Orientador: Carlos Augusto Araújo Valadão / Banca: Andrigo Barboza de Nardi / Banca: Juan Carlos Duque Moreno / Banca: Stelio Pacca Loureiro Luna / Banca: Rafael Resende Faleiros / Resumo: Pacientes candidatos à analgesia espinhal por tempo prolongado são geralmente portadores de dores crônicas ou com afecções álgicas agudas com alto índice de cronicidade. Ainda que os equídeos sejam comumente acometidos por afecções que justifiquem o uso da técnica, observa-se que o uso de cateteres espinhais se restringe quase que exclusivamente a pesquisa, principalmente devido a extremidade proximal de o cateter permanecer exteriorizada, o que requer cuidado intensivo e restrição de movimento do animal. Diante deste desafio, este estudo desenvolveu uma técnica para a implantação de cateter epidural totalmente implantado (sistema port-a-cath) em equinos e asininos, objetivando a patência prolongada da via epidural em animais mantidos em piquetes e isentos de cuidados intensivos. Para tanto, foram selecionados 10 equinos e seis asininos, nos quais foi implantado um cateter epidural de poliuretano, através de incisão em elipse na região sacrococcígea. A extremidade proximal foi transposta para a região glútea e conectada a um portal totalmente implantado, sepultado na mesma região. Após a implantação os animais permaneceram em baias individuais em média 20 dias e depois foram alojados em piquetes coletivos, nos quais permaneceram com o cateter implantado por períodos de 4 a 14 meses. A cada 15 dias foi realizado a administração de 2mL de água destilada estéril para teste da patência da via. A manipulação e a administração percutânea foram bem toleradas, sendo a patência da via epidural viável, exceto em dois asininos, durante todo o experimento. Nenhum animal apresentou alterações comportamentais ou fisiológicas pela implantação e permanência do cateter e portal. Dois equinos apresentaram vazamentos transitórios pelo portal e 5/6 asininos desenvolveram úlceras sobre o portal, complicações que não inviabilizaram o uso do dispositivo. Diante destes resultados, concluiu-se que a técnica ... / Abstract: Long term spinal analgesia typically performed in patients suffering from chronic pain or acute painful conditions with high chronicity. Although the horses are commonly affected by disorders that justify the use of this technique, it is observed that the use of spinal catheters is almost exclusively to research purposes, especially because the proximal end of the catheter remain externalized, which requires an intensive care and animal's movement restrictions. Facing this challenge, this study developed a technique to implant an epidural port-a-cath system in horses and donkey, aiming long term epidural patency in animals kept in paddocks and without intensive care. Ten horses and six donkeys were selected in which a polyurethane epidural catheter was implanted through elliptical incision in the sacrococcygeal region. The proximal end catheter was transposed to the gluteal region and connected to the port, buried in this area. After implantation the animals were kept in individual stall on average 20 days and then were housed in collective paddocks whereas remained with the catheter implanted for 8 to 14 months. The percutaneous administrations were well tolerated and the patency still viable, excepting two donkeys. None animal showed behavioral or physiological alterations caused by the surgery procedure or the catheter permanence. Two horses had transient leakage through the port and 5/6 donkeys developed skin ulcers on the port, complications that not did prevent the use of the device. Considering these results, it was concluded that the epidural port-cath system implantation technique is feasible for equine and asinine species and the system was able to maintain a prolonged epidural patency without nosocomial infections and intensive care, which allows the use for research purposes and in patients with painful conditions / Doutor

Orientadores: Amaury Sanchez Oliveira e Jose Guilherme Cecatti / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-07-22T01:56:13Z (GMT). No. of bitstreams: 1 Pereira_RosaInesCosta_D.pdf: 3048020 bytes, checksum: de6d2d8ba4748f94db15ba38571eb35a (MD5) Previous issue date: 1996 / Resumo: Admite--se existir significativa melhora dos efeitos analgésicos com a associação de bupivacaina e sufentanil para analgesia de parto através do bloqueio peridural contínuo. Com o objetivo de avaliar a eficácia e segurança, materna e neonatal, deste tipo de associação, foi realizado um ensaio clínico prospectivo, randomizado e duplo cego em sessenta nulíparas atendidas na Maternidade do CAISM/UNICAMP. Ao receberem indicação de analgesia, as parturientes foram divididas aleatoriamente' em dois grupos: grupo BS que recebeu 12,5 mg de bupivacaína a 0,125% com adrenalina associada a 30 µg de sufentanil e grupo B que recebeu 12,5 mg de bupivacaína a 0,125% com adrenalina e placebo, administrados na