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Brioschi FA, Gioeni D, Lazzarini E, Del Prete G, Bronzo V, Jacchetti A, Carotenuto AM. Clinical effects of preemptive intra-articular lidocaine, dexmedetomidine and lidocaine-dexmedetomidine administration in dogs undergoing arthroscopy. Vet J 2021; 276:105730. [PMID: 34391917 DOI: 10.1016/j.tvjl.2021.105730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
This study investigated the perioperative effects of preemptive intra-articular lidocaine (L group), dexmedetomidine (D group) and lidocaine-dexmedetomidine (LD group) in dogs. Physiological variables were intraoperatively recorded at 5 min intervals starting from baseline (5 min before intra-articular injection). If nociception occurred, IV fentanyl was administered. Postoperative pain was assessed using the Short Form-Glasgow Composite Measure Pain Scale. Twenty-four dogs (eight in each group) were included in this prospective, randomized, masked clinical study. In the LD group, systolic arterial pressure significantly increased at T10 (P = 0.027), T15 (P = 0.021) and T20 (P = 0.022), compared with baseline. In the D and LD groups, mean arterial pressure significantly increased at T10 (P = 0.022; 0.024), T15 (P = 0.024; 0.09) and T20 (P = 0.019; 0.021), compared with baseline and diastolic arterial pressure significantly increased at T10 (P = 0.026; 0.047), T15 (P = 0.021; 0.023), T20 (P = 0.011; 0.012) and T25 (P = 0.019; 0.027), compared with baseline. In the LD group, heart rate significantly decreased at T5 (P = 0.031), T10 (P = 0.026) and T15 (P = 0.034), compared with baseline. Atrioventricular blocks appeared more frequently in the LD group than in L and D groups (P = 0.002). Group L received more fentanyl than the D and LD groups (P = 0.03). No differences in postoperative pain score were detected (P = 0.121). These findings suggested systemic absorption of intra-articular dexmedetomidine. Intra-articular lidocaine-dexmedetomidine was associated with a greater incidence of atrioventricular blocks. Intra-articular dexmedetomidine, alone and combined with lidocaine, provided better intraoperative analgesia than lidocaine in dogs undergoing arthroscopy, although the 12 h postoperative analgesic effect of the three treatments was similar.
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Affiliation(s)
- F A Brioschi
- Ospedale Veterinario San Francesco, Milano, 20148, Italy.
| | - D Gioeni
- Ospedale Veterinario San Francesco, Milano, 20148, Italy
| | - E Lazzarini
- Ospedale Veterinario San Francesco, Milano, 20148, Italy
| | - G Del Prete
- Ospedale Veterinario San Francesco, Milano, 20148, Italy
| | - V Bronzo
- Department of Veterinary Medicine, Università degli Studi di Milano, Milano, 20133, Italy
| | - A Jacchetti
- Ospedale Veterinario San Francesco, Milano, 20148, Italy
| | - A M Carotenuto
- Ospedale Veterinario San Francesco, Milano, 20148, Italy
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An M, Su X, Wei M, Zhang B, Gao F, Hu B, Dong C, Liu Y, Qi W, Li C. Local anesthesia combined with intra-articular ropivacaine can provide satisfactory pain control in ankle arthroscopic surgery: A retrospective cohort study. J Orthop Surg (Hong Kong) 2021; 28:2309499020938122. [PMID: 32700623 DOI: 10.1177/2309499020938122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Local anesthesia (LA) is widely used in knee arthroscopic surgery but not in ankle arthroscopy. OBJECTIVE To understand the effectiveness and safety of LA combined with ropivacaine in pain control for ankle arthroscopy. STUDY DESIGN Retrospective cohort. METHODS We retrospectively collected data for patients who underwent ankle arthroscopy from April 2012 to April 2017. Patients were grouped by anesthesia method: LA, LA with ropivacaine (LA+R), spinal anesthesia (SA), and SA with ropivacaine (SA+R). Intra- and postoperative visual analog scale (VAS) scores, complications, doses of supplemental pain medication, hospitalization cost and duration, and satisfaction with pain control during hospitalization were analyzed. RESULTS The study included 276 patients (LA: 93; LA+R: 124; SA: 31; SA+R: 28). The LA and LA+R groups had significantly higher intraoperative VAS scores (LA vs. SA, p = 0.001; LA vs. SA+R, p = 0.002; LA+R vs. SA, p = 0.00; LA+R vs. SA+R, p = 0.00), but fewer complications, than the SA and SA+R groups. The LA+R and SA+R groups had significantly better outcomes for postoperative pain control (LA vs. LA+R, p = 0.01; LA vs. SA+R, p = 0.01; SA vs. SA+R, p = 0.01; SA vs. LA+R, p = 0.03) and required less supplemental pain medication. Hospitalization cost was lower and duration shorter in the LA and LA+R groups than in the SA and SA+R groups. There was no significant difference in satisfaction among the four groups. LIMITATIONS This was a single-center retrospective and relatively short-term study. CONCLUSIONS LA+R which could be safely applied in ankle arthroscopy provided satisfactory pain control, reduced postoperative pain intensity, fewer complications, shorter hospital stay, and good cost-effectiveness. It can be safely applied in ankle arthroscopy for the specific patients with ankle osteoarthritis.
