Forelimb surgery in dogs: brachial plexus block with ropivacaine vs systemic analgesia alone — MAYBE (weak evidence)

STAMP: MAYBE (weak evidence): No eligible record exists for this shelf, and this pack is honestly empty (no cards). PubMed searches run at drafting (brachial plexus block combinations with ropivacaine, forelimb surgery, postoperative analgesia and rescue opioid/fentanyl in dogs, Nov 10, 2026) found NO study that compares a brachial plexus block using ropivacaine with systemic analgesia alone (no block) in dogs undergoing forelimb surgery — so there is no direct evidence on whether a ropivacaine block reduces rescue opioid need against that comparator. Near-misses, documented here and deliberately not carded: (1) Benigni 2019 (PMID: 30825890) used ropivacaine 0.75% at 1.5 mg/kg in BOTH arms of 32 dogs undergoing surgery distal to the mid humeral diaphysis, comparing ultrasound-guided brachial plexus block at the first rib with neurostimulation-guided paravertebral block: success (defined as no need for rescue analgesia during surgery plus complete blockade after recovery) was 14/16 (87%) with ultrasound guidance and 12/16 (75%) with neurostimulation (P = 0.65), with hypotension in 1 vs 2 dogs and Horner's syndrome in 1 vs 2 dogs — a technique-vs-technique comparison with no systemic-analgesia-alone arm. (2) De Marzo 2012 (PMID: 22464864) compared brachial plexus block with intravenous regional anaesthesia in 20 dogs undergoing pancarpal arthrodesis (10 per group): no patient in either group required intra-operative fentanyl — but the block arm received a 1:1 mixture of 2% lidocaine and 1% ropivacaine (not ropivacaine alone), and the comparator is another regional technique, not systemic analgesia alone. (3) Wenger 2005 (PMID: 15894729) DOES compare a brachial plexus block with a saline control in forelimb surgery (carpal arthrodesis or radius/ulna fracture) — 20 dogs, 10 per group — and the block group received significantly less intra-operative fentanyl (median 0 vs 0.05 µg/kg/minute in controls) and less postoperative methadone (median 0 vs 0.2 mg/kg) — but the block was induced with a mixture of lidocaine and bupivacaine, not ropivacaine, so it answers the block-vs-systemic question for a different local anaesthetic mixture and is not carded on this ropivacaine shelf. (4) Sakonju 2009 (PMID: 19887731) compared the nerve-blocking properties of bupivacaine and ropivacaine for brachial plexus block in 12 experimental Beagles (mean duration of full block 387 minutes for 0.5% bupivacaine with a nerve stimulator, 184 minutes for 0.5% ropivacaine and 275 minutes for 0.75% ropivacaine) — a sensory-block study with no surgery and no analgesia or rescue-opioid outcome. (5) Skelding 2019 (PMID: 31308592), a prospective randomised blinded trial in 24 dogs undergoing thoracic-limb surgery, compared three blind brachial plexus block techniques and found no differences among them in anaesthetic or postoperative pain measures — but every dog received bupivacaine 0.5%, not ropivacaine, and there was no no-block arm. Design class (c): randomisation is not established, because no eligible record exists at all. One-home cross-points: epidural morphine for hindlimb surgery (shelf #523), intraperitoneal bupivacaine (shelf #529) and liposomal bupivacaine infiltration after stifle surgery (shelf #188) are different techniques, sites and drugs, and none of their records is re-carded here. Until a ropivacaine brachial plexus block is trialled against systemic analgesia alone in forelimb surgery, any opioid-sparing claim for the ropivacaine block specifically rests on extrapolation from other local anaesthetics and other block comparisons, as documented above — not on evidence carded here. Tier C is not engaged (no mortality/survival claim). Drafted Nov 10, 2026 (VetMed build, topic #524); all figures from the abstracts fetched and verified at drafting.