indução do bloqueio. Nas doses subseqüentes, quando necessário, foi empregado apenas bupivacaína em quantidade idêntica à inicial. Avaliaram-se os parâmetros relativos à qualidade e duração da analgesia, relaxamento muscular, duração do trabalho de parto, efeitos cardiocirculatórios, respiratórios e colaterais maternos, como também as possíveis repercussões sobre os recém-nascidos. Os resultados demonstraram a superioridade da associação quando se incluiu o sufentanil, quanto ao grau de analgesia durante a vigência da ação da primeira e segunda doses de AL e, um aumento de mais de 80% na duração da analgesia produzida pela injeção inicial de bupivacaína. Não houve comprometimento da força muscular, nem alteração na duração do trabalho de parto após início da analgesia, comparativamente entre os grupos. Também não houve diferença quanto à via de parto. Os valores relativos à pressão arterial e freqüência cardíaca foram semelhantes. O grupo que utilizou sufentanil apresentou uma diminuição significativa da freqüência respiratória. Em relação às condições de vitalidade dos recém-nascidos, não houve diferenças entre os grupos, sendo os RNs considerados igualmente vigorosos tanto pelo índice de Apgar, gasometrias de sangue de cordão e pelos testes de capacidade neuroadaptativa. A incidência de efeitos adversos foi a mesma entre ambos os grupos, com exceção de prurido que ocorreu em 36% das pacientes do grupo BS. Para esse mesmo grupo houve um aumento significativo na duração da analgesia residual apenas para as mulheres que receberam uma dose total de bupivacaína inferior a 40 mg. Conclui-se que a associação de 30 µg de sufentanil à primeira dose de bupivacaína é segura e eficaz, melhorando a qualidade da analgesia, aumentando sua duração, preservando a força muscular e não interferindo com a evolução do trabalho de parto e resultados neonatais / Abstract: It is believed that there- is. a significant improvement of the analgesic effects. of the association bupivacaine with sufentanil for labor and delivery analgesia through a continuous epidural blockade; With the purpose of evaluating the efficacy and safety of this association in both mother and the neonate, of this association, a randomized double blind prospective clinical trial was performed including: sixty nulipara women: treated at the Maternity of , CAISM/UNICAMP. At the moment the analgesic procedure was requested, the women were randomly allocated into two groups: group BS receiving 12.5 mg of bupivacaine (0.125% with adrenaline) plus 30 µg of sufentanil and group B receiving 12.5 mg of bupivacaine (0.125% with adrenaline) plus placebo, administered during the induction of the blockade; When additional doses necessary, only the same amount of bupivacaine as used in the beginning was administered. The parameters concerning the quality and duration of analgesia, degree of motor blockade, duration of labor, cardiovascular, respiratory and maternal side effects, and also the possible effects on the neonate were evaluated. The results showed the superiority of the addition of sufentanil regarding the degree of analgesia during the time of action of the first and second doses of local anesthetics, and also an increase over 80% in the duration of analgesia produced by the first injection of bupivacaine. There was neither a decrease in motor function nor an increase in the duration of labor after the onset of analgesia when comparing both groups. There is also no difference in the route of delivery. Blood pressure and heart rate values were similar for both groups. The group using sufentanil presented a significant decrease in the respiratory rate. Concerning the neonate evaluation there were no differences between the two groups. The newborn infants were considered equally vigorous not only through the Apgar score but also through the cord blood gas' analysis and the NACS (Neurologic and Adaptive Capacity Score). The incidence of side effects was the same for both groups except for pruritus which occurred in 36% of the women in group BS. For this same group there is a significant increase in the duration of residual analgesia only among those women who. received a total dose of bupivacaine below 40rng. It is concluded that the association of 30 µg of sufentanil to the first dose of bupivacaine is safe and efficacious. It improves the quality of analgesia, raises its duration, preserves motor function and does not affect the progress of labor and neonatal outcome / Doutorado / Medicina Interna / Doutor em Ciências Médicas