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Affiliation(s)
- Mingyang An
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiangzheng Su
- Department of Emergency, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Min Wei
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Baiqing Zhang
- Department of Orthopedics Surgery, The Beijing Armed Police General Corps Hospital, Beijing, People's Republic of China
| | - Feng Gao
- Department of Sports Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, People's Republic of China
| | - Bo Hu
- The Second Department of Orthopaedics, Beijing Chaoyang Integrative Medicine Emergency Medical Center, Beijing, People's Republic of China
| | - Chenhui Dong
- Department of Sports Medicine, Orthopedic Surgery and Research Centre of PLA, Hospital 940 of PLA Joint Logistics Support Force, Lanzhou, People's Republic of China
| | - Yujie Liu
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wei Qi
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Chunbao Li
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
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Di Salvo A, Chiaradia E, Nannarone S, Della Rocca G. Intra-articular use of analgesic/antinflammatory drugs in dogs and horses. Res Vet Sci 2020; 134:159-170. [PMID: 33387756 DOI: 10.1016/j.rvsc.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/24/2020] [Accepted: 12/22/2020] [Indexed: 12/27/2022]
Abstract
Joint pain is a major cause of lameness in animals such as horses and dogs, and it may affect their athletic performance and quality of life. The intra-articular administration of analgesic/antinflammatory drugs is a common practice in veterinary medicine, for both lameness diagnosis and joint pain management. It is used either perioperatively, such as in animals undergoing arthroscopy/arthrotomy, and in osteoarthritic animals. However, evidence regarding efficacy and safety of each drug is limited, and controversies persist in these areas. In particular, it is often uncertain whether a defined treatment is effective by simply relieving the symptomatic pain associated with the joint disease, or whether it has a positive effect on the joint environment. Moreover, there is still much hesitation about treatments for joint diseases, related to the time of their application for the best outcome, and to any possible deleterious side effects. This article includes a review of the literature concerning the main analgesic/antinflammatory drugs used intra-articularly for managing acute and chronic joint pain/inflammation in dogs and horses. Three main issues for each class of drugs are considered, including clinical efficacy, pharmacokinetics, and local cytotoxic effects.
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Affiliation(s)
- Alessandra Di Salvo
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy; Department of Veterinary Medicine, Research Center on Animal Pain, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy
| | - Elisabetta Chiaradia
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy
| | - Sara Nannarone
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy; Department of Veterinary Medicine, Research Center on Animal Pain, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy.
| | - Giorgia Della Rocca
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy; Department of Veterinary Medicine, Research Center on Animal Pain, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy
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Di Salvo A, Chiaradia E, Della Rocca G, Giorgi M, Mancini F, Marenzoni ML, Conti MB, Nannarone S. Efficacy, chondrotoxicity and plasma concentrations of tramadol following intra-articular administration in horses undergoing arthroscopy: preliminary findings. Vet Q 2019; 38:129-137. [PMID: 30773122 PMCID: PMC6831008 DOI: 10.1080/01652176.2018.1546963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Intra-articular administration of analgesics is performed to ensure good perioperative pain management avoiding undesirable systemic effects. To evaluate the effect of intra-articular injection of tramadol on postoperative pain after arthroscopy in horses and to determine whether tramadol had a local effect. Before the in vivo study, an in vitro test was performed aiming to evaluate the viability of equine chondrocytes after exposure to various concentrations of tramadol. The concentration identified as most appropriate was used to treat the horses’ joints. Twelve horses affected by osteochondrosis were randomly assigned to two groups that were treated intra-articularly at the end of surgery with tramadol (4 mg/mL) and saline, respectively. At predetermined time-points a Composite Pain Scale was applied and blood samples were collected in order to define the extent of tramadol absorption into the systemic circulation. The Mann-Whitney test was used for statistical analysis. Serum of four out of six treated horses revealed traces of tramadol (range 10.6–19.3 ng/mL) sporadically between 0.5 and 4 hours post-treatment, while in the other two horses, no trace of drug was found. Findings suggested that any eventual effect was probably due to local action rather than systemic absorption. The pain scores obtained in tramadol-treated horses were lower between 1 and 6 hours post-administration, than those obtained in the control group, but the differences were not statistically significant. These preliminary results suggest that tramadol, at this concentration, is only mildly beneficial in the pain management of horses after arthroscopy.
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Affiliation(s)
- Alessandra Di Salvo
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy
| | - Elisabetta Chiaradia
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy.,b CSCS-Centro di Studi del Cavallo Sportivo, University of Perugia , Perugia , Italy
| | - Giorgia Della Rocca
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy.,c CeSDA-Centro di Studio sul Dolore Animale, University of Perugia , Perugia , Italy
| | - Mario Giorgi
- d Department of Veterinary Sciences , University of Pisa , Pisa , Italy
| | - Francesco Mancini
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy
| | | | - Maria Beatrice Conti
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy.,c CeSDA-Centro di Studio sul Dolore Animale, University of Perugia , Perugia , Italy
| | - Sara Nannarone
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy.,b CSCS-Centro di Studi del Cavallo Sportivo, University of Perugia , Perugia , Italy.,c CeSDA-Centro di Studio sul Dolore Animale, University of Perugia , Perugia , Italy
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