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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]

A 13.9 kg, 4‐year‐old, male cocker spaniel dog was scheduled for cystotomy. Premedication consisted of intravenous medetomidine (5 µg/kg), induction with propofol (1 mg/kg, intravenous) and anaesthesia maintenance with isoflurane in O2 100%. A medetomidine constant‐rate infusion (1 µg/kg/h) was administered throughout. A bilateral quadratus lumborum block with 3 ml of 0.5% bupivacaine (each side) was performed, and intermittent positive‐pressure ventilation was initiated. At the end of the surgery, medetomidine constant‐rate infusion and intermittent positive‐pressure ventilation ceased. The patient remained in apnoea and developed severe hypercapnia (end‐tidal carbon dioxide: 12 kPa). Thirty minutes after isoflurane discontinuation, respiratory muscles movement started. Three days before, the dog underwent a mini‐hemilaminectomy (similar anaesthetic protocol) without complications. Epidural/spinal migration from the right quadratus lumborum block was suspected, although the definitive cause of transient respiratory arrest after bilateral quadratus lumborum block could not be ascertained. We advise caution when performing quadratus lumborum if previous neighbouring spinal surgery was performed. [ABSTRACT FROM AUTHOR]

Purpose: Hip fractures are a common health problem among the elderly with an increasing incidence. They are associated with high mortality and morbidity. Optimal pain management remains challenging and inadequate pain control is known for negatively affecting outcomes. Loco-regional anaesthetics (LRA) have been proven to benefit pain management and to lower the risks of opioid use and -related side effects. We aimed to evaluate the use and efficacy of different LRA in elderly hip fracture patients. Methods: Single-center cohort study of elderly hip fracture patients, who were treated in central Switzerland. We compared patients who received LRA in the form of a femoral nerve block (FNB) or a continuous femoral nerve catheter (CFNC) with patients who did not receive LRA. Primary outcomes were pain—as measured in perioperative morphine use—hospital length of stay (HLOS), postoperative complications, postoperative falls and mortality. Results: 407 patients were included for analysis. Mean age was 85.2 (SD6.3). There was a significant difference in intraoperative morphine use between the groups (p = 0.007). Postoperative morphine use differed significantly and was lowest in patients with FNB and highest in patients without LRA (p < 0.001). The use of LRA was a significant predictor for postoperative morphine use for postoperative morphine use at the recovery room and for postoperative morphine use 48 h after surgery. No significant differences were found in postoperative complications, a significant difference was found in 1-year mortality. Conclusions: This article shows that LRA in the form of FNB and CFNC causes a significant decrease in postoperative opioid consumption. Differences between single-shot FNB or CFNC were minimal. There were no significant differences in clinical outcomes such as HLOS, delirium, 30-day and 90-day mortality and postoperative falls. We suggest that use of LRA should be incorporated in the perioperative treatment of elderly patients with a hip fracture. For future research, we recommend evaluating the number of postoperative complications and mortality. [ABSTRACT FROM AUTHOR]

Background: Loco-regional anaesthetic techniques are considered important in the multimodal approach to analgesia in both human and veterinary medicine. No such techniques are described in the alpaca, bar the use of epidural. This is in part due to the lack of anatomical description for this species. Whilst this limitation exists, the use of ultrasound guidance makes peripheral nerve blocks a viable possibility in the alpaca. Case description: A 12-month-old alpaca was referred for the treatment a septic left tarso-crural joint. Due to a poor prognosis, amputation of the limb under general anaesthesia was performed. A sciatic and psoas compartment block was attempted with the ultrasound-guided injection of ropivacaine prior of the start of the procedure. While the femoral nerve was possible to visualise, no obturator nerve was identified. A 5-year old alpaca was also referred for a left hind lateral claw removal, due to a squamous cell carcinoma. The sciatic nerve block was performed prior to the claw amputation under general anaesthesia. No changes in heart and respiratory rate, or blood pressure suggestive of nociception were observed in either of these cases. At the end of both the procedures, the patients experienced uneventful recoveries characterised by the ability to maintain the standing position, interest in food and normal behaviour. Conclusion: This report identifies the ease of performance and the challenges encountered using the ultrasound-guided psoas compartment and sciatic nerve blocks in the alpaca. It is our hope that this report encourages the use of ultrasound-guided loco-regional techniques in this species.

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., Competing Interests: The authors declare that there is no conflict of interest.

