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Lidocaine: Dosages Lidocaine for injection or preservative free 1.0-2.0% Single LS injection 1ml/5kg lean body weight for caudal procedures 1ml/3.5kg lean BW for abdominal procedures Bupivacaine: dosages Bupivacaine with epinephrine: 0.25-0.50% Single LS injection 1ml/5kg lean body weight for caudal procedures 1ml/3.5kg lean BW for abdominal procedures Bupivacaine preservative free (no epi) 1ml/5-3.5kg lean BW +/- CRI 0.1-0.4mg/kg/day *CVT XIII p. 127, B. Hansen Duration of action Lidocaine ~1 hour Bupivacaine ~4-6 hour Toxicity Seizures Crossing of BBB Treat with diazepam Respiratory depression artificial ventilation and oxygen Cardiovascular depression Hypotension Myocardial depression Opioids Morphine, Fentanyl, oxymorphone, meperidine, buprenorphine Selectively block pain conduction without: Motor, sensory or sympathetic blockade Central effects MAC reduction Hemodynamic stability Blockade of autonomic response to noxious stimuli Opioids mechanism of action Bind at opioid receptors on interneurons of superficial laminae of dorsal horn of spinal cord segments Pre/postsynaptic inhibition of afferent transmission (glutamate substance P) Better for dull aching post-op pain than acute intraoperative Must cross dura to CSF and spinal cord Diffuse across meninges into CSF then SC* Arachnoid mater is main meningeal diffusion barrier Travel thru perineurium of spinal nn. along n. root into SC Absorbed by spinal segmental aa. or epidural vv. and then to brain and SC *Quandt Rawlings, “Reducing Post-operative pain for dogs: Local Anesthetic and Analgesic Techniques,” Compendium, pp. 101-111,1996. Opioid Agents More lipophilic = quicker onset = shorter acting Most to least lipid soluble Fentanyl Buprenorphine Oxymorphone Morphine Morphine Least lipid-soluble Peak effect ~90 min. May persist for 24 hours Cephalad migration independent of volume Other Opioid Agents Fentanyl Little use as a single agent Does not extend more than 2 spinal segments from site Useful in c
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