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Pisack EK, Kleine SA, Hampton CE, Smith CK, Weisent J, DeBolt R, Schumacher C, Bussières G, Seddighi R. Evaluation of the analgesic efficacy of grapiprant compared with robenacoxib in cats undergoing elective ovariohysterectomy in a prospective, randomized, masked, non-inferiority clinical trial. J Feline Med Surg 2024; 26:1098612X241230941. [PMID: 38511293 PMCID: PMC10983605 DOI: 10.1177/1098612x241230941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVES The main objective of this study was to compare the postoperative analgesic effects of grapiprant with those of robenacoxib in cats undergoing ovariohysterectomy (OVH). METHODS In total, 37 female cats (age range 4 months-10 years, weighing ⩾2.5 kg) were enrolled in a prospective, randomized, masked, non-inferiority (NI) clinical trial. Cats received oral robenacoxib (1 mg/kg) or grapiprant (2 mg/kg) 2 h before OVH. Analgesia was assessed via the Feline Grimace Scale (FGS), the Glasgow Composite Measure Pain Scale-Feline (CMPS-F), von Frey monofilaments (vFFs) and pressure algometry (ALG) 2 h before treatment administration, at extubation, and 2, 4, 6, 8, 18 and 24 hours after extubation. Hydromorphone (<8 h postoperatively) or buprenorphine (>18 h postoperatively) were administered to cats with scores of ⩾5/20 on CMPS-F and/or ⩾4/10 on FGS. NI margins for CMPS-F and vFFs were set at 3 and -0.2, respectively. A mixed-effect ANOVA was used for FGS scores (P <0.05). Data are reported as mean ± SEM. RESULTS The data from 33 cats were analyzed. The upper limit of the 95% confidence interval (CI) (0.35) was less than the NI margin of 3 for CMPS-F, and the lower limit of the 95% CI (0.055) was greater than the NI margin of -0.2 for vFFs, indicating NI of grapiprant. The FGS scores were greater than baseline at extubation for both treatments (1.65 ± 0.63; P = 0.001); however, there was no difference between treatments. There was no difference between treatments, nor treatment by time interaction, for vFFs (P <0.001). The CMPS-F scores for both treatments were higher at extubation but returned to baseline after 4 h (P <0.001). For ALG, there was no difference in treatment or treatment by time interaction. The robenacoxib group had lower pressure readings at extubation and 6 h compared with baseline. CONCLUSIONS AND RELEVANCE These results indicate that grapiprant was non-inferior to robenacoxib for mitigating postsurgical pain in cats after OVH performed via ventral celiotomy. The impact of grapiprant for analgesia in OVH via the flank is unknown.
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Affiliation(s)
- Elizabeth K Pisack
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Stephanie A Kleine
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Chiara E Hampton
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Christopher K Smith
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Jennifer Weisent
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Rebecca DeBolt
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Cambrie Schumacher
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Genevieve Bussières
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Reza Seddighi
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
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Sandersen C. Optimising postoperative pain management in cats undergoing ovariohysterectomy. Vet Rec 2023; 193:320-322. [PMID: 37861153 DOI: 10.1002/vetr.3584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Charlotte Sandersen
- Department of Companion Animals and Equids, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
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Hillen F, Polson S, Yates D, Watkinson R, White K. Robenacoxib versus meloxicam following ovariohysterectomy in cats: A randomised, prospective clinical trial involving owner-based assessment of pain. Vet Rec 2023; 193:e3264. [PMID: 37494365 DOI: 10.1002/vetr.3264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Injectable non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to queens undergoing ovariohysterectomy (OVH), but the requirement for postoperative administration is unclear and practices vary. Existing studies assessing efficacy rely on pain scoring by experienced clinicians. However, following OVH, most cats are discharged within hours of recovery. METHODS Cats undergoing OVH were randomly assigned to two treatment groups: MEL and ROB. Cats in the MEL group (n = 76) received meloxicam (0.2 mg/kg) and those in the ROB group (n = 65) received robenacoxib (2 mg/kg). Owners were contacted by a blinded assessor 3 days postoperatively and asked to identify physical or behavioural changes and to assign pain scores using a numerical rating scale. RESULTS More cats in the ROB group displayed abnormal behaviours than cats in the MEL group (p = 0.03). Most owners assigned a pain score of 0 (72%) (n = 101), but pain scores were significantly higher in the ROB group than in the MEL group (p = 0.005). LIMITATION Methods of owner assessment of pain in cats have not been validated. CONCLUSIONS Both meloxicam and robenacoxib are effective in controlling postoperative pain. Meloxicam may have improved efficacy in certain patient populations. Applying a blanket approach to prescribing NSAIDs to cats undergoing OVH postoperatively may not be necessary. This has safety, environmental and cost implications.