A espécie leporina vem sendo utilizada de forma ampla como modelo experimental em diversas áreas da medicina e medicina veterinária. A escassez de estudos publicados nesta área torna questionável a utilização ética da espécie em experimentos cirúrgicos. O objetivo foi determinar a duração dos bloqueios motor e sensitivo da lidocaína e bupivacaína administradas pela via peridural sacrococcígea e lombossacra e seus efeitos cardiovasculares e respiratórios associados a anestesia geral inalatória em coelhos submetidos a orquiectomia. Foram utilizados 30 animais da espécie leporina, raça Nova Zelândia Branco, pesando entre 2,350 e 3,300 kg, distribuídos em cinco grupos experimentais. O grupo Lido LS recebeu 0,3 ml/kg de lidocaína a 2% pela via peridural lombossacra; o grupo Lido SC recebeu 0,3 ml/kg de lidocaína a 2% pela via peridural sacrococcígea; o grupo Bupi LS recebeu 0,3 ml/kg de bupivacaína a 0,5% pela via peridural lombossacra; o grupo Bupi SC recebeu 0,3 ml/kg de bupivacaína a 0,5% pela via peridural sacrococcígea e o grupo Controle recebeu 0,3 ml/kg de solução fisiológica pela via peridural lombossacra. A administração peridural foi realizada por meio de punção simples com agulha hipodérmica. Na primeira parte do experimento, os animais foram anestesiados com sevofluorano em oxigênio a 100% com auxílio de máscara, e após a administração do protocolo de cada grupo, os reflexos sensitivos foram testados por meio de pinçamento dos dermátomos cutâneos e dos dígitos dos membros pélvicos e cauda. Os reflexos motores foram avaliados por meio de escore de tônus muscular dos membros pélvicos e cauda. Esta fase teve como objetivo determinar a duração e padrão de dispersão do bloqueio sensitivo e motor. Duas semanas após a determinação da duração do bloqueio sensitivo e motor, os animais foram anestesiados com isofluorano em máscara, intubados, e a administração do mesmo protocolo de anestesia peridural foi realizada para a realização de orquiectomia. A frequência cardíaca, frequência respiratória, pressão arterial sistólica, média e diastólica, concentração de dióxido de carbono ao fim da expiração, concentração de isofluorano inspirado e expirado, saturação de oxihemoglobina e temperatura corpórea foram monitorados a cada 10 min durante 50 min. Logo após a administração peridural e ao fim do procedimento, uma amostra de sangue arterial foi colhida para avaliação hemogasométrica. A dispersão, avaliada pelo número de dermátomos bloqueados, nos grupos que receberam a administração lombossacra foi maior que nos grupos de administração sacrococcígea. O período médio de bloqueio sensitivo com a lidocaína foi de 70±13,78 min pela via lombossacra e 60,83±23,11 min pela via sacrococcígea. Com a administração de bupivacaína pela via lombossacra, a duração do bloqueio sensitivo foi de 199,16±15,30 min e pela via sacrococcígea foi de 168,33±44,57 min. O grupo controle teve maior consumo de anestésico geral e maior requerimento de analgésico trans-operatório e de fármacos vasoativos durante o procedimento, demonstrando analgesia insuficiente e depressão cardiovascular superior aos grupos em que houve a associação da anestesia peridural e geral. Houve ocorrência de bloqueio unilateral em 50 % dos animais que receberam a administração sacrococcígea. Conclui-se que a administração peridural lombossacra apresentou duração e dispersão maiores que a administração sacrococcígea em coelhos. A ocorrência de bloqueio unilateral foi maior com a utilização do sítio sacrococcígeo. Foi observada maior depressão cardiovascular nos animais que não receberam a administração de anestésico local no espaço epidural. A utilização de lidocaína e bupivacaína levou a anestesia peridural satisfatória na espécie leporina, sendo uma técnica eficiente e de fácil execução. / Rabbits have been widely used as an experimental model in different areas of medicine and veterinary medicine. The few published studies in this area make the ethical use of this species in surgical experiments questionable. The aim of this study was to determine the duration of sensory and motor block of lidocaine and bupivacaine epidurally administered in lumbosacral or sacrococcygeal sites and their cardiovascular and respiratory effects associated with inhalation anesthesia in rabbits undergoing orchiectomy. Thirty New Zealand White rabbits were used, weighing between 2,350 and 3.300 kg, divided into 5 experimental groups. The Lido LS group received 0.3 ml / kg of 2% lidocaine lumbosacral epidural; Lido SC group received 0.3 ml / kg of 2% lidocaine sacrococcygeal epidural; Bupi LS group received 0.3 ml / kg of 0.5% bupivacaine for lumbosacral epidural; Bupi SC group received 0.3 ml / kg of 0.5% bupivacaine for sacrococcygeal epidural; and the control group received 0.3 ml / kg of saline epidural lumbosacral. Epidural was performed by single puncture with hypodermic needle. In the first part of the experiment, the animals were anesthetized with sevoflurane in 100% oxygen mask, and after the administration of each protocol group, the sensitive reflexes were tested by pinching the skin dermatomes and the digits of the hind limbs and tail. The motor reflexes were evaluated by scoring muscle tone of the pelvic limbs and tail. Two weeks after the determination of the duration of sensory and motor block, the animals were anesthetized with isoflurane in mask, intubated, and the administration of