Continuous Infusion of Ketamine and Lidocaine Either with or without Maropitant as an Adjuvant Agent for Analgesia in Female Dogs Undergoing Mastectomy

Abstract

Maropitant, an antagonist of neurokinin-1 (NK-1) receptors, blocks the pharmacological action of substance P on the central and peripheral nervous systems. The objective of this study was to compare the antinociceptive and cardiorespiratory effects of the continuous intraoperative infusion of maropitant with ketamine and lidocaine in female dogs undergoing unilateral radical mastectomy. Twenty-four female dogs were used and were divided randomly into two groups (n = 12). The GLK group received ketamine bolus (1.0 mg/kg), lidocaine bolus (1.5 mg/kg), and continuous infusion of ketamine and lidocaine (10 mcg/kg/min and 50 mcg/kg/min), respectively; the GLKM group received the same anesthetic protocol combined with maropitant bolus (1.5 mg/kg/IV) and continuous infusion of maropitant (100 mcg/kg/h). Continuous infusion was initiated at the start of surgery and was maintained until 1 hour postoperatively. Pain was evaluated in the postoperative period using four scales and a digital analgesimeter. Data were analysed using analysis of variance, Student's t-test, Mann–Whitney test, and Friedman’s test ( P < 0.05). Kaplan–Meier curves were compared using the log-rank test. The results indicated lower pain scores, better survival curves with a lower number of patients requiring rescue analgesia, and lower peripheral sensitization, in the GLKM group than in the GLK group. It was concluded that the coadministration of maropitant with ketamine and lidocaine had an adjuvant effect with minimal cardiorespiratory effects and effective analgesia, improving pain management and patient comfort.

Usefulness and Reliability of the Bispectral Index during Balanced Anesthesia for Neurovascular Surgery in New Zealand White Rabbits

“…As no studies investigating the effect of a ketamine, dexmedetomidine and methadone combination on BIS have been performed so far, neither in human nor in veterinary medicine, it is impossible to compare our results with others. Lidocaine has been previously shown to have both antinociceptive and MAC sparing effects in different animal species and in humans [37][38][39][40]. In our study, its use in combination with the other administered drugs, might have allowed to maintain a stable an anesthetic level with values of ETIso lower than MAC.…”

Cardiorespiratory Effects and Desflurane Requirement in Dogs Undergoing Ovariectomy after Administration Maropitant or Methadone

“…A co-induction with propofol and ketamine (Ketofol) [63] after the premedication used in our Maropi group (dexmedetomidine and maropitant) could result in an anesthetic protocol that is also appropriate for somatic surgery, given the somatic analgesic effect of ketamine [64][65][66]. Adding ketamine to propofol and subsequently reducing their doses could greatly reduce the side effects of both agents.…”

Ketamine and the Disinhibition Hypothesis: Neurotrophic Factor-Mediated Treatment of Depression

“…Glutamate receptor ionotropic, NMDA 3A antagonist blocks the open ion channel directly and through negative allosteric regulation; prevents the activation of a calcium-dependent NO synthetase, which plays a role in nociception and neurotoxicity [59] 5-hydroxytryptamine receptor 3A potentiator increases voltage-gated potassium channel activity; binds at supratherapeutic doses, and is thought to increase the effects of the receptor through indirect mechanisms [60] α-7 nicotinic cholinergic receptor subunit antagonist its effects on skeletal muscle tone are not noticed unless unmasked by additional muscle relaxants; ketamine's NMDAR antagonism additionally inhibits acetylcholine release through the receptors [61] Muscarinic acetylcholine receptor M1 inhibitor primarily found in the hippocampus and the cerebral cortex [62] Nitric oxide synthase indirect inhibitor in the brain; functions through the glutamate/NO/cGMP system; may contribute to neuroprotective, sympathetic activating, and additional analgesic effects [63] Neurokinin 1 receptor antagonist through noncompetitive inhibition; possibly contributes to an analgesic effect, as this receptor modulates spinal cord nociception, but the therapeutic relevance of this interaction is not fully clear [64] Dopamine D2 receptor agonist/partial agonist specifically binds to the high-affinity state of the receptor; binding is more than 10 times weaker than that of dopamine and phencyclidine [65] Opioid receptors mild agonist binding affinity from strongest to weakest: mu > kappa > delta; related to some analgesic properties and adverse side effects, particularly with the kappa receptor [66,67] Sodium-dependent noradrenaline transporter inhibitor blocks reuptake in the heart, leading to increased chronotropy and vasoconstriction [68] Ketamine's mechanism of action as an anesthetic agent relies on its non-competitive antagonism of the NMDAR. These anesthetic effects, coupled with maintained blood pressure, spontaneous respiration, and laryngeal reflexes, made it a useful agent in various clinical scenarios [69].…”