Perioperative evaluation of tumescent anaesthesia technique in bitches submitted to unilateral mastectomy

BMC Veterinary Research

Lidia Raquel de Carvalho³  Jaqueline Neratika Negrette Garcia⁴  Giancarlo Bressane Gomes⁴  Luciano Cacciari Baruffaldi Almeida da Silva⁴  Fabio Futema⁴  Stelio Pacca Loureiro Luna¹  Leonardo de Freitas Guimaraes Arcoverde Credie² 

[1] Department of Veterinary Surgery and Anaesthesiology, Faculty of Veterinary Medicine and Animal Science, UNESP – Univ Estadual Paulista, Botucatu, Sao Paulo, Brazil;Department of Anaesthesiology, Faculty of Medicine, UNESP – Univ Estadual Paulista, Botucatu, Sao Paulo, Brazil;Department of Biostathistics, Biosciences Institute, UNESP – Univ Estadual Paulista, Botucatu, Sao Paulo, Brazil;University of Guarulhos, Guarulhos, Sao Paulo, Brazil

关键词: Lidocaine;    Regional anaesthesia;    Mastectomy;    Dogs;   

Others  :  1119460
DOI  :  10.1186/1746-6148-9-178

 received in 2013-02-19, accepted in 2013-09-02,  发布年份 2013

【 摘 要 】

Background

Tumescent anaesthesia (TA) is a widely used technique in oncologic surgeries necessitating large resection margins. This technique produces transoperative and postoperative analgesia, reduces surgical bleeding, and facilitates tissue divulsion. This prospective, randomised, blind study evaluated the use of TA in bitches submitted to mastectomy and compared the effect of TA with an intravenous fentanyl bolus. A 2.5-mcg/kg intravenous fentanyl bolus (n = 10) was compared with TA using 0.275% lidocaine (n = 10) in bitches submitted to unilateral mastectomy. Sedation was performed by intramuscular (IM) injection of 0.05 mg/kg of acepromazine combined with 2 mg/kg of meperidine. Anaesthesia was induced with 5 mg/kg of intravenous propofol and maintained with isoflurane/O₂. Heart and respiratory rates; systolic, mean, and diastolic arterial blood pressures; central venous pressure; SpO₂; ETCO₂; inspired and expired isoflurane concentrations; and temperature were measured transoperatively. Visual analogue scales for sedation and pain and the Glasgow composite and Melbourne pain scales were used for postoperative assessment. The surgeon investigated the quality of the surgical approach, considering bleeding and resection ability, and the incidence of postoperative wound complications.

Results

The heart rate was lower and the end-tidal isoflurane concentration was higher in dogs treated with fentanyl than in dogs treated with TA. A fentanyl bolus was administered to 8 of 10 dogs treated with fentanyl and to none treated with TA. Intraoperative bleeding and the mammary gland excision time were lower in dogs treated with TA. The maximal mean and individual plasma lidocaine concentrations were 1426 ± 502 ng/ml and 2443 ng/ml at 90 minutes after infiltration, respectively. The Glasgow Composite Pain Scale scores were higher in dogs treated with fentanyl than in dogs treated with TA until 2 hours after extubation.

Conclusions

Compared with intravenous fentanyl, TA in bitches: may be easily performed in non-inflamed, ulcerated, adhered mammary tumours; has an isoflurane-sparing effect; improves transoperative and immediate postoperative analgesia; is apparently safe for use in clinical conditions as evidenced by the fact that it did not produce any adverse signs or lidocaine plasma concentrations compatible with toxicity; does not modify the recovery time; and facilitates the surgical procedure without interfering with wound healing.