the same protocol of epidural anesthesia was performed for the orchiectomy. Heart and respiratory rate, systolic, mean and diastolic arterial blood pressure, end-tidal CO2, concentration of isoflurane inhaled and exhaled, oxyhemoglobin saturation and body temperature were monitored every 10 minutes during a 50 minutes surgery. Soon after epidural administration and at the end of the procedure, a sample of arterial blood was collected for evaluation of arterial blood gases. The dispersion was measured by the number of dermatomes blocked and groups receiving lumbosacral administration had a higher number than groups that received sacrococcygeal administration. The mean duration of sensory block with lidocaine was 70±13.78 min via lumbosacral site and 60.83±23.11 min via sacrococcygeal site. In bupivacaine lumbosacral group, the duration of sensory block was 199.16±15.30 min and in sacrococcygeal group was 168.33±44.57 min. The control group had higher consumption of general anesthetic and trans-operative analgesic requirement and had higher vasoactive requirement during the surgical procedure, demonstrating greater cardiovascular depression than the groups that received an association of epidural and general anesthesia. There was 50% occurrence of unilateral block in animals that received the sacrococcygeal administration. It is concluded that epidural administration showed lumbosacral length and dispersion greater than sacrococcygeal administration in rabbits. The incidence of unilateral block was higher when used the sacrococcygeus site. Greater cardiovascular depression was observed in animals that did not receive the administration of local anesthetic into the epidural space. The use of lidocaine and bupivacaine led to satisfactory epidural anesthesia in rabbits, being an efficient and easy technique to perform.

INTRODUCTION: The implementation of open posterior component separation (PCS) surgery has led to improved outcomes for complex hernias. While the PCS technique has been shown to decrease recurrence rates, and provide a feasible option to repair hernias in nontraditional locations, there is still significant postoperative pain associated with the laparotomy and extensive abdominal wall manipulation. Systemic opioids and thoracic epidural analgesia (TEA) are both commonly utilized, either together or independently, as postoperative analgesic regimens. The benefits of TEA have been studied following a variety of surgeries, however to date no study has been performed to investigate its efficacy in this particular surgery. The aim of this study is to evaluate the benefits of TEA following open PCS. We hypothesized that the incorporation of TEA in a patients postoperative analgesic regimen would show an advantage in time to bowel recovery. METHODS: An electronic medical record query was done to identify patients who had undergone an open PCS. Once this list was compiled, a retrospective chart review was performed and patients receiving TEA (either alone or combined with systemic opioids) were compared to patients receiving only systemic opioids. The primary endpoint compared time to resumption of a full diet, given by the patients postoperative day (POD). Secondarily, time to resumption of a liquid diet, postoperative length of stay (LOS), intensive care unit (ICU) admission rate, ICU LOS, and rates of several postoperative complications were all recorded and compared. A post-hoc analysis was also performed using the same endpoints. This analysis compared cohorts of patients receiving TEA and avoiding all systemic opioids, to patients who received systemic opioids (whether alone or combined with TEA). RESULTS: Based on inclusion parameters, 101 patients met criteria for analysis. In the initial analysis, 62 patients received TEA with or without systemic opioids, and 39 patients received only systemic opioids. In comparing these groups, there was no statistically significant difference in time to full diet (TEA 2.6 ± 1.7 vs Systemic opioids 3.1 ± 2.1 [mean POD ± SD]; P=0.21). In addition, no differences were found in the secondary outcomes of time to liquid diet, ICU admission, ICU LOS, or postoperative complications. In the post-hoc analysis, the 37 patients that received only TEA, were compared against 64 patients that received systemic opioids (either with or without TEA). In this comparison, the group receiving only TEA was found to have a statically shorter time to bowel recovery compared to patients receiving systemic opioids (TEA alone 2.2 ± 1.0 vs Systemic opioids 3.2 ± 2.2, P=0.0033). This subgroup (TEA only) also showed statically shorter time to liquid diet and a decreased postoperative LOS. CONCLUSION: For patients undergoing an open PCS, the inclusion of TEA in the postoperative analgesic regimen did not shorten return of bowel function. However, when TEA was utilized and systemic opioids were avoided, time to bowel recovery and hospital LOS were both significantly shortened.

