Locoregional techniques for dogs undergoing tibial plateau leveling osteotomy : a literature review, anesthesiologist survey, and future directions

Abstract

Over the past several decades there have been significant advancements in our understanding and ability to provide effective analgesia to animals undergoing elective orthopedic surgery through methods that can help us minimize the risk of adverse effects. In dogs, one of the most common elective orthopedic surgeries performed on the pelvic limb is the tibial plateau levelling osteotomy (TPLO) for the treatment of cranial cruciate ligament disease (CCLD). While historically the lumbosacral epidural has been considered the primary method of locoregional therapy for dogs undergoing TPLO, the development of peripheral nerve blocks has been a rapidly growing area of veterinary research. An in-depth knowledge of the pain cycle and ways to intervene in nociception is an immense area of interest in both the human and veterinary worlds. This thesis examines the pain cycle and how protective pain becomes pathologic, along with an exploration of the various pharmaceuticals and locoregional techniques that can be utilized for the lumbosacral epidural, peripheral nerve block, and the peri-incisional infiltration technique. Additional information about locoregional analgesic preferences is gleaned through a survey-based study of board-certified veterinary anesthesiologists. This study demonstrated that newer graduates prefer the use of bupivacaine-dexmedetomidine for peripheral nerve blocks in dogs undergoing TPLO and that analgesic decision-making in the clinical setting is multi-factorial. Overall, this research demonstrates that while significant advancements have occurred in the veterinary anesthesia and analgesia, further research into the effectiveness of various techniques as well as the clinical application of these methods is needed.