The perfusion index as a method of assessing epidural anaesthesia efficacy in healthy dogs

Itoh, Harumichi; Inoue, Hajime; Itamoto, Takuya; Tani, Kenji; Sunahara, Hiroshi; Nemoto, Yuki; Nakaichi, Munekazu; Iseri, Toshie; Itamoto, Kazuhito

doi:10.2478/jvetres-2024-0048

Abstract

Introduction

Perfusion index (PI) is used as assessment of epidural anaesthesia efficacy in human medicine, but its usefulness in dogs is unknown. The aim of this study was to evaluate the usefulness of PI in determining epidural anaesthesia effectiveness.

Material and Methods

This is prospective cross-over experimental study. Five healthy adult beagle dogs were anaesthetised and an epidural catheter was inserted in the lumbosacral area and adjusted so that the end of the catheter was placed at the fourth lumbar vertebra. Single-port catheters were used in the control group and multiple-port catheters were used in the treatment group. A PI probe was placed on a hind leg, and the catheter placement was confirmed via computed tomography. The treatment group received a bolus dose of lidocaine, and the control group received saline, via epidural catheter. The PI value was recorded every 5 min until 30 min after lidocaine injection.

Results

The PIs of the hind limbs were not significantly different over time, nor were they between the control and lidocaine-injected groups at any point in time.

Conclusion

The PI is not useful in determining the efficacy of epidural anaesthesia in dogs under general anaesthesia. In the future, finding a reliable method to evaluate the success of regional anaesthesia, even in patients under general anaesthesia, will be necessary.

References

Doyle C.R., Riccó Pereira C.H., Wanstrath A.W., Lerche P., Aarnes T.K., Bednarski R.M., Werre S.R.: Evaluation of perfusion index as a noninvasive tool to determine epidural anesthesia effectiveness in dogs. Vet Anaesth Analg 2021, 48, 782–788, doi: 10.1016/j.vaa.2021.06.011.
Open DOI Search in Google Scholar Back to article
Freire C.D., Torres M.L., Fantoni D.T., Cavalcanti R.L., Noel-Morgan J.: Bupivacaine 0.25% and methylene blue spread with epidural anesthesia in dog. Vet Anaesth Analg 2010, 37, 63–69, doi: 10.1111/j. 1467-2995.2009.00493.x.
Open DOI Search in Google Scholar Back to article
Gatson B.J., Garcia-Pereira F.L., James M., Carrera-Justiz S., Lewis D.D.: Use of a perfusion index to confirm the presence of sciatic nerve blockade in dogs. Vet Anaesth Analg 2016, 43, 662–669, doi: 10.1111/vaa.12378.
Open DOI Search in Google Scholar Back to article
Ginosar Y., Weiniger C.F., Meroz Y., Kurz V., Bdolah-Abram T., Babchenko A., Nitzan M., Davidson E.M.: Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia. Acta Anaesthesiol Scand 2009, 53, 1018–1026, doi: 10.1111/j.1399-6576.2009.01968.x.
Open DOI Search in Google Scholar Back to article
Goldman J.M., Petterson M.T., Kopotic R.J., Barker S.J.: Masimo signal extraction pulse oximetry. J Clin Monit Comput 2000, 16, 475–483, doi: 10.1023/a:1011493521730.
Open DOI Search in Google Scholar Back to article
Heath R.B.: Lumbosacral epidural management. Vet Clin North Am Small Anim Pract 1992, 22, 417–419, doi: 10.1016/s0195-5616(92)50655-6.
Open DOI Search in Google Scholar Back to article
7. Jones R.S.: Epidural analgesia in the dog and cat. Vet J 2001, 161, 123–131, doi: 10.1053/tvjl.2000.0528.
Jones R.S. : Epidural analgesia in the dog and cat . Vet J 2001 , 161 , 123 – 131 , doi: 10.1053/tvjl.2000.0528 .

Open DOI Back to article
Kapral S., Greher M., Huber G., Willschke H., Kettner S., Kdolsky R., Marhofer P.: Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med 2008, 33, 253–258, doi: 10.1016/j.rapm.2007.10.011.
Open DOI Search in Google Scholar Back to article
Magides A.D., Sprigg A., Richmond M.N.: Lumbar epidurography with multi-orifice and single orifice epidural catheters. Anaesthesia 1996, 51, 757–763, doi: 10.1111/j.1365-2044.1996.tb07891.x.
Open DOI Search in Google Scholar Back to article
Mathews K., Kronen P.W., Lascelles D., Nolan A., Robertson S., Steagall P.V., Wright B., Yamashita K.: Guidelines for recognition, assessment and treatment of pain. J Small Anim Pract 2014, 55, E10–E68, doi: 10.1111/jsap.12200.
Open DOI Search in Google Scholar Back to article
Michael S., Richmond M.N., Birks R.J.: A comparison between open-end (single hole) and closed-end (three lateral holes) epidural catheters. Complications and quality of sensory blockade. Anaesthesia 1989, 44, 578–580, doi: 10.1111/j.1365-2044.1989.tb11446.x.
Open DOI Search in Google Scholar Back to article
Sebastiani A., Philippi L., Boehme S., Closhen D., Schmidtmann I., Scherhag A., Markstaller K., Engelhard K., Pestel G.: Perfusion index and plethysmographic variability index in patients with interscalene nerve catheters. Can J Anaesth 2012, 59, 1095–1101, doi: 10.1007/s12630-012-9796-3.
Open DOI Search in Google Scholar Back to article
Spence B.C., Beach M.L., Gallagher J.D., Sites B.D.: Ultrasound-guided interscalene blocks: understanding where to inject the local anaesthetic. Anaesthesia 2011, 66, 509–514, doi: 10.1111/j.1365-2044.2011.06712.x.
Open DOI Search in Google Scholar Back to article
Spiegel J.E., Vasudevan A., Li Y., Hess P.E.: A randomized prospective study comparing two flexible epidural catheters for labour analgesia. Br J Anaesth 2009, 103, 400–405, doi: 10.1093/bja/aep174.
Open DOI Search in Google Scholar Back to article
Stevens M.F., Werdehausen R., Hermanns H., Lipfert P.: Skin temperature during regional anesthesia of the lower extremity. Anesth Analg 2006, 102, 1247–1251, doi: 10.1213/01.ane.0000198627.16144.77.
Open DOI Search in Google Scholar Back to article
Troncy E., Junot S., Keroack S., Sammut V., Pibarot P., Genevois J.P., Cuvelliez S.: Results of preemptive epidural administration of morphine with or without bupivacaine in dogs and cats undergoing surgery: 265 cases (1997–1999). J Am Vet Med Assoc 2002, 221, 666–672, doi: 10.2460/javma.2002.221.666.
Open DOI Search in Google Scholar Back to article
Vashishth S., Nandal N., Kaur K., Kadian Y.S., Johar S., Kaur S., Bhardwaj M., Mahor V.: Evaluation of perfusion index as a predictor of successful caudal block in pediatric patients: A prospective randomized study. J Anaesthesiol Clin Pharmacol 2024, 40, 108–113, doi: 10.4103/joacp.joacp_228_22.
Open DOI Search in Google Scholar Back to article
Yokoyama M., Hanazaki M., Fujii H., Mizobuchi S., Nakatsuka H., Takahashi T., Matsumi M., Takeuchi M., Morita K.: Correlation between the distribution of contrast medium and the extent of blockade during epidural anesthesia. Anesthesiology 2004, 100, 1504–1510, doi: 10.1097/00000542-200406000-00024.
Open DOI Search in Google Scholar Back to article