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synergistic effects. 1–4 Epidural administration of analgesic agents is a common technique used in animals to alleviate pain, particularly in the pelvic limbs. Of the several combinations of opioids and local anesthetics that have been studied, the morphine-bupivacaine

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in Journal of the American Veterinary Medical Association

several reports 5–8 on various pain management protocols in cats undergoing onychectomy. One case report 9 concerns the use of a 4-point regional nerve block by use of bupivacaine as an additional form of analgesia for onychectomy in cats. The use of

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in Journal of the American Veterinary Medical Association

maxillary nerve block approach (lateral percutaneous or infraorbital). A washout period of at least 2 weeks was allowed between approaches. The local anesthetic used consisted of a 2-mL mixture (50:50 [vol/vol]) of 2% lidocaine i and 0.5% bupivacaine i

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in American Journal of Veterinary Research

of local anesthetics to perform various dental nerve blocks. However, results of a 2016 study 5 indicate that the deposition of 1 mL of a bupivacaine-lidocaine mixture into the infraorbital canal of dogs (approx body weight, 20 kg) achieves a

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in American Journal of Veterinary Research

Abstract

Objective—To determine whether addition of a continuous, local infusion of bupivacaine would improve postoperative analgesia in dogs undergoing total ear canal ablation.

Design—Randomized controlled trial.

Animals—16 dogs undergoing total ear canal ablation (12 unilaterally and 4 bilaterally with > 1 month between procedures).

Procedure—Dogs were randomly allocated to receive morphine (0.25 mg/kg [0.11 mg/lb]) at the end of the procedure (10 procedures) or morphine and a continuous, local infusion of bupivacaine (0.13 to 0.21 mg/kg/h [0.06 to 0.1 mg/lb/h]; 10 procedures). Dogs were observed for 48 hours after surgery. Additional doses of morphine were administered up to every 4 hours in dogs with signs of severe pain.

Results—Temperament, sedation, analgesia, and cumulative pain scores were not significantly different between groups any time after surgery. Recovery score was significantly higher for dogs that received bupivacaine than for control dogs 2 hours after extubation but not at any other time. Serum cortisol concentration was not significantly different between groups at any time but, in both groups, was significantly increased at the time of extubation, compared with all other observation times. Total number of additional doses of morphine administered was not significantly different between groups. Bupivacaine was not detected in the plasma of any of the dogs that received the local bupivacaine infusion.

Conclusions and Clinical Relevance—Results suggest that addition of a continuous, local infusion of bupivacaine did not significantly increase the degree of postoperative analgesia in dogs that underwent total ear canal ablation and were given morphine at the end of surgery. (J Am Vet Med Assoc 2005;227:414–419)

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To determine prevalence of adverse effects associated with epidural administration of morphine with or without bupivacaine in dogs and cats undergoing surgery and evaluate effects of epidural administration of morphine on postoperative pain severity.

Design—Retrospective study.

Animals—242 dogs and 23 cats.

Procedure—Morphine with or without bupivacaine was administered prior to surgery with a Tuohy needle, spinal needle, or epidural catheter. In 18 dogs that underwent surgery twice, results of preemptive epidural administration of morphine with or without bupivacaine were compared with results of systemic administration of oxymorphone and ketoprofen.

Results—The delivered fraction of isoflurane was significantly lower in animals given morphine and bupivacaine than in animals given morphine alone. Analgesia was of significantly longer duration in dogs given morphine and bupivacaine than in dogs given morphine alone. During anesthesia, mild respiratory and cardiovascular depression was reported. Seven dogs and 2 cats had urine retention, and 2 dogs developed pruritus. Six dogs vomited when a second dose of morphine was given epidurally the day after surgery. Eight of 72 dogs had delayed hair growth. In 18 dogs that underwent surgery twice, the delivered fraction of isoflurane was significantly lower and the duration of analgesia was significantly longer when morphine with or without bupivacaine was given epidurally than when oxymorphone and ketoprofen were given.

Conclusions and Clinical Relevance—Results suggest that preemptive epidural administration of morphine with or without bupivacaine is a safe and effective method of inducing long-lasting analgesia in dogs and cats and is superior to standard management of postoperative pain with repeated injection of oxymorphone and ketoprofen. (J Am Vet Med Assoc 2002;221:666–672)

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in Journal of the American Veterinary Medical Association

SUMMARY

Pharmacokinetic variables of bupivacaine (bpv) were determined after iv and epidural administrations in the same 6 dogs. Plasma bpv concentration curves after iv administration were adjusted to biexponential kinetics: a rapid distribution phase was followed by a slower elimination phase, with half-life of 34.5 ± 7.8 minutes. Mean plasma clearance was 20.2 ± 7.4 ml/min/kg of body weight, and mean volume of distribution at steady state was 0.7 ± 0.2 L/kg.

After epidural administration, absorption was rapid. Peak plasma concentration, 1.4 ± 0.4 μg/ml, was detected approximately 5 minutes after bpv administration. The half-life corresponding to epidural administration (179 ± 33.6 minutes) was 5 to 6 times longer than that observed after iv administration, possibly because of the slow release of bpv from the epidural space. Induction times were short (2.3 ± 2.2 minutes); anesthesia quickly began and lasted for more than 2 hours (158 ± 48.8 minutes). During that period, bpv plasma concentration ranged between 1.4 and 0.2 μg/mi. Changes in systolic blood pressure and heart rate were correlated to high plasma concentration of bpv. These modifications were observed for the first 30 minutes, reaching baseline values after 60 minutes.