【 授权许可】

   
2013 Credie et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]De Nardi AB, Rodaski S, Rocha NS, Fernandes SC: Neoplasias mamárias. In Oncologia em cães e gatos. 1st edition. Edited by Daleck CR, De Nardi AB, Rodaski S. Sao Paulo: Roca; 2009:371-383.
• [2]Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkinet RH: Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain 2006, 7:626-634.
• [3]Brown AK, Christo PJ, Wu CL: Strategies for postoperative pain management. Best Pract Res Clin Anaesthesiol 2004, 18:703-717.
• [4]Liu SS, Strodtbeck WM, Richman JM, Wu CL: A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg 2005, 101:1634-1642.
• [5]Oderda G: Challenges in the management of acute postsurgical pain. Pharmacotherapy 2012, 32(suppl 2):6-11.
• [6]Gupta K, Kshirsagar S, Chang L, Schwartz R, Law P, Yee D, Hebbel RP: Morphine stimulates angiogenesis by activating proangiogenic and survivalpromoting signaling and promotes breast tumor growth. Cancer Res 2002, 62:4491-4498.
• [7]Shavit Y, Ben-Eliyahu S, Zeidel A, Beilin B: Effects of fentanyl on natural killer cell activity and on resistance to tumor metastasis in rats. Neuroimmunomodulation 2004, 11:255-260.
• [8]Santamaria LB, Schifilliti D, La Torre D, Fodale V: Drugs of anaesthesia and cancer. Surg Oncol 2010, 19:63-81.
• [9]Gach K, Wyrębska A, Fichna J, Janecka A: The role of morphine in regulation of cancer cell growth. Naunyn Schmiedebergs Arch Pharmacol 2011, 384:221-230.
• [10]Klein JA: Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg 1993, 92:1085-1098.
• [11]Ostad A, Kageyama N, Moy RL: Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg 1996, 22:921-927.
• [12]Klein JA: Anesthetic formulation of tumescent solutions. Dermatol Clin 1999, 17:751-759.
• [13]Klein JA: The tumescent technique for liposuction surgery. J Am Acad Cosmetic Surg 1987, 4:263-267.
• [14]Samdal F, Amland PF, Bugge JF: Blood loss during liposuction using the tumescent technique. Aesthetic Plast Surg 1994, 18:157-160.
• [15]Upadya M, Upadya GM: Anesthesia for dermatological surgery. Indian J Dermatol Venereol Leprol 2005, 71:145-154.
• [16]Carlson GW: Total mastectomy under local anesthesia: the tumescent technique. Breast J 2005, 11:100-102.
• [17]Habbema L: Breast reduction using liposuction with tumescent local anesthesia and powered cannulas. Dermatol Surg 2009, 35:41-52.
• [18]Hanke CW: The tumescent facial block: tumescent local anesthesia and nerve block anesthesia for full-face laser resurfacing. Dermatol Surg 2001, 27:1003-1005.
• [19]Mizukami T, Hamamoto M: Tumescent local anesthesia for a revascularization of a coronary subclavian steal syndrome. Ann Thorac Cardiovasc Surg 2007, 13:352-354.
• [20]Eichhorn K, Renner R, Haustein UF: Sentinel node biopsy in melanoma of the trunk and extremities in tumescent local anesthesia. Dermatol Surg 2004, 30:253-256.
• [21]Thomas J: Adjunctive tumescent technique in massive resections. Aesthetic Plast Surg 2001, 25:343-346.
• [22]Bussolin L, Busoni P, Giorgi L, Cresciolli M, Messeri A: Tumescent local anesthesia for the surgical treatment of burns and postburn sequelae in pediatric patients. Anesthesiol 2003, 99:1371-1375.
• [23]Jones BM, Grover R: Reducing complications in facelift surgery by tumescent infiltration: a comparative trial evaluating 678 consecutive patients. Plast Reconstr Surg 2004, 113:398-403.
• [24]Gilliland MD, Coates N: Tumescent liposuction complicated by pulmonary edema. Plast Reconstr Surg 1997, 99:215-219.
• [25]Klein JA: Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol 1990, 16:248-263.
• [26]Lehnhardt M, Homann HH, Daigeler A, Hauser J, Palka P, Steinau HU: Major and lethal complications of liposuction: a review of 72 cases in Germany between 1998 and 2002. Plast Reconstr Surg 2008, 121:396-403.
• [27]Lapid O: Syringe-delivered tumescent anesthesia made easier. Aesth Plast Surg 2010, 35:601-602.
• [28]Kukanich B, Clark TP: The history and pharmacology of fentanyl: relevance to a novel, longacting transdermal fentanyl solution newly approved for use in dogs. J Vet Pharmacol Therap 2012, 35:3-19.
• [29]Pypendop BH, Ilkiw JE: The effects of intravenous lidocaine administration on the minimum alveolar concentration of isoflurane in cats. Anesth Analg 2005, 100:97-101.
• [30]Valverde A, Doherty TJ, Hernandez J, Davies W: Effect of lidocaine on the minimum alveolar concentration of isoflurane in dogs. Vet Anesth Analg 2004, 31:264-271.