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Affiliation(s)
- Florence Hillen
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | | | | | | | - Kate White
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
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Lees P, Toutain PL, Elliott J, Giraudel JM, Pelligand L, King JN. Pharmacology, safety, efficacy and clinical uses of the COX-2 inhibitor robenacoxib. J Vet Pharmacol Ther 2022; 45:325-351. [PMID: 35460083 PMCID: PMC9541287 DOI: 10.1111/jvp.13052] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 02/23/2022] [Accepted: 03/06/2022] [Indexed: 12/14/2022]
Abstract
Robenacoxib is a veterinary‐approved non‐steroidal anti‐inflammatory drug (NSAID) of the coxib group. It possesses anti‐hyperalgesic, anti‐inflammatory and anti‐pyretic properties. Robenacoxib inhibits the cyclooxygenase (COX)‐2 isoform of COX selectively (in vitro IC50 ratios COX‐1:COX‐2, 129:1 in dogs, 32:1 in cats). At registered dosages (2 mg/kg subcutaneously in dogs and cats, 1–4 mg/kg orally in dogs and 1–2.4 mg/kg orally in cats), robenacoxib produces significant inhibition of COX‐2 whilst sparing COX‐1. The pharmacokinetic (PK) profile of robenacoxib is characterized by a high degree of binding to plasma proteins (>98%) and moderate volume of distribution (at steady state, 240 ml/kg in dogs and 190 ml/kg in cats). In consequence, the terminal half‐life in blood (<2 h) is short, despite moderate body clearance (0.81 L/kg/h) in dogs and low clearance (0.44 L/kg/h) in cats. Excretion is principally in the bile (65% in dogs and 72% in cats). Robenacoxib concentrates in inflamed tissues, and clinical efficacy is achieved with once‐daily dosing, despite the short blood terminal half‐life. In dogs, no relevant breed differences in robenacoxib PK have been detected. Robenacoxib has a wide safety margin; in healthy laboratory animals daily oral doses 20‐fold (dog, 1 month), eight‐fold (cat, 6 weeks) and five‐fold (dog, 6 months) higher than recommended clinical doses were well tolerated. Clinical efficacy and safety have been demonstrated in orthopaedic and soft tissue surgery, and in musculoskeletal disorders in dogs and cats.
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Affiliation(s)
- Peter Lees
- Royal Veterinary College, University of London, London, UK
| | - Pierre-Louis Toutain
- Royal Veterinary College, University of London, London, UK.,INTHERES, INRA, ENVT, Université de Toulouse, Toulouse, France
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Moreno KL, Scallan EM, Monteiro BP, Steagall PV, Simon BT. The thermal antinociceptive effects of a high-concentration formulation of buprenorphine alone or followed by hydromorphone in conscious cats. Vet Anaesth Analg 2021; 48:570-576. [PMID: 33926823 DOI: 10.1016/j.vaa.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/26/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the thermal antinociceptive effects of a high-concentration formulation of buprenorphine alone or followed by hydromorphone in conscious cats. STUDY DESIGN Randomized, blinded, placebo-controlled crossover study design. ANIMALS A total of six purpose-bred, adult female ovariohysterectomized Domestic Short Hair cats. METHODS Cats were allocated into three treatments each consisting of two injections, subcutaneous then intravenous (IV) administration, 2 hours apart: treatment SS, two injections of 0.9% saline; treatment BS, buprenorphine (0.24 mg kg-1, 1.8 mg mL-1) and saline; and treatment BH, buprenorphine (0.24 mg kg-1) and hydromorphone (0.1 mg kg-1). Skin temperature (ST) and thermal threshold (TT) were recorded before (baseline) and for 24 hours following first injection. TT data were analyzed using mixed linear models and a Benjamini-Hochberg sequential adjustment procedure (p < 0.05). RESULTS There were no significant differences among treatments for baseline ST and TT values, treatment SS over time and between treatments BS and BH. Compared with baseline, TT was significantly increased at all time points in treatments BH and BS except at 2 hours in treatment BS. TT was significantly higher than SS at 3-18 hours and 4-12 hours for treatments BS and BH, respectively. Maximal increases in TT were 47.5 °C at 2 hours, 53.9 °C at 3 hours and 52.4 °C at 6 hours in treatments SS, BS and BH, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Administration of IV hydromorphone following high-concentration buprenorphine provided no additional antinociception and decreased the duration of effect when compared with high-concentration buprenorphine alone. Alternative analgesics should be considered if additional analgesia is required after administration of high-concentration buprenorphine.
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Affiliation(s)
- Kara L Moreno
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Elizabeth M Scallan
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Beatriz P Monteiro
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Paulo V Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Bradley T Simon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
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Gordon-Evans WJ, Suh HY, Guedes AG. Controlled, non-inferiority trial of bupivacaine liposome injectable suspension. J Feline Med Surg 2020; 22:916-921. [PMID: 31833793 PMCID: PMC10814399 DOI: 10.1177/1098612x19892355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Recently, a bupivacaine liposome injectable suspension (BLIS) became commercially available in the veterinary market that may provide local analgesia for 72 h. The purpose of this study was to compare a BLIS incisional block with a control protocol in cats after ovariohysterectomy (OHE). The hypothesis was that a BLIS block would provide equivalent pain relief. METHODS This study was designed as a randomized, double-blind, non-inferiority trial. Students performed an OHE followed by a two-layer incisional and body wall block with either standard bupivacaine (control) or BLIS. Postoperatively, cats in the control group received robenacoxib, whereas the BLIS cats received saline. All cats were evaluated using the feline Glasgow Composite Measure Pain Scale (GCMPS) at multiple time points postoperatively. RESULTS There were 24 control cats and 23 BLIS cats. One cat from each group required rescue medication. The mean GCMPS scores were low and the groups were equivalent at all time points (P <0.05). This study showed that BLIS was equivalent to the control group up to 42 h and pain scores remained low up to 68 h after surgery. CONCLUSIONS AND RELEVANCE BLIS incisional block is equivalent to a control pain protocol and reduces the need for continued postoperative drug administration.
