A comparison of four methods of analgesia in cats following ovariohysterectomy

Intraoperative and early postoperative pain in cats that underwent ovariohysterectomy using a spay hook: a randomised, masked, experimental study

BACKGROUND

This study aimed to compare the feasibility and practicality of the ovariohysterectomy (OHE) technique in cats with or without a spay hook with respect to the incision size, surgical time, surgical variables, and intra- and postoperative pain. Twenty-nine female cats underwent OHE using a spay hook (spay hook group [SHG], n = 15) or without using a spay hook (control group [CG], n = 14) to achieve the ovaries and cervix. Physiological parameters were monitored during the intraoperative period, and postoperative pain was assessed using a multidimensional composite and visual analogue pain scales.

RESULTS

The SHG had a significantly shorter operative time than the CG. The variables in the intraoperative period showed no statistically significant difference between both groups, as well as the early postoperative pain.

CONCLUSIONS

Less invasive OHE using a spay hook could potentially be a viable and feasible technique when performed by an inexperienced surgeon with appropriate training, especially in sterilisation campaigns, reducing the time to perform the procedure and increasing the number of animals spayed per time.

Comparative Multimodal Palliative efficacy of gabapentin and tramadol By Using Two Pain Scoring Systems in Cats Undergoing Ovariohysterectomy

The analgesic efficacy of the gabapentin-tramadol combination was compared with meloxicam-tramadol and tramadol perioperative analgesic regimens in cats brought to the clinic for ovariohysterectomy. Thirty adult cats belonging to comparable demographics (age, body weight), were enrolled into a randomized, blinded study after due consent from their owners into four treatment groups. A Gabapentin-Tramadol group (GT-group, n = 10), Meloxicam-Tramadol group (MT-group, n = 10), and a Tramadol group (T-group, n = 10) were formed. Gabapentin capsules at 50 mg were administered orally 2 hours before surgery while the rest received a placebo dose. Tramadol (2 mg/kg, IM) and meloxicam at (0.2 mg/kg, SC) were injected immediately prior to anesthetic premedication. Anesthetic protocol involved premedication with ketamine and xylazine, while anesthesia was induced using propofol. Inhalant isoflurane anesthesia was used to maintain a surgical plane. GT group scored lower on IVAS as well as CPS than MT group, and T group for up to 8 hours after surgery. The mechanical nociceptive threshold remained higher (98±0) for up to 12 hours postoperatively a nd serum cortisol concentrations remained significantly lower during the 24hr period. The addition of gabapentin to the tramadol regimen significantly improved analgesia and mechanical nociceptive threshold than when used on its own.

Controlled, non-inferiority trial of bupivacaine liposome injectable suspension

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.

Comparison of perioperative analgesia using the infiltration of the surgical site with ropivacaine alone and in combination with meloxicam in cats undergoing ovariohysterectomy

Background

Infiltration of the surgical site with local anesthetics combined with nonsteroidal anti-inflammatory drugs may play an important role in improving perioperative pain control. This prospective, randomized, blinded, controlled clinical trial aimed to evaluate intraoperative isoflurane requirements, postoperative analgesia, and adverse events of infiltration of the surgical site with ropivacaine alone and combined with meloxicam in cats undergoing ovariohysterectomy. Forty-five cats premedicated with acepromazine/meperidine and anesthetized with propofol/isoflurane were randomly distributed into three treatments (n = 15 per group): physiological saline (group S), ropivacaine alone (1 mg/kg, group R) or combined with meloxicam (0.2 mg/kg, group RM) infiltrated at the surgical site (incision line, ovarian pedicles and uterus). End-tidal isoflurane concentration (FE’ISO), recorded at specific time points during surgery, was adjusted to inhibit autonomic responses to surgical stimulation. Pain was assessed using an Interactive Visual Analog Scale (IVAS), UNESP-Botucatu Multidimensional Composite Pain Scale (MCPS), and mechanical nociceptive thresholds (MNT) up to 24 h post-extubation. Rescue analgesia was provided with intramuscular morphine (0.1 mg/kg) when MCPS was ≥6.

