Evaluation of Postoperative Residual Analgesia of Two Solutions Used for Local Anesthesia By Tumescence In Bitches who Underwent a Unilateral Mastectomy

Lianna Ghisi Gomes, Deborah Braga Pytlak, Ângela Renata Bólico do Amaral, Dábila Araújo Sônego, Samuel Monzem, Giulia Maria Dilda Campos, Marcos de Almeida Souza, Alexandre Pinto Ribeiro, Fabíola Niederauer Flôres, Luciana Dambrósio Guimarães

Abstract


Background: Breast tumors are common and require surgical treatment. A mastectomy causes edema, inflammation, and moderate to severe pain; therefore, analgesics should be used efficiently during the trans- and postoperative periods. Tumescence anesthesia has been studied in veterinary medicine; however, there is limited literature on the comparison of the constituents of the different solutions and the most suitable protocol. The objective of this study was to evaluate the residual postoperative analgesia of two solutions through the Melbourne, Modified Glasgow for dogs (EGM), and Visual Analogue (EVA) scales in bitches who underwent a unilateral mastectomy.

Materials, Methods & Results: Twelve bitches, weighing between 5 and 15 kilograms and aged between 5 and 13 years old, were included in the study. To determine if the animals were medically fit to undergo the procedure, they were evaluated by clinical examination, laboratory testing (complete blood count, serum biochemistry [urea, creatinine and alanine aminotransferase/ALT], and imaging (thorax x-ray and abdominal ultrasonography). Patients were randomly divided into two groups. One group received a lidocaine-containing tumescent solution (GTL) that consisted  of 210 mL of lactated Ringer's solution (at a temperature between 8 and 12°C), 40 mL of 2% lidocaine hydrochloride without vasoconstrictor, and 0.5 mL of adrenaline (1 mg/mL). The other group received ropivacaine (GTR) with 233.3 mL of lactated Ringer's solution (at the same temperature as the previous group’s), 16.7 mL of ropivacaine (7.5 mg/mL), and 0.5 mL of adrenaline (1 mg/mL). Both groups received a combination of acepromazine (0.04 mg/kg) and meperidine (2 mg/kg) as preanesthetic medication (MPA), followed by induction using propofol (to effect) and maintenance using isoflurane. The solutions were infused  subcutaneously (SC) 5 min after stabilization of the anesthetic plane. For the mastectomy, the solutions were distributed throughout the mammary chain to be withdrawn, starting at the thoracic and abdominal regions and ending in the inguinal region. In the postoperative period, the animals were evaluated using three different scales (Melbourne, Glasgow modified for dogs [EGM], and Visual Analogue [EVA] scales), at six time points: one, two, four, eight, 12 and 24 h after extubation, or until the time of analgesic rescue when the animal presented with a score higher than 3.33 on the EGM scale. There were no statistical differences between the groups (P > 0.05) in any of the scales evaluated; however, most of the animals demonstrated analgesic rescue in the first hour of evaluation. GTR showed an additional rescue compared to GTL.

Discussion: Analgesic rescue occurred in the first hour of the postoperative period. This differs from other studies that used morphine in MPA and observed higher analgesia. This occurred because meperidine, the drug used in the study, has a shorter duration and is a less potent analgesic than morphine. We opted for this opioid because of its minimal interaction with the drug used in MPA and to better identify the residual effect of the administered solution. In addition, it does not interact with the other drugs used in the anesthetic protocol. It is known that the tumescence technique prolongs the analgesic effect of MPA because of subcutaneous absorption of a portion of the injected solution adjacent to the area being operated on. However, this was not observed as 50% of the animals in each group were rescued during the first hour of the evaluation. From this study, it was concluded that the tumescent solutions used in the trans-operative period should not be expected to have analgesic effects during the postoperative period of mastectomies because of the short duration of action.


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References


Abimussi C.J.X., Ferreira J.Z., Floriano B.P., Paes F., Perri S.H.V. & Oliva V.N.L.S. 2013. Anestesia local por tumescência com lidocaína em cadelas submetidas a mastectomia. Arquivo Brasileiro de Medicina Veterinária e Zootecnia. 65(5): 1297-1305.

Abimussi C.J., Menegheti T.M., Wagatsuma J.T., Floriano B.P., Arruda A.M., dos Santos P.S. & Oliva V.N. 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 A.B. 2014. Anestesia convencional e técnica de tumescência em cadelas submetidas à mastectomia. Avaliação da dor pós-operatória. Arquivo Brasileiro de Medicina Veterinária e Zootecnia. 66(4): 1073-1079.

Carlson G.W. 2005. Total mastectomy under local anesthesia: the tumescent technique. The Breast Journal. 11(2): 100-102.

Credie L.F., Luna S.P., Futema F., da Silva L.C., Gomes G.B., Garcia J.N. & de Carvalho L.R. 2013. Perioperative evaluation of tumescente anaesthesia technique in bitches submitted to unilateral mastectomy. BMC Veterinary Research. 11(9): 178.

Crociolli G.C., Cassu R.N., Barbero R.C., Rocha T.L., Gomes D.R. & Nicácio G.M. 2015. Gabapentin as an adjuvant for postoperative pain management in dogs undergoing mastectomy. The Journal of Veterinary Medical Science. 77(8): 1011-1015.

Dyson H.D. 2008. Perioperative Pain Management in Veterinary Patients. The Veterinary Clinics of North America. Small Animal Practice. 38(6): 1309-1327.

Ferreira L.F.L., Braccini P. & Franklin N. 2014. Escala de dor em pequenos animais – revisão de literatura. PUBVET – Publicações em Medicina Veterinária e Zootecnia. 8(1): 1651.

Fossum T.W. 2015. Cirurgia de Pequenos Animais. [Tradução: ngela Manetti et al.]. 4ª Ed. Rio de Janeiro: Elsevier, 1640p.

Futema F. 2005. Anestesia por tumescência. In: Encontro de Anestesiologia Veterinária (São Luiz, Brasil). p.88-97.

Horta R.S., Figueiredo M.S., Lavalle G.E., Costa M.P., Cunha R.M.C. & Araújo R.C. 2015. Surgical stress and postoperative complications related to regional and radical mastectomy in dogs. Acta Veterinaria Scandinavica. 57(34): 1-10.

Landa L. 2012. Pain in domestic animals and how to assess it: a review. Veterinární Medicína. 57(4): 185-192.

Minto B.W., Rodrigues L.C., Steagall P.V.M., Monteiro E.R. & Brandão C.V.S. 2013. Assessment of postoperative pain after unilateral mastectomy using two different surgical techniques in dogs. Acta Veterinaria Scandinavica. 55(60): 1-9.

Morrison J.E. & Jacobs V.R. 2003. Reduction or elimination of postoperative pain medication after mastectomy through use of a temporarily placed local anasesthetic pump vs control group. Zentralblatt für Gynäkologie. 125(1): 17-22.

Natalini C.C. 2007. Teorias e técnicas em anestesiologia veterinária. 1.ed. Porto Alegre: Artmed, 296p.

Yilmaz Ö.T., Toydemir T.S., Kirşan İ., Dokuzeylul B., Gunay Z. & Karacam E. 2014. Effects of Surgical Wound Infiltration with Bupivacaine on Postoperative Analgesia in Cats Undergoing Bilateral Mastectomy. The Journal of Veterinary Medical Science. 76(12): 1595-1601.




DOI: https://doi.org/10.22456/1679-9216.83159

Copyright (c) 2018 Lianna Ghisi Gomes, Deborah Braga Pytlak, Ângela Renata Bólico do Amaral, Dábila Araújo Sônego, Samuel Monzem, Giulia Maria Dilda Campos, Marcos de Almeida Souza, Alexandre Pinto Ribeiro, Fabíola Niederauer Flôres, Luciana Dambrósio Guimarães

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