Eficácia da técnica epidural sacrococcígea na prevenção da ativação do sistema nervoso simpático em ovariectomia felina
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A ovariectomia pode desencadear dor somática e visceral. Sendo a dor somática resultante do estímulo causado pelo trauma na parede abdominal aquando da celiotomia, e a dor visceral a principal fonte de estimulação nociceptiva durante o período intraoperatório, principalmente no momento da tração e hemóstase dos pedículos ováricos. A anestesia locoregional epidural sacrococcígea pode fazer parte de um protocolo anestésico multimodal, complementando a analgesia sistémica e reduzindo assim o consumo de opioides e os seus efeitos adversos indesejáveis associados e, consequentemente, reduzindo ou bloqueando completamente a ativação do sistema nervoso simpático durante este procedimento. Este estudo teve como objetivo avaliar o efeito antinociceptivo da administração do anestésico local bupivacaína a 0,25%, por via epidural sacrococcígea, em ovariectomia felina e identificar se esta contribui para um aumento da estabilidade dos parâmetros hemodinâmicos e bloqueio da ativação do sistema nervoso simpático. Dois grupos de animais foram avaliados em cinco momentos intraoperatórios, sendo o grupo de controlo composto por 18 gatas com apenas analgesia sistémica e o grupo epidural sacrococcígea composto por 20 gatas com bupivacaína a 0,25% combinada com analgesia sistémica. Os animais de ambos os grupos foram pré-medicados com dexmedetomidina (20?g/kg intramuscular) e metadona (0,2mg/kg intramuscular), a anestesia geral foi induzida com propofol endovenoso ad effectum e mantida com isoflurano em oxigénio a 100%. A frequência cardíaca (FC) frequência e respiratória (FR), a pressão arterial sistólica (PAS) e pressão arterial média (PAM) não invasiva, e a atividade do tónus parassimpático instantâneo (PTAi), foram monitorizados durante todo o procedimento. Com o presente estudo, foi possível concluir que que um protocolo anestésico multimodal complementado pela utilização da técnica epidural sacrococcígea com bupivacaína a 0,25%, quando comparado com um protocolo anestésico que incluí apenas analgesia sistémica, demonstra proporcionar uma maior estabilidade hemodinâmica e por consequente uma necessidade inferior de utilização de opioides para o sucesso analgésico da cirurgia. No entanto, a utilização desta técnica não previne a ativação do sistema nervoso simpático durante a ovariectomia felina. Palavras-Chave: felino, ovariectomia, sistema nervoso simpático, epidural sacrococcígea, atividade do tónus parassimpático
Ovariectomy can trigger somatic and visceral pain. Somatic pain results from the stimulus caused by trauma to the abdominal wall at the time of celiotomy, and visceral pain is the main source of nociceptive stimulation during the intraoperative period, especially at the time of traction and hemostasis of the ovarian pedicles. Sacrococcygeal epidural locoregional anaesthesia can be part of a multimodal anaesthetic protocol, complementing systemic analgesia and thereby reducing opioid consumption and its associated undesirable adverse effects and consequently reducing or completely blocking the activation of the sympathetic nervous system during this procedure. The objective of this study was to evaluate the antinociceptive effect of administering the local anesthetic 0,25% bupivacaine by sacrococcygeal epidural in feline ovariectomy and to identify whether it contributes to an increase of hemodynamic stability and blockade of sympathetic nervous system activation. Two groups of animals were evaluated in five intraoperative moments, the control group consisting of 18 cats with only systemic analgesia and the sacrococcygeal epidural group consisting of 20 cats with 0,25% bupivacaine combined with systemic analgesia. The animals in both groups were premedicated with dexmedetomidine (20μg/kg intramuscular) and methadone (0,2mg/kg intramuscular), general anesthesia was induced with intravenous propofol ad effectum and maintained with isoflurane in 100% oxygen. Heart rate (HR) and respiratory rate (RR), non-invasive systolic blood pressure (SAP) and mean blood pressure (MAP), and instantaneous parasympathetic tone activity (PTAi) were monitored throughout the procedure. With the present study, it was possible to conclude that a multimodal anesthetic protocol complemented by the use of sacrococcygeal epidural technique with 0,25% bupivacaine, when compared to an anesthetic protocol that includes only systemic analgesia, demonstrates to provide greater hemodynamic stability and consequently a lower need for the use of opioids for the analgesic success of the surgery. However, the use of this technique does not prevent activation of the sympathetic nervous system during feline ovariectomy. Keywords: feline, ovariectomy, sympathetic nervous system, sacrococcygeal epidural, parasympathetic tone activity.
Ovariectomy can trigger somatic and visceral pain. Somatic pain results from the stimulus caused by trauma to the abdominal wall at the time of celiotomy, and visceral pain is the main source of nociceptive stimulation during the intraoperative period, especially at the time of traction and hemostasis of the ovarian pedicles. Sacrococcygeal epidural locoregional anaesthesia can be part of a multimodal anaesthetic protocol, complementing systemic analgesia and thereby reducing opioid consumption and its associated undesirable adverse effects and consequently reducing or completely blocking the activation of the sympathetic nervous system during this procedure. The objective of this study was to evaluate the antinociceptive effect of administering the local anesthetic 0,25% bupivacaine by sacrococcygeal epidural in feline ovariectomy and to identify whether it contributes to an increase of hemodynamic stability and blockade of sympathetic nervous system activation. Two groups of animals were evaluated in five intraoperative moments, the control group consisting of 18 cats with only systemic analgesia and the sacrococcygeal epidural group consisting of 20 cats with 0,25% bupivacaine combined with systemic analgesia. The animals in both groups were premedicated with dexmedetomidine (20μg/kg intramuscular) and methadone (0,2mg/kg intramuscular), general anesthesia was induced with intravenous propofol ad effectum and maintained with isoflurane in 100% oxygen. Heart rate (HR) and respiratory rate (RR), non-invasive systolic blood pressure (SAP) and mean blood pressure (MAP), and instantaneous parasympathetic tone activity (PTAi) were monitored throughout the procedure. With the present study, it was possible to conclude that a multimodal anesthetic protocol complemented by the use of sacrococcygeal epidural technique with 0,25% bupivacaine, when compared to an anesthetic protocol that includes only systemic analgesia, demonstrates to provide greater hemodynamic stability and consequently a lower need for the use of opioids for the analgesic success of the surgery. However, the use of this technique does not prevent activation of the sympathetic nervous system during feline ovariectomy. Keywords: feline, ovariectomy, sympathetic nervous system, sacrococcygeal epidural, parasympathetic tone activity.