Hypobaric intrathecal anaesthesia for partial hemipelvectomy in a dog

Summary

Objective: To report the intrathecal use of a hypobaric anaesthetic solution for partial hemipelvectomy in a nine-year-old, neutered female, Golden Retriever dog, weighing 34 kg. Methods: Under inhalational anaesthesia, with the dog lying in lateral recumbency and the surgical side uppermost, 1.9 ml of a hypobaric solution containing 3.42 mg of bupivacaine and 0.66 mg of morphine were administered in the subarachnoid space at L5–6 level 30 minutes before surgery. Following the intrathecal injection the dog was maintained for five minutes in a 10° head-down position, then for three minutes in a 10° head-up position. Results: Apart from a transient increase in heart and respiratory rates during resection of the sartorius muscle, which was treated with a plasma Target Controlled Infusion (TCI) of fentanyl, spinal anaesthesia provided cardiovascular stability and excellent relaxation of the surgical site. Neither motor blockade nor proprioceptive deficit were apparent in the contra-lateral hind limb at recovery, 200 minutes after injection. Postoperatively, rescue analgesia was not required in the 48 hours following surgery. Clinical significance: In dogs, the use of intrathecal hypobaric bupivacaine and morphine as a part of a balanced anaesthetic protocol should be considered during unilateral major orthopaedic surgeries of the pelvis and hind limb, as it allowed a reduction in the dose administered compared to isobaric solutions, providing selective spinal anaesthesia, excellent longlasting analgesia, and rapid recovery of ambulation.

Keywords

Spinal anaesthesia - selective spinal anaesthesia - analgesia - intrathecal - hypobaric - regional anaesthesia - SSA

• References

• 1 Pittoni G, Toffoletto F, Calcarella G. et al. Spinal anesthesia in outpatient knee surgery: 22-gauge versus 25-gauge Sprotte needle. Anesth Analg 1995; 81: 73-79.
• 2 Sheskey MC, Rocco AG, Bizzarri-Schmidt M. et al. A dose-response study of bupivacaine for spinal anesthesia. AnesthAnalg 1983; 62: 931-935.
• 3 Liu SS, Ware PD, Allen HW. et al. Dose-response characteristics of spinal bupivacaine in volunteers. Clinical implication for ambulatory anesthesia. Anesthesiology 1996; 85: 729-736.
• 4 Casati Casati, Vinciguerra F. Intrathecal anesthesia. Curr Opin Anaesthesiol 2002; 15: 543-551.
• 5 Liu Liu, McDonald SB. Current issues in spinal anesthesia. Anesthesiology 2001; 94: 888-906.
• 6 Kuusniemi KS, Pihlajamaki KK, Kirvela OA. et al. Spinal anesthesia with hypobaric bupivacaine for knee arthroscopies: effect of posture on motor block. Reg Anesth Pain Med 2001; 26: 30-34.
• 7 Wang C, Chakrabarti MK, Whitwam JG. Specific enhancement by fentanyl of the effects of intrathecal bupivacaine on nociceptive afferent butnot on sympathetic efferent pathways in dogs. Anesthesiology 1993; 79: 766-773.
• 8 Slappendel R, Weber EW, Dirksen R. et al. Optimization of the dose of intrathecal morphine in total hip surgery: a dose-finding study. Anesth Analg 1999; 88: 822-826.
• 9 Vaghadia H, Viskari D, Mitchell GWE. et al. Selective spinal anesthesia for outpatient laparoscopy. I: Characteristics of three hypobaric solutions. Can JAnesth 2001; 48: 256-260.
• 10 Ben-David B, Solomon E, Levin H. et al. Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery. AnesthAnalg 1997; 85: 560-565.
• 11 Carobbi B, White RAS, Novello L. Low-dose intrathecal lidocaine for femur fracture repair in a cat [abstract]. ISVRA Conference 2005, Carrara, Italy. Taken from VRA 2005; 3: 49-56.
• 12 Novello Novello, Corletto F. Combined spinal-epidural anesthesia in a dog. Vet Surg 2006; 35: 191-197.
• 13 Sano T, Nishimura R, Kanazawa H. et al. Pharmacokinetics of fentanyl after single intravenous injection and constant rate infusion in dogs. Vet Anaesth Analg 2006; 33: 266-273.
• 14 Mathews KA. Non-steroidal anti-inflammatory analgesics for acute pain management in dogs and cats. Vet Comp Orthop Traumatol 1997; 10: 122-129.
• 15 Novello Novello, Platt SR. Low-dose intrathecal morphine for postoperative analgesia after cervical laminectomy. VRA 2006; 4: 9-17.
• 16 Mosing M, Leschnik M, Iff I. Specific gravity of cerebrospinal fluid in dogs and cats: comparison with different anaesthetic drug solutions [abstract]. ISVRA Conference 2006, Pordenone, Italy. Taken from VRA 2006; 4: 27-33.
• 17 Casati A, Fanelli G, Aldegheri G. et al. Frequency of hypotension during conventional or asymmetric hyperbaric spinal block. Reg Anesth Pain Med 1999; 24: 214-219.
• 18 McGoldrick KE. The role of spinal anesthesia in the ambulatory venue: current issues and concerns. Curr Opin Anaesthesiol 2001; 14: 605-609.
• 19 Vaghadia H. Spinal anesthesia for outpatients: controversies and new techniques. Can J Anesth 1998; 45: R64-70.
• 20 Torske Torske, Dyson DH. Epidural analgesia and anesthesia. Vet Clin North Am Small Anim Pract 2000; 30: 859-874.
• 21 Robinson TM, Kruse-Elliott KT, Markel MD. et al. A comparison of transdermal fentanyl versus epidural morphine for analgesia in dogs undergoing major orthopedic surgery. J Am Anim Hosp Assoc 1999; 35: 95-100.
• 22 Liu S, Chiu AA, Carpenter RL. et al. Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery. AnesthAnalg 1995; 80: 730-734.
• 23 Gray JR, Fromme GA, Nauss LA. et al. Intrathecal morphine for post-thoracotomy pain. Anesth Analg 1986; 65: 873-876.
• 24 Yamaguchi H, Watanabe S, Motokawa K. et al. Intrathecal morphine doseresponse data for pain relief after cholecystectomy. Anesth Analg 1990; 70: 168-171.
• 25 Novello L, Stefanelli E, Carobbi B. et al. Doppia osteosintesi in anestesia regionale in paziente ASA 4 [abstract]. Proceedings from 50th SCIVAC Conference 2005. Rimini; Italy: p 368
• 26 Ko S, Goldstein DH, Van Den Kerkhof EG. Definitions of ‘respiratory depression’ with intrathecal morphine postoperative analgesia: areview ofthe literature. Can J Anesth 2003; 50: 679-688.
• 27 Stevens JD, Braithwaite P, Corke CF. et al. Double- blind comparison of epidural diamorphine and intramuscular morphine after elective caesarean section, with computerised analysis of continuous pulse oximetry. Anaesthesia 1991; 46: 256-259.
• 28 Wheatley RG, Somerville ID, Sapsford DJ. et al. Postoperative hypoxaemia: comparison of extra- dural, i.m. and patient-controlled opioid analgesia. Br J Anaesth 1990; 64: 267-275.
• 29 Hansen BD. Epidural catheter analgesia in dogs and cats: technique and review of 182 cases (1991-1999). J Vet Emerg Crit Care 2001; 11: 95-103.