Veterinary Anaesthesia and Analgesia, 2016, 43, 571578 doi:10.1111/vaa.

12348

RESEARCH PAPER

Intraperitoneal bupivacaine with or without incisional

bupivacaine for postoperative analgesia in dogs
undergoing ovariohysterectomy

Karin S Kalchofner Guerrero*, Ivo Campagna, Rodolfo Bruhl-Day*, Cecilia Hegamin-Younger &
Tomas G Guerrero*
*Small Animal Medicine & Surgery Department, School of Veterinary Medicine, St Georges University, St.Georges, Grenada
Equine Department, Section Anaesthesiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
Department of Public Health and Preventive Medicine, School of Medicine, St. Georges University, St.Georges, Grenada

Correspondence: Karin S Kalchofner Guerrero, Small Animal Medicine & Surgery Department, School of Veterinary Medicine, St Georges
University, True Blue, Grenada, West Indies. E-mail: kguerrero@sgu.edu

Postoperative analgesia was assessed with a

Abstract
Objective Intraperitoneal (IP) bupivacaine pro-
vides postoperative analgesia in dogs undergoing
ovariohysterectomy (OHE) alone or in combina-
tion with incisional (INC) bupivacaine. This study
investigated whether the combination of INC and
IP bupivacaine is superior to IP bupivacaine
alone.
dynamic interactive visual analogue scale, the short
form of the Glasgow Composite Pain Scale, and
mechanical nociceptive threshold (MNT) measure-
ment at 0.5, 1, 2, 4, 6, 8, 12 and 20 hours after
surgery by one blinded observer. Parametric data
were tested using t-test; nonparametric data were
analysed using the two-sample Wilcoxon test
(p < 0.05).

Study design Prospective, randomized, blinded clin-
ical study.
Animals Thirty-nine privately owned dogs under-
going OHE, aged 25  23 months and weighing
11.8  5.7 kg.
Methods Dogs were premedicated with acepro-
mazine (0.05 mg kg 1) and morphine
(0.5 mg kg 1) intramuscularly (IM); anaesthesia
was induced with propofol and maintained with
isoflurane in oxygen. Carprofen (4 mg kg 1) was
administered subcutaneously (SC) after intubation.
Bupivacaine (3 mg kg 1) IP was administered
before complete closure of the linea alba to all dogs.
Dogs were randomly assigned into two groups:
group B received bupivacaine (n = 20; 1 mg kg 1)
and group S received saline (n = 19; 0.2 mL kg 1)
INC as a subcutaneous splash before skin closure.
Results There was no significant difference between
groups with regard to age, weight, surgical and
anaesthetic duration, incision length, sedation and
pain scores. MNT values decreased in both groups at
all time points as compared with the baseline. No
dog required rescue analgesia. No postoperative
complications were observed.
Conclusion and clinical relevance Bupivacaine IP
and carprofen SC after morphine IM did provide
satisfactory postoperative analgesia in dogs
undergoing OHE with the anaesthetic protocol
used. There appears to be no clinical advantage
to adding bupivacaine INC. Neither protocol
could prevent the development of primary
hyperalgesia.
Keywords canine, hyperalgesia, local anaesthesia,
ovariohysterectomy, pain.