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, hospitals rapidly ran out of intensive care beds. Because minimally invasive surgery and general anaesthesia are both aerosol-generating procedures, their use has become controversial. We report a case series of awake undelayable colorectal surgeries which, innovatively, took advantage of intraoperative pain distraction. Moreover, we describe our frugal solution to social distancing in psychological support of inpatients.Methods: Between October 2020 and February 2021, five patients underwent acute-care colorectal surgery under locoregional anaesthesia in our department. A 3D mobile theatre (3DMT) was used during the operation to distract the patients from pain. Vital signs, pain intensity, ergonomic comfort/discomfort, sense of presence and distress were intraoperatively monitored. A postoperative “cuddle delivery” service was instituted: video messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional effects were investigated through clinical interviews conducted by a psychologist at our hospital.Results: Both intraoperative and postoperative pain were always well controlled. Conversion to general anaesthesia and postoperative intensive support/monitoring were never necessary. The “cuddle delivery” initiative helped patients fill the emotional gap created by the strict containment measures implemented inside the hospital, distracting them from emotional anxiety and physical pain.Conclusions: During the next phase of the COVID-19 pandemic and even after the COVID-19 era, awake laparotomy under locoregional anaesthesia may be a crucial option for delivering acute-care surgery to selected patients when intensive care beds are unavailable and postponing surgery is unacceptable. We also introduce a new modality for the provision of emotional support during postoperative inpatient care as a countermeasure to the restrictions imposed by social distancing measures.

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.

OBJECTIVE: Since minimally invasive surgery and general anesthesia are both aerosol-generating procedures, their use became controversial during the outbreak of coronavirus disease 2019 (COVID-19). Moreover, social distancing resulted in serious psychological consequences for inpatients. This case report investigates pain distraction during awake laparotomy, as well as new possibilities for emotional postoperative support to inpatients. PATIENTS AND METHODS: A 72-year-old man affected by middle rectal adenocarcinoma underwent lower anterior resection plus total mesorectal excision under combined spinal-epidural anesthesia. A 3D mobile theatre (3DMT) was intraoperatively used for pain distraction. A postoperative "Cuddle delivery" service was instituted: video-messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional correlations were investigated through a clinical interview by the psychologist of our Hospital. RESULTS: Intraoperative, as well as postoperative pain, resulted well-controlled: visual analogue scale (VAS) ≤3. Conversion to general anesthesia and postoperative intensive support/monitoring were unnecessary. The "Cuddle delivery" initiative positively fed our patient's mood and attitude, strengthening his bond to life. CONCLUSIONS: During pandemic, awake laparotomy under loco-regional anesthesia may be a crucial option in delivering acute care surgery to selected patients when intensive care beds are unavailable. Our procedure introduces potential ways to optimize this approach. [ABSTRACT FROM AUTHOR]

The infraorbital complex belongs to the maxillary bone and it is an important landmark in dentistry, especially for loco-regional anaesthesia. For this study, bilateral measurements of the components of the infraorbital complex on twenty dry dentated human skulls were performed. Results: the average length of the the infraorbital groove (IOG) was 12.55 mm and the average length of the infraorbital canal (IOC) was 12.92 mm. Regarding the infraorbital foramen (IOF), its shape was oval in 65% of the cases and the average distance between the infraorbital foramen and the inferior orbital margin (IOF-IOM distance) was 7.87 mm. IOF was located on the vertical line drawn between premolars in 50% of the cases and on the vertical line drawn through the axis of the maxillary second premolar in 45% of the cases. The morphometric data obtained can be useful in dentoalveolar surgery.

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]

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.

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]

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Copyright of EMC-Dermatologie--Cosmetologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, hospitals rapidly ran out of intensive care beds. Because minimally invasive surgery and general anaesthesia are both aerosol-generating procedures, their use has become controversial. We report a case series of awake undelayable colorectal surgeries which, innovatively, took advantage of intraoperative pain distraction. Moreover, we describe our frugal solution to social distancing in psychological support of inpatients. Methods: Between October 2020 and February 2021, five patients underwent acute-care colorectal surgery under locoregional anaesthesia in our department. A 3D mobile theatre (3DMT) was used during the operation to distract the patients from pain. Vital signs, pain intensity, ergonomic comfort/discomfort, sense of presence and distress were intraoperatively monitored. A postoperative "cuddle delivery" service was instituted: video messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional effects were investigated through clinical interviews conducted by a psychologist at our hospital. Results: Both intraoperative and postoperative pain were always well controlled. Conversion to general anaesthesia and postoperative intensive support/monitoring were never necessary. The "cuddle delivery" initiative helped patients fill the emotional gap created by the strict containment measures implemented inside the hospital, distracting them from emotional anxiety and physical pain. Conclusions: During the next phase of the COVID-19 pandemic and even after the COVID-19 era, awake laparotomy under locoregional anaesthesia may be a crucial option for delivering acute-care surgery to selected patients when intensive care beds are unavailable and postponing surgery is unacceptable. We also introduce a new modality for the provision of emotional support during postoperative inpatient care as a countermeasure to the restrictions imposed by social distancing measures., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Romanzi, Gallo, De Rango, Vignati and Vannelli.)

Background: The aim of this study was to investigate whether patients undergoing elective endovascular aneurysm repair (EVAR) with loco-regional anaesthetic techniques have better outcomes than those treated with general anaesthesia (GA)., Patients and Methods: We retrospectively evaluated outcomes of EVAR performed with regional anaesthesia (RA) or GA over a five-year period. Furthermore, we searched electronic bibliographic sources (MEDLINE, EMBASE, CINAHL, and CENTRAL) to identify studies comparing different anaesthetic methods in EVAR. We defined perioperative mortality and morbidity as well as length of hospital stay (LOS) as the primary outcome measures. Pooled effect estimates were calculated using fixed-effect or random-effects models. Results are reported as the odds ratio (OR) or mean difference (MD) and 95 % confidence interval (CI)., Results: Three hundred and fifty-five patients underwent standard EVAR over the study period (RA, 215 patients; GA 140 patients). Patients in both groups had comparable baseline demographics and clinical characteristics. Perioperative mortality was significantly lower in the RA group (0.5 % vs. 4.3 %, P = 0.017). No difference was found in perioperative morbidity (P = 0.370), LOS (P = 0.146), postoperative destination (P = 0.799), reoperation (P = 0.355) or readmission within 30 days (P = 0.846). Meta-analysis of data on 15,472 patients from 15 observational studies found a significantly lower perioperative mortality (OR 0.70, 95 % CI 0.52-0.95, P = 0.02) and morbidity (OR 0.73, 95 % CI 0.55-0.96, P = 0.02) in patients treated with loco-regional anaesthetic techniques compared to those treated with GA. Our sub-group analysis demonstrated that both local anaesthesia (LA) (P = 0.003) and RA (P < 0.0001) were associated with a significantly shorter LOS compared to GA., Conclusions: Local and/or regional anaesthetic techniques may be advantageous over GA in elective EVAR, as indicated by reduced perioperative mortality and morbidity and a shorter hospital stay. Considering the current level of evidence, LA or RA should be considered in selected patients. Further clinical research is required to provide high level evidence on the optimal anaesthetic technique in EVAR.

Objective: The objective of this study was to compare three analgesic protocols for feline castration., Study Design: Prospective, randomized clinical study., Animals: Forty-nine client-owned cats., Methods: Cats were injected with intramuscular (IM) dexmedetomidine (15 μg kg -1 ) and alfaxalone (3 mg kg -1 ) and assigned randomly to one of three treatment groups. Group ITL (n = 15) were administered intratesticular 2% lidocaine (0.05 mL each testicle), group SCL (n = 15) a sacrococcygeal epidural injection of 2% lidocaine (0.1 mL kg -1 ) and group IVM (n = 19) intravenous (IV) methadone (0.3 mg kg -1 ), before surgery. Cardiorespiratory variables were recorded. In case of autonomic nociceptive response, IV fentanyl (2 μg kg -1 ) was administered. During recovery, time from IM atipamezole (75 μg kg -1 , administered at the end of surgery) to sternal recumbency and to active interaction was recorded. Quality of recovery was assessed using a simple descriptive scale. Postoperative analgesia was evaluated using a visual analogue scale and the UNESP-Botucatu multidimensional composite pain scale (MCPS) at return of active interaction and then 1, 2 and 3 hours later., Results: The three analgesic protocols were comparable in terms of intraoperative fentanyl and propofol requirement. Cardiorespiratory variables stayed within normal ranges in the majority of the cases, although group IVM had the lowest intraoperative respiratory rate (p = 0.0009). No differences were detected between groups in UNESP-Botucatu MCPS scores (p = 0.21). However, group ITL showed higher visual analogue scale score than group IVM (p = 0.001). Four cats enrolled in group ITL, as well as three of group SCL and one of group IVM, required rescue analgesics before the completion of pain assessment., Conclusions and Clinical Relevance: Intratesticular and sacrococcygeal epidural lidocaine injections could be regarded as good alternatives to systemic opioids in cats undergoing castration, although the benefits of these techniques seem to be of shorter duration than IV methadone., (Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. All rights reserved.)