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Physiological variables for the objective detection of intraoperative nerve block failure in dogs
Dissertation (MMedVet (Anaesthesiology))--University of Pretoria, 2023.
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| Format: | Thesis |
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University of Pretoria
2024
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| _version_ | 1867613497858195456 |
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| access_status_str | Open Access |
| author2 | Zeiler, Gareth Edward |
| author_browse | Zeiler, Gareth Edward |
| author_facet | Zeiler, Gareth Edward |
| collection | Thesis |
| dc_rights_str_mv | © 2021 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. |
| description | Dissertation (MMedVet (Anaesthesiology))--University of Pretoria, 2023. |
| format | Thesis |
| id | oai:repository.up.ac.za:2263/98536 |
| institution | University of Pretoria (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:37:05.780Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UPSpace — University of Pretoria Institutional Repository |
| publishDate | 2024 |
| publishDateRange | 2024 |
| publishDateSort | 2024 |
| publisher | University of Pretoria |
| publisherStr | University of Pretoria |
| record_format | dspace |
| source_str | UPSpace — University of Pretoria Institutional Repository |
| spelling | oai:repository.up.ac.za:2263/98536 Physiological variables for the objective detection of intraoperative nerve block failure in dogs Zeiler, Gareth Edward drpebasson@gmail.com Kadwa, Abdur R. Basson, Pierre Etienne UCTD Analgesia Intraoperative nociception Nerve block Physiological variables Dissertation (MMedVet (Anaesthesiology))--University of Pretoria, 2023. Objective To identify physiological variables that can be used to objectively detect intraoperative nociception to indicate peripheral nerve block failure. Study design A prospective blinded randomized clinical study. Animals A sample of 14 male (40.8 ± 12 kg; mean ± SD) and 16 female (34.3 ± 11.4 kg) client-owned dogs undergoing a stifle arthrotomy. Methods Dogs were randomly assigned to one of three treatment groups for psoas compartment and proximal sciatic nerve blocks (0.2 mL kg-1 per site): guided bupivacaine (GBB) or saline (GSB) blocks or blind bupivacaine block (BBB). Guided blocks were performed using ultrasound and nerve stimulation. Dogs were premedicated intramuscularly with 0.01 mg kg-1 medetomidine and 0.3 mg kg-1 morphine. General anaesthesia was induced with propofol (to effect to achieve tracheal intubation) and maintained with isoflurane in oxygen (targeted end-tidal concentration of 1.6%). The assigned investigator, based on randomisation, allotted a confidence score [1 (poor) to 4 (high)] that the block will be successful after administering the assigned nerve block treatment. The blinded investigator allotted a binomial subjective score of the nerve block outcome (“Yes”: response to surgical stimulation; “No”: no discernible response) at each time point. Receiver of operator characteristic curve analysis was used to compare actual values and change in values of physiological variables between GSB (Yes nociception) and GBB (No nociception) at the time of the arthrotomy. The Youden index and associated criterions for each physiological variable were used as an objective measure. Fishers exact t-test, McNemar's test and Cohens kappa statistical analysis were used to determine association, differences and inter-score reliability, respectively between the objective and subjective scoring for the BBB. The subjective score was compared to objective scores after being stratified into the assigned confidence scores using Kendall’s tau-b rank correlation coefficient. Results The cardiovascular variables had good discriminating ability in distinguishing a nociceptive response (p < 0.01). The Youden indexes for MAP and DAP had the best potential effectiveness in detecting a response to surgical stimulus. The highest sensitivity was that of delta MAP (100%). Good agreement was indicated between the subjective and objective scores with delta HR or SAP. The use of delta MAP (> 6 mmHg), delta SAP (> 10 mmHg), delta DAP (> 8 mmHg) had the best ability in indicating peripheral nerve block failure (p < 0.001). Conclusions and clinical relevance The use of delta MAP, delta SAP or delta DAP can be considered as objective measures to detect intraoperative peripheral nerve block failure in anaesthetised dogs undergoing stifle arthrotomy. The determination of criterion values for different populations and conditions will benefit future clinical trials. Companion Animal Clinical Studies MMedVet (Anaesthesiology) Unrestricted Faculty of Veterinary Science 2024-10-07T13:13:58Z 2024-10-07T13:13:58Z 2024-04 2023-08 Dissertation * A2024 http://hdl.handle.net/2263/98536 en © 2021 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. application/pdf University of Pretoria |
| spellingShingle | UCTD Analgesia Intraoperative nociception Nerve block Physiological variables Physiological variables for the objective detection of intraoperative nerve block failure in dogs |
| title | Physiological variables for the objective detection of intraoperative nerve block failure in dogs |
| title_full | Physiological variables for the objective detection of intraoperative nerve block failure in dogs |
| title_fullStr | Physiological variables for the objective detection of intraoperative nerve block failure in dogs |
| title_full_unstemmed | Physiological variables for the objective detection of intraoperative nerve block failure in dogs |
| title_short | Physiological variables for the objective detection of intraoperative nerve block failure in dogs |
| title_sort | physiological variables for the objective detection of intraoperative nerve block failure in dogs |
| topic | UCTD Analgesia Intraoperative nociception Nerve block Physiological variables |
| url | http://hdl.handle.net/2263/98536 |