The use of multimodal anaesthesia and analgesia is desirable as part of a complete analgesic plan. Analgesic strategies for perioperative pain treatment include combinations of drugs with different means of action to increase their efficacy and to reduce the required doses and adverse effects. Local anaesthetics prevent the transduction and transmission of painful stimuli through their action on neuronal cell membranes. They undergo minimal systemic absorption and are therefore ideal alternatives to drugs that could result in systemic toxicity. Numerous benefits have been recognised for the use of local anaesthesia, such as a decreased need for systemic analgesics and decreased hospitalisation periods. Local anaesthetics have been used in veterinary medicine in several ways. Anatomical landmarks can be used to identify the target nerves and the clinician can employ an electrical nerve stimulator or ultrasound guidance to perform a more accurate injection. Local anaesthetic techniques can implement other drugs, apart from or in combination with local anaesthetics, such as opioids, α₂−adrenergic agonists or vasoconstricting agents. This review article presents and discusses the most common techniques of local anaesthetic use in small animals, with the aim of providing the clinician with further and comprehensive information regarding the analgesic options during the perioperative period.

In animals, gastro-oesophageal reflux (GOR) may occur during anaesthesia, and it can lead to severe consequences such as oesophagitis and oesophageal stricture. This systematic review investigates the effect of fasting duration and anaesthetic and nonanaesthetic drugs on GOR in dogs and cats during general anaesthesia. Fifteen clinical studies met the inclusion criteria in this systematic review. In thirteen studies the population was dogs, while in two studies the population was cats. In the meta-analysis, seven studies were included. Four studies on the effect of fasting duration on GOR in dogs were included in the meta-analysis. In total, 191 dogs had a fasting duration less than 5 h, while 311 dogs had a fasting duration more than 5 h. The heterogeneity of the studies was high and statistically significant (p = 0.0002, I² = 85%), but the overall effect was statistically nonsignificant (p = 0.82, odds ratio = 0.81, 95% CI 0.15, 4.26), in favour of the low fasting duration (<5 h). Concerning the effect of antacids on GOR, three studies were included in the meta-analysis. The heterogeneity of the studies was low and nonsignificant (p = 0.13, I² = 52%) and the overall effect was statistically nonsignificant (p = 0.24). The low number of studies and the diverse factors affecting the incidence of reflux prevented us from reaching valuable conclusions on the risk factors for GOR.

The aim of this prospective, non-randomized study was to evaluate the effect of nine different premedication medications on the incidence of gastroesophageal reflux (GOR) in anesthetized dogs. Two hundred and seventy dogs undergoing non-intrathoracic, non-intrabdominal elective surgeries or invasive diagnostic procedures were included in the study, and were allocated into nine groups (30 dogs/group) defined by the type of premedication administered. Premedication consisted of dexmedetomidine with either morphine, pethidine or butorphanol, acepromazine with either one of the three opioids or midazolam with one of the above-mentioned opioids. Anesthesia was induced with propofol and maintained with isoflurane in oxygen. Esophageal pH was measured with the use of a pH-meter electrode and a pH-value less than 4 and over 7.5 was considered to be GOR. The study revealed that 119/270 (44.1%) dogs experienced a reflux episode during anesthesia. The incidence of reflux did not differ among groups (p = 0.117). In group AB the dogs refluxed within 10 min of the beginning of pH-measurements, in comparison with group DB in which dogs refluxed within 30 min (p = 0.029). Invasive diagnostic procedures had a lower incidence of GOR in comparison to castrations (p = 0.09). The outcome of the study suggests that none of the opioids used increased the incidence of GOR in anesthetized dogs.