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Affiliation(s)
- Wanda J Gordon-Evans
- Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, MN, USA
| | | | - Alonso G Guedes
- Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, MN, USA
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Leedham R, White KL, Yates D, Brown L. Comparison of two high doses of subcutaneous buprenorphine in cats undergoing ovariohysterectomy. ACTA ACUST UNITED AC 2019. [DOI: 10.12968/coan.2019.0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objectives: The aim of the study was to evaluate the analgesia and recovery effects of two doses (0.12 mg/kg and 0.24 mg/kg) of subcutaneous buprenorphine in cats undergoing ovariohysterectomy. Methods: This was an assessor-blinded, randomised, clinical study. A total of 83 cats were recruited and randomly allocated to receive 0.12 mg/kg buprenorphine or 0.24 mg/kg buprenorphine subcutaneously, followed 30 minutes later by 40 μg/kg medetomidine intramuscularly. Anaesthesia was induced with intravenous alfaxalone to effect and maintained with isoflurane in oxygen. All cats received meloxicam before surgery. Temperament score, quality of sedation, induction of anaesthesia, dose of alfaxalone and recovery were scored using simple descriptive scales. Atipamazole was administered following surgery. Physiological variables during anaesthesia were recorded. Cats were assessed postoperatively by the same blinded observer at 2, 4 and 24 hours using a modified Colorado Feline Acute Pain scale. The presence or absence of mydriasis was noted. Results: No significant differences were identified between groups. Three cats in the 0.12 mg/kg group and four in the 0.24 mg/kg group required rescue analgesia. Mydriasis persisting for at least 24 hours was evident in 75 cats. Conclusions and relevance: No differences in analgesia were detected between groups with these protocols; mydriasis was common in both groups.
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Affiliation(s)
- Rosa Leedham
- RSPCA Greater Manchester Animal Hospital, 411 Eccles New Rd, Salford M5 5NN, UK
| | - Kate L White
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough UK
| | - David Yates
- RSPCA Greater Manchester Animal Hospital, 411 Eccles New Rd, Salford M5 5NN, UK
| | - Lauren Brown
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough UK
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Martin de Bustamante MG, Good KL, Leonard BC, Hollingsworth SR, Edwards SG, Knickelbein KE, Cooper AE, Thomasy SM, Maggs DJ. Medical management of deep ulcerative keratitis in cats: 13 cases. J Feline Med Surg 2019; 21:387-393. [PMID: 29767565 PMCID: PMC10814642 DOI: 10.1177/1098612x18770514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CASE SERIES SUMMARY Described are 13 cats diagnosed with deep ulcerative keratitis and successfully managed medically without grafting procedures. Typical treatment involved frequent topical application of serum and antibiotics (usually a fluoroquinolone and a cephalosporin). Seven cats also received systemic antibiotics. Analgesia was achieved using various combinations of topical atropine and systemic buprenorphine, robenacoxib or corticosteroids. Six cats were hospitalized for a median (range) period of 2.5 (1-8) days, typically because of frequent medication administration. Median (range) follow-up time was 41.5 (9-103) days. Median (range) number of recheck examinations was 4 (2-6). Median (range) time to corneal re-epithelialization was 21 (9-103) days. Median (range) topical antibiotic course was 29.5 (16-103) days. Median (range) duration of Elizabethan collar use was 28 (13-73) days. At the time of writing, no further recheck examinations were recommended for 10 cats; median (range) time between initial to final examinations in these cats was 35 (20-103) days. All cats retained the affected globes and were apparently comfortable and visual at the latest recheck examination. RELEVANCE AND NOVEL INFORMATION These cases reveal that aggressive medical management is highly successful in select cats with deep ulcerative keratitis, and can result in a cosmetically acceptable, apparently comfortable and visual globe. However, therapy is intensive with frequent administration of multiple topical and sometimes systemic medications, and requires multiple veterinary visits over many weeks. Referral to a veterinary ophthalmologist for consideration of surgical stabilization is recommended, as not all cases may be amenable to the medical therapy described here.
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Affiliation(s)
| | - Kathryn L Good
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Brian C Leonard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Steven R Hollingsworth
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Sydney G Edwards
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Kelly E Knickelbein
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Ann E Cooper
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - David J Maggs
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
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Murrell J. Perioperative use of non‐steroidal anti‐inflammatory drugs in cats and dogs. IN PRACTICE 2018. [DOI: 10.1136/inp.k3545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kongara K, Chambers JP. Robenacoxib in the treatment of pain in cats and dogs: safety, efficacy, and place in therapy. VETERINARY MEDICINE-RESEARCH AND REPORTS 2018; 9:53-61. [PMID: 30148083 PMCID: PMC6101027 DOI: 10.2147/vmrr.s170893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Robenacoxib is a novel nonsteroidal anti-inflammatory drug (NSAID) of coxib class developed for the control of inflammation and pain in dogs and cats. It shows high selectivity for the cyclooxygenase-2 (COX-2) enzyme in rats, cats, and dogs. Robenacoxib is available in both injectable and tablet formulations. This review initially focuses on the preclinical pharmacology of robenacoxib in rats that includes its high affinity for COX-2 enzyme and weaker and rapidly reversible binding for COX-1 enzyme in in vitro and ex vivo models of inflammation and its pharmacokinetics in the blood and inflammatory exudate, selective tissue distribution, and safety. These basic pharmacological profiles highlight the suitability of robenacoxib for use in target species, such as cats and dogs. Since the level of expression and activity of COX enzymes is species specific, COX-2-selective inhibition and the resultant effects of coxibs must be studied in target species. The pharmacological and toxicological profiles of robenacoxib in cats and dogs have been discussed prior to reviewing its clinical efficacy and safety. Large, multicenter field trials conducted in cats and dogs demonstrated the noninferior efficacy and safety of robenacoxib compared with noncoxib NSAIDs used in dogs and cats. These trials investigated the efficacy of robenacoxib against various acute and chronic painful conditions. Robenacoxib produced superior efficacy to placebo and COX-2 preferential inhibitors in postsurgical cats. The tissue-selective anti-inflammatory activity of robenacoxib has been demonstrated in dogs with osteoarthritis. Robenacoxib has also been shown to be safe in healthy dogs and cats receiving antihypertensive drugs and loop diuretics that could cause renal injury. The developmental objective of coxibs, comparable efficacy but superior safety to less selective/nonselective NSAIDs, is well established with robenacoxib in preclinical studies. More studies need to be conducted to fully explore the benefits of robenacoxib in clinical subjects.