Results

Area under the curve (AUC) of FE’ISO was significantly lower (P < 0.0001) in the RM (17.8 ± 3.1) compared to S (23.1 ± 2.2) and R groups (22.8 ± 1.1). Hypertension (systolic arterial pressure > 160 mmHg) coinciding with surgical manipulation was observed only in cats treated with S and R (4/15 cats, P = 0.08). The number of cats receiving rescue analgesia (4 cats in the S group and 1 cat in the R and RM groups) did not differ among groups (P = 0.17). The AUC of IVAS, MCPS and MNT did not differ among groups (P = 0.56, 0.64, and 0.18, respectively). Significantly lower IVAS pain scores were recorded at 1 h in the RM compared to the R and S groups (P = 0.021–0.018). There were no significant adverse effects during the study period.

Conclusions

Local infiltration with RM decreased intraoperative isoflurane requirements and resulted in some evidence of improved analgesia during the early postoperative period. Neither R nor RM infiltration appeared to result in long term analgesia in cats undergoing ovariohysterectomy.

Evaluation of intraoperative analgesia provided by incisional lidocaine and bupivacaine in cats undergoing ovariohysterectomy

Objectives The objective of this study was to assess the intraoperative analgesic effect of preoperative infiltration of the incision site with lidocaine or a mixture of lidocaine with bupivacaine in cats undergoing ovariohysterectomy (OHE). Methods This was a prospective, randomised clinical study. Healthy female intact cats (n = 75) undergoing OHE under medetomidine-ketamine-buprenorphine anaesthesia were assigned randomly into three treatment groups (n = 25 per group) to receive one of two local anaesthesia protocols or placebo preoperatively in the midline incision: lidocaine 1.5 mg/kg (group GL) or mixture of lidocaine 1 mg/kg and bupivacaine 1 mg/kg (group GLB) or sodium chloride 0.9% (control group). Blood pressure, heart and respiratory rate, temperature, muscle tonus and pupillary reflex were registered during surgery. During recovery, the cats were observed for side effects. Postoperative analgesia was provided with meloxicam (0.2 mg/kg). Most cats were rechecked 2 weeks postoperatively to remove skin sutures. Results There was no significant difference between groups regarding breed, age, body weight, surgical time and postoperative complication rate. The majority of the cats (60%) included in the control group received a supplemental bolus of propofol during surgery, when compared with 43% and 44% of the cats included in the GL and GLB groups, respectively. Heart rate was significantly higher ( P <0.05) in the control group at the time of excision of the second ovary and the uterine body. Mean arterial pressure (MAP) was stable in both treatment groups; in contrast, it tended to increase in the control group. Heart rate and MAP were similar between treatment groups. Conclusions and relevance Preoperative incisional block with only lidocaine or combined with bupivacaine seems to produce a similar intraoperative analgesia in cats undergoing OHE. Despite the similar intraoperative analgesic effect between treatment groups, the combination of lidocaine and bupivacaine reduced the required doses, and had a faster onset of action and prolonged effect.

Evaluation of a laparoscopically assisted ovariectomy technique in cats

OBJECTIVE

To describe a laparoscopically assisted ovariectomy (LAO) technique in the cat with a bipolar vessel sealing device (BVSD) or suture ligation and to compare the outcomes to open ovariohysterectomy (OO).

STUDY DESIGN

Randomized prospective study ANIMALS: Healthy, adult, sexually intact female cats (n = 30).

METHODS

Ten cats were assigned to each group: LAO with BVSD (group A), LAO with ligation (group B), and OO with ligation (group C). Surgical times and complications were assessed. Serum glucose and cortisol were measured prior to surgery and at 1, 2, 4, 6, 12, and 24 hours after surgery. Pain was scored by using an interactive visual analog scale (IVAS) at 0, 1, 2, 4, 6, 8, 12, 18, 24, 36, and 48 hours after surgery. Rescue analgesia was provided when IVAS score was 4 or more. Physiological and serum values and IVAS scores were compared among groups with area under the curve (AUC) by using a 1-way ANOVA.

RESULTS

Surgical time was shortest for group C (19.1 ± 5.2 minutes; P < .0002); there was no significant difference between groups A (27.7 ± 6.6 minutes) and B (33.2 ± 8.2 minutes). All procedures were completed successfully. No significant differences among groups were found in IVAS scores (P = .36), rescue analgesia (P = .22), glucose AUC (P = .53), or cortisol AUC (P = .27).

