Mudasir Ahmad SHAH, Prakash KINJAVDEKAR, Deepti Amarpal SHARMA, Abhijit Motiram PAWDE, Abu Rafee MALIK, Abas Rashid BHAT

Effect of epidural dexmedetomidine with or without local anesthetics on pain score and serum IL-6 levels in dogs undergoing elective ovariohysterectomy

To evaluate the postoperative analgesic effects of epidural dexmedetomidine with or without local anesthetics, prospectiverandomized double-blinded clinical trials were performed with 24 healthy client-owned mixed-breed adult dogs with an average weightof 18.1 ± 2.4 kg allotted equally (n = 6) to four groups: A, B, C, and D. All animals were premedicated intramuscularly with atropine(0.04 mg/kg) and after 5 min by intravenous midazolam (0.7 mg/kg). After 10 min of premedication, in group A dexmedetomidine(7 μg/kg) and in groups B, C, and D, in addition to dexmedetomidine (7 μg/kg), lidocaine (4.4 mg/kg), bupivacaine (2 mg/kg), andropivacaine (2 mg/kg), respectively, were administered to the lumbosacral epidural space, respectively. Anesthesia was maintainedwith 1% propofol as and when needed. Postoperative analgesia was assessed subjectively using the University of Melbourne Pain Scale(UMPS) at 1, 2, 4, and 24 h postoperatively and objectively by measuring the circulating levels of interleukin-6 (IL-6) at 0 (baseline),1, 2, 4, and 24 h postoperatively. Overall, UMPS scores were lower in groups B, C, and D at all time points compared to group A.Serum IL-6 levels showed a nonsignificant decrease in groups B and C with a nonsignificant increase in group D at different intervalsas compared to baseline. However, a significantly higher serum IL-6 level was recorded at 4 h in group A as compared to the otherthree groups. It was concluded that epidural dexmedetomidine in combination with lidocaine, bupivacaine, or ropivacaine at the dosesstudied provides better postoperative analgesia than dexmedetomidine alone in dogs undergoing elective ovariohysterectomy. However,the dexmedetomidine/ropivacaine combination revealed comparatively lower postoperative analgesia than dexmedetomidine/lidocaineand dexmedetomidine/bupivacaine combinations.

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1. Bonnet F, Marret E. Influence of anaesthetic and analgesic techniques on outcome after surgery. Brit J Anaesth 2005; 95: 52-58.
2. Wagner AE, Worland GA, Glawe JC, Hellyer PW. Multicenter randomized controlled trial of pain related behaviors following routine neutering in dogs. J Am Vet Med Assoc 2008; 233: 109- 115.
3. Lin HC. Dissociative anesthetics. In: Tranquilli WJ, Thurmon JC, Grimm KA, editors. Lumb & Jones Veterinary Anesthesia & Analgesia. 4th ed. Ames, IA, USA: Blackwell; 2007. pp. 301- 353.
4. Omote K, Kitahata LM, Collins JG. Interaction between opiate subtype and alpha-2 adrenergic agonists in suppression of noxiously evoked activity of WDR neurons in the spinal dorsal horn. Anesthesiology 1991; 74: 737-743.
5. Karsli B, Kayacan N, Kucukyavuz Z, Mimaroglu C. Effects of local anesthetics on pregnant uterine muscles. Polish J Pharmacol 2003; 55: 51-56.
6. Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative analgesic agent. In: Proceedings of Baylor University Medical Center; 2001; Dallas, TX, USA. pp. 13-21.
7. Calzada BC, de Artinano AA. Alpha-adrenoceptor subtypes. Pharmacol Res 2001; 44: 195-208.
8. Firth AM, Haldane SL. Development of a scale to evaluate postoperative pain in dogs. J Am Vet Med Assoc 1999; 214: 651-659 .
9. Lin E, Calvano SE, Lowry SF. Inflammatory cytokines and cell response in surgery. Surgery 2000; 127: 117-126.
10. Beilin B, Shavit Y, Trabekin E. The effects of postoperative pain management on immune response to surgery. Anesth Analg 2003; 97: 822-827.
11. Kato M, Suzuki H, Murakami M. Elevated plasma levels of interleukin-6, interleukin-8 and granulocyte colony- stimulating factor during and after major abdominal surgery. J Clin Anesth 1997; 9: 293-298.
12. Kuo CP, Jao SW, Chen KM. 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. Brit J Anaesth 2006; 97: 640-646.
13. Snedecor GW, Cochran WG. Statistical Methods. 8th ed. Ames, IA, USA: Iowa State University Press; 1994.
14. Asano T, Dohi S, Ohta S. Antinociception by epidural and systemic alpha-2 adrenoceptor agonists and their binding affinity in rat spinal cord and brain. Anesth Analg 2000; 90: 400-407.
15. Sabbe MB, Penning MD, Ozaki GT. Spinal and systemic action of the alpha-2 receptor agonist dexmedetomidine in dogs. Anesthesiology 1994; 80: 1057-1072.
16. Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibary S, Abdellatif AA, Afifi W. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesth Scand 2009; 53: 251-256.
17. Kang SH, Kim YS, Hong TH, Chae MS, Cho ML, Her ML, Lee J. Effects of dexmedetomidine on inflammatory responses in patients undergoing laparoscopic cholecystectomy. Acta Anaesth Scand 2013; 57: 480-487.
18. Eisenach JC, De Kock M, Klimscha W. α 2 -Adrenergic agonists for regional anesthesia: a clinical review of clonidine (1984- 1995). Anesthesiology 1996; 85: 655-674.
19. Nour EM, Othman MM, Karrouf GIA, Zaghloul AEI. Comparative evaluation of the epidural dexmedetomidine, ketamine or fentanyl in combination with bupivacaine in dogs. Am J Anim Vet Sci 2013; 8: 230-238.
20. Singh J, Shah RS, Vaidya N, Mahato PK, Srestha S, Shrestha BL. Comparison of ketamine, fentanyl and clonidine as an adjuvant during bupivacaine caudal anaesthesia in paediatric patients. Kathmandu Univ Med J 2012; 3: 25-29.
21. Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S. Dexmedetomidine and clonidine in epidural anaesthesia: a comparative evaluation. Indian J Anaesth 2011; 55: 116-121.
22. Yayla S, Kaçar C, Kılıç E, Kaya S, Kuru M, Ermutlu CŞ, Özaydın İ, Hüseyinoğlu Ü, Öğün M. The effects of intrathecal administration of bupivacaine or ropivacaine following administration of propofol in dogs undergoing ovariohysterectomy. Kafkas Univ Vet Fak 2017; 23: 363-367.
23. Bigat Z, Boztug N, Karsli B, Cete N, Ertok E. Comparison of hyperbaric ropivacaine and hyperbaric bupivacaine in unilateral spinal anaesthesia. Clin Drug Invest 2006; 26: 35-41.
24. Yayla S, Kılıç E. The comparison of clinical, histopathological and some hemodynamic effects of spinal anaesthesia applied in dogs through bupivacaine HCl and ropivacaine HCl in two different concentrations. Kafkas Univ Vet Fak 2010; 16: 835- 840.