• [31]Steagall PVM, Francisco J, Teixeira Neto FJ, Bruno W, Minto BW, Campagnol D, Correa MA: Evaluation of the isoflurane-sparing effects of lidocaine and fentanyl during surgery in dogs. J Am Vet Med Assoc 2006, 229:522-527.
• [32]Armstrong SR, Roberts BK, Aronsohn M: Perioperative hypothermia. J Vet Emerg Crit Care 2005, 15:32-37.
• [33]de Jong RH, Grazer FM: Perioperative management of cosmetic liposuction. Plast Reconstr Surg 2001, 107:1039-1044.
• [34]Snyder GL, Greenberg S: Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth 2010, 105:106-115.
• [35]Shakhar G, Shamgar Ben-Eliyahu S: Potential prophylactic measures against postoperative immunosuppression: could they reduce recurrence rates in oncological patients? Ann Surg Oncol 2003, 10:972-992.
• [36]Fossum TW: Biomateriais, sutura e hemostasia. In Cirurgia de pequenos animais. 1st edition. Edited by Fossum TW, Hedlund CS, Johnson AL, Seim HBIII, Willard MD, Carroll GL. Sao Paulo: Roca; 2002:48-64.
• [37]Liu P, Feldman HS, Brian M, Covino BM, Giasi R, Covino BG: Acute cardiovascular toxicity of intravenous amide local anesthetics in anesthetized ventilated dogs. Anesth Analg 1982, 61:317-322.
• [38]Liu PL, Feldman HS, Giasi R, Patterson MK, Covino BG: Comparative CNS toxicity of lidocaine, etidocaine, bupivacaine, and tetracaine in awake dogs following rapid intravenous administration. Anesth Analg 1983, 62:375-379.
• [39]Martins CAS: Anestésicos locais. In Anestesia regional: princípios e práticas. 1st edition. Edited by Carneiro AF, Valverde Filho J, Auler Junior JOC, Imbelloni LE, Gouveia MA. Barueri: Manole; 2010:91-104.
• [40]Lemo N, Vnuk D, Radisic B, Skender L, Karacic V, Brcic I: Determination of the toxic dose of lidocaine in dogs and its corresponding serum concentration. Vet Rec 2007, 160:374-375.
• [41]Smith LJ, Shih A, Miletic G, Miletic V: Continual systemic infusion of lidocaine provides analgesia in an animal model of neuropathic pain. Pain 2002, 97:267-273.
• [42]Robertson SA, Sanchez LC, Merritt AM, Doherty TJ: Effect of systemic lidocaine on visceral and somatic nociception in conscious horses. Equine Vet J 2005, 37:122-127.
• [43]Clarke C, McConachie I, Banner R: Lidocaine infusion as a rescue analgesic in the perioperative setting. Pain Res Manage 2008, 13:421-423.
• [44]Smith LJ, Bentley E, Shih A, Miller PE: Sistemic lidocaine infusion as an analgesic for intraocular surgery in dogs: a pilot study. Vet Anaesth Analg 2004, 31:53-63.
• [45]McCarthy GC, Megalla SA, Habib AS: Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs 2010, 70:1149-1163.
• [46]Cassuto J, Wallin G, Hogstrom S, Faxen A, Rimback G: Inhibition of postoperative pain by continuous low-dose intravenous infusion of lidocaine. Anesth Analg 1985, 64:971-974.
• [47]Koppert W, Weigand M, Neumann F: Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg 2004, 98:1050-1055.
• [48]Groudine SB, Fisher HAG, Kaufman R Jr, Patel MK, Wilkins LJ, Mehta SA, Lumb PD: Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg 1998, 86:235-239.
• [49]Kuo CP, Jao SW, Chen KM, Wong CS, Yeh CC, Sheen MJ, Wu CT: Comparison of the effects of thoracic epidural analgesia and i.v. infusion with lidocaine on cytokine response, postoperative pain and bowel function in patients undergoing colonic surgery. Br J Anaesth 2006, 97:640-646.
• [50]Pflug AE, Halter JB: Effect of spinal anesthesia on adrenergic tone and the neuroendocrine responses to surgical stress in humans. Anesthesiol 1981, 55:120-126.
• [51]Sacerdote P, Bianchi M, Gaspani L, Manfredi B, Maucione A, Terno G, Ammatuna M, Panerai AE: The Effects of tramadol and morphine on immune responses and pain after surgery in cancer patients. Anesth Analg 2000, 90:1411-1414.
• [52]Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI: Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiol 2006, 105:660-664.
• [53]Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ: Anesthetic technique for radical prostatectomy surgery affects cancer recurrence. Anesthesiol 2008, 109:180-187.
• [54]Bar-Yosef S, Melamed R, Page GG, Shakhar G, Shakhar K, Ben-Eliyahu S: Attenuation of the tumor-promoting effect of surgery by spinal blockade in rats. Anesthesiol 2001, 94:1066-1073.
• [55]Mammoto T, Higashiyama S, Mukai M, Mammoto A, Ayaki M, Mashimo T, Hayashi Y, Kishi Y, Nakamura H, Akedo H: Infiltration anesthetic lidocaine inhibits cancer cell invasion by modulating ectodomain shedding of heparin-binding epidermal growth factor-like growth factor (HB-EGF). J Cell Physiol 2002, 192:351-358.