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Background: The popularity of tortoises kept in captivity is increasing and has caused concern regarding the necessity to establish safe and straightforward anaesthesia for those reptiles. Aim: This study aimed to compare four protocols using levobupivacaine in spinal anaesthesia for the blockade of the caudal neuraxis of red-footed tortoises (Chelonoidis carbonarius). Methods: Twenty-four tortoises were randomly assigned into four groups: G1, levobupivacaine 0.75% (1.15 mg kg−1); G2, levobupivacaine 0.37% (1.15 mg kg−1); G3, levobupivacaine 0.75% (2.3 mg kg−1); and G4, levobupivacaine 0.75% (0.1 ml 5 cm−1 of straight carapace length). Tortoises were evaluated for respiratory rate, muscle relaxation, response to hindlimb or tail pinch, and cloacal reflex. Results: A 1.15 mg kg−1 dose of levobupivacaine 0.37% appears adequate for shorter procedures, whereas a 1.15 mg kg−1 dose of levobupivacaine 0.75% should be appropriate for longer procedures in red-footed tortoises. Conclusion: Our results are the first to show the effects of levobupivacaine on spinal anaesthesia in reptiles. Weight-based doses presented more intense and more homogeneous effects than carapace length-based doses in red-footed tortoises. Spinal anaesthesia of red-footed tortoises was safe and effective with any of the weight-based protocols. [ABSTRACT FROM AUTHOR]

Context: The circumcision is the most frequent procedure in paediatric surgery worldwide, performed for medical and ritual purposes. In developing countries, because of the difficult accessibility to healthcare, even a common procedure could be unsafe.Aims: The aim of the article is to compare the perioperative and anaesthesiological management of circumcision in children between two Italian and two sub-Saharan African hospitals.Materials and Methods: Medical records of paediatric circumcision from January 2014 to December 2016 have been reviewed. The involved hospitals were: Padua (Italy), Ferrara (Italy), Sao José em Bor (Guinea Bissau) and Yaoundé (Cameroun).Results: In Padua, 77 circumcisions were performed, 19 of these (24.6%) were ritual. In 75 children (97.4%), locoregional anaesthesia (LRA) together with sedation was used; only one complication (1.3%) occurred. In Ferrara, 200 interventions were done, 140 (70%) ritual; general anaesthesia was administered to 183 (93.5%) patients. There were five complications (2.5%). In Bissau, 53 procedures were performed, 21 (39.6%) ritual; in 34 children (64.1%), LRA with sedation was preferred. Two complications (3.8%) were reported. In Yaoundé, 60 children were circumcised, 15 (25%) for ritual purposes; in 51 (85%), only LRA was performed; there was only one (1.7%) complication. In the African hospital, no post-operative analgesia was administered.Conclusion: Despite the different anaesthesiological techniques, the study shows no difference in rate of complications for the in-hospital setting. Training of the local medical team in pain management and post-operative care should be emphasised. [ABSTRACT FROM AUTHOR]

To design and assess the perioperative analgesic efficacy of an ultrasound (US)-guided radial (R), ulnar (U), median (M) and musculocutaneous (Mc) nerve blocks, performed together in the axillary space by a single, in-plane approach. Anatomical research and prospective clinical study. A group of three dog cadavers and 15 client-owned dogs undergoing orthopaedic thoracic limb surgery. Phase 1: Anatomical dissection and US study of the axillary space were performed to design the US-guided proximal RUMM block. The technique was considered successful if a total volume of 0.15 mL kg–1 new methylene blue solution completely stained the four nerves in two cadavers for ≥2 cm. Phase 2: In 15 client-owned dogs undergoing orthopaedic thoracic limb surgery, the RUMM block designed in phase 1 was performed to provide analgesia using a total volume of 0.15 mL kg–1 of ropivacaine 0.5%. The block was considered effective if the intraoperative fentanyl requirement was <1.2 mcg kg–1 hour–1 and until the postoperative pain score was [short-form Glasgow Composite Measure Pain Scale (SF-GCMPS)] ≤5/20. Phase1: Detection of the four nerves was always feasible in a single US-window. The axillary artery and Mc nerve were used as landmarks. In-plane needling approach was feasible in both cadavers. All the nerves were completely stained for >2 cm. No intrathoracic dye spread was found. Phase 2: In 14/15 anaesthetized dogs, mean intraoperative fentanyl requirement was 0.25 ± 0.05 mcg kg–1 hour–1. Postoperatively, all dogs had SF-GCMPS ≤5/20 up to 8 hours. The US-guided proximal RUMM block performed at the axillary level with a single, in-plane needling approach using 0.15 mL kg–1 of ropivacaine 0.5% minimized fentanyl requirement during thoracic limb surgery, contributing to postoperative analgesia up to 8 hours after execution of the peripheral nerve block. [ABSTRACT FROM AUTHOR]