571
Local anaesthesia for canine ovariohysterectomy KS Kalchofner Guerrero et al.
Introduction
Canine ovariohysterectomy (OHE) is a very common
surgical procedure in veterinary practice. This pro-
cedure is performed under general anaesthesia and
is considered to give rise to mild to moderate
abdominal pain. The pain from OHE originates from
the surgical incision, from manipulation of the
abdominal viscera, and from stretching of associated
ligaments (Gaynor & Muir 2014).
Local anaesthetic techniques are part of the
multimodal approach to postoperative pain man-
agement (Slingsby 2008; Gurney 2012). The use of
wound infiltration with local anaesthesia for post-
operative pain relief may be an attractive method
because of its simplicity and low cost (Moiniche et al.
1998). Intraperitoneal (IP) and incisional (INC)
administration of local anaesthetics have been
shown to reduce postoperative pain and opioid
consumption in women undergoing (ovario)hys-
terectomy (Hannibal et al. 1996; Zohar et al. 2001;
Ng et al. 2002). However, the conclusions of many
clinical trials in humans have been controversial (Ng
& Smith 2002).
There are only a few reports assessing the use of IP
and/or INC infiltration of local anaesthetics for
postoperative pain relief after OHE in dogs (Carpen-
ter et al. 2004; Fitzpatrick et al. 2010; Campagnol
et al. 2012; McKune et al. 2014). The pre- and post-
INC administration of bupivacaine  lidocaine did
not show analgesic benefits in two studies (Fitz-
patrick et al. 2010; McKune et al. 2014). The
combination of IP and INC bupivacaine was shown
to provide effective analgesia in one study (Carpenter
et al. 2004), but the impact of each technique was
not clear. One study comparing IP and INC bupiva-
caine revealed lower pain scores with IP bupivacaine
during the first hour after surgery and a trend
towards a decreased need for rescue analgesia
(Campagnol et al. 2012).
Considering the fact that the administration of
INC bupivacaine addresses incisional pain, whereas
the use of IP bupivacaine aims to treat the pain
caused by manipulation of the viscera, we hypoth-
esized that the combination of both techniques
would improve postoperative analgesia compared
with the use of IP bupivacaine alone. To test our
hypothesis, we conducted a study comparing post-
operative analgesia in two groups of dogs undergo-
ing OHE. One group received both INC and IP
bupivacaine and the second group received INC
saline and IP bupivacaine.
572 2016 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 43, 571578
Materials and methods
This blinded, randomized study was approved by the
Animal Care and Use Committee of St Georges
University (IACUC-12016-R). Written, informed
consent was obtained from the owner of each
animal.
Animals
In all, 39 female client-owned dogs presenting for
routine OHE were included in the study. Based on
physical examination and haematological and bio-
chemical profile, all dogs were considered clinically
healthy. The age, weight and breed of the dogs were
recorded. Animals that were found to be aggressive
on handling were excluded, as were pregnant or
lactating dogs. Dogs were also excluded if they were
having other procedures performed in addition to
OHE, such as repair of an umbilical hernia. Dogs
were randomly assigned to one of two groups,
bupivacaine (B) or saline (S), using a computer
program (R 3.0.1; GNU Software Foundation,
Switzerland) before the start of the study.
Anaesthesia and surgery
Dogs arrived at the surgical facilities on the morning
of the day before surgery for preoperative evaluation.
In the afternoon, baseline measurements were
collected for heart rate (HR), respiratory rate (fR),
rectal temperature (T), and mechanical nociceptive
threshold (MNT) in close proximity to the planned
incision line. Food was withheld overnight; access to
water was given until administration of the
premedication.
Premedication consisted of acepromazine
0.05 mg kg 1 (Acepromazine maleate injection;
Vedco Inc, MO, USA) and morphine 0.5 mg kg 1
(Martindale Pharma, UK) intramuscularly (IM).
Twenty minutes later, an intravenous (IV) catheter
was placed in a cephalic vein following aseptic
preparation, and anaesthesia was induced with
propofol IV (PropoFlo; Abbott Laboratories, IL,
USA) until conditions were adequate for orotracheal
intubation. Anaesthesia was maintained with isoflu-
rane (IsoFlo; Abbott Laboratories) in 100% oxygen.
Carprofen 4 mg kg 1 (Rimadyl, Pfizer Inc, NY, USA)
was administered subcutaneously (SC) after intuba-
tion. Lactated Ringers solution (LRS) (Veterinary
Lactated Ringers Injection; Abbott Animal Health,
IL, USA) was started at a constant rate of
 Local anaesthesia for canine ovariohysterectomy KS Kalchofner Guerrero et al.
10 mL kg 1 hour 1. Intraoperative monitoring
included an electrocardiogram, noninvasive (oscil-