CONCLUSION

The LAO technique was accomplished as described in all cats with no complications or failures. Pain scores were not different from cats undergoing OO. LAO can be performed efficiently to maximize the benefits of minimally invasive surgery and is amenable to clinical practice.

The Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs

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.

Systematic review of the behavioural assessment of pain in cats

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.

Botulinum toxin type A as an adjunct in postoperative pain management in dogs undergoing radical mastectomy

The aim of this randomised placebo-controlled, observer-blinded study was to evaluate the analgesic effects of botulinum toxin type A (BoNT-A) as an adjunct for postoperative pain control in dogs. Sixteen dogs undergoing bilateral radical mastectomy for treatment of mammary tumours were enrolled. Twenty-four hours before surgery, the subjects were distributed into two groups of eight dogs each: 7 iu/kg BoNT-A (BoNT-A) or saline (Control) was administered subcutaneously in each mammary gland. Following sedation with intramuscular 0.03 mg/kg acepromazine and 0.3 mg/kg morphine, anaesthesia was induced intravenously with 4 mg/kg propofol and maintained with isoflurane/O2. Postoperative analgesia was evaluated for 72 hours after extubation using the Visual Analogue Scale (VAS) and modified Glasgow Composite Measure Pain Scale (modified-GCMPS). Rescue analgesia was provided with intramuscular morphine (0.5 mg/kg). Data were analysed using analysis of variance, Tukey's test, Mann-Whitney U test and Friedman test (P<0.05). The pain scores were significantly lower in the BoNT-A than in the Control from 8 hours to 60 hours and from 12 hours to 60 hours after extubation, based on the VAS and modified-GCMPS, respectively. Rescue analgesia was required by significantly more dogs in the Control (7/8) compared with the BoNT-A (2/8) (P=0.022). Pre-emptive BoNT-A appears to be effective as an adjuvant for postoperative pain management in dogs undergoing bilateral radical mastectomy.

Practical use of opioids in cats: a state-of-the-art, evidence-based review

RATIONALE

Recent recognition of the need to improve pain management in cats has led to the investigation of the pharmacokinetics and efficacy of opioid analgesic drugs in this species. The results of these studies may be difficult to interpret because the effect of these drugs varies with dose, route of administration and the method used to assess them. As equipotency of different opioids is not known, it is hard to compare their effects. Animals do not verbalise the pain they feel and, in cats, it may be more difficult to recognise signs of pain in comparison with other species such as dogs.

AIM

This article reviews the use of opioid analgesics in cats. It must be remembered that not all drugs are licensed for use in cats, and that marketing authorisations vary between different countries.

Analgesic effects of maxillary and inferior alveolar nerve blocks in cats undergoing dental extractions

The aim of this study was to evaluate the analgesic effects of maxillary and/or inferior alveolar nerve blocks with lidocaine and bupivacaine in cats undergoing dental extractions. Twenty-nine cats were enrolled. Using an adapted composite pain scale, cats were pain scored before the dental procedure and 30 mins, and 1, 2 and 4 h after isoflurane disconnection. Cats were sedated with buprenorphine (20 µg/kg), medetomidine (10 µg/kg) and acepromazine (20 µg/kg) intramuscularly. Anaesthesia was induced using alfaxalone (1-2 mg/kg) intravenously and maintained with isoflurane in oxygen. Each cat was randomly assigned to receive maxillary and/or inferior alveolar nerve blocks or no nerve blocks prior to dental extractions. Each nerve block was performed using lidocaine (0.25 mg/kg) and bupivacaine (0.25 mg/kg). Heart rate, systolic arterial blood pressure, respiratory rate, end tidal carbon dioxide and isoflurane vaporiser settings were recorded 5 mins before and after the dental extractions, and the difference calculated. Group mean differences (mean ± SD) for heart rate (-9.7 ± 10.6 vs 7.6 ± 9.5 beats/min [nerve block vs control group, respectively], P <0.0001), systolic arterial blood pressure (-10.33 ± 18.44 vs 5.21 ± 15.23 mmHg, P = 0.02) and vaporiser settings (-0.2 ± 0.2 vs 0.1 ± 0.4, P = 0.023) were significantly different between groups. The control group had higher postoperative pain scores (median [interquartile range]) at 2 h (3 [1.75-4.00] vs 1 [0-2], P = 0.008) and 4 h (4 [2-6] vs 2 [1-2], P = 0.006) after the dental extractions. Maxillary and inferior alveolar nerve blocks with lidocaine and bupivacaine administered prior to dental extractions resulted in a reduction in heart rate and blood pressure while allowing for a reduction in isoflurane. Cats receiving nerve blocks had lower postoperative pain scores than the group without nerve blocks.