Video-assisted thoracoscopic surgery is a widespread technique that has been linked to improved postoperative respiratory function, reduced hospital length of stay and a higher level of tolerability for the patients. Acute postoperative pain is of considerable significance, and the late development of neuropathic pain syndrome is also an issue. As anaesthesiologists, we have investigated the available evidence to optimize postoperative pain management. An opioid-sparing multimodal approach is highly recommended. Loco-regional techniques such as the thoracic epidural and peripheral blocks can be performed. Several adjuvants have been employed with varying degrees of success both intravenously and in combination with local anesthetics. Opioids with different pharmacodynamic and pharmacokinetic profiles can be used, either through continuous infusion or on demand. Non-opioid analgesics are also beneficial. Finally, perioperative gabapentinoids may be implemented to prevent the onset of chronic neuropathic pain. [ABSTRACT FROM AUTHOR]

The authors present an annotated part of a surgical textbook from 1921. The first edition was published in 1917 during WWI. The first part of the textbook concerns anaesthesiology and the text is divided into 5 parts because of the extent (Introduction, Local Anaesthesia, Intravenous Regional Anaesthesia and Neuraxial Blockades, General Anaesthesia I and General Anaesthesia II). Each part has been annotated in order to provide historical context of the anaesthetic methods and their origin. The textbook follows the German and Vienna schools of medicine. [ABSTRACT FROM AUTHOR]

The authors present an annotated part of a surgical textbook from 1921. The first edition was published in 1917 during WWI. The first part of the textbook concerns anaesthesiology and the text is divided into 5 parts because of the extent (Introduction, Local and Regional Anaesthesia, Intravenous Regional Anaesthesia and Spinal Anaesthesia, General Anaesthesia I and General Anaesthesia II). Each part has been annotated in order to provide historical context of the anaesthetic methods and their origin. The textbook follows the German and Vienna schools of medicine. [ABSTRACT FROM AUTHOR]

Lameness is the most commonly reported health problem in horses, and lameness investigations which include local anaesthetic injections are routinely performed by equine practitioners. Through this process, bacteria can enter the tissues perforated by the needle and may cause local infections at the injection site. The objective of this in vitro study was to investigate if local anaesthetics at concentrations available in commercially available solutions could inhibit growth and/or kill bacteria that could be inoculated into the synovial space or soft tissues during injection. This study evaluated the antimicrobial activity of the local anaesthetics bupivacaine, lidocaine and mepivacaine against 40 equine clinical bacterial isolates of the Actinobacillus , Corynebacterium , Enterobacter , Escherichia , Pseudomonas , Rhodococcus , Staphylococcus and Streptococcus genera. Minimum inhibitory and minimum bactericidal concentrations (MICs and MBCs) were determined by the broth microdilution method. Clinically applied concentrations of bupivacaine, lidocaine, and mepivacaine inhibited visual growth of 93%, 93%, and 80% of isolates tested, respectively. For the majority (80%) of the inhibited isolates, the concentrations were also bactericidal. The tested local anaesthetics possessed antimicrobial activity against equine pathogens at concentrations that are routinely applied in clinical cases. However, this antimicrobial activity should not discourage antiseptic preparation prior to local anaesthetic injections. [ABSTRACT FROM AUTHOR]

