Abstract：
OBJECTIVE: To evaluate the efficacy of a perineural injection of dexmedetomidine combined with ropivacaine for reducing postoperative methadone requirements in dogs after tibial plateau levelling osteotomy (TPLO).
METHODS: A prospective, clinical, randomized and blinded trial.
METHODS: A total of 58 client-owned dogs.
METHODS: Ultrasound-guided midfemoral sciatic and inguinal femoral nerve blocks with ropivacaine (1 mg kg-1 per nerve block) combined with either dexmedetomidine (0.5 μg kg-1 per nerve block; group DEX) or the same volume of saline (group CON) were performed in dogs undergoing TPLO. Pain was assessed 30 minutes, 2 hours and then every 4 hours for 24 hours after surgery with a validated pain scale (4AVet). Meloxicam (0.15 mg kg-1) was administered intravenously (IV) at recovery. Rescue methadone (0.2 mg kg-1 IV) was administered if a score ≥ 6 (maximal score 18) was recorded and the number of postoperative doses was analysed by Fisher exact tests. The study was performed in parallel at a Veterinary Teaching Hospital (VTH) and a private Veterinary Referral Centre (VRC).
RESULTS: Dogs received a total of 22 and 31 postoperative doses of methadone in groups DEX (14 doses at VRC, eight doses at VTH) and CON (28 doses at VRC, three doses at VTH), respectively. Overall, there was no difference in the postoperative rescue analgesia requirements between groups (p = 0.244). At the VRC, dogs received less methadone (p = 0.026) in group DEX compared with group CON, whereas at the VTH, there was no difference between groups (p = 0.216).
CONCLUSIONS: Perineural dexmedetomidine combined with ropivacaine did not reduce postoperative methadone requirements in dogs after TPLO, but results may differ from one centre to another. This discrepancy might be linked to variations in clinical practices and questions the validity of results obtained from single-centre randomized controlled trials but applied to different clinical settings.
METHODS: A prospective, clinical, randomized and blinded trial.
METHODS: A total of 58 client-owned dogs.
METHODS: Ultrasound-guided midfemoral sciatic and inguinal femoral nerve blocks with ropivacaine (1 mg kg-1 per nerve block) combined with either dexmedetomidine (0.5 μg kg-1 per nerve block; group DEX) or the same volume of saline (group CON) were performed in dogs undergoing TPLO. Pain was assessed 30 minutes, 2 hours and then every 4 hours for 24 hours after surgery with a validated pain scale (4AVet). Meloxicam (0.15 mg kg-1) was administered intravenously (IV) at recovery. Rescue methadone (0.2 mg kg-1 IV) was administered if a score ≥ 6 (maximal score 18) was recorded and the number of postoperative doses was analysed by Fisher exact tests. The study was performed in parallel at a Veterinary Teaching Hospital (VTH) and a private Veterinary Referral Centre (VRC).
RESULTS: Dogs received a total of 22 and 31 postoperative doses of methadone in groups DEX (14 doses at VRC, eight doses at VTH) and CON (28 doses at VRC, three doses at VTH), respectively. Overall, there was no difference in the postoperative rescue analgesia requirements between groups (p = 0.244). At the VRC, dogs received less methadone (p = 0.026) in group DEX compared with group CON, whereas at the VTH, there was no difference between groups (p = 0.216).
CONCLUSIONS: Perineural dexmedetomidine combined with ropivacaine did not reduce postoperative methadone requirements in dogs after TPLO, but results may differ from one centre to another. This discrepancy might be linked to variations in clinical practices and questions the validity of results obtained from single-centre randomized controlled trials but applied to different clinical settings.
摘要：
目的：评价右美托咪定复合罗哌卡因神经周注射降低犬胫骨平台整平截骨(TPLO)术后美沙酮用量的疗效。
方法：前瞻性，临床,随机和盲法试验。
方法：共有58只客户拥有的狗。
方法：超声引导下用罗哌卡因（每个神经阻滞1mgkg-1）联合右美托咪定（每个神经阻滞0.5μgkg-1；DEX组）或相同体积的生理盐水（CON组）对接受TPLO的犬进行股中部和腹股沟股神经阻滞。疼痛评估30分钟，2小时，然后每4小时手术后24小时与验证的疼痛量表（4AVet）。在恢复时静脉内(IV)施用美洛昔康(0.15mgkg-1)。如果记录评分≥6（最大评分18），则给予抢救美沙酮（0.2mgkg-1IV），并通过Fisher精确检验分析术后剂量。该研究在兽医教学医院（Vth）和私人兽医转诊中心（VRC）并行进行。
结果：DEX组的狗在术后总共接受了22和31剂量的美沙酮（VRC为14剂量，八剂在VTH）和CON（28剂在VRC，在Vth下给三个剂量），分别。总的来说,两组之间的术后抢救镇痛需求没有差异（p=0.244）。在VRC，与CON组相比，DEX组的狗接受的美沙酮较少（p=0.026），而在VTH,组间无差异(p=0.216)。
结论：右美托咪定联合罗哌卡因并没有降低TPLO后犬术后美沙酮的需求量，但是结果可能因中心而异。这种差异可能与临床实践的变化有关，并质疑从单中心随机对照试验获得的结果的有效性，但适用于不同的临床环境。
方法：前瞻性，临床,随机和盲法试验。
方法：共有58只客户拥有的狗。
方法：超声引导下用罗哌卡因（每个神经阻滞1mgkg-1）联合右美托咪定（每个神经阻滞0.5μgkg-1；DEX组）或相同体积的生理盐水（CON组）对接受TPLO的犬进行股中部和腹股沟股神经阻滞。疼痛评估30分钟，2小时，然后每4小时手术后24小时与验证的疼痛量表（4AVet）。在恢复时静脉内(IV)施用美洛昔康(0.15mgkg-1)。如果记录评分≥6（最大评分18），则给予抢救美沙酮（0.2mgkg-1IV），并通过Fisher精确检验分析术后剂量。该研究在兽医教学医院（Vth）和私人兽医转诊中心（VRC）并行进行。
结果：DEX组的狗在术后总共接受了22和31剂量的美沙酮（VRC为14剂量，八剂在VTH）和CON（28剂在VRC，在Vth下给三个剂量），分别。总的来说,两组之间的术后抢救镇痛需求没有差异（p=0.244）。在VRC，与CON组相比，DEX组的狗接受的美沙酮较少（p=0.026），而在VTH,组间无差异(p=0.216)。
结论：右美托咪定联合罗哌卡因并没有降低TPLO后犬术后美沙酮的需求量，但是结果可能因中心而异。这种差异可能与临床实践的变化有关，并质疑从单中心随机对照试验获得的结果的有效性，但适用于不同的临床环境。
