Success Rate and Perioperative Complications of Lumbosacral Extradural Anaesthesia in Dogs Undergoing Total Hip Replacement: A Double-Centre Retrospective Study

Abstract

Objective The aim of this study was to retrospectively evaluate the success rate and perioperative complications of lumbosacral extradural anaesthesia in dogs undergoing total hip replacement.

Study Design Records of dogs undergoing total hip replacement in which lumbosacral extradural anaesthesia with 0.5% levo- or bupivacaine combined with either morphine or buprenorphine were retrieved. Success rate was defined as intraoperative fentanyl consumption <1 μg/kg/h with no intravenous infusion of other analgesic drugs and no additional morphine/methadone within the first 3 hours from premedication. Prevalence of intraoperative anaesthetic and postoperative surgical complications was calculated.

Results Overall, 206 dogs were included in the study. Success rate was 88.7%. Hypercapnia (75.2%), hypotension (46.1%), hypothermia (27.7%) and regurgitation (6.3%) were recorded during anaesthesia. Within 24 hours post-surgery, urinary retention (17.8%), vomiting/regurgitation/diarrhea (8.2%) and sciatic neurapraxia of the operated limb (5.8%) were recorded. Luxation of the operated hip occurred at 48 and 72 hours after surgery in two dogs and one dog respectively. One dog had cardiopulmonary arrest at 52 hours after surgery.

Conclusion While hypercapnia, hypotension and hypothermia might develop intraoperatively, the high success rate and the relatively low prevalence of postoperative surgical complications directly associated with lumbosacral extradural anaesthesia justify its use in dogs undergoing total hip replacement.

Keywords

extradural anaesthesia - total hip replacement - dog - complication rate

Authors' Contributions

I.V. acquired data and drafted the manuscript. H.K. critically revised the manuscript. E.W. was involved in data collection and revision of the manuscript. E.V. was involved in study design, statistical analysis, critical revision and approval of final version. All authors approved the submitted manuscript.