Comparison of Surgical Variables and Pain in Cats Undergoing Ovariohysterectomy, Laparoscopic-Assisted Ovariohysterectomy, and Laparoscopic Ovariectomy

Laparoscopy is an established modality in veterinary medicine. To date, laparoscopy in feline surgery is rarely reported. The objectives of this study were to compare surgical time, complications, and postoperative pain in a group of cats undergoing laparoscopic ovariectomy (LOVE), laparoscopic-assisted ovariohysterectomy (LAOVH), and ovariohysterectomy via celiotomy (COVH). Eighteen healthy cats were randomly assigned to undergo LOVE, LAOVH, or COVH. Severity of pain was monitored 1, 2, 3, and 4 hr after surgery. Surgical time was significantly longer for LAOVH (mean ± standard deviation [SD], 51.6 ± 7.7 min) compared to COVH (mean ± SD, 21.0 ± 7.1 min) and LOVE (mean ± SD, 34.2 ± 11.2 min). There were no major intraoperative complications, although minor complications were more common in both laparoscopic groups. Cats sterilized via laparoscopy (LOVE and LAOVH) were statistically less painful than cats spayed via celiotomy (COVH) 4 hr following surgery. Results suggested that LOVE in cats is safe, can be performed in a comparable amount of time as COVH, and may result in less postoperative discomfort.

Effects of surgical wound infiltration with bupivacaine on postoperative analgesia in cats undergoing bilateral mastectomy

The analgesic effect of wound infiltration with bupivacaine was evaluated in cats undergoing bilateral mastectomy. Twenty-one female cats with mammary gland tumors were anesthetized with propofol and oxygen-isoflurane anesthesia following premedication with atropine. In the trial group (Group I; n=11), 30 ml of saline containing 2 mg/kg of bupivacaine was infiltrated topically into the surgical wound right after removal of the mammary glands, whereas only saline solution was infiltrated in the control group (Group II; n=10). At the same time, carprofen (4 mg/kg) was also administered subcutaneously in both groups. Behavioral signs of pain were monitored during the recovery period after general anesthesia. In order to examine the behavioral changes associated with acute pain, a questionnaire was prepared and given to the owners to be completed 4 hr and then 10 hr after the operation. According to the owners' anwers to the questionnaire, a pain score was specified using a "numerical rating scale" for each cat. Although some cats showed mild to moderate pain, the pain score recorded at 4 hr after the operation was significantly lower in Group I (P<0.001). No significant difference was found at 10 hr after the operation between the groups. The incidence of vocalization, aggression and convulsion within 2 hr after the operation was also lower in Group I. In conclusion, wound infiltration with bupivacaine before incisional closure provided reliable analgesia at least 4 hr after bilateral radical mastectomy in cats.

Comparison of surgical variables in cats undergoing single-incision laparoscopic ovariectomy using a LigaSure or extracorporeal suture versus open ovariectomy

OBJECTIVE

To evaluate the applicability of single-incision laparoscopic ovariectomy (SILOVE) in cats using a single-incision laparoscopic port (SILP); to compare surgical time, complications, and postoperative pain after SILOVE using a LigaSure (SILOVE-LS) or extracorporeal suture (SILOVE-ECS), and open ovariectomy (open-OVE).

STUDY DESIGN

Randomized, blinded, prospective study.

ANIMALS

Healthy, domestic female cats (n = 24).

