What’s New in Companion Animal Anesthesia? By Jenn Bornkamp, DVM
One of the best aspects of veterinary anesthesia is that even with new anesthetic drugs, techniques, and guidelines that come out, the basics of anesthesia stay the same. Overall, we want to produce an anesthetic experience for the patient that provides multimodal analgesia, unconsciousness, amnesia, and immobility in a safe and effective manner. Since 2018, there have been various anesthetic and analgesic drug shortages especially with opioids, local anesthetics, nonsteroidal anti-inflammatory agents (NSAID), and anesthetic support drugs such as dopamine, atropine, and intravenous fluids. The Food and Drug Administration (FDA) has a comprehensive list of drugs that are in shortage at their website: bit.ly/fda-drugshortages. There are several new additions to the veterinary anesthesia and analgesia market including alfaxalone, robenacoxib, and grapiprant. Alfaxalone (Alfaxan Multidose®) is an induction agent that entered the U.S. market in 2012. In 2018, a multidose bottle was introduced
to the U.S. market. Alfaxalone (10 mg/ mL) is a neurosteroid induction agent that provides smooth induction and recovery, has a wide safety margin and minimal cardiorespiratory depression. It can be used for up to 28 days after the vial is broached. It is labeled for use in dogs and cats and some minor species including reptiles, fish, and amphibians. Robenacoxib (Onsior®) is a coxib NSAID that is approved for postoperative pain and inflammation in cats and dogs for up to 3 days. It can be given as an injection or tablet in cats > 5.5 pounds and > 4 months old; but is only available as an injectable for dogs currently. Grapiprant (Galliprant®) is a unique NSAID as it targets the prostaglandin EP4 receptor antagonist that is associated with the pain and inflammation of osteoarthritis only. It can be used in patients older than 9 months and over 8 pounds, but has not been studied in patients that have heart disease. The use of local anesthetics and various locoregional techniques in addition to sedation and anesthetic drugs can improve peri-operative pain management.
The “old” local anesthetic and easy-toperform techniques like infiltrative blocks (i.e., testicular or ring blocks), dental nerve blocks, and epidural techniques are still the most commonly recommended techniques. New, advanced techniques like femoral/sciatic and brachial plexus blocks using nerve-stimulation or ultrasound-guidance are also available but require more advanced training. A new local anesthetic that is improving postoperative pain management is Nocita®. Nocita® is liposomal bupivacaine, which provides immediate analgesia and extends it at the injection site for up to 72 hours. It is approved for use in dogs for cranial cruciate ligament surgery and in cats for onychectomy procedures. However, many hospitals also use it off-label under AMDUCA for other procedures including abdominal exploratory and nonmalignant mass removal, and has been a game changer for postoperative analgesia in total ear canal ablation and mastectomy procedures.
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