The authors present an annotated part of a surgical textbook from 1921. The first edition was published in 1917 during WWI. The first part of the textbook concerns anaesthesiology and the text is divided into 5 parts because of the extent (Introduction, Local and Regional Anaesthesia, Intravenous Regional Anaesthesia and Spinal Anaesthesia, General Anaesthesia I and General Anaesthesia II). Each part has been annotated in order to provide historical context of the anaesthetic methods and their origin. The textbook follows the German and Vienna schools of medicine. [ABSTRACT FROM AUTHOR]

Opioids are a key component of multimodal analgesia. Methadone is licensed in Europe for IV, IM and SC use in dogs despite there being no published studies assessing the analgesic efficacy of SC administration. Our intention was to compare the analgesic effect of IV or SC methadone. Fifteen dogs presenting for stifle surgery were administered 0.4 mg/kg methadone IV followed by a randomised 0.0.4 mg/kg methadone IV or SC dose 3 h later. All dogs received ultrasound-guided sciatic and saphenous nerve blocks with bupivacaine prior to surgery. This protocol resulted in opioid adverse effects (hypersalivation, vomiting and/or regurgitation) in 5/15 dogs (33%). Thus, in consultation with the ethical review committee, an otherwise identical protocol using a revised 0.2 mg/kg methadone dose was implemented. In the next three dogs studied, similar opioid adverse effects were found in all three dogs and the study was terminated. This paper highlights the potential for post operative nausea and vomiting (PONV), which may have been induced by methadone when used in combination with efficacious locoregional anaesthesia. • Post operative nausea and vomiting (PONV) may be induced by opioids. • Loco-regional techniques reduce intra and post operative opioid requirement. • PONV may occur if methadone is given alongside effective loco-regional anaesthesia. • Methadone remains an excellent analgesic for dogs in pain [ABSTRACT FROM AUTHOR]

Major surgery is usually invasive and associated with significant tissue trauma; therefore, adequate analgesia using a combination of analgesic drugs and techniques is paramount. Opioids remain the backbone of peri-operative analgesic regimens for major surgery and also contribute significantly to a balanced anaesthesia technique. Ideally, full Mu agonist opioids should be used peri-operatively for major surgery because they provide superior analgesia to partial Mu agonists and butorphanol for management of moderate-to-severe pain. Where possible, consider the use of loco-regional anaesthesia and analgesia techniques in order to contribute to a reduction in required volatile agent concentration and thus provide balanced anaesthesia and contribute to a multi-modal analgesia approach. Analgesic adjuncts such as ketamine and lidocaine should be used in combination with opioids and are best administered by continuous-rate infusion using controlled infusion apparatus, such as a syringe driver. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the sciatic-femoral nerve block (SFNB) in goats and to evaluate the peri-operative analgesia when the goats underwent stifle arthrotomy. The animals were randomly assigned to one of four treatment groups: groups 0.25, 0.5 and 0.75 received 0.25%, 0.5% and 0.75% of bupivacaine, respectively, while group C (control group) received 0.9% NaCl. In all groups, the volume administered was 0.2 mL/kg, Intra-operatively, the proportion of animals receiving rescue propofol was significantly lower in groups 0.5 and 0.75, compared to group C. Post-operatively, the visual analogue scale (VAS) and total pain score were significantly higher in group C than in the other groups. Group 0.75 had the highest percentage of animals showing motor blockade. SFNB performed with bupivacaine resulted in better intra- and post-operative analgesia than SFNB performed with saline. Compared to the other concentrations, 0.5% bupivacaine resulted in satisfactory analgesia with acceptable side effects. [ABSTRACT FROM AUTHOR]