Publication History

Received: 01 May 2021

Accepted: 11 August 2021

Article published online:
24 September 2021

• References

• 1 Bergh MS, Gilley RS, Shofer FS, Kapatkin AS. Complications and radiographic findings following cemented total hip replacement: a retrospective evaluation of 97 dogs. Vet Comp Orthop Traumatol 2006; 19 (03) 172-179
• 2 Nelson LL, Dyce J, Shott S. Risk factors for ventral luxation in canine total hip replacement. Vet Surg 2007; 36 (07) 644-653
• 3 Guerrero TG, Montavon PM. Zurich cementless total hip replacement: retrospective evaluation of 2nd generation implants in 60 dogs. Vet Surg 2009; 38 (01) 70-80
• 4 Schiller TD. BioMedtrix total hip replacement systems: an overview. Vet Clin North Am Small Anim Pract 2017; 47 (04) 899-916
• 5 Andrews CM, Liska WD, Roberts DJ. Sciatic neurapraxia as a complication in 1000 consecutive canine total hip replacements. Vet Surg 2008; 37 (03) 254-262
• 6 Massat BJ, Vasseur PB. Clinical and radiographic results of total hip arthroplasty in dogs: 96 cases (1986-1992). J Am Vet Med Assoc 1994; 205 (03) 448-454
• 7 Forster KE, Wills A, Torrington AM. et al. Complications and owner assessment of canine total hip replacement: a multicenter internet based survey. Vet Surg 2012; 41 (05) 545-550
• 8 Olmstead ML. Total hip replacement. Vet Clin North Am Small Anim Pract 1987; 17 (04) 943-955
• 9 Liska WD. Femur fractures associated with canine total hip replacement. Vet Surg 2004; 33 (02) 164-172
• 10 Vettorato E, Bradbrook C, Gurney M, Aprea F, Clark L, Corletto F. Peripheral nerve blocks of the pelvic limb in dogs: a retrospective clinical study. Vet Comp Orthop Traumatol 2012; 25 (04) 314-320
• 11 Sarotti D, Rabozzi R, Franci P. Comparison of epidural versus intrathecal anaesthesia in dogs undergoing pelvic limb orthopaedic surgery. Vet Anaesth Analg 2015; 42 (04) 405-413
• 12 Lardone E, Peirone B, Adami C. Combination of magnesium sulphate and ropivacaine epidural analgesia for hip arthroplasty in dogs. Vet Anaesth Analg 2017; 44 (05) 1227-1235
• 13 Troncy E, Junot S, Keroack S. et al. Results of preemptive epidural administration of morphine with or without bupivacaine in dogs and cats undergoing surgery: 265 cases (1997-1999). J Am Vet Med Assoc 2002; 221 (05) 666-672
• 14 Palomba N, Vettorato E, De Gennaro C, Corletto F. Peripheral nerve block versus systemic analgesia in dogs undergoing tibial plateau levelling osteotomy: analgesic efficacy and pharmacoeconomics comparison. Vet Anaesth Analg 2020; 47 (01) 119-128
• 15 Romano M, Portela DA, Breghi G, Otero PE. Stress-related biomarkers in dogs administered regional anaesthesia or fentanyl for analgesia during stifle surgery. Vet Anaesth Analg 2016; 43 (01) 44-54
• 16 Bini G, Vettorato E, De Gennaro C, Corletto F. A retrospective comparison of two analgesic strategies after uncomplicated tibial plateau levelling osteotomy in dogs. Vet Anaesth Analg 2018; 45 (04) 557-565
• 17 Johnson RL, Kopp SL, Burkle CM. et al. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth 2016; 116 (02) 163-176
• 18 Adami C, Gendron K. What is the evidence? The issue of verifying correct needle position during epidural anaesthesia in dogs. Vet Anaesth Analg 2017; 44 (02) 212-218
• 19 Steffey EP, Howland Jr D. Isoflurane potency in the dog and cat. Am J Vet Res 1977; 38 (11) 1833-1836
• 20 Kazama T, Ikeda K. Comparison of MAC and the rate of rise of alveolar concentration of sevoflurane with halothane and isoflurane in the dog. Anesthesiology 1988; 68 (03) 435-437
• 21 Reid J, Nolan AM, Hughes JML, Lascellas D, Pawson P, Scott EM. Development of the short-form Glasgow Composite Measure Pain Scale (CMPS-SF) and derivation of an analgesic intervention score. Anim Welf 2007; 16: 97-104
• 22 Wakshlag JJ. The role of nutrition in canine performance and rehabilitation. In: Zink MC, van Dyke JB. eds. Canine Sports Medicine and Rehabilitation. Chichester, UK: Wiley & Sons; 2013: 60-81
• 23 Kona-Boun JJ, Cuvelliez S, Troncy E. Evaluation of epidural administration of morphine or morphine and bupivacaine for postoperative analgesia after premedication with an opioid analgesic and orthopedic surgery in dogs. J Am Vet Med Assoc 2006; 229 (07) 1103-1112
• 24 Garcia-Pereira FL, Sanders R, Shih AC, Sonea IM, Hauptman JG. Evaluation of electrical nerve stimulation for epidural catheter positioning in the dog. Vet Anaesth Analg 2013; 40 (05) 546-550
• 25 Iff I, Moens YP. Evaluation of extradural pressure waves and the ‘lack of resistance’ test to confirm extradural needle placement in dogs. Vet J 2010; 185 (03) 328-331
• 26 Naganobu K, Hagio M. The effect of body position on the ‘hanging drop’ method for identifying the extradural space in anaesthetized dogs. Vet Anaesth Analg 2007; 34 (01) 59-62
• 27 Galloway DS, Ko JCH, Reaugh HF. et al. Anesthetic indices of sevoflurane and isoflurane in unpremedicated dogs. J Am Vet Med Assoc 2004; 225 (05) 700-704
• 28 Pavlidou K, Savvas I, Moens YPS, Vasilakos D, Raptopoulos D. The effect of four anaesthetic protocols for maintenance of anaesthesia on trans-diaphragmatic pressure in dogs. PLoS One 2013; 8 (10) e75341
• 29 Iizuka T, Kamata M, Yanagawa M, Nishimura R. Incidence of intraoperative hypotension during isoflurane-fentanyl and propofol-fentanyl anaesthesia in dogs. Vet J 2013; 198 (01) 289-291
• 30 Hopper K, Powell LL. Basics of mechanical ventilation for dogs and cats. Vet Clin North Am Small Anim Pract 2013; 43 (04) 955-969
• 31 Redondo JI, Suesta P, Serra I. et al. Retrospective study of the prevalence of postanaesthetic hypothermia in dogs. Vet Rec 2012; 171 (15) 374
• 32 Bosmans T, Schauvliege S, Gasthuys F. et al. Cardiovascular effects of epidural administration of methadone, ropivacaine 0.75% and their combination in isoflurane anaesthetized dogs. Vet Anaesth Analg 2011; 38 (02) 146-157
• 33 Galatos AD, Raptopoulos D. Gastro-oesophageal reflux during anaesthesia in the dog: the effect of preoperative fasting and premedication. Vet Rec 1995; 137 (19) 479-483
• 34 Wilson DV, Evans AT, Miller R. Effects of preanesthetic administration of morphine on gastroesophageal reflux and regurgitation during anesthesia in dogs. Am J Vet Res 2005; 66 (03) 386-390
• 35 Lamata C, Loughton V, Jones M. et al. The risk of passive regurgitation during general anaesthesia in a population of referred dogs in the UK. Vet Anaesth Analg 2012; 39 (03) 266-274
• 36 Torrente C, Vigueras I, Manzanilla EG. et al. Prevalence of and risk factors for intraoperative gastroesophageal reflux and postanesthetic vomiting and diarrhea in dogs undergoing general anesthesia. J Vet Emerg Crit Care (San Antonio) 2017; 27 (04) 397-408
• 37 Campoy L, Martin-Flores M, Ludders JW, Erb HN, Gleed RD. Comparison of bupivacaine femoral and sciatic nerve block versus bupivacaine and morphine epidural for stifle surgery in dogs. Vet Anaesth Analg 2012; 39 (01) 91-98
• 38 Odette O, Smith LJ. A comparison of epidural analgesia provided by bupivacaine alone, bupivacaine + morphine, or bupivacaine + dexmedetomidine for pelvic orthopedic surgery in dogs. Vet Anaesth Analg 2013; 40 (05) 527-536
• 39 Cha Y-H, Lee Y-K, Won S-H, Park J-W, Ha Y-C, Koo K-H. Urinary retention after total joint arthroplasty of hip and knee: systematic review. J Orthop Surg (Hong Kong) 2020; 28 (01) 2309499020905134
• 40 Peterson NW, Buote NJ, Bergman P. Effect of epidural analgesia with opioids on the prevalence of urinary retention in dogs undergoing surgery for cranial cruciate ligament rupture. J Am Vet Med Assoc 2014; 244 (08) 940-943