Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20190034
Brazilian Journal of Pain
Relato de Caso

Interventional analgesic block in a dog with cauda equina syndrome. Case report

Bloqueio analgésico intervencionista em cão com síndrome da cauda equina. Relato de caso

Rodrigo Mencalha; Camila de Souza Generoso; Daniel Sacchi de Souza

http://dx.doi.org/10.5935/2595-0118.20190034 BrJP, vol.2, n2, p.199-203, 2019
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Abstract

BACKGROUND AND OBJECTIVES: The cauda equina syndrome is a neurological condition prevalent in dogs which neurological signs are caused by the compression of the nerve roots located in the lumbosacral spinal canal and is frequently associated with pain, claudication, paresis or paralysis of the hindlimbs and changes in the functioning of the sphincters. The objective of this study was to check the effects of the epidural injection with the combination of dexamethasone, bupivacaine and morphine on the relief of pain and neurological signs in a dog with traumatic cauda equina syndrome.

CASE REPORT: Case study of a 2-year old Red Heeler dog, weighing 16kg with a diagnosis of post-trauma cauda equina syndrome. The evaluation consisted of neurological and pain assessment (visual analog scale), quality of life ("5H2M") and infrared thermography. After the initial evaluation and authorization of the tutor, the dog was submitted to general anesthesia and a lumbosacral epidural block, guided by electrostimulation, with the association of dexamethasone, bupivacaine and morphine. After the procedure, the dog showed immediate remission of claudication, paresis and satisfactory analgesia on days 0, 15, 30 and 60 after the intervention.

CONCLUSION: The epidural block was effective in improving pain, quality of life and neurological signs and may be an excellent alternative in dogs with pain syndromes associated with the spinal canal.

Keywords

Epidural anesthesia, Cauda equina syndrome, Pain, Polyradiculopathy, Veterinary

Resumo

JUSTIFICATIVA E OBJETIVOS: A síndrome da cauda equina é uma afecção neurológica prevalente em cães cujos sinais neurológicos são causados pela compressão de raízes nervosas localizadas no canal espinhal lombossacral sendo frequentemente associada à dor, claudicação, paresia ou paralisia de membros pélvicos e alterações do funcionamento dos esfíncteres. O objetivo deste estudo foi verificar os efeitos da injeção peridural com a associação de dexametasona, bupivacaína e morfina no alívio da dor e dos sinais neurológicos em um cão com síndrome da cauda equina de origem traumática.

RELATO DO CASO: Estudo do caso de um animal da espécie canis familiaris, raça red heeler, fêmea, 2 anos de idade e 16kg de peso corporal com diagnóstico de síndrome da cauda equina pós-trauma. A avaliação consistiu no exame neurológico completo, avaliação de dor (escala analógica visual), de qualidade de vida ("5H2M") e por termografia infravermelha. Após a avaliação inicial e autorização do tutor, a cadela foi submetida à anestesia geral e a um bloqueio intervencionista peridural lombossacral, guiado por eletroestimulação, com a associação de dexametasona, bupivacaína e morfina. Após o procedimento, a cadela apresentou imediata remissão da claudicação, da paresia e uma satisfatória analgesia nos dias 0, 15, 30 e 60 após a intervenção.

CONCLUSÃO: O bloqueio peridural intervencionista foi eficaz na melhora da dor, da qualidade de vida e dos sinais neurológicos, podendo ser uma excelente alternativa em cães com síndromes dolorosas associadas ao canal espinhal.

Palavras-chave

Anestesia peridural, Cauda equina, Dor, Polirradiculopatia, Veterinária

Referências

Orendácová J, Marsala M, Sulla I, Kafka J, Jalc P, Cizková D. Incipient cauda equina syndrome as a model of somatovisceral pain in dogs: spinal cord structures involved as revealed by the expression of c-fos and NADPH diaphorase activity. Neuroscience. 2000;95(2):543-57.

Tan JM, Wu J, Shi JG, Shi GD, Liu YL, Liu XH. Brain-derived neurotrophic factor is up-regulated in severe acute cauda equina syndrome dog model. Int J Clin Exp Med. 2013;6(6):431-7.

Saey V, Martlé V, Van Ham L, Chiers K. Neuritis of the cauda equina in a dog. J Small Anim Pract. 2010;51(10):549-52.

Neves EB, Vilaça-Alves J, Rosa C, Reis VM. Thermography in neurologic practice. Open Neurol J. 2015;9:24-7.

Niehof SP, Huygen FJ, van der Weerd RW, Westra M, Zijlstra FJ. Thermography imaging during static and controlled thermoregulation in complex regional pain syndrome type 1: diagnostic value and involvement of the central sympathetic system. Biomed Eng Online. 2006;5:30.

Niehof SP, Beerthuizen A, Huygen FJ, Zijlstra FJ. Using skin surface temperature to differentiate between complex regional pain syndrome type 1 patients after a fracture and control patients with various complaints after a fracture. Anesth Analg. 2008;106(1):270-7.

Gulevich SJ, Conwell TD, Lane J, Lockwood B, Schwettmann RS, Rosenberg N. Stress infrared telethermography is useful in the diagnosis of complex regional pain syndrome, type I (formerly reflex sympathetic dystrophy). Clin J Pain. 1997;13(1):50-9.

De Decker S, Watts V, Neilson DM. Dynamic lumbosacral magnetic resonance imaging in a dog with tethered cord syndrome with a tight filum terminale. Front Vet Sci. 2017;4:134.

Spector LR, Madigan L, Rhyne A, Darden 2nd B, Kim D. Cauda equina syndrome. J Am Acad Orthop Surg. 2008;16(8):471-9.

Villalobos AE. Quality-of-life assessment techniques for veterinarians. Vet Clin North Am Small Anim Pract. 2011;41(3):519-29.

Turner TA, Waldsmith J, Marcella K, Henneman K, Purohit RC, Morino D. Veterinary guidelines for infrared thermography. .

Cocicov AF, Cocicov HL, da Silva MB, Skare TL. Epidural steroids for low back pain syndromes. Rev Bras Anestesiol. 2004;54(1):129-41.

Hermeto LC, Rossi R, Bicudo NA, Assis KT, Escobar LL, Camargo PS. The effect of epidurally administered dexamethasone with lignocaine for post-operative analgesia in dogs undergoing ovariohysterectomy. A dose-response study. Acta Cir Bras. 2017;32(4):307-18.

Steagall PVM, Simon BT, Teixeira Neto FJ, Luna SPL. An update on drugs used for lumbosacral epidural anesthesia and analgesia in dogs. Front Vet Sci. 2017;4:68.

Otero PE, Verdier N, Ceballos MR, Tarragona L, Flores M, Portela DA. The use of electrical stimulation to guide epidural and intrathecal needle advancement at the L5-L6 intervertebral space in dogs. Vet Anaesth Analg. 2014;41(5):543-7.

Marsala J, Sulla I, Jalc P, Orendacova J. Multiple protracted cauda equina constrictions cause deep derangement in the lumbosacral spinal cord circuitry in the dog. Neurosci Lett. 1995;193(2):97-100.

Kaiser R, Nasto LA, Venkatesan M, Waldauf P, Perez B, Stokes OM. Time factor and disc herniation size: are they really predictive for outcome of urinary dysfunction in patients with cauda equina syndrome?. Neurosurgery. 2018;83(6):1193-200.

Janssens L, Beosier Y, Daems R. Lumbosacral degenerative stenosis in the dog. The results of epidural infiltration with methylprednisolone acetate: a retrospective study. Vet Comp Orthop Traumatol. 2009;22(6):486-91.

Rosen MA, Hughes SC, Shnider SM, Abboud TK, Norton M, Dailey PA. Epidural morphine for the relief of postoperative pain after cesarean delivery. Anesth Analg. 1983;62(7):666-72.

Fuller JG, McMorland GH, Douglas MJ, Palmer L. Epidural morphine for analgesia after caesarean section: a report of 4880 patients. Can J Anaesth. 1990;37(6):636-40.

Dias RSG, Soares JHN, Castro DDSE, Gress MAKA, Machado ML, Otero PE. Cardiovascular and respiratory effects of lumbosacral epidural bupivacaine in isoflurane-anesthetized dogs: the effects of two volumes of 0.25% solution. PLoS One. 2018;13(4).

Valverde A. Epidural analgesia and anesthesia in dogs and cats. Vet Clin North Am Small Anim Pract. 2008;38(6):1205-30.

Submetido em:
20/11/2018

Aceito em:
18/02/2019

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