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in American Journal of Veterinary Research

Objective

To compare the analgesic effects of epidural administration of morphine (MOR), bupivacaine hydrochloride (BUP), their combination (COM), and 0.9% sterile NaCl solution (SAL) in dogs undergoing hind limb orthopedic surgeries.

Design

Blinded, randomized clinical trial.

Animals

41 healthy dogs admitted for elective orthopedic surgeries involving the pelvis or hind limbs.

Procedure

Analgesic and control agents were administered postoperatively prior to recovery from isoflurane anesthesia. Ten dogs received MOR, 0.1 mg/ kg of body weight; 10 received BUP, 0.5%, 1 ml/10- cm distance from the occipital protuberance to the lumbosacral space; 11 received COM; and 10 received SAL epidurally. Dogs were monitored for 24 hours after epidural injection for pain score, heart and respiratory rates, blood pressure, time to required administration of supplemental analgesic agent, total number of supplemental doses of analgesic agent required, and plasma concentrations of cortisol, MOR, and BUP.

Results

Pain scores were significantly lower in dogs in the COM and BUP groups than in dogs in the SAL group. Pain scores also were significantly lower in dogs in the COM group than in dogs in the MOR group. Time to required administration of supplemental analgesic agent was longer for dogs in the COM group than for dogs in the MOR and SAL groups. Total number of supplemental doses of analgesic agent required was lower for dogs in the BUP and COM groups than for dogs in the SAL group.

Clinical Implications

Postoperative epidural administration of COM or BUP alone provides longerlasting analgesia, compared with MOR or SAL. (J Am Vet Med Assoc 1996;209:698-607)

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in Journal of the American Veterinary Medical Association

Abstract

Objective

To evaluate cardiovascular effects of epidurally administered oxymorphone (OXY) and an OXY-bupivacaine combination (O/B) in halothaneanesthetized dogs.

Animals

6 dogs.

Procedure

In a randomized crossover design study, dogs were anesthetized with halothane and given OXY, O/B, and saline solution (SAL). Eucapnia and end-tidal halothane concentration of 1.2% were established. Heart rate (HR), systemic and pulmonary arterial pressures, central venous pressure (CVP), and cardiac output were measured at baseline and 5, 15, 30, 45, 60, and 75 minutes after treatment. At 90 minutes, glycopyrrolate was administered IV, and measurements were repeated at 95 minutes. Cardiac index (CI), stroke volume, stroke index, systemic vascular resistance (SVR), and left ventricular work were calculated. End-tidal halothane concentration was decreased to 0.8% from 17 to 45 minutes and to 0.5% from 47 to 95 minutes for OXY and O/B, where-as for SAL, it was maintained at 1.5 and 1.2%, respectively. Samples were obtained at 0, 2, 5, 15, 30, 45, 60, and 95 minutes for measurement of serum opiate concentration and comparison with values after IM administration of OXY.

Results

HR decreased, but CVP and SVR increased in response to OXY and O/B. These changes were reversed after IV administration of glycopyrrolate, resulting in significant increase in CI, compared with that in response to SAL. Serum opiate concentration increased markedly and peaked within 15 minutes after OXY and O/B administration but did not differ from values after IM administration.

Conclusions

Epidural administration of OXY results in rapid systemic uptake and decreased HR. Glycopyrrolate administration improves HR, resulting in improved CI at equipotent halothane concentrations. (Am J Vet Res 1999;60:194–200)

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in American Journal of Veterinary Research

Abstract

Objective

To determine pharmacokinetic variables and pharmacologic effects of the S(-) isomer of bupivacaine (S[-]-BPV) in dogs.

Animals

6 adult male Beagles.

Procedure

Dogs received S(-)-BPV (1 mg/kg of body weight) IV, and 15 days later, the same dogs received 1.8 mg/kg epidurally. Pharmacokinetic variables and pharmacologic effects were determined for each route of administration.

Results

After IV administration, plasma concentration versus time curves were adjusted, using biexponential equations that indicated a rapid distribution phase followed by a slower elimination phase, with a mean ± SD half-life of 33.5 ± 17.0 minutes. Mean plasma clearance was 21.0 ± 10.7 ml/min/kg, and mean volume of distribution at steady state was 0.8 ± 0.2 L/kg. After IV administration, mean peak plasma concentration was 2.6 ± 0.7 µg/ml; after epidural administration, it was 0.9 ± 0.5 µg/ml at approximately 3 minutes. Half-life after epidural administration was 5 times longer than that observed after IV administration. Motor block began immediately after the end of epidural administration and lasted for 3 to 4 hours. Changes in systolic blood pressure and heart rate after epidural administration were slight but occurred at the same time that plasma concentration peaked. After IV administration, motor block or variations in physiologic variables studied were not observed.

Conclusions and Clinical Relevance

In dogs, the pharmacologic behavior of S(-)-BPV was similar to that of the bupivacaine racemate, but motor block attributable to S(-)-BPV lasted longer than that attributable to the racemate, with lower plasma concentrations observed at equivalent sample collection times. (AJVR 1999;60:832–835)

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in American Journal of Veterinary Research