METHODS

Cats underwent physical examination, packed cell volume, total solids and blood urea nitrogen analysis. Cats were randomly assigned to 1 of 3 groups: SILOVE-LS (n = 8), SILOVE-ECS (8) or open-OVE (8). Surgical time, complications, and postoperative pain scores were recorded.

RESULTS

Single-incision laparoscopic ovariectomy was successful in (n = 8) SILOVE-LS cats and (n = 5) SILOVE-ECS cats. Surgical time was significantly longer for the SILOVE-ECS group compared with the SILOVE-LS (P < .0001) and open-OVE (P < .0001) groups, which were not different (P = .55). Complications were more frequent in the SILOVE-ECS group and removal of the SILP was required to complete ovariectomy in 3 cats. Cumulative 4-hour pain scores were not different between groups.

CONCLUSIONS

Single-incision laparoscopic ovariectomy using a SILP is a feasible method for OVE in cats. Single-incision laparoscopic ovariectomy using an extracorporeal suture is more time consuming and associated with more complications than either the SILOVE-LS or open-OVE methods.

Confiabilidade e pontuação mínima relacionada à intervenção analgésica de uma escala multidimensional para avaliação de dor pós-operatória em gatos

Avaliou-se a confiabilidade e determinou-se a pontuação mínima relacionada à necessidade de intervenção analgésica de uma escala multidimensional para avaliação de dor pós-operatória em gatas submetidas à ovário-histerectomia. Trinta gatas foram filmadas em quatro momentos predeterminados: pré-operatório, pós-operatório antes e depois da analgesia de resgate e às 24 horas após a cirurgia. Quatro observadores, não cientes dos momentos de avaliação, e um observador, considerado padrão-ouro - pesquisador que desenvolveu a escala - , avaliaram os vídeos em ordem aleatória, a partir da aplicação da escala, e determinaram a suficiência ou não de analgesia, baseando-se na experiência clínica. Os vídeos foram reavaliados dois meses após a primeira análise. O grau de concordância entre as avaliações dos diferentes observadores e das avaliações feitas pelo mesmo observador em diferentes ocasiões foi verificado pelo coeficiente de correlação intraclasse, que variou entre bom e muito bom para todos os itens da escala, exceto atividade, atitude e miscelânea de comportamentos que apresentaram confiabilidade moderada. O ponto de corte ótimo (> 7) foi selecionado pela análise descritiva e da curva Receiver Operating Characteristic. Os resultados suportam a confiabilidade em termos de reprodutibilidade e estabilidade e indicam que a terapia analgésica deve ser considerada em pontuações >8.

Feasibility of single-portal access laparoscopic ovariectomy in 17 cats

Laparoscopic ovariectomy (LapOVE) using single-portal access was attempted in 17 client-owned cats of different breeds admitted for elective ovariectomy. A 12 mm umbilical portal was placed 1 cm caudal to the umbilicus with the cat in dorsal recumbency. Then, a laparoscope with an operating channel was introduced into the portal with the cat in lateral recumbency. The right ovary was pulled to the abdominal wall using grasping forceps and fixed to the abdominal wall by a transabdominal suspension suture. The ovarian vasculature, suspensory ligament and proper ligament were progressively cauterised and transected with multifunction bipolar electrocoagulation forceps. The resected right ovary was exteriorised through the umbilical portal cannula. The left ovary was then removed from the abdomen in a similar fashion. Surgical time, intraoperative haemorrhage, amount of fat in the ovarian ligament, surgical complications and postoperative pain were recorded. The mean (sd) surgical time was 23 minutes and seven seconds (five minutes and 55 seconds). Intraoperative blood loss and fat deposition of the ovarian ligament were minimal. No intra- and postoperative complications were encountered. No cats needed rescue analgesia within 24 hours postsurgery.

Refinement and initial validation of a multidimensional composite scale for use in assessing acute postoperative pain in cats

OBJECTIVE

To refine and test construct validity and reliability of a composite pain scale for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy.

SAMPLE POPULATION

40 cats that underwent ovariohysterectomy in a previous study.

PROCEDURES

In a previous randomized, double-blind, placebo-controlled study, a composite pain scale was developed to assess postoperative pain in cats that received a placebo or an analgesic (tramadol, vedaprofen, or tramadol-vedaprofen combination). In the present study, the scale was refined via item analysis (distribution frequency and occurrence), a nonparametric ANOVA, and item-to-total score correlation. Construct validity was assessed via factor analysis and known-groups discrimination, and reliability was measured by assessing internal consistency.

RESULTS

Respiratory rate and respiratory pattern were rejected after item analysis. Factor analysis resulted in 5 dimensions (F1 [psychomotor change], posture, comfort, activity, mental status, and miscellaneous behaviors; F2 [protection of wound area], reaction to palpation of the surgical wound and palpation of the abdomen and flank; F3 [physiologic variables], systolic arterial blood pressure and appetite; F4 [vocal expression of pain], vocalization; and F5 [heart rate]). Internal consistency was excellent for the overall scale and for F1, F2, and F3; very good for F4; and unacceptable for F5. Except for heart rate, the identified factors and scale total score could be used to detect differences between the analgesic and placebo groups and differences among the analgesic treatments.

CONCLUSIONS AND CLINICAL RELEVANCE

Results provided initial evidence of construct validity and reliability of a multidimensional composite tool for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy.

Comparison of the effects of tramadol, codeine, and ketoprofen alone or in combination on postoperative pain and on concentrations of blood glucose, serum cortisol, and serum interleukin-6 in dogs undergoing maxillectomy or mandibulectomy

OBJECTIVE

To compare analgesic effects of tramadol, codeine, and ketoprofen administered alone and in combination and their effects on concentrations of blood glucose, serum cortisol, and serum interleukin (IL)-6 in dogs undergoing maxillectomy or mandibulectomy.

ANIMALS

42 dogs with oral neoplasms.

PROCEDURES

30 minutes before the end of surgery, dogs received SC injections of tramadol (2 mg/kg), codeine (2 mg/kg), ketoprofen (2 mg/kg), tramadol+ketoprofen, or codeine+ketoprofen (at the aforementioned dosages). Physiologic variables, analgesia, and sedation were measured before (baseline) and 1, 2, 3, 4, 5, and 24 hours after surgery. Blood glucose, serum cortisol, and serum IL-6 concentrations were measured 1, 3, 5, and 24 hours after administration of analgesics.

RESULTS

All treatments provided adequate postoperative analgesia. Significant increases in mean+/-SD blood glucose concentrations were detected in dogs receiving tramadol (96+/-14 mg/dL), codeine (120+/-66 mg/dL and 96+/-21 mg/dL), ketoprofen (105+/-22 mg/dL), and codeine+ketoprofen (104+/-16 mg/dL) at 5, 1 and 3, 5, and 3 hours after analgesic administration, respectively, compared with preoperative (baseline) values. There were no significant changes in physiologic variables, serum IL-6 concentrations, or serum cortisol concentrations. Dogs administered codeine+ketoprofen had light but significant sedation at 4, 5, and 24 hours.

CONCLUSIONS AND CLINICAL RELEVANCE

Opioids alone or in combination with an NSAID promoted analgesia without adverse effects during the 24-hour postoperative period in dogs undergoing maxillectomy or mandibulectomy for removal of oral neoplasms.

A prospective multi-centre clinical trial to compare buprenorphine and butorphanol for postoperative analgesia in cats

One hundred and fifty-three cats undergoing surgery in seven veterinary practices in Great Britain were studied. They were randomly allocated to receive either 10-20 microg/kg buprenorphine or 0.4 mg/kg butorphanol with acepromazine before anaesthesia with propofol, Saffan or thiopentone and isoflurane or halothane. Routine monitoring was undertaken. Pain and sedation were assessed blind using a four point (0-3) simple descriptive scale (SDS) at 1, 2, 4, 8 and 24h. Pain and sedation data were compared using non-parametric statistical tests and continuous data using t tests or analysis of variance (ANOVA). Anaesthesia and surgery were uneventful, and cardiorespiratory data were within normal limits. After surgery, overall, more cats had pain score 0 after buprenorphine and more had pain score 3 after butorphanol (P=0.0465). At individual time points, more cats had lower pain scores after buprenorphine at 2 (P=0.040) and 24 (P=0.036)h. At 24h 83% after buprenorphine and 63% after butorphanol had pain score 0 (P<0.04). Buprenorphine provided better and longer lasting postoperative analgesia than butorphanol.

Analgesic efficacy of perioperative use of vedaprofen, tramadol or their combination in cats undergoing ovariohysterectomy

The analgesic efficacy of tramadol and/or vedaprofen was evaluated in cats submitted for elective ovariohysterectomy, using a randomised double blind placebo controlled design. Forty adult female cats (3.0+/-0.32kg; 1.8+/-0.7 years) were distributed into four groups. Vedaprofen PO (0.5mg/kg), tramadol SC (2mg/kg), both, or placebo was administered 1h before surgery and every 24 and 8h, respectively, for 72h after surgery. Pain score evaluated by interactive visual analogue and composite pain score and hyperalgesia by the von Frey filament test were recorded at 1, 2, 4, 6, 8, 12, 24, 28, 32, 48, 52, 56, 72, 96h and on the 7th day after surgery. Animals treated with combined vedaprofen and tramadol treatment did not need rescue analgesia, did not develop hyperalgesia, and their serum cortisol concentrations and pain scores were lower than placebo until 24 and 72h after surgery, respectively. Combined vedaprofen and tramadol treatment provided more effective postoperative analgesia and prevented hyperalgesia than when used on their own. Multimodal technique is a superior method of treating pain after feline ovariohysterectomy. This work also provides evidence for the benefits of analgesia for up to 3 days following ovariohysterectomy.

Perioperative administration of vedaprofen, tramadol or their combination does not interfere with platelet aggregation, bleeding time and biochemical variables in cats

A randomized double blind and placebo controlled design was used to investigate the hemostatic, biochemical, gastrointestinal and behavioral effects of pre- and postoperative administration of vedaprofen 0.5mg/kg PO (V), tramadol 2mg/kg SC (T), their association (VT) or placebo (P) in 40 adult female cats (3.0+/-0.32kg; 1.8+/-0.7 years) distributed in groups of 10. Platelet aggregation and bleeding time were measured before and 52h after ovariohysterectomy. Serum urea, creatinine, alanine aminotransferase, alkaline phosphatase and gamma-glutamyl transferase concentrations were measured before and 7 days postoperatively. The occurrence of vomiting, frequency and consistency of feces, and behavior were observed for 7 days postoperatively. Morphine (0.5mg/kg, IM) was used as rescue analgesic. Laboratory variables did not change. Vomiting was observed only after morphine administration. Mild euphoria was observed in T and VT. The perioperative use of vedaprofen and/or tramadol did not modify the hemostatic, biochemical and gastrointestinal function in cats.

Perioperative pain management in veterinary patients

Pain exists; however, we can prevent it, and we can treat it. The fallacy that pain is protective and must be allowed to avoid risk for damage after surgery needs to be eradicated. Preoperative and postoperative analgesia is directed at aching pain, whereas sharp pain associated with inappropriate movements persists. Analgesia provides much more benefit than concern. This article provides suggestions for development of an analgesic plan from the point of admission to discharge. These guidelines can then be adjusted according to the patient's needs and responses.

The Association of Shelter Veterinarians veterinary medical care guidelines for spay-neuter programs

As efforts to reduce the overpopulation and euthanasia of unwanted and unowned dogs and cats have increased, greater attention has been focused on spay-neuter programs throughout the United States. Because of the wide range of geographic and demographic needs, a wide variety of programs have been developed to increase delivery of spay-neuter services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, feral cat programs, and services provided through private practitioners. In an effort to ensure a consistent level of care, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. The guidelines consist of recommendations for preoperative care (eg, patient transport and housing, patient selection, client communication, record keeping, and medical considerations), anesthetic management (eg, equipment, monitoring, perioperative considerations, anesthetic protocols, and emergency preparedness), surgical care (eg, operating-area environment; surgical-pack preparation; patient preparation; surgeon preparation; surgical procedures for pediatric, juvenile, and adult patients; and identification of neutered animals), and postoperative care (eg, analgesia, recovery, and release). These guidelines are based on current principles of anesthesiology, critical care medicine, microbiology, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs.