Effects of perineural dexmedetomidine combined with ropivacaine on postoperative methadone requirements in dogs after tibial plateau levelling osteotomy: a two-centre study

Marolf, Vincent; Selz, Julie; Picavet, Pierre; Spadavecchia, Claudia; Tutunaru, Alexandru; Sandersen, Charlotte (2022). Effects of perineural dexmedetomidine combined with ropivacaine on postoperative methadone requirements in dogs after tibial plateau levelling osteotomy: a two-centre study. Veterinary anaesthesia and analgesia, 49(3), pp. 313-322. Elsevier 10.1016/j.vaa.2022.01.004

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Objective: To evaluate the efficacy of a perineural injection of dexmedetomidine combined with ropivacaine for reducing postoperative methadone requirements in dogs after tibial plateau levelling osteotomy (TPLO).

Study design: A prospective, clinical, randomized and blinded trial.

Animals: A total of 58 client-owned dogs.

Methods: Ultrasound-guided midfemoral sciatic and inguinal femoral nerve blocks with ropivacaine (1 mg kg-1 per nerve block) combined with either dexmedetomidine (0.5 μg kg-1 per nerve block; group DEX) or the same volume of saline (group CON) were performed in dogs undergoing TPLO. Pain was assessed 30 minutes, 2 hours and then every 4 hours for 24 hours after surgery with a validated pain scale (4AVet). Meloxicam (0.15 mg kg-1) was administered intravenously (IV) at recovery. Rescue methadone (0.2 mg kg-1 IV) was administered if a score ≥ 6 (maximal score 18) was recorded and the number of postoperative doses was analysed by Fisher exact tests. The study was performed in parallel at a Veterinary Teaching Hospital (VTH) and a private Veterinary Referral Centre (VRC).

Results: Dogs received a total of 22 and 31 postoperative doses of methadone in groups DEX (14 doses at VRC, eight doses at VTH) and CON (28 doses at VRC, three doses at VTH), respectively. Overall, there was no difference in the postoperative rescue analgesia requirements between groups (p = 0.244). At the VRC, dogs received less methadone (p = 0.026) in group DEX compared with group CON, whereas at the VTH, there was no difference between groups (p = 0.216).

Conclusions and clinical relevance: Perineural dexmedetomidine combined with ropivacaine did not reduce postoperative methadone requirements in dogs after TPLO, but results may differ from one centre to another. This discrepancy might be linked to variations in clinical practices and questions the validity of results obtained from single-centre randomized controlled trials but applied to different clinical settings.

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