The internal vertebral venous plexus (IVVP) is an extensive vascular network recently implicated in various human and canine spinal disorders. Nevertheless, little recent information is available regarding normal anatomy of canine IVVP and its role in acute spinal injuries. The objectives of the study were; (1) to describe the normal IVVP morphology in the canine cervical region using transverse anatomy sections and computed tomography (CT), (2) to develop a technique for CT examination of the IVVP in vivo, (3) to analyze the quantitative characteristics of the IVVP, and (4) to assess the effect of acute experimental spinal cord compression on IVVP morphology. In the first experiment, CT of the cervical vertebral canal was performed in 6, normal, adult mixed-breed dogs. After dogs were euthanized, a gelatin and iothalamate mixture was injected into the right external jugular vein. Cadavers were then frozen to â 8°C, sliced into transverse sections, and compared with CT images. Vascular components such as the IVVP, interarcuate veins, intervertebral veins, and vertebral veins were accurately depicted on CT images. In the second experiment, CT venography was performed using a biphasic IV injection of iodinated contrast medium. Dimensions of the IVVP and other vertebral canal components were calculated for the C3-C7 vertebral region. Sagittal diameters of the IVVP ranged from 0.6 mm to 3.2 mm. The IVVP area occupied 30.61% of the cervical vertebral epidural space area. When C3-C7 segments were considered as a group, IVVP area dimensions were significantly correlated (r > 0.7, p < 0.0001) with vertebral canal area and dural sac area. In the last experiment, acute spinal cord compression (ASCC) was induced and maintained for 10 minutes using an angioplasty balloon catheter device over the C3/4 vertebral region in 6 dogs. Dogs were evaluated prior to, during, and after compression using digital subtraction venography (DSV) and CT venography. Results showed that ASCC produced a significant change in diameter of the IVVP at the site of compression. This effect persisted during the post-compression period. In conclusion, findings indicate that CT venography and DSV accurately depict the IVVP in dogs, and that significant changes of the IVVP morphology occur under ASCC conditions. / Ph. D.

The objective of this study was to determine if administering epidural ketamine before or after the induction of a sodium urate crystal synovitis provides analgesia in dogs. In Part I, sixteen dogs were anesthetized with propofol (4 mg kg-1 intravenously). A sodium urate crystal synovitis was induced in the right stifle and allowed to develop for 12 hours. These dogs were again anesthetized with propofol and an epidural injection at the lumbosacral space of either ketamine (2 mg kg-1) or placebo (saline containing not more than 0.1 mg ml-1 benzethonium chloride) was performed. Analgesia was measured with a force platform and a numerical rating scale (NRS). Assessments were performed before and at 12, 14, 16, 18, 20 and 24 hours after the induction of synovitis. Vertical ground reaction forces were significantly decreased and numerical rating scale scores of total pain were significantly increased after the induction of synovitis in all dogs (p<0.05). No significant differences in ground reaction forces or total pain scores were measured between the ketamine and the control groups at any assessment period. In Part II, synovitis was induced in the right stifle as described in Part I. Epidural injections at the lumbosacral space followed immediately. Analgesia was assessed at 2, 4, 6, 8, and 12 hours after the epidural injection and the induction of synovitis. Dogs that received ketamine had significantly lower NRS scores two hours after treatment (p < 0.05). NRS scores did not differ between the two treatment groups at any other evaluation. Vertical ground reaction forces did not significantly differ between treatment groups at any assessment period. Results of this study indicate that ketamine, when administered epidurally at a dose of 2 mg kg-1 after the induction of a chemical synovitis, does not provide a significant level of analgesia. However, administration of ketamine immediately before the induction of synovitis resulted in a significantly decreased subjective pain score at two hours, but not at later evaluation periods. / Master of Science

