Effect of Metoclopramide / Ranitidine (*) combination on the incidence of vomiting associated with epidural bupivacaine (**) / Morphine in dogs.


Otero P, Degenaro M, Fuensalida S, N. Verdier

Chair of Anesthesiology and Algiología. Faculty of Veterinary Sciences, UBA. Argentina. potero@fvet.uba.ar

 

 

Introduction

 

The use of strong opioids as part of the anesthetic protocol in dogs undergoing different surgical procedures is highly widespread in veterinary medicine (Pascoe 2000). Opioids bind specifically to subpopulations of opioid receptors and can be used as pre-anesthetics, analgesics and inductors. Morphine acts as an agonist OP3 and is mainly used for its analgesic properties (Valverde et al. 1989). However, morphine is highly associated with the occurrence of vomiting, with a reported incidence in unmedicated patients with antiemetics 62% (Guedes et al 2005). In addition, the persistent increase in muscle tone on the sphincters of the gastrointestinal tract motility inhibits causing constipation (Vaught et al.1985; Branson & Gross 2001).

Morphine has an average 4 hour period canine action when used systemically, necessitating a dose range of 4 to 6 hours depending on the case, to sustain the therapeutic effect (Otero et al. 2012). The epidural opioid administration has been referenced in numerous related trans analgesic intake and postoperative (Troncy et al. 2002, Naganobu et al. 2004, Leibetseder et al. 2006, Ambros et al 2009, studies Campoy et al. 2012 ). Among the advantages provided by this route of administration the dramatic reduction of the total dose (Valverde et al. 1989) and significantly increased duration of analgesic effect (Pascoe and Dyson 1993) are counted. While the incidence of vomiting associated with administration of lumbosacral epidural morphine is low (Troncy et al. 2002, Pekcan et al. 2010) previous work experience of our group we found a significant prevalence, when the drug is given by high epidural approach (L1-2).

The aim of this study was to evaluate the efficacy of metoclopramide / Ranitidine (*) combination to prevent vomiting during the recovery period in canine females undergoing abdominal surgery who received as part of a combination of anesthetic Bupivacaine protocol (**) / epidural morphine.

 

Materials and methods

This study was then performed to obtain the written consent of the owners of the seized animals. In no event maneuvers outside the protocol established by the institution where the study was conducted they were done.

Twenty female dogs (American Society of Anesthesiologists (ASA) physical status I or II) different weight 18.3 ± 11.2 kg (mean ± standard deviation) and mean age 4.2 (0.6 to 9) years [(Minimum -maximum)], scheduled to be submitted to an elective ovariectomy were included in the study. ASA> II, opposition owner, aggressive animal, pregnancy, neurological or muscle diseases, coagulation disorders, infection at the puncture site, history of kidney, liver or gastrointestinal diseases and any: As exclusion criteria included the following situations contraindication to the use of NSAIDs or local anesthetics.

The animals were distributed to roast (in sealed envelopes 1: 1) into two groups to receive a dose of the combination Metoclopramide / Ranitidine (gastrine Injection, Richmond, Vet Pharma Argentina) 0.05 mL / kg iv (Group G) or saline (Group S) in the same volume, before extubation.

All animals were channeled in the forearm cephalic vein from which an electrolytic solution based maintenance lactated Ringer was administered at 3 mL / kg / hr. About 10 minutes after administered at a dose mode inductor Propofol (Propovet, Richmond Vet Pharma, Argentina) at 2 mg / kg / min until a compatible anesthetic plane with orotracheal intubation. Anesthesia was maintained by administration of isoflurane (Forane, Abbott Laboratories, Argentina) oxygen from a semi-circle anesthetic circuit. During the proceedings were recorded by a multiparameter monitor (Goldway US Vet 420F, USA), the following parameters: heart rate (HR), respiratory rate (RR), systolic blood pressure, diastolic and mean (SBP, DBP, MAP) pulse oximetry (SpO2), core temperature, CO2 concentration at the end of exhalation (ETCO2) and concentration of isoflurane end tidal (ETISO). Once the balance achieved animals received an epidural anesthesia for thoracic approach based L1-2 0.25% bupivacaine (0.05 mL / cm / LOC) + morphine 0.1 mg / kg. Thirty minutes after neuraxial blockade implemented animals were relaxed by administration of vecuronium (Esmeron, Organon Argentina Saqi and C, 0.05 mg / kg iv). Then controlled ventilation scheme that aimed to keep ETCO2 45-50 mmHg and 0.9-1.3 vol% ETISO began. Surgical maneuvers were started immediately after the initiation of controlled ventilation. At the end of surgery the patients were treated with a dose of 0.2 mg / kg IV of meloxicam and gastrine Injection (Richmond Vet Pharma Argentina) or saline as appropriate.

The animals were kept for 24 hours evaluation. The occurrence of nausea and vomiting was recorded.

The results were analyzed using a nonparametric test for paired samples (Mann-Whitney U-test (M-W U-test). Differences were considered significant at p <0.05.

 

Results

No differences between groups were recorded in relation to the variables weight and age (17.3 ± 9.9 and 19.9 ± 13.2 kg and 3.7 [1-7] and 4.8 [06- 9] years for the S and G, respectively) groups.

No significant changes in the values ??monitored during the surgical proceeding in any of the treated groups were recorded. In 2 to 1 patients in group S and G, respectively, intraoperative analgesia had to be rescued with a bolus of 3 ug / kg iv fentanyl coinciding with the manipulation of any of the ovarian pedicles.

After discontinuation of isoflurane patients were extubated to 5.7 ± 3.8 and 4.5 ± 1.0 minutes, adopted and maintained sternal recumbency to 18.5 ± 3.8 and 19.7 ± 11.8 minutes and they wandered on a voluntary and coordinated 28.7 ± 10.4 and 28.8 ± 9.4 minutes in group S and group G, respectively.

The average duration of intraoperario period was 67.2 ± 25.7 and 58.0 ± 17.5 minutes for group S and G, respectively.

vomiting was recorded during the first 24 hours after surgery in 40% and 0% of the animals in group S and G, respectively. Gastrine administration Injection (Richmond Vet Pharma Argentina) significantly reduced the occurrence of vomiting.

 

 

Conclusion

I.v. Metoclopramide / Ranitidine significantly reduced the occurrence of vomiting in dogs treated ovariectomized Bupivacaine and thoracic epidural morphine.

 

 

References:

 

Bupivacaine - Richmond BUPINEX VET Vet Pharma Argentina

Propofol - Richmond Vet Pharma PROPOVET Argentina

Metoclopramide & Ranitidine - gastrine Injection Richmond Vet Pharma Argentina

 

 

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Pekcan, Z., & Koc, B. (2010). The post-operative analgesic effects of epidurally administered morphine and transdermal fentanyl patch after ovariohysterectomy in dogs. Veterinary anesthesia and analgesia, epidural morphine and fentanyl patch in dogs, 37 (6), 557-565.