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Lidocaine–Meloxicam Combinations

Clinician's Brief (Capsule)

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Lidocaine decreases the MAC of inhalant anesthetics in anesthetized dogs and has a sedative effect that may yield a longer but smoother postanesthetic recovery period. This study measured the efficacy of lidocaine, meloxicam, or combination in controlling postoperative pain in dogs undergoing elective ovariohysterectomy. Twenty-seven dogs were randomly assigned to 3 experimental groups of 9 dogs each. All were premedicated with acepromazine (0.03 mg/kg IV), induced with propofol (4–6 mg/kg IV), and maintained with isoflurane. Before induction, group L received a bolus of lidocaine (1 mg/kg IV) followed by a CRI of lidocaine at 0.025 mg/kg/min, and group M received a meloxicam bolus (0.2 mg/kg IV), and group M+L received both meloxicam and lidocaine. Pain and sedation were assessed at 0, 1, 2, 4, 8, and 12 hours postoperatively. Results showed no significant differences in pain scores or glucose and cortisol levels. Group L experienced significantly more sedation at 1 and 2 hours after extubation but scored comparably at all other time points. All dogs had good pain control; none needed rescue analgesia. Lidocaine may be a good preoperative analgesic with an efficacy comparable to meloxicam in dogs undergoing ovariohysterectomy. Lidocaine with meloxicam did not provide more analgesia than either drug given alone. The sedative effects of lidocaine may help smooth recovery by decreasing agitation.

Global Commentary

This study involved the administration of 2 common analgesics that are noncontrolled and widely available, although validated pain scoring systems (ie, Glasgow composite pain scale) would have been more useful and reliable. Recent data have shown that a lidocaine infusion is inadequate for postoperative analgesia in dogs after ovariohysterectomy. Furthermore, a separate study found that pain after lidocaine infusion was similar to morphine after ophthalmologic surgery in dogs; however, only 4 dogs were used in that pilot study and treatment failure was observed in 2 of these dogs (50%). Lidocaine has a short duration of action that requires CRI administration. It may be an excellent technique to provide inhalant-sparing effect during surgery or as an adjuvant to opioid analgesia. However, the drug should not be used as a sole analgesic method. Multimodal analgesia (ie, opioid + NSAID) is recommended for the treatment of postoperative pain after ovariohysterectomy.—Paulo Steagall, MV, MS, PhD, DACVAA

Source

Comparison of postoperative effects of lidocaine infusion, meloxicam, and their combination in dogs undergoing ovariohysterectomy. Tsai TY, Chang SK, Chou PY, Yeh LS. VET ANAESTH ANALG 40:615-622, 2013.

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