lometric and Doppler) blood pressure measurement,
oesophageal temperature, and haemoglobin satura-
tion with oxygen (SpO2) (UT6000A; Goldway, NY,
USA). Respiratory rate was assessed via oesophageal
stethoscope. The isoflurane vaporizer dial was
adjusted to deliver adequate concentration for
surgery based on clinical signs, including absence
of palpebral reflex, absence of jaw tone and mean
arterial pressure (MAP) between 60 and 90 mmHg.
Body temperature was maintained using forced-air
warming system (Bair Hugger 505; Augustine
Medical, MN, USA). Hypotension, defined as
MAP < 60 mmHg, was treated by lowering the
isoflurane percentage, if indicated, and administer-
ing one 10 mL kg 1 bolus of LRS. When hypoten-
sion persisted for >10 minutes, dogs received
hydroxethyl starch (510 mL kg 1; Vetstarch,
Abbott Animal Health).
Ovariohysterectomy via midline coeliotomy was
performed by third-year veterinary students under
close supervision of an experienced clinical faculty or
board-certified surgeon. Anaesthesia was performed
by third-year veterinary students under close super-
vision of a board-certified anaesthesiologist.
Prior to complete closure of the linea alba,
bupivacaine 3 mg kg 1 (Carbostesin 0.5%; Astra-
Zeneca AG, Switzerland) was administered IP at the
cranial portion of the incision using a 20 gauge IV
catheter to all dogs; the surgeon gently lifted the
cranial edge of the incision with a spay hook during
IP instillation. Prior to skin closure, dogs in group B
received bupivacaine (n = 20; 1 mg kg 1) and dogs
in group S received saline (n = 19; 0.2 mL kg 1) as
a SC splash (INC). The entire volume was dripped
slowly over 1 minute on the SC tissue; no attempt
was made to prevent it from running off during
closure of the skin. Administration of IP and INC
drugs was performed by one single anaesthesiologist
(K.K.). General anaesthesia was discontinued when
suturing of the skin was complete. Dogs were placed
in the sternal position and transported to the kennel
after extubation.
Surgery and anaesthesia duration were recorded,
as well as any complications that occurred during
the perioperative period.
Postoperative measurements
The length of the surgical incision was measured at
the end of anaesthesia, as well as the length between
2016 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 43, 571578
the os pubis and the xyphoid, and the ratio was
calculated.
Postoperative measurements and assessments
were performed 0.5, 1, 2, 4, 6, 8, 12 and
20 hours after extubation by one observer (I.C.)
who was unaware of the treatment given. Vital
parameters (HR, fR, body temperature, capillary
refill time and colour of mucous membranes) were
assessed at the same time points. Sedation was
assessed using a scale from 0 to 3 points as
follows; 0, dog is completely awake, can walk; 1,
dog is slightly sedated, can lift head; 2, dog is
heavily sedated, reacts upon vocal interaction; 3,
dog sleeps, does not react upon vocal stimulation.
Pain scoring was performed using three different
methods: 1) a dynamic interactive visual analogue
scale (DIVAS; Lascelles et al. 1998) of 100 mm
was used with the ends anchored at 0 (no pain
after OHE) and 100 (worst possible pain after
OHE); 2) the short form of the Glasgow Composite
Pain Scale (GCPS; Reid et al. 2007), with a
possible maximum of 24 points, or 20 if mobility
is impossible to assess (additionally, the ratio of the
actual score versus the maximum possible score
was calculated); and 3) an MNT measurement
using a force algometer (probe tip, 4 mm; Prod;
Topcat Metrology Ltd, UK). To measure MNT,
steadily increasing pressure was applied in close
proximity (10 mm) around the incision line until
the animal showed a response. Any sudden move-
ment of the dog away from the device, turning of
the head towards the device, vocalization, a sudden
tense abdomen or attempts to bite were considered
a response. Pressure was then instantly released
and the applied force [in newtons (N)] was read
from the display. Three measurements were taken
at three different sides along the wound at each
time point, one next to the middle of the wound
and two at the edges of the wound (force range,
0.525 N, accuracy, 0.5 N, according to the
manufacturer). The highest preoperative measure-
ment (baseline) was taken as the individual limit
not to be exceeded when performing the postoper-
ative measurements. The average of the three
measurements was recorded as the MNT value for
statistical analysis. The interactions with the dogs
were standardized and measurements were always
performed in exactly the same sequence, with
increasing order of invasiveness. Rescue morphine
0.3 mg kg 1 IM was administered if > 6/24 or 5/
20 points were reached in the GCPS or > 30 mm
in the DIVAS.
573
Local anaesthesia for canine ovariohysterectomy KS Kalchofner Guerrero et al.

Data analysis Postoperative assessments

Initial power calculations were performed before
starting the study. An alpha error was set at 5%.
Standard deviation (SD) was set at 1.8 GCPS units
(Morton et al. 2005). A beta error level was set at
20%. According to these calculations, 19 dogs were
needed in each group, considering a difference of 2.6
on the GCPS as significant (Morton et al. 2005).
Data were analysed using the statistical software
SPSS v21 (IBM Corporation, NY, US). Data were
assessed with the ShapiroWilk normality test. For
analysis of parametric data, two-tailed t-tests were
used; nonparametric data were analysed using the
two-sample Wilcoxon test. Results of normally
distributed data are presented as means  SD.
Nonparametric results (sedation, GCPS, DIVAS) are
presented as median [interquartile range (IQR)].
Significance was identified at p < 0.05.
Results
Demographical data
A total of 36 dogs completed the study (B, n = 18; S,
n = 18). Three dogs were excluded: one dog needed
additional sedation after premedication to allow IV
catheter placement; one dog had already been
spayed; and in one dog deciduous canine teeth were
removed during the same anaesthesia. Mixed-breed
dogs (n = 35) and one German Shepherd dog were
included. Groups did not differ with regard to age,
body weight, duration of surgery and anaesthesia,
ratio of the length of incision to the length from the
os pubis to the xyphoid, and time to extubation
(Table 1).
No difference in sedation could be detected postop-
eratively [0.5 hours after extubation: B, 1 (11); S, 1
(02) (p = 0.44); 1 hour after extubation: B, 1 (0
1); S, 0.5 (02) (p = 0.4); 2 hours after extubation:
B, 0 (01); S, 0 (01) (p = 0.73)]. Sedation was
scored as 0 for all dogs from time point 4 hours until
the end of the study (p = 1).
No significant difference between groups could be
found with any of the pain scores used at any time
point (Figs 13). Similarly, the ratio of GCPS to the
maximum possible score did not differ. Values for
MNT decreased significantly in both groups at all
time points when compared with the baseline
(p 0.002), with no difference between groups.
Heart rate was higher at baseline in group B; there
was no other difference with respect to HR or fR at
any of the time points measured postoperatively. HR
and fR decreased significantly in both groups when
compared with baseline at every time point, with the
exception of 0.5 and 20 hours after extubation
(Table 2). No dog required rescue analgesia. No peri-
or postoperative complications were observed. Dogs
were discharged from the hospital on the day after
surgery and the owners reported no problems when
contacted 7 days after surgery.
Discussion
The combination of INC and IP bupivacaine did not
show any additional analgesic benefits in the post-
operative phase in dogs undergoing OHE as com-
pared with IP bupivacaine alone.
In the scope of multimodal pain treatment, all
dogs received morphine and carprofen before

Table 1 Demographic data, duration of anaesthesia and surgery, ratio of length of incision (IL) to length from os pubis to
xyphoid, and time to extubation for 36 dogs undergoing ovariohysterectomy treated with intraperitoneal bupivacaine plus
either incisional bupivacaine (group B) or saline (group S). Results are expressed as means  SD (range)

Group

Variable Group B Group S p-Value

Age (months) 23  15 (660) 27  28 (5120) 0.27

Weight (kg) 11.5  6.5 (3.722.8) 12.1  5 (5.121.7) 0.38
Duration of anaesthesia (minutes) 190  24 (130235) 196  26 (150240) 0.26
Duration of surgery (minutes) 141  25 (87190) 145  22 (115190) 0.28
Ratio of IL:length from os pubis to xyphoid (mm) 0.47  0.15 (0.30.81) 0.43  0.06 (0.320.56) 0.18
Time to extubation (minutes) 7  3 (314) 9  6 (120) 0.13

