目的:阶段1:确定使用超声引导的直肌鞘阻滞(USRSB)对直肌鞘内的脊神经腹侧支进行脱敏的可行性。阶段2:确定术前USRSB对术中对手术刺激和术后疼痛的反应的影响。
方法:尸体研究和前瞻性,随机化,失明,平行臂临床试验。
方法:一组五只猫尸体和37只收容所拥有的猫接受卵巢子宫切除术。
方法:第1阶段:对一具未注射的尸体进行解剖解剖。在双侧USRSB后,使用1:1新亚甲基蓝和0.5%布比卡因(总计0.8mLkg-1)解剖了四具尸体(八个半腹)的腹壁。阶段2:术前双侧USRSB用0.8mLkg-1的0.25%布比卡因(RSB)或等量的0.9%盐水(对照)进行。术中收缩压(SAP),心率(HR),皮肤切口前记录呼吸频率(fR)和蒸发器设置(VAP%),在开腹和腹壁闭合期间。在恢复中,给猫皮下施用罗贝昔布(2mgkg-1;对照)或0.9%盐水(0.1mLkg-1;RSB)。使用格拉斯哥综合疼痛量表评估术后疼痛6小时。
结果:第1阶段:在直肌鞘内发现脊髓神经T9-L3,并染色在0%,40%,63%,75%,100%,88%,50%和13%的半腹,分别。第二阶段:包括37只猫(RSB,n=17;控制,n=20)。术中,SAP,组间HR和fR无显著差异。腹侧切开术(p=0.036)和闭合术(p=0.044)期间RSB的Vap%显著较低。术后,RSB猫需要抢救镇痛的可能性是对照猫的5.3倍(95%CI1.8-8.3)。
结论:手术期间,与布比卡因相比,USRSB提供的益处较小,并且提供的术后镇痛效果明显少于罗宾昔布,表明依靠USRSB为猫的卵巢子宫切除术提供了不足的术后镇痛。
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.
METHODS: Cadaveric study and prospective, randomized, blinded, parallel-arm clinical trial.
METHODS: 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 (fR) 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 fR 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: 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.