Onset of Action of Bupivacaine Administered via Dural Puncture Epidural versus Spinal, Lumbosacral, and Sacrococcygeal Epidural Injections in Dogs: Randomised Clinical Trial

Simple Summary Epidural anaesthesia is commonly performed to provide long-lasting local anaesthesia in animals. Spinal anaesthesia has become popular in human anaesthesia due to a faster onset, but shorter duration, than epidural anaesthesia. Recently, dural puncture epidural anaesthesia (DPE) has been proposed as a compromise between spinal and epidural anaesthesia, providing longer duration than spinal anaesthesia with similar onset of action. This study aimed to compare the technical aspects of these techniques (onset of action, number of attempts, and time to perform them). The results showed no difference between the techniques in number of attempts required, while the epidural injections tended to be shorter than spinal and dural puncture epidural injections. The onset of action (measured as disappearance of the patellar reflex) was longer in the sacrococcygeal epidural injection than any other techniques (including lumbosacral epidural injections). The study aimed to compare bupivacaine onset time when administered via epidural anaesthesia injecting both at the lumbosacral and sacrococcygeal spaces, spinal anaesthesia, and DPE in clinical dogs. A total of 41 dogs requiring neuraxial anaesthesia as part of their anaesthetic protocol were recruited. They were randomly allocated to receive an epidural injection in the sacrococcygeal space aided by the nerve stimulator (SCO), an epidural injection in the lumbosacral (LS), a subarachnoid injection (SPI), or a DPE. The onset of anaesthesia was assessed every 30 s after the injection by testing the presence of patellar ligament reflex. The number of attempts and time to perform the technique were also recorded. Data were analysed using a one-way ANOVA for trimmed means with post hoc Lincoln test and a Kaplan-Meier curve. The significance level was set at p < 0.05, and the results are presented in absolute values and median (range). There was no difference in the number of attempts required to complete the techniques between groups (p = 0.97). Epidural injections (LS and SCO) tended to be shorter than SPI and DPE techniques, but there was no statistically significant difference (p = 0.071). The time to the disappearance of patellar ligament reflex (Westphal's sign) in the SCO group was longer than in any other group. In conclusion, all techniques provided a rapid block of the patellar reflex. The SCO technique was the slowest in onset, while the other groups (SPI, DPE, and LS) were faster and almost indistinguishable.

Automated summary

This study compared the technical aspects of epidural anaesthesia, spinal anaesthesia, and dural puncture epidural anaesthesia in animals. Results showed no difference in the number of attempts required between the techniques, but epidural injections tended to be shorter. The onset of action was longest in sacrococcygeal epidural injections.