574 2016 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 43, 571578
 Local anaesthesia for canine ovariohysterectomy KS Kalchofner Guerrero et al.
Figure 1 Box-and-whisker plots of the dynamic interactive
visual analogue scale (DIVAS) in 36 dogs undergoing
ovariohysterectomy with intraperitoneal bupivacaine,
combined with either incisional bupivacaine (group B) or
saline (group S). Each box represents the interquartile
range, and the median value is the horizontal line within
each box. The upper and lower whiskers represent the
upper and lower range of values, respectively.
Figure 2 Box-and-whisker plots of the Glasgow Composite
Pain Scale (GCPS) in 36 dogs undergoing ovariohysterec-
tomy with intraperitoneal bupivacaine, combined with
either incisional bupivacaine (group B) or saline (group S).
For an explanation of the plots, see Fig. 1 caption.
surgery. It cannot be excluded completely that
premedication with morphine had an impact on
early postoperative pain scores, but considering the
mean duration of anaesthesia plus the time from
premedication until induction of anaesthesia, and
the pharmacokinetics of morphine in dogs (Barnhart
et al. 2000; Kukanich et al. 2005), we believe that
the effect of morphine was negligent during the
postoperative phase. A potential difference between
groups may have been masked by the analgesic
protocol used; however, the aim of this study was to
2016 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 43, 571578
Figure 3 Box-and-whisker plots of mechanical nociceptive
threshold (MNT) measurement in 36 dogs undergoing
ovariohysterectomy with intraperitoneal bupivacaine,
combined with either incisional bupivacaine (group B) or
saline (group S). For an explanation of the plots, see Fig. 1
caption.
evaluate local anaesthesia as part of multimodal
analgesia, not as a sole analgesic technique. Fur-
thermore, it has been shown that inexperienced
surgeons affect their patients differently from expe-
rienced surgeons through the degree of tissue
trauma and anaesthesia duration (Michelsen et al.
2012); with third-year students performing the
surgeries it was deemed ethical to provide the dogs
with a well-established analgesic protocol before
surgery.
Three different pain measurements were used in
this study to optimize pain scoring. None of the pain
measurements was able to show a difference
between treatments. The DIVAS scoring system
and the GCPS both involve interaction with the
animal (Lascelles et al. 1998; Reid et al. 2007),
which is important for sensitive detections of pain in
animals (Anil et al. 2002). MNT measurement using
a calibrated tool capable of recording an applied
force is regarded as an objective method for grading
nociceptive thresholds by some authors (Conzemius
et al. 1997); however, we could not detect any
significant difference between groups by MNT
testing.
The fact that no dog required rescue analgesia
raises the question of whether the cut-off points for
providing additional analgesia were adequate. The
cut-off for GCPS was chosen as > 6/24 or 5/20; if the
cut-off had been set as > 5/24 or > 4/20, eight dogs
in group B and nine in group S would have received
rescue analgesia within the first 2 hours after
surgery. In contrast, DIVAS scores never reached
575
Local anaesthesia for canine ovariohysterectomy KS Kalchofner Guerrero et al.

Table 2 Heart rate (HR) and respiratory rate (fR) at baseline and during the first 20 hours postoperatively in 36 dogs undergoing ovariohysterectomy treated with intraperitoneal
more than 30 mm throughout the entire study. In

17
26

14
13
104 
104 

24 
26 
one study comparing different analgesic treatments

0.93

0.61
20
in dogs undergoing OHE, rescue analgesia was
administered if a dog was deemed to be unaccept-
ably uncomfortable by one of two experienced pain

16*
25*

5*
4*
assessors (Shih et al. 2008); rescued animals, on

98 
92 

17 
16 
0.35

0.48
average, had a GCPS of 8.7  3.2, and a DIVAS of
12

53  18.2. The decision on the ideal cut-off point

for provision of rescue analgesia is a delicate matter,
18*
20*

3*
4*
as discussed by Brondani et al. (2013), who deter-
92 
88 

17 
15  mined a cut-off point for visual analogue scale in cats
0.56

0.18 of >28 mm.

8

The MNT was measured to investigate the devel-

17*
25*

11*

opment of primary hyperalgesia, which is mainly

5*

related to incisional pain (Lascelles et al. 1998).

89 
89 

20 
16 
0.95

0.23

Each group showed reduced values in MNT in

6

comparison to preoperative values at all time points

postoperatively. Thus we found that hyperalgesia
14*
16*

6*
3*

occurred in both groups after surgery, suggesting

84 
86 

17 
15 
0.68

0.19

that neither analgesic protocol (morphine, carpro-

4

fen, bupivacaine IP  INC) was effective in prevent-

ing primary hyperalgesia. The fact that hyperalgesia
14*
11*

6*
3*

was present postoperatively despite satisfactory pain

87 
85 

17 
15 

scores may indicate that the pain assessment meth-

0.60

0.39
2

ods used were not sensitive enough to detect

incisional pain.
14*
21*

It is possible that the postoperative decrease of HR

3*
6*

and fR at most time points as compared with baseline

91 
94 

18 
18 
0.56

0.90

is because the dogs were comfortable and not in

1
Time after extubation (hours)

pain; the results of the different pain scores support

this theory. Furthermore, HR and fR were increasing
bupivacaine plus either incisional bupivacaine (group B) or saline (group S)

25
23

11
5

again at 20 hours after extubation, a possible sign

115 
113 

23 
23 
0.78

0.78

that carprofen was no longer effective. Another

0.5

explanation may be that dogs were nervous or

excited upon arrival, resulting in a comparatively
25
21

11
Baseline

higher baseline HR and fR.

133 
117 

37 
39 
0.04

0.79

The dose of IP bupivacaine in the present study

was lower than that in the other two canine studies
using IP bupivacaine (4.45.0 mg kg 1) (Carpenter
Number

et al. 2004; Campagnol et al. 2012). As IP doses of

*Significantly different compared with baseline.

bupivacaine in human anaesthesia range between

18
18

18
18

2.0 and 3.5 mg kg 1 (Moiniche et al. 1998; Ng

et al. 2002), we were expecting to reach analgesic
Group

effects using 3.0 mg kg 1. The difference in out-

B
S

B
S

come of studies on IP instillation of local anaesthetics

could be a result of the location, dose, type and
timing of instillation (Ng & Smith 2002). The failure
)
HR (beats minute 1)

1
fR (breaths minute

in some studies to show an analgesic effect could

result from rapid dilution of local anaesthetics in the
peritoneal cavity (Schulte-Steinberg et al. 1995). It
Variable

p-Value

p-Value

is not possible, however, to increase the dose of local

anaesthetics without increasing the risk of systemic

576 2016 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 43, 571578
 Local anaesthesia for canine ovariohysterectomy KS Kalchofner Guerrero et al.
toxicity. Bupivacaine is known for its cardiotoxicity
(Marx 1984; Feldman et al. 1989), characterized by
depression of the myocardial conductance and
contraction (Fujita et al. 1998). Recommended
doses for bupivacaine in veterinary and human
anaesthesia are in the range 0.53.0 mg kg 1,
dependent on the route of administration and
procedure, whereas toxic doses are reported as being
in the range 3.54.5 mg kg 1 (Berde & Strichartz
2014; Borer-Weir 2014). There were no obvious
signs of cardiotoxicity in this study.
No complications were observed during the course
of this study. This supports the technique of simple
instillation of local anaesthetics versus more targeted
administration. In one study, lidocaine was infil-
trated into the mesovarium before OHE in dogs
(Bubalo et al. 2008); first, this technique did not
reduce the isoflurane requirement during surgery;
and secondly, it caused a high incidence of formation
of haematomas. The infiltration of local anaesthetic
IM and SC over the planned incision site in another
study resulted in a higher complication rate, includ-
ing excessive inflammation, splenic laceration and
herniation (Fitzpatrick et al. 2010).
There are several limitations to this study. First, a
control group was not included because it has been
previously shown that the combination of bupiv-
caine IP and INC is superior to saline in providing
postoperative analgesia in dogs undergoing OHE
(Carpenter et al. 2004). However, the lack of a
control group makes it difficult to conclude that
either treatment provides the best analgesia for the
procedure. Secondly, one potential reason why we
could not find a difference between groups was the
number of dogs included in the study. Our initial
sample size calculations used a difference of 2.6 in
the GCPS, based on previous work (Morton et al.
2005). Based on the smaller differences and
increased variance observed in the current study
(Fig. 1), a post hoc power analysis was conducted.
The results suggested that more animals would be
needed to detect smaller differences such as those
observed in this study. Thirdly, the INC bupivacaine
administration method we employed may have
resulted in a variable dose rate; it is possible that
infiltration of the bupivacaine into the tissue using a
fine needle would have led to a different outcome.
Conclusion
Premedication with acepromazine and morphine,
anaesthesia with propofol and isoflurane, and
2016 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 43, 571578
analgesia with carprofen and IP bupivacaine
resulted in satisfactory postoperative analgesia in
dogs undergoing OHE. The addition of bupivacaine
SC at the incisional site had no impact on postop-
erative pain scores and could not prevent the
occurrence of primary hyperalgesia.
Acknowledgements
The project was supported by the Small Research
Grant Initiative of St Georges University; Topcat
Metrology Ltd sponsored the MNT measurement
device. The authors would also like to thank Dr M.
Lanza-Perea and the staff of SGU Junior Surgery and
Anaesthesia laboratory for their assistance with the
dogs, and Dr K. Clarke for reviewing the manuscript.
Authors contributions
KK worked on the study design, data collection and
preparation of the manuscript; IC performed data
collection and management, and revised the manu-
script; RB-D worked on the study design, logistical
support and revision of the manuscript; CH-Y
analysed and interpreted the data and revised the
manuscript; TG carried out data collection and
revised the manuscript.
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Received 25 February 2015; accepted 10 June 2015.