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Affiliation(s)
- Kavitha Kongara
- Animal Welfare Science and Bioethics Centre, School of Veterinary Science, Massey University, Palmerston North, New Zealand,
| | - John Paul Chambers
- Animal Welfare Science and Bioethics Centre, School of Veterinary Science, Massey University, Palmerston North, New Zealand,
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Sattasathuchana P, Phuwapattanachart P, Thengchaisri N. Comparison of post-operative analgesic efficacy of tolfenamic acid and robenacoxib in ovariohysterectomized cats. J Vet Med Sci 2018; 80:989-996. [PMID: 29695672 PMCID: PMC6021869 DOI: 10.1292/jvms.17-0443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to evaluate the efficacy of a non-selective COX inhibitor
(tolfenamic acid) and a selective COX-2 inhibitor (robenacoxib) for post-operative pain
control in cats. Thirty cats undergoing ovariohysterectomy were randomly divided into
three groups: the control (placebo) group, the tolfenamic acid (4 mg/kg/day) group, and
the robenacoxib (1 mg/kg/day) group. Non-steroidal anti-inflammatory drugs (NSAIDs) were
administered orally 2 hr before anesthesia induction and 24 and 48 hr post-operation.
Buccal mucosal bleeding times (BMBTs) were assessed prior to anesthesia induction.
Colorado pain scores and composite pain scores were evaluated in a blinded fashion before
induction and 2, 8, 24, 30 and 48 hr post-operation. The Colorado pain scores of cats
receiving robenacoxib were significantly lower than those of cats in the control group at
30 (P=0.0126) and 48 (P=0.0439) hr post-operation. The
composite pain scores of cats from the robenacoxib group were lower than those of cats in
the control group at 30 (P=0.0299) and 48 (P=0.0103) hr
post-operation. The Colorado pain scores of cats receiving tolfenamic acid were
significantly lower than those of cats in the control group at 30 hr
(P=0.0186) post-operation. The composite pain scores in cats in the
tolfenamic acid group were lower than the scores of cats in the control group at 24
(P=0.0403) and 48 (P=0.0413) hr post-operation. BMBTs
remained within normal limits in all groups. Both tolfenamic acid and robenacoxib are
useful for post-operative pain control in cats.
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Affiliation(s)
- Panpicha Sattasathuchana
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand
| | - Prangtip Phuwapattanachart
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand
| | - Naris Thengchaisri
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand
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Watts J. The use of bipolar electrosurgical forceps for haemostasis in open surgical ovariectomy of bitches and queens and castration of dogs. J Small Anim Pract 2018; 59:465-473. [PMID: 29608797 DOI: 10.1111/jsap.12838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 02/21/2018] [Accepted: 02/26/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe a technique using bipolar electrosurgical forceps for haemostasis during open ovariectomy of bitches and queens and for castration of dogs and to determine whether these forceps reduced surgical time compared to ligation with suture. MATERIALS AND METHODS Bipolar electrosurgical forceps were used for haemostasis in 3744 open surgeries including ovariectomies in bitches (n=1406) and queens (n=859) and castrations in dogs (n=1335). The forceps were also used to assist with ovariohysterectomy in bitches (n=89) and queens (n=55). The effect of bipolar electrocoagulation and other likely factors influencing surgical time was examined using linear regression analysis of 367 surgeries. RESULTS The use of the forceps reduced surgical time by 9·7 ±2·8 minutes in bitches and by 3·0 ±1·5 minutes in queens. The complications encountered initially were small superficial skin burns requiring topical treatment and one case of haemorrhage associated with surgical technique. CLINICAL SIGNIFICANCE Bipolar electrosurgical forceps reduce surgical time in ovariectomies, and complications are rare. This technique has promise for widespread application in veterinary practice to assist with haemostasis in ovariectomy of bitches and queens.
