Pre-emptive multimodal analgesia with tramadol and ketamine–lidocaine infusion for suppression of central sensitization in a dog model of ovariohysterectomy

Abstract

ObjectivesThe effects of pre-emptive infusion of ketamine–lidocaine with tramadol on the suppression of central sensitization were investigated in a dog ovariohysterectomy model.Patients and methodsTwelve dogs were randomly assigned to two groups: ketamine–lidocaine–tramadol (KLT) and tramadol (T) groups. Both groups received intravenous tramadol 4 mg/kg body weight as premedication. Immediately after induction, the KLT group received ketamine and lidocaine at 0.5 and 2 mg/kg loading dose, followed by continuous rate infusion of 50 and 100 µg/kg/min, respectively, for 2 hours. Dogs in T group received saline bolus and continuous rate infusion at equi-volume. Intraoperatively, hemodynamic responses to surgical stimulation were recorded, whereas postoperative pain was evaluated using an algometer and short form of the Glasgow composite measure pain scale.ResultsIntraoperatively, hemodynamic responses to surgical stimulation were obtunded to a greater degree in KLT compared to T group. Postoperatively, the pain scores increased only for the first hour in KLT group, compared to 12 hours in T group. Mechanical thresholds at the abdomen decreased postoperatively between 12 and 60 hours in KLT group versus the entire 72 hours in T group. Thresholds at tibia and radius in both groups increased in the immediate 1 hour postoperatively, but decreased thereafter. Significant decrement of thresholds from baseline were detected in the tibia at 24, 42, and 60 hours in KLT group compared to 24–72 hours in T group, and in the radius between 36 and 48 hours in T group, but none in KLT group.ConclusionAddition of pre-emptive ketamine–lidocaine infusion to single intravenous dose of tramadol enhanced attenuation of central sensitization and improved intra- and postoperative analgesia.

Addition of Celebrex and Pregabalin to Ropivacaine for Posterior Spinal Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial

“…Preemptive and multimodal analgesia are two novel concepts to improve the efficacy of pain management. 17 , 18 The pathophysiology of surgical pain includes peripheral sensitization initiated by inflammatory mediators and central sensitization resulting from hyperexcitability of the spinal neurons in the dorsal horn. 18 , 19 Preemptive analgesia requires the administration of analgesics prior to surgery and aims to prevent this hyperexcitability of the central nervous system.…”

“… 17 , 18 The pathophysiology of surgical pain includes peripheral sensitization initiated by inflammatory mediators and central sensitization resulting from hyperexcitability of the spinal neurons in the dorsal horn. 18 , 19 Preemptive analgesia requires the administration of analgesics prior to surgery and aims to prevent this hyperexcitability of the central nervous system. 20 , 21 Various analgesics are combined in multimodal analgesia and act through different mechanisms and at different sites in order to provide more effective analgesia.…”

Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities

“… 31 In a recent animal study about multimodal preemptive analgesic strategy, the addition of preemptive ketamine–lidocaine infusion to single intravenous dose of tramadol enhanced the attenuation of central sensitization and improved intraoperative and postoperative analgesia in dogs undergoing ovariohysterectomy. 32 Therefore, our results suggest that preemptive analgesia should be included in multimodal analgesia rather than as a single method.…”

Postoperative Analgesic Effects of Laserpuncture and Meloxicam in Bitches Submitted to Ovariohysterectomy

“…The relatively low postoperative pain scores both in DIVAS and GCMPS may be explained by the use of preventive analgesics [ 36 ] and minimal surgical manipulation performed by an experienced surgeon [ 37 ]. The difference of findings in the evaluation between the scales used can be explained by the absence of descriptors in the DIVAS, which allows, as demonstrated by Hofmeister and others [ 33 ], that an experienced evaluator considers other factors than those established by the scale to determine the patient’s pain score.…”