This study aimed to compare incisional wound healing in cats and dogs after the topical application of Μanuka honey and a new medical device, Dermapliq. Comparisons were made between each treatment and control, between the two treatments, and between dogs and cats. Twelve cats and twelve dogs were included in this study, and the impact of the two substances was examined through cosmetic, clinical, ultrasonographical, and histological evaluation. The use of Dermapliq in first-intention wound healing achieved a significantly better cosmetic evaluation score and better total clinical score at days 20–41, compared to the control, in both dogs and cats. The ultrasonographically estimated wound area was smaller with Dermapliq compared to the control. Wounds treated with Dermapliq showed histologically less inflammation compared to the control. The use of Manuka honey did not show a significantly better cosmetic score compared to the control. Skin thickening was significantly higher after using Manuka honey compared to the control and so was the total clinical score. However, the median wound area, as was evaluated ultrasonographically, was significantly smaller when wounds were treated with Manuka honey, the difference being more apparent in dogs. Dermapliq was proven to be a better choice in achieving favorable wound healing than Manuka honey in dogs and cats in first-intention healing. In our study, cats had a statistically better cosmetic score and less skin thickening and scar width compared to dogs. Histologically, cats showed significantly less edema, higher inflammation and angiogenesis scores, and lower fibroblast and epidermis thickening scores when compared to dogs.

The administration of lidocaine as part of multimodal analgesia in dogs undergoing ovariohysterectomies demonstrates variable analgesic efficacy. The aim of this prospective, double–blinded clinical study was to evaluate the effectiveness of lidocaine 2% irrigation on the ovarian suspensory ligament, followed by localised massage, in achieving sufficient intraoperative analgesia. Thirty-eight female dogs were randomly divided to two groups and received either a splash block of 0.5 ml lidocaine 2% on each ovarian suspensory ligament (GL) or an equal volume of saline (GNS). All dogs were premedicated with dexmedetomidine (5 μg·kg⁻¹) and buprenorphine (20 μg·kg⁻¹) intramuscularly and meloxicam (0.2 mg·kg⁻¹) subcutaneously. Anaesthesia was induced with propofol and maintained with isoflurane. The surgical procedure was initiated after an adequate depth of anaesthesia was achieved. Heart rate (HR), respiratory rate (f_R) and mean arterial pressure (MAP) were continuously monitored. Fentanyl (2 μg·kg⁻¹) was administered as rescue analgesia in case of a 30% increase in HR, f_R, or MAP, compared to their values before manipulation of the ovaries. Data were analysed using a mixed model for repeated measures ANOVA and Pearson’s Chi-Square test. The need for rescue analgesia differed significantly between the two groups (p < 0.0005). In GNS, 89.47% (17/19) of the dogs required rescue analgesia, compared to 10.53% (2/19) of the dogs in GL. The relative risk of rescue for the GNS compared to the GL was approximately 8.5. In conclusion, intraoperative analgesia during ovariohysterectomies in dogs can be enhanced using a lidocaine 2% splash block combined with massage of the ovarian suspensory ligament.

The administered dose of dexmedetomidine may occasionally fail to produce the anticipated sedative effects. Therefore, a subsequent dose or administration of another sedative may enhance sedation; however, patient safety may be affected. The safety of seven different drugs administered at the following time point after an insufficient dose of dexmedetomidine was evaluated in a crossover, blind, experimental study that included six healthy adult cats. All cats received an initial dose of dexmedetomidine and a subsequent dose of either dexmedetomidine (Group DD), NS 0.9% (DC), tramadol (DT), butorphanol (DBT), buprenorphine (DBP), ketamine (DK), or midazolam (DM). Animal safety was assessed using repeated blood gas analysis and measurement of electrolytes, glucose, cardiac troponin I, and creatinine to evaluate cardiac, respiratory, and renal function. The median values of creatinine, cardiac troponin I, pH, partial pressure of carbon dioxide, potassium, and sodium did not change significantly throughout the study. Heart rate was significantly decreased in all groups after administration of the drug combinations, except for in the DK group. Respiratory rate decreased significantly after administration of the initial dose of dexmedetomidine and in the DBP and DM groups. The partial pressure of oxygen, although normal, decreased significantly after the administration of dexmedetomidine, whereas the median concentration of glucose increased significantly following the administration of dexmedetomidine. The results of our study suggest that the drug combinations used did not alter the blood parameters above normal limits, while cardiac and renal function were not compromised. Therefore, a safe level of sedation was achieved. However, the administration of dexmedetomidine reduced the partial pressure of oxygen; thus, oxygen supplementation during sedation may be advantageous. Additionally, the increase in glucose concentration indicates that dexmedetomidine should not be used in cats with hyperglycaemia, whereas the decrease in haematocrit suggests that dexmedetomidine is not recommended in anaemic cats.