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Affiliation(s)
- J Watts
- Wyndham Veterinary Clinic, 133 Market Road, Werribee, Victoria, 3030, Australia
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Sharpe EK, Meekins JM, Roush JK, Rankin AJ, KuKanich B. Effect of oral administration of robenacoxib on inhibition of paracentesis-induced blood-aqueous barrier breakdown in healthy cats. Am J Vet Res 2018; 79:443-449. [PMID: 29583043 DOI: 10.2460/ajvr.79.4.443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effect of oral administration of robenacoxib on inhibition of anterior chamber paracentesis (ACP)-induced breakdown of the blood-aqueous barrier (BAB) and assess whether robenacoxib can cross an intact BAB in healthy cats. ANIMALS 12 healthy adult domestic shorthair cats. PROCEDURES Cats received robenacoxib (6-mg tablet in a treat, PO; n = 6) or a control treatment (treat without any drug, PO; 6) once daily for 3 days, beginning 1 day before ACP. One eye of each cat served as an untreated control, whereas the other underwent ACP, during which a 30-gauge needle was used to aspirate 100 μL of aqueous humor for determination of robenacoxib concentration. Both eyes of each cat underwent anterior chamber fluorophotometry at 0 (immediately before), 6, 24, and 48 hours after ACP. Fluorescein concentration and percentage fluorescein increase were used to assess extent of ACP-induced BAB breakdown and compared between cats that did and did not receive robenacoxib. RESULTS Extent of BAB breakdown induced by ACP did not differ significantly between cats that did and did not receive robenacoxib. Low concentrations of robenacoxib were detected in the aqueous humor (mean, 5.32 ng/mL; range, 0.9 to 16 ng/mL) for 5 of the 6 cats that received the drug. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that oral administration of robenacoxib did not significantly decrease extent of BAB breakdown in healthy cats. Detection of low robenacoxib concentrations in the aqueous humor for most treated cats indicated that the drug can cross an intact BAB.
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Skouropoulou D, Lacitignola L, Centonze P, Simone A, Crovace AM, Staffieri F. Perioperative analgesic effects of an ultrasound-guided transversus abdominis plane block with a mixture of bupivacaine and lidocaine in cats undergoing ovariectomy. Vet Anaesth Analg 2018; 45:374-383. [PMID: 29627201 DOI: 10.1016/j.vaa.2018.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/12/2017] [Accepted: 01/20/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the perioperative analgesic effects of a transversus abdominis plane (TAP) block with a mixture of lidocaine and bupivacaine administered to cats undergoing ovariectomy. STUDY DESIGN Controlled, randomized, prospective, blinded clinical study. ANIMALS A group of 20 healthy cats. METHODS Robenacoxib (2 mg kg-1) was administered subcutaneously 0.5 hour before intramuscular (IM) administration of ketamine (5 mg kg-1), methadone (0.1 mg kg-1) and dexmedetomidine (0.01 mg kg-1). General anesthesia was induced with intravenous (IV) propofol and maintained with isoflurane. An ultrasound-guided TAP block was performed by injecting 0.5% bupivacaine (0.2 mL kg-1) diluted in a total volume of 1.5 mL 2% lidocaine bilaterally (TAP group, n = 10) or the same volume of saline solution bilaterally in controls (CTR group, n = 10). During surgery, a 20% increase in heart rate and respiratory frequency was treated with IV fentanyl (0.001 mg kg-1). Before premedication and at 1, 2, 3, 4, 6, 8, 12, 16, 20 and 24 hours after extubation, pain was assessed with a simple descriptive pain scale, that ranged from 0 (no pain) to 4 (intense pain). For pain scores ≥3, IM methadone (0.1 mg kg-1) was administered. Data were analyzed with the Friedman or the analysis of variance (anova) test, and p < 0.05 was considered statistically significant. RESULTS Only two cats in the CTR group were administered one dose of fentanyl during surgery. At 2, 6, 8, 12, 16, 20 and 24 hours after surgery, the pain score was higher in the CTR group. A mean dose of 0.5 ± 0.2 mg kg-1 methadone was administered to all cats in the CTR groups within 24 hours. Methadone was not administered to the TAP group (pain score < 3). CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound-guided TAP block can be a reliable adjunctive technique, providing analgesia for up to 24 hours in cats undergoing ovariectomy.
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Affiliation(s)
- Despoina Skouropoulou
- Transplants of Organs and Tissues and Cellular Therapies, D.E.O.T., University of Bari, Italy; Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy
| | - Luca Lacitignola
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy
| | - Paola Centonze
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy
| | - Angela Simone
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy
| | - Alberto M Crovace
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy
| | - Francesco Staffieri
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy.
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Griffin B, Bushby PA, McCobb E, White SC, Rigdon-Brestle YK, Appel LD, Makolinski KV, Wilford CL, Bohling MW, Eddlestone SM, Farrell KA, Ferguson N, Harrison K, Howe LM, Isaza NM, Levy JK, Looney A, Moyer MR, Robertson SA, Tyson K. The Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs. J Am Vet Med Assoc 2017; 249:165-88. [PMID: 27379593 DOI: 10.2460/javma.249.2.165] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs.
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Bellini L, Mollo A, Contiero B, Busetto R. Intraoperative end-tidal concentration of isoflurane in cats undergoing ovariectomy that received tramadol, buprenorphine or a combination of both. J Feline Med Surg 2017; 19:110-116. [PMID: 26581470 PMCID: PMC10816558 DOI: 10.1177/1098612x15615655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The aim of the study was to evaluate the end-tidal concentration of isoflurane required to maintain heart and respiratory rate within ± 20% of basal measurement in cats undergoing ovariectomy that received buprenorphine, tramadol or a combination of both. Methods Thirty cats, divided into three groups, were enrolled in a simple operator-blinded, randomised study. Cats received acepromazine (0.03 mg/kg) and one of the following treatments: buprenorphine (0.02 mg/kg), tramadol (2 mg/kg) or a combination of both. Anaesthesia was induced with propofol and maintained with isoflurane titrated in order to maintain heart and respiratory rate within the target values recorded before premedication. Results Groups were similar for age, weight, dose of propofol administered, sedation and recovery scores. Cats receiving tramadol with buprenorphine were extubated earlier after isoflurane discontinuation. No statistical differences were detected in end-tidal fraction of isoflurane between buprenorphine alone or with tramadol. In cats that received tramadol or buprenorphine alone, ovarian pedicle traction caused a statistical increase in end-tidal isoflurane concentration compared with that measured during incision and suture of the skin. In cats that received the combination of tramadol plus buprenorphine no differences among surgical time points were observed. Conclusions and relevance Tramadol added to buprenorphine did not provide any advantage in decreasing the end-tidal fraction of isoflurane compared with buprenorphine alone, although it is speculated there may be an infra-additive interaction between tramadol and buprenorphine in cats.
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Affiliation(s)
- Luca Bellini
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Antonio Mollo
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Barbara Contiero
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Roberto Busetto
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
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Enomoto M, Kigin PD, Bledsoe D, Slone R, Hash J, Smith CE, Lascelles BDX. Pilot evaluation of a novel unilateral onychectomy model and efficacy of an extended release buprenorphine product. BMC Vet Res 2017; 13:32. [PMID: 28118835 PMCID: PMC5259973 DOI: 10.1186/s12917-017-0943-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/06/2017] [Indexed: 11/29/2022] Open
Abstract
Background Non-steroidal anti-inflammatory drugs (NSAIDs), transdermal fentanyl patches, and transmucosal buprenorphine are probably the most commonly used options for providing post-operative analgesia in the early at-home period. However, these require daily administration or are associated with abuse concerns. One of the significant unmet needs in veterinary surgery and pain management is for longer acting opioids for cats to effectively bridge the gap between the in-hospital and at-home recovery periods. A proof of concept study of an extended release formulation of buprenorphine HCL (ER-Bup) was conducted using objective kinetic measures and a unilateral onychectomy model. Using a blinded, randomized, two period crossover design, four cats were allocated to control (saline) or ER-Bup (0.6 mg/kg, subcutaneously [SC]) treatment groups. All animals underwent a unilateral forelimb onychectomy per period with a washout/recovery period in between. Observational pain scores and kinetic data (using a pressure sensitive walkway [PSW]) were collected prior to (baseline) and at intervals for 72 h following surgery. Symmetry indices were derived for kinetic variables (peak vertical force [PVF]; vertical impulse [VI]) of each forelimb for landing following a jump and for walking. A rescue analgesic protocol was in place. Effect of surgery and treatment were evaluated using a mixed model statistical approach. Results No cats required rescue analgesics based on subjective pain score. ER-Bup had a positive influence on subjective pain scores during the 72 h postsurgery (p = 0.0473). PVF and VI of the operated limb were significantly decreased for both landing (p < 0.0001 and p < 0.0001) and walking (p < 0.0001 and p < 0.0001 respectively) compared to control. ER-Bup resulted in significantly decreased asymmetry in limb use during landing (PVF, p < 0.0001; VI, p < 0.0001) and walking (PVF, p = 0.0002, VI, p < 0.0001). The novel use of data collected following a jump from an elevated platform appeared to provide all desired information and was easier to collect than walking data. Conclusion This study demonstrates that SC administration of ER-Bup may be an effective analgesic for a 72 h period postoperatively. Furthermore, landing onto a PSW from an elevated perch may be a useful and efficient way to assess analgesics in cats using a unilateral model of limb pain. Electronic supplementary material The online version of this article (doi:10.1186/s12917-017-0943-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Masataka Enomoto
- Comparative Pain Research Laboratory Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | | | - David Bledsoe
- Farnam Companies, Inc., Phoenix, AZ, USA.,Present Address: Qualitas BioSciences, LLC, Peoria, AZ, USA
| | | | - Jonathan Hash
- Comparative Pain Research Laboratory Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Charles E Smith
- Department of Statistics, North Carolina State University, Raleigh, NC, 27695, USA
| | - B Duncan X Lascelles
- Comparative Pain Research Laboratory Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA. .,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, 27606, USA. .,Center for Pain Research and Innovation, UNC School of Dentistry, Chapel Hill, NC, USA.
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18
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Ambrosio AM, Carvalho-Kamakura TPA, Ida KK, Varela B, Andrade FSRM, Facó LL, Fantoni DT. Ventilation distribution assessed with electrical impedance tomography and the influence of tidal volume, recruitment and positive end-expiratory pressure in isoflurane-anesthetized dogs. Vet Anaesth Analg 2017; 44:254-263. [PMID: 28457827 DOI: 10.1016/j.vaa.2016.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/29/2016] [Accepted: 06/08/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the intrapulmonary gas distribution of low and high tidal volumes (VT) and to investigate whether this is altered by an alveolar recruitment maneuver (ARM) and 5 cmH2O positive end-expiratory pressure (PEEP) during anesthesia. STUDY DESIGN Prospective randomized clinical study. ANIMALS Fourteen client-owned bitches weighing 26 ± 7 kg undergoing elective ovariohysterectomy. METHODS Isoflurane-anesthetized dogs in dorsal recumbency were ventilated with 0 cmH2O PEEP and pressure-controlled ventilation by adjusting the peak inspiratory pressure (PIP) to achieve a low (7 mL kg-1; n = 7) or a high (12 mL kg-1; n = 7) VT. Ninety minutes after induction (T90), an ARM (PIP 20 cmH2O for 10 seconds, twice with a 10 second interval) was performed followed by the application of 5 cmH2O PEEP for 35 minutes (RM35). The vertical (ventral=0%; dorsal=100%) and horizontal (right=0%; left=100%) center of ventilation (CoV), four regions of interest (ROI) (ventral, central-ventral, central-dorsal, dorsal) identified in electrical impedance tomography images, and cardiopulmonary data were analyzed using two-way repeated measures anova. RESULTS The low VT was centered in more ventral (nondependent) areas compared with high VT at T90 (CoV: 38.8 ± 2.5% versus 44.6 ± 7.2%; p = 0.0325). The ARM and PEEP shifted the CoV towards dorsal (dependent) areas only during high VT (50.5 ± 7.9% versus 41.1 ± 2.8% during low VT, p = 0.0108), which was more distributed to the central-dorsal ROI compared with low VT (p = 0.0046). The horizontal CoV was centrally distributed and cardiovascular variables remained unchanged throughout regardless of the VT, ARM, and PEEP. CONCLUSIONS AND CLINICAL RELEVANCE Both low and high VT were poorly distributed to dorsal dependent regions, where ventilation was improved following the current ARM and PEEP only during high VT. Studies on the role of high VT on pulmonary complications are required.
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Affiliation(s)
- Aline M Ambrosio
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation 8, Posgraduate Program in Anesthesiology, Medical School, University of São Paulo, São Paulo, Brazil
| | - Tatiana P A Carvalho-Kamakura
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Keila K Ida
- Laboratory of Medical Investigation 8, Posgraduate Program in Anesthesiology, Medical School, University of São Paulo, São Paulo, Brazil.
| | - Barbara Varela
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Felipe S R M Andrade
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Lara L Facó
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Denise T Fantoni
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation 8, Posgraduate Program in Anesthesiology, Medical School, University of São Paulo, São Paulo, Brazil
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Abstract
OBJECTIVES The objectives were to review systematically the range of assessment tools used in cats to detect the behavioural expression of pain and the evidence of their quality; and to examine behavioural metrics (considering both the sensory and affective domains) used to assess pain. METHODS A search of PubMed and ScienceDirect, alongside articles known to the authors, from 2000 onwards, for papers in English was performed. This was followed by a manual search of the references within the primary data sources. Only peer-reviewed publications that provided information on the assessment tool used to evaluate the behavioural expression of pain in cats, in conscious animals (not anaesthetised cats), were included. RESULTS No previous systematic reviews were identified. One hundred papers were included in the final assessment. Studies were primarily related to the assessment of pain in relation to surgical procedures, and no clear distinction was made concerning the onset of acute and chronic pain. Ten broad types of instrument to assess pain were identified, and generally the quality of evidence to support the use of the various instruments was poor. Only one specific instrument (UNESP-Botucatu scale) had published evidence of validity, reliability and sensitivity at the level of a randomised control trial, but with a positive rather than placebo control, and limited to its use in the ovariohysterectomy situation. The metrics used within the tools appeared to focus primarily on the sensory aspect of pain, with no study clearly discriminating between the sensory and affective components of pain. CONCLUSIONS AND RELEVANCE Further studies are required to provide a higher quality of evidence for methods used to assess pain in cats. Furthermore, a consistent definition for acute and chronic pain is needed. Tools need to be validated that can detect pain in a range of conditions and by different evaluators (veterinary surgeons and owners), which consider both the sensory and emotional aspects of pain.
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Affiliation(s)
| | - Daniel S Mills
- School of Life Sciences, University of Lincoln, Lincoln, UK
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20
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Slingsby LS, Bortolami E, Murrell JC. Methadone in combination with medetomidine as premedication prior to ovariohysterectomy and castration in the cat. J Feline Med Surg 2015; 17:864-72. [PMID: 25406177 PMCID: PMC11112194 DOI: 10.1177/1098612x14558893] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
OBJECTIVES The aim of the study was to evaluate the tolerability, sedative and analgesic effects of methadone in combination with medetomidine for premedication prior to neutering in healthy cats. METHODS This was an assessor-blinded, randomised, clinical research study. Forty-five cats were recruited and divided into three treatment groups of 15. Following premedication with medetomidine (20 µg/kg) and one of the three test drugs - methadone 0.5 mg/kg, buprenorphine 20 µg/kg or butorphanol 0.4 mg/kg intramuscularly - anaesthesia was induced with propofol and maintained with isoflurane, and neutering was carried out. Sedation and physiological parameters were assessed before premedication, after premedication before induction of anaesthesia, and at 90 mins and 2, 3, 4, 6, 7, 8 and 24 h after premedication. Pain and mechanical nociceptive threshold were assessed at similar time points. RESULTS There were no differences between groups with respect to age, sex, duration of anaesthesia or surgery. Most cats had low pain scores in the postoperative period, with small differences in pain scores between groups at individual time points only. Five, two and no cats required additional rescue analgesia in the postoperative period in the butorphanol, methadone and buprenorphine groups, respectively, representing no significant difference between groups. CONCLUSIONS AND RELEVANCE Medetomidine combined with methadone for premedication prior to neutering in healthy cats provided adequate analgesia for the first 6 h after administration with no adverse effects; effects overall were comparable with medetomidine combined with buprenorphine or butorphanol. Administration of further analgesia with methadone at 6 h and a non-steroidal anti-inflammatory drug at 8 h provided adequate analgesia for the first 24 h after surgery.
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Affiliation(s)
| | - Elisa Bortolami
- School of Veterinary Sciences, University of Bristol, Langford, UK
| | - Joanna C Murrell
- School of Veterinary Sciences, University of Bristol, Langford, UK
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21
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Whitehouse W, Viviano K. Update in feline therapeutics: clinical use of 10 emerging therapies. J Feline Med Surg 2015; 17:220-34. [PMID: 25701861 PMCID: PMC11148892 DOI: 10.1177/1098612x15571879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
PRACTICAL RELEVANCE The field of veterinary medicine is constantly evolving. New medications are being introduced into clinical practice, and novel uses for established medications are frequently being discovered as new information comes to light. CLINICAL CHALLENGES Therapeutic options for our feline patients can be restricted based on inadequate clinical evidence, adverse effects and patient compliance concerns. Additionally, with the reduced availability of commonly used medications in some regions, clinicians are forced to utilize alternatives with which they may have limited experience. AUDIENCE This review article is directed towards primary care veterinarians working with feline patients. The selection of medications discussed is based on many of the clinical challenges commonly encountered in practice. EVIDENCE BASE The evidence for use of some of these medications is limited due to their novelty. Known mechanisms of action, pharmacokinetic and pharmacodynamics data, adverse effects and clinical uses are reviewed where possible, with clinical recommendations made based on the evidence of data available.
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Affiliation(s)
- William Whitehouse
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, Madison, WI 53706, USA
| | - Katrina Viviano
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, Madison, WI 53706, USA
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22
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Warne LN, Beths T, Holm M, Carter JE, Bauquier SH. Evaluation of the perioperative analgesic efficacy of buprenorphine, compared with butorphanol, in cats. J Am Vet Med Assoc 2015; 245:195-202. [PMID: 24984130 DOI: 10.2460/javma.245.2.195] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the analgesic effects of buprenorphine and butorphanol in domestic cats. DESIGN 2-phase positive-controlled randomized masked clinical trial. ANIMALS 39 healthy female cats (10 in phase 1 and 29 in phase 2). PROCEDURES Cats admitted for ovariohysterectomy received buprenorphine (4 in phase 1; 14 in phase 2) or butorphanol (6 in phase 1; 15 in phase 2). In phase 1, cats were premedicated with buprenorphine (0.02 mg/kg [0.009 mg/lb], IM) or butorphanol (0.4 mg/kg [0.18 mg/lb], IM), in combination with medetomidine. Anesthesia was induced with propofol (IV) and maintained with isoflurane in oxygen. After extubation, medetomidine was antagonized with atipamezole. A validated multidimensional composite scale was used to assess signs of pain after surgery starting 20 minutes after extubation and continuing for up to 360 minutes, and pain score comparisons were made between the 2 groups. Phase 2 proceeded similar to phase 1 with the following addition: during wound closure, cats from the butorphanol and buprenorphine groups received butorphanol (0.4 mg/kg, IM) or buprenorphine (0.02 mg/kg, IM), respectively. RESULTS Phase 1 of the study was stopped after 10 cats were ovariohysterectomized because 9 of 10 cats required rescue analgesia at the first evaluation. In phase 2, at the first pain evaluation, pain scores from the buprenorphine group were lower, and all cats from the butorphanol group required rescue analgesia. None of the cats from the buprenorphine group required rescue analgesia at any time. CONCLUSIONS AND CLINICAL RELEVANCE Buprenorphine (0.02 mg/kg, IM) given before surgery and during wound closure provided adequate analgesia for 6 hours following ovariohysterectomy in cats, whereas butorphanol did not.
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Affiliation(s)
- Leon N Warne
- Faculty of Veterinary Science, University of Melbourne, Werribee, VIC 3030, Australia
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Steagall PVM, Monteiro-Steagall BP, Taylor PM. A review of the studies using buprenorphine in cats. J Vet Intern Med 2014; 28:762-70. [PMID: 24655078 PMCID: PMC4895465 DOI: 10.1111/jvim.12346] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 02/07/2014] [Accepted: 02/19/2014] [Indexed: 11/27/2022] Open
Abstract
Pain management is a crucial component of feline medicine and surgery. This review critically evaluates studies using buprenorphine in cats and highlights the clinical application of the opioid in this species. The pharmacokinetic-pharmacodynamic (PK-PD) modeling of IV buprenorphine has been best described by a combined effect compartmental/receptor association-dissociation model with negative hysteresis. Therefore, plasma concentrations of the drug are not correlated with analgesia, and clinicians should not expect to observe pain relief immediately after drug administration. In addition, a ceiling effect has not been demonstrated after administration of clinical doses of buprenorphine in cats; dosages of up to 0.04 mg/kg have been reported. The route of administration influences the onset, duration, and magnitude of antinociception and analgesia when using this drug in cats. At clinical dosages, the SC route of administration does not appear to provide adequate antinociception and analgesia whereas the buccal route has produced inconsistent results. Intravenous or IM administration at a dosage of 0.02-0.04 mg/kg is the preferred for treatment of pain in the acute setting. A literature search found 14 clinical trials evaluating buprenorphine sedation, analgesia, or both in cats. There were 22 original research studies reporting the antinociceptive effects of buprenorphine by means of thermal threshold, mechanical threshold, or both, minimal alveolar concentration, or PK-PD. Individual variability in response to buprenorphine administration has been reported, indicating that buprenorphine may not provide sufficient analgesia in some cats. Pain assessment is important when evaluating the efficacy of buprenorphine and determining whether additional analgesic treatment is needed.
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Affiliation(s)
- P V M Steagall
- Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
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