Comparação de três métodos de bloqueio local com lidocaína em gatas submetidas à ovariectomia laparoscópica

Abstract

In cats, the recognition of pain is a marked challenge for the evaluators, and the same has been described as a cause of pain sub – treatment in this species. One of the most efficient ways to control pain during and after surgery is by infiltration of local anesthetic agents that block afferent nerve impulses. Lidocaine is the most versatile and widely used local anesthetic in veterinary medicine due to its short latency, duration of effect and moderate toxicity. The aim of this work was to compare three techniques of local blockade, as part of a multimodal protocol in cats submitted to elective laparoscopic ovariectomy. This prospective, controlled, randomized, blind study included 38 cats, assigned to four groups (GC, n = 10, GInc, n = 10, GIP, n = 9 and GCAVO, n = 9). They were evaluated subjectively and objectively using EVA, EUNESP and CMPS-F, prior to surgery, one, two, three and six hours after extubating, as well as the hemodynamic and trans-surgical hemogasometric parameters. A significant increase in HR during hemostasis of the first and second ovary was observed compared to the beginning and end of surgery (p = 0.000; p = 0.000) in all groups. MAP was significantly higher during hemostasis of the first (p = 0.05) and second ovary (p = 0.01), compared to the end of surgery in all groups. There was statistical difference between T0 and T1 by the VAS (p = 0.040); as well as in T1 and T2 compared to T0 through EUNESP (p = 0.025 and p = 0.027, respectively). Significantly higher values were observed two hours after extubating (T2) in contrast to the sixth hour (T6) both by EUNESP (p = 0.005) and CMPS-F scale (p = 0.017). In T3, the pain scores achieved by GIP were significantly higher than the GCAVO (p = 0.041). 15.8% of the cats received transoperative analgesic rescue due to the increase in HR, MAP and/or f, 66% belonged to GInc, 17% to GIP and 17% to GCAVO. In the postoperative period, 13.5% (5/38) received analgesic rescue. Of these, 60% belonged to GIP, 20% to GCAVO and 20% to GC. Intraperitoneal administration of lidocaine may be a useful technique to reduce trans-surgical pain, while the use of incisional infiltration with this medication improves early postoperative pain in laparoscopic catheterization.