2015 AAHA/AAFP pain management guidelines for dogs and cats

A combined treatment for self-traumatic chronic skin lesions associated with post-surgical neuropathic pain in a domestic cat: a pharmacological and cold atmospheric plasma approach

Cold atmospheric plasma (CAP) has been employed as a therapy against both acute and chronic skin lesions, contaminated or not, and has effects on angiogenesis and reepithelialization promoting healing. In this context, the present study aimed to evaluate the effects of a CAP jet associated with pharmacological treatment described by the 2015 AAHA/AAFP pain management guidelines and the 2022 WSAVA guidelines for the recognition, assessment, and treatment of pain, on the healing of chronic skin lesions caused by a pruritic reaction resulting from post-surgical neuropathic pain. To this end, a single CAP application was performed on a feline patient with a 6 months old recurrent contaminated cervical skin lesions along with administration of ketamine (10 µg/kg/min) following the prescription of prednisone (1 mg/kg, SID, 6 days), gabapentin (8 mg/kg, BID, 60 days) and amitriptyline (0.5 mg /kg, SID, 60 days). A single application of plasma associated with an NMDA antagonist, anti-inflammatory steroid, tricyclic antidepressant and gabapentinoid thus provided a significant improvement in the macroscopic appearance of the lesion within 10 days, and the owner reported the cessation of intense itching within the first four hours after treatment and a consequent improvement in the animal's quality of life. The medical treatment was finished almost a year since the writing of this paper, without clinical or reported recurrent signs of the condition. Therefore, we observed that single dose CAP application associated with ketamine, gabapentin, amitriptyline and prednisone leads to significant healing of chronically infected skin lesions resulting from post-surgical neuropathic pain.

Inter-rater reliability in performing stifle goniometry in normal and cranial cruciate ligament disease affected dogs: a prospective randomized controlled study

BACKGROUND

Goniometry can be performed clinically in dogs with cranial cruciate ligament disease (CCLD). The purpose of this study was (1) to compare reliability of stifle goniometry in dogs with CCLD and healthy dogs and (2) to investigate the effect of compliance on measurements. Dogs presented for surgical intervention for CCLD (CCL-Dogs; n = 15) and orthopedically healthy dogs (C-Dogs; n = 11) were enrolled in this prospective randomized controlled trial. In each dog, three observers randomly measured maximum stifle flexion (mSF) and maximum stifle extension (mSE) three times with a standard goniometer with the scale covered, while dog compliance was scored (Scores: C0: excellent - C4: poor). Intraclass correlation coefficient (ICC) was calculated for intra-/interobserver reliability. Effects on measurements were evaluated with mixed-effect models (MEM).

RESULTS

Maximum stifle extension and mSE-compliance were significantly decreased in CCL-Dogs compared to C-Dogs (p ≤ 0.004), but mSF and mSF-compliance did not differ between groups. Intraobserver reliability was excellent for all dogs during mSE (ICC:0.75-0.99) and mSF (ICC:0.89-0.99). Interobserver reliability was excellent for mSF in both groups (ICC: C-Dogs:0.84, CCL-Dogs:0.9) and for mSE in CCL-Dogs (ICC:0.94) but only fair for mSE in C-Dogs (ICC:0.58). Robust MEM showed that the combined average of all mSE measurements of all three observers was affected by compliance in both groups (p < 0.001). This effect was not observed for single mSE-measurements by themselves.

CONCLUSION

The results of this study indicate that compliance may affect goniometric stifle extension measurements in healthy and CCLD dogs. In a clinical setting, intra-/interobserver reliability was excellent for all measurements except for maximum stifle extension in healthy dogs.

Development and validation of a quality of life and treatment satisfaction measure in canine osteoarthritis

Introduction

Canine osteoarthritis (OA) causes pain and mobility impairment. This can reduce dog quality of life (QoL), owner QoL and owners' satisfaction with, and adherence to, treatments. No existing canine OA-specific instrument assesses all three impacts. This study aimed to develop and psychometrically evaluate an owner-completed canine OA-specific measure of dog QoL, owner QoL and owner treatment satisfaction; the "Canine OA Quality of Life and Treatment Satisfaction Questionnaire" (CaOA-QoL-TS).

Methods

The CaOA-QoL-TS was developed using a conceptual model derived from a meta-synthesis of published literature followed by cognitive interviews with ten owners of dogs with OA, to evaluate content validity.

Results

Based on interview findings, ten items were reworded, four removed, and two added; resulting in 26 items that all owners understood and considered relevant. The recall period and response options were well understood and appropriate to almost all owners. To evaluate its psychometric properties, the CaOA-QoL-TS (draft 26-item version) was administered, across six timepoints in a phase 4 field study, to owners of OA treated dogs, recruited from veterinary practices (N = 93). Inter-item correlations suggested items clustered into three distinct domains: Dog QoL, Owner QoL and Treatment Satisfaction, as hypothesized. Confirmatory factor analysis supported deletion of two items and calculation of the three domain scores, with acceptable model fit. The resulting 24-item CaOA-QoL-TS instrument demonstrated strong internal consistency and good to excellent test-retest reliability. Convergent validity was supported by moderate to strong correlations with concurrent measures. Known groups validity was supported by statistically significant differences between groups categorized by owner global impression of QoL. Ability to detect change was demonstrated through statistically significant improvements over time in Owner and Dog QoL, with larger within-group effect sizes reported for the mean of 'improved' dogs compared to the mean of 'stable' dogs. Only a small sample of dogs worsened throughout the study. Anchor-based analyses supported-0.9 and-1.0-point within-group responder definitions for dog and owner QoL domains, respectively.

Discussion

Findings support the content validity of the CaOA-QoL-TS in canine OA. The 24-item CaOA-QoL-TS is a reliable and valid instrument to measure owner and canine QoL and TS and is sensitive to improvements following OA treatment.

Improving rat welfare through the development of a peribulbar anaesthesia technique for ophthalmic procedures: A preliminary study

Rats are a commonly used animal model for the study of the pathogenesis and novel treatments of glaucoma, which is induced experimentