti T.M., Wagatsuma J.T., Floriano B.P., Arruda A.M.M., dos Santos P.S.P. & Oliva V.N.L.S. 2014. Tumescent local anesthesia with ropivacaine in different concentrations in bitches undergoing mastectomy: plasma concentration and post-operative analgesia. Veterinary Anaesthesia and Analgesia. 41(5): 516-525.

Aguirre C.S., Minto B.W., Faria E.G., Horr M., Filgueira F.G.F. & Nardi AB. 2014. Conventional anesthesia and tumescent technique in bitches which underwent mastectomy. Evaluation of postoperative pain. Arquivo Brasileiro de Medicina Veterinária e Zootecnia. 66(4): 1073-1079.

Bednarski R.M. 2015. Dogs and Cats. In: Grimm K.A., Lamont L.A., Tranquilli W.J., Greene S.A. & Robertson S.A. (Eds). Lumb & Jones´ Veterinary Anesthesia and Analgesia. 5th edn. Ames: Wiley Blackwell, pp.819-826.

Breuninger H., Hobbach P.S. & Schimek F. 1999. Ropivacaine: a important anesthetic agent for slow infusion and other forms of tumescent anesthesia. Dermatologic Surgery. 25(10): 799-802.

Cabral R.R., Ciasca B.D., Oliveira V.M.C., Vaz-Curado A.P. & Larsson M.H.M.A. 2010. Valores da pressão arterial em cães pelos métodos oscilométrico e doppler vascular. Arquivo Brasileiro de Medicina Veterinária e Zootecnia. 62(1): 64-71.

Cavalcante A.N., Gurrieri C., Sprung J., Schroeder D.R. & Weingarten T.N. 2018. Isoflurane and postoperative respiratory depression following laparoscopic surgery: a retrospective propensity matched analysis. Bosnian Journal of Basic Medical Sciences. 18(1): 95-100.

Credie L.F.G.A., Luna S.P.L., Futema F., da Silva L.C.B.A., Gomes G.B., Garcia J.N.N. & Carvalho L.R. 2013. Perioperative evaluation of tumescent anaesthesia technique in bitches submitted to unilateral mastectomy. BMC Veterinary Research. 9(1): 178-189.

Comasseto F., Rosa L., Ronchi S.J., Fuchs K., Regalin B.D., Regalin D., Padilha V. & Oleskovicz N. 2017. Correlação entre as escalas analógica visual, da Glasgow, Colorado e Melbourne na avaliação de dor pós operatória em cadelas submetidas à mastectomia total unilateral. Arquivo Brasileiro de Medicina Veterinária e Zootecnia. 69(2): 355-363.

Costa Júnior J.S., Goiozo P.F.I. & Silva E.O. 2016. Estudo epidemiológico de tumores de mama em cadelas na região do oeste paulista. Colloquium Agrariae. 12(1): 27-31.

Daleck C.R., Franceschini P.H., Alessi A.C., Santana A.E. & Martins M.I.M. 1998. Aspectos clínico e cirúrgicos do tumor mamário canino. Ciência Rural. 28(1): 95-100.

Dumantepe M. & Uyar I. 2015. Comparing cold and warm tumescent anesthesia for pain perception during and after the endovenous laser ablation procedure with 1470 nm diode laser. Phlebology. 30(1): 45-51.

Esteves N.A., Eneas M.D., Abimussi C.J.X. 2015. Tumescent local anesthesia with lidocaine 0,08% in dog undergoing unilateral mastectomy: case report. Almanaque de Medicina Veterinária e Zootecnia. 1(1): 21-25.

Feitosa F.L.F. 2008. Exame físico geral ou de rotina. In: Feitosa L.F.L. (Ed). Semiologia Veterinária - A Arte do Diagnóstico. 2.ed. São Paulo: Roca, pp.65-86.

Firth A.M. & Haldane S.L. 1999. Development of a scale to evaluate postoperative pain in dogs. Journal of the American Veterinary Medical Association. 214(5) :651-659.

Gomes L.G., Pytlak D.B., Amaral A.R.B., Sônego D.A., Monzem S., Campos G.M.D., Souza M.A., Ribeiro A.P., Flôres F.N. & Guimarães L.D. 2018. Evaluation of postoperative residual analgesia of two solutions used for local anesthesia by tumescence in bitches who underwent a unilateral mastectomy. Acta Scientiae Veterinariae. 46: 1567. https://doi.org/10.22456/1679-9216.83159

Guyton A.C. & Hall J.E. 2006. Local and humoral control of blood flow by the tissues. In: Guyton A.C. & Hall J.E. (Eds). Textbook of Medical Physiology. 11th edn. Philadelphia: Elsevier Saunders, pp.195-203.

Guyton A.C. & Hall J.E. 2006. States of brain activity – sleep, brain waves, epilepsy, psychoses. In: Guyton A.C. & Hall J.E. (Eds). Textbook of Medical Physiology. 11th edn. Philadelphia: Elsevier Saunders, pp.739-747.

Hendrickson D. & Virgin J. 2005. Factors that affect equine wound repair. Veterinary Clinics of North America Equine Practice. 21(1): 33-44.

Klaumann P.R., Wouk A.F.P.F. & Sillas T. 2008. Patofisiologia da dor. Archives of Veterinary Sciences. 3(1): 1-12.

Lapid O. 2011. Syringe-delivered tumescent anesthesia made easier. Aesthetic Plastic Surgery. 35(4): 601-602.

Martins T.L. & Fantoni D.T. 2010. Recuperação pós-anestésica. In: Fantoni D.T. & Cortopassi S.R.G. (Eds). Anestesia em cães e gatos. 2.ed. São Paulo: Roca, pp.591-604.

Mitch P. & Hellyer P. 2008. Objective categoric methods for assessing pain and analgesia. In: Gaynor J. & Muir W. III. (Eds). Handbook of veterinary pain management. 2nd edn. St. Louis: Mosby, pp.78-109.

Morton C.M., Reid J., Scott E.M., Holton L.L. & Nolan A.M. 2005. Application of scaling model to establish and validate a interval level pain scale for assessment of acute pain in dogs. American Journal of Veterinary Research. 66(12): 2154-2166.

Murrell J.C., Psatha E.P., Scott E.M., Reid J. & Hellebrekers L.J. 2008. Application of a modified form of the Glasgow pain scale in a veterinary teaching centre in the Netherlands. Veterinary Records. 162(13): 403-408.

Oliveira Filho J.C., Kommers G.D., Masuda E.K., Marques B.M.F.P.P., Fighera R.A., Irigoyen L.F. & Barros C.S.L. 2010. Estudo retrospectivo de 1647 tumores mamários em cães. Pesquisa Veterinária Brasileira. 30(2): 177-185.

Rialland P., Authier S., Guillot M., Del Castilho J.R.E., Veilleux-Lemieux D., Frank D., Gauvin D. & Troncy E. 2012. Validation of orthopedic postoperative pain assessment methods for dogs: a prospective, blinded, randomized, placebo-controlled study. PLoS ONE. 7(11): e49480.

Sarandy M.M. 2007. Avaliação do efeito cicatrizante do extrato de repolho (Brassica oleracea var capitata) em ratos wistar. 49f. Viçosa, MG. Dissertação (Mestrado em Biologia Celular e Estrutural) - Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa.

Silva L.D.G., Tacla M.T.G.M. & Rossetto E.G. 2010. Manejo da dor pós-operatória na visão dos pais da criança hospitalizada. Escola Anna Nery Revista de Enfermagem. 14(3): 519-526.

Skarda R.T. & Tranquilli W.J. 2007. Local anesthetics. In: Tranquilli W.J., Thurmon J.C. & Grimm K.A. (Eds). Lumb & Jones´ Veterinary Anesthesia and Analgesia. 4th edn. Ames: Blackwell Publishing, pp.561-593.




DOI: https://doi.org/10.22456/1679-9216.102649

Copyright (c) 2020 Fabiana Del Lama Rocha, Newton Nunes, Paula Chiconi Dacunto dos Santos, Cléber Kazuo Ido, Paloma do Espírito Santo Silva, Eveline Simões Azenha Aidar, Helen Roberta Amaral da Silva, Tiago Carmagnani Prada

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.