Objective: To evaluate epidurally administered deracoxib and its ability to mediate clinical signs and effects of a sodium urate crystal-induced stifle synovitis in dogs, and to compare the effects of epidural versus subcutaneously injected deracoxib. Study Design: Experimental, randomized, double-blinded, placebo controlled modified cross over design. Animals or Study Population: 24 random source adult mixed breed dogs, 14 males and 10 females. Methods: Sodium urate crystals were used to create a stifle synovitis model to evaluate the effectiveness of administered deracoxib. Dogs were divided into four treatment groups; 3 mg/kg epidural deracoxib, 1.5 mg/kg epidural deracoxib, 3 mg/kg subcutaneous deracoxib and a placebo group (the vehicle for deracoxib was used). Force plate and subjective evaluations were performed at Time 0, 2, 4, 8, 12, and 24 hours post treatment. A repeated measures ANOVA with Bonferroni-corrected post-hoc comparisons was used to determine treatment effects. Results: Overall, peak vertical force (PVF) and vertical impulse (VI) were both significantly higher in all deracoxib treated dogs compared to placebo. Both 3 mg/kg epidural and subcutaneous deracoxib had significantly higher PVF and VI than 1.5 mg/kg epidural deracoxib. The overall pain score for all deracoxib treated dogs was significantly lower than the placebo treated dogs. Conclusions: Epidural deracoxib is effective at providing analgesia in an acute pain model, but it does not appear to be more effective than systemic administration. Clinical Relevance: The use of injectable deracoxib is effective in providing analgesia in acute inflammatory conditions of the stifle joint in dogs. / Master of Science

Os opióides, como o fentanil e o sufentanil, embora amplamente utilizados em cães são raramente empregados pela via epidural nesta espécie. O presente estudo teve como objetivo avaliar comparativamente os efeitos cardiovasculares e sistêmicos bem como a analgesia no período pós-operatório imediato e tardio da anestesia epidural realizada com fentanil ou sufentanil associados a bupivacaína ou desta sozinha em cadelas, sedados com infusão contínua de propofol. Para tanto foram utilizadas 30 fêmeas da espécie canina, submetidas a ovariosalpingohisterectomia eletiva, distribuídas aleatoriamente em 3 grupos de 10 animais cada. Todos os animais deste estudo receberam acepromazina (0,1 mg/kg), e infusão contínua de propofol para sedação. Os animais do grupo I foram então tratados com o fentanil (2 &micro;g/kg) e bupivacaína (1,0 mg/kg), os do grupo II com sufentanil (1&micro;g/kg) e bupivacaína (1,0 mg/kg), e os do grupo III com bupivacaína (1,0 mg/kg). Os agentes foram administrados pela via epidural, no espaço lombo-sacral, e diluídos em solução salina para um volume total de 0,36 ml/kg. A freqüência cardíaca, freqüência respiratória, e pressões arterial sistólica, média e diastólica foram mensuradas bem como pH e gases sangüíneos. Para avaliação de parâmetros sistêmicos relacionados á qualidade da analgesia no trans e pós-operatório foram analisados grau de analgesia e sedação e catecolaminas. A avaliação da extensão do bloqueio foi realizada através do teste do panículo. Para avaliação da latência e duração de ação motora e sensitiva dos fármacos foi realizado o pinçamento do espaço interdigital de membros pélvicos e da região perianal. O período total de avaliação foi de 6 horas após a realização da anestesia epidural. Não foram verificadas diferenças significativas quanto a alterações no sistema cardiovascular e respiratório, nem quanto a alterações na avaliação da sedação. Pode-se observar que o grupo tratado com bupivacaína e sufentanil obteve menores escores de dor no período pós-operatório, mas os demais grupos obtiveram valores satisfatórios em relação a este parâmetro. Pelos resultados obtidos, pode-se concluir que todos os protocolos permitiram a realização do procedimento cirúrgico, e produziram analgesia adequada, nos animais estudados, com modulação da resposta neuroendócrina à dor e mínimos efeitos adversos. / Potent opioids such as fentanyl and sufentanil, althought largely used in dogs, are rarely employed at the epidural space on this species. The aim of the present study was to compare the cardiovascular and systemics effects, as well as the analgesic action on the post operative period