Optimal pain management: epidural or locoregional nerve blocks for canine stifle surgery?

PICO question: In dogs undergoing stifle surgery, do locoregional nerve blocks compared with epidural anaesthesia improve perioperative antinociception and reduce residual block? Category of research: Treatment. Number and type of study designs reviewed: Six studies were appraised; all were prospective, blinded, randomised, controlled clinical trials. Strength of evidence: Moderate. Outcomes reported: Overall, the studies suggest that locoregional nerve blocks are a viable alternative to epidural anaesthesia (EPID) for dogs undergoing stifle surgeries. All studies demonstrated consistent success with locoregional nerve blocks, while two studies reported failures with EPID. Moreover, all studies found that locoregional nerve blocks provided similar analgesic effects to EPID, with one study suggesting that EPID bupivacaine might offer better intraoperative analgesia but require more rescue analgesia compared to combined femoral and sciatic nerve block (F+S), while another study suggested that the saphenous and sciatic nerve block (SSNB) group had lower pain scores than the EPID group at 4 and 8 hours postoperatively. Additionally, one study suggested that F+S bupivacaine might lead to a lower incidence of urinary retention compared to EPID, while another study indicated that lumbar plexus and sciatic nerve block (LPS) with bupivacaine could facilitate an earlier return of motor function. Conclusion: Despite no conclusive evidence suggesting the superiority of either locoregional nerve blocks or EPID in dogs undergoing stifle surgery, there is evidence that locoregional nerve blocks may serve as an alternative to EPID, with a similar success rate, comparable perioperative analgesia, and fewer incidences of residual block. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient's circumstances and owners' values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.