Objective To determine the influence on the distribution of the volume of a local anaesthetic-methylene blue solution at three different nerve block sites in the dog. Study design Randomized, controlled, blinded experimental trial. Animals 23 hound-cross dogs weighing 16–40 kg and aged 2 ± 0 years (mean ± SD). Methods Dogs were anaesthetized and randomly assigned to three groups of seven or eight dogs each, based on volume administered: low, medium and high volume (L, M and H). Using electrolocation, the injection was performed after a positive response was elicited (flexion of the elbow for the brachial plexus block, quadriceps contractions for the lumbar plexus and dorsiflexion/plantar extension of the foot for the sciatic nerve block). At the brachial plexus site, groups L, M and H received 0.075, 0.15 and 0.3 mL kg−1, respectively. At the lumbar plexus site, groups L, M and H received 0.1, 0.2 and 0.4 mL kg−1, respectively. At the proximal sciatic nerve site, groups L, M and H received 0.05, 0.1 and 0.25 mL kg−1, respectively. Necropsies were performed immediately following euthanasia. Staining of ≥2 cm along the nerve was considered sufficient; the proportions sufficient were compared with Fisher’s exact test. The volume was recommended when all the relevant nerves were stained sufficiently in all or all but one of the dogs within the group. Results In the brachial plexus, only in group H were all the nerves stained sufficiently. In the lumbar plexus site, no statistical difference was found, but we suggest the H group volume to balance sufficient and excessive staining. At the sciatic nerve site, all volumes tested produced sufficient staining in all (or all but one) dogs. Conclusions and clinical relevance Volumes of 0.3 and 0.05 mL kg−1 produced sufficient distribution for performing brachial plexus, and sciatic nerve blocks, respectively. Additionally, a volume of 0.4 mL kg−1 might also be adequate for a lumbar plexus block (no statistical significance was reached). [ABSTRACT FROM AUTHOR]

Simple Summary: Postoperative analgesia is very important because pain causes various negative effects that prevent patient recovery. Our study aimed to evaluate the analgesic efficacy of subarachnoid anaesthesia combined with intercostal nerve block compared with a constant-rate infusion of sufentanyl citrate in cats undergoing unilateral mastectomy. This study demonstrated that the use of spinal anaesthesia with anaesthetic block of intercostal nerves, using levobupivacaine, guarantees long-lasting and high-quality analgesic coverage and minimises the post-surgical pain inevitably associated with invasive surgical procedures such as radical mastectomy. This study stemmed from a general trend towards increasing attention on postoperative pain after spaying procedures in cats. Since veterinarians are becoming more focused on relieving surgical pain, anaesthetists are expected to use better protocols that can minimise pain and therefore optimise surgical results. This method, considering the relative simplicity of its execution, can be used in daily clinical practice. Unilateral mastectomy is a common surgical procedure in feline species and requires postoperative pain management. Our study aimed to evaluate the analgesic efficacy of subarachnoid anaesthesia combined with an intercostal nerve block, in comparison with the use of sufentanyl citrate administered as a constant-rate infusion (CRI). Twenty cats were randomly divided into two groups (n = 10/group) based on the analgesic protocol used: the first received loco-regional anaesthesia with levobupivacaine (LR group), and the second received a CRI of sufentanyl (SUF group). The evaluation criteria during surgery were the need for a bolus of fentanyl in the event of an increased heart rate or increased blood pressure. In the postoperative period, the levels of comfort/discomfort and pain were used to obtain a score according to the UNESP-Botucatu multimodal scale. Subjects who scored above seven received analgesic drug supplementation. Intraoperative analgesia was satisfactory, with good haemodynamic stability in both groups. Four patients in the LR group required an extra dose of methadone after they achieved the sternal decubitus position, whereas those in the SUF group required many more doses. The analgesia achieved in the LR group was more satisfactory than that in the SUF group. [ABSTRACT FROM AUTHOR]