of epidural anaesthesia performed with bupivacaine alone or associated with fentanyl and sufentanil, in bitches sedated with continuous infusion of propofol. Thirty female dogs, submitted to ovariosalpingohisterectomy, allocated in three groups of ten animals each were used. All the animals received acepromazine (0,1 mg/kg), and continuous infusion of propofol for sedation. The animals of group I received fentanyl (2&micro;g/kg) and bupivacaine (1 mg/kg), animals of group II received sufentanil (1&micro;g/kg) and bupivacaine (1 mg/kg) and those of group III received bupivacaine (1mg/kg). The agentes were administered at the lumbosacral space, and diluted in saline soluction to a total volume of 0,36 ml/kg. Cardiac and respiratory rate, arterial blood pressure were evaluated, as well as pH and blood gases. Analgesia and sedation levels, and plasmatic cathecolamines were measured for the evaluation of systemic parameters. The evaluation of blook extension was performed by the panniculus test. Pinprick performed at the interdigital space and at perineum region were utilized to evaluate onset time of sensitive and motor blockage. All parameters were evaluated during a total time of 6 hours. No significant changes related to the cardiovascular, respiratory and sedation parameters were observed during the study. The degree of analgesia observed at the post operative period were higher in the sufentanil group. However both fentanyl and bupivacaine groups also obtained a sufficient level of analgesia. Based on the results obtained, the authors concluded that the surgical procedure could be performed by means of the three anesthetic techniques employed producing sufficient analgesia and an acceptable neuroendocrine modulation of pain with minimal adverse effects.

O emprego da anestesia peridural em cães vem se tornando mais freqüente na prática clínica em comparação a anestesia geral. O aumento de publicações científicas a respeito da técnica comprova esta afirmação. No entanto, a literatura referente à dispersão de bloqueio anestésico em relação à dose, concentração e volume utilizados é conflitante. O objetivo deste estudo foi avaliar a dispersão da bupivacaína no espaço peridural, analisando os bloqueios sensitivo, motor e autonômico, bem como seu comportamento na medula de cães. Para tanto, foram utilizados 20 cães fêmeas com pesos de 9,9 ± 1,9 kg e comprimento de coluna de 53,4 ± 5,1 cm, sendo divididos em 4 grupos de 5 animais. O volume administrado por grupo foi de 0,2; 0,4; 0,6; e 0,8 mL/kg de uma solução padrão de bupivacaína 0,25% e azul de metileno. Após inserção de cateter na artéria femoral e no espaço peridural lombossacro, com os animais em estação e acordados, foram administrados diferentes volumes da solução padrão. As avaliações foram feitas ao final da administração em 2, 5, 10, 15, 20 e 30 minutos. Além de FC e PAM, a avaliação do bloqueio sensitivo foi feita por pinçamento dos dermátomos acima das vértebras, da cauda, interdígito, ânus e vulva dos animais. O bloqueio motor foi avaliado observando-se o tempo para ocorrência de ataxia e de incapacidade de sustentação do próprio peso e diminuição do tônus muscular dos membros pélvicos e cauda. O bloqueio autonômico foi avaliado através da diferença das temperaturas cutâneas ao longo da coluna entre a basal e as aferidas aos 15 minutos. Após 30 minutos os animais foram eutanasiados e feitas laminectomias seriadas com exposição da medula espinhal para análise da mancha produzida pelo azul de metileno na duramater. Como resultados, observaram-se diminuição da FC dos 5 minutos até os 30 e de PAM dos 20 aos 30 minutos. Com 0,2 mL/kg de bupivacaína 0,25% foram bloqueados em média 5 dermátomos, 0,4 mL/kg bloqueou 14,2 dermátomos e 0,6 mL/kg bloqueou em média 20,2 dermátomos, sendo estatisticamente diferentes. Já 0,8 mL/kg bloqueou 21 dermátomos e não diferiu de 0,6. Aos 5 minutos, em média, ocorreu ação anestésica significativamente mais intensa até os 20 minutos, sugerindo inicio e final de ação do fármaco. Quando comparadas as tendências de insensibilização e diminuição de tônus muscular da região caudal dos animais, observou-se uma ação mais intensa e duradoura do bloqueio motor em relação ao sensitivo. Os tempos para aparecimento de ataxia e incapacidade de sustentação do peso foram maiores quanto maior o volume administrado do anestésico, e, em todos os grupos, a temperatura cutânea ao longo da coluna vertebral aumentou aos 15 minutos de anestesia no sentido caudo-cranial. A mancha de azul de metileno foi crescente com o aumento de volume de 0,2 a 0,4 mL/kg e não dispersou mais com a aplicação de mais anestésico. Concluiu-se que quanto maior o volume de bupivacaína 0,25% administrada, mais cranial é o bloqueio sensitivo, até um limite de 0,6 mL/kg, e maior sua dispersão, até um limite de 0,4 mL/kg. Ou seja, entre esses 2 volumes quanto mais anestésico se administrar mais dermátomos serão bloqueados sem aumento de dispersão do mesmo no canal medular. A anestesia peridural com bupivacaína em cães causa bloqueio motor mais intenso e duradouro do que sensitivo em sua região caudal. Há aumento de temperatura cutânea no sentido caudo-cranial / The use of epidural anesthesia has grown in veterinary anesthesia in relation to the indiscriminate employment of general anesthesia, shown in the increasing number of scientific publications in the area. Nevertheless, the dose/volume/concentration relationship with rostral spread of anesthetic block is uncertain. The aim of the present study was to evaluate the spread of bupivacaine in the epidural space of dogs, assessing the sensitive, motor and autonomic blocks, as well as its diffusion in the spinal cord. Twenty mongrel dogs weighing 9.9 ± 1.9 kg and measuring 53.4 ± 5.1 cm in column length, were divided in 4 groups of 5 animals. A standard solution of 0.25% bupivacaine and methylene blue was injected epidurally at volumes of 0.2, 0.4, 0.6 and 0.8 mL/kg in the different experimental groups. After the insertion of one femoral and one epidural catheter in the lumbosacral space, the different volumes were administered as of waking and rising of dogs. The data were collected after injection at 2, 5, 10, 15, 20 and 30 minutes. Besides HR and MAP, sensitive block was evaluated by dermatome pinch as well as tail, interdigital membrane, anal and vulvar pinch. Motor block was determined by times of ataxia and incapability to withstand its own weight, and reduced muscular tonus of tail and pelvic limbs. Autonomic block was assessed comparing the basal skin temperature of the column and the temperature checked 15 minutes after anesthesia. After data collection, dogs were euthanized and the spinal cord exposed by serial laminectomies to inspect the appearance of methylene blue dye in the dura-mater. HR decreased from 5 to 30 minutes and MAP from 20 to 30 minutes. On average, 0.2 mL/kg of 0.25% bupivacaine blocked 5 dermatomes, 0.4 mL/kg blocked 14.2, and 0.6 mL/kg blocked on average 20.2 dermatomes, with statistical significance. However, 0.8 mL/kg blocked on average 21 dermatomes, not differing from the 0.6 mL/kg volume. Anesthetic block was observed to be constant between 5 and 20 minutes, and statistically less intense at 2 and 30 minutes, which suggests times of latency and duration of action of the drug, respectively. Comparing the decreased muscular tonus and insensitiveness tendencies, a more intense and longer motor block instead sensitive block was observed. The times to ataxia and sustentation were longer when the volume of local anesthetic was increased, and, in all groups, the skin temperature measured on the column was lower in the caudal than the cranial portion 15 minutes after anesthesia. Dye spread was longer with the volume increase from 0.2 to 0.4 mL/kg and did not change with larger volumes of bupivacaine. So, the higher the volume of 0.25% bupivacaine epidurally injected to dogs, the more cranial is the sensitive block (to the maximum of 0.6 mL/kg) and larger is the spinal spread (to the limit of 0.4 mL/kg). Therefore, between the volumes of 0.4 and 0.6 mL/kg, more dermatomes are blocked without the spread of the local anesthetic in the spinal canal. The epidural anesthesia in dogs with bupivacaine produces a more intense and longer motor block as compared to sensitive block in the caudal region of dogs, and increase skin temperatures in a caudal-rostral gradient

Orientadores: Rosa Ines Costa Pereira, Jose Guilherme Cecatti / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-11-07T13:14:57Z (GMT). No. of bitstreams: 1 Baciuk_EricaPassos_D.pdf: 6936092 bytes, checksum: c77ac78d2a89de858849dc1f9432dcce (MD5) Previous issue date: 2005 / Doutorado / Ciencias Biomedicas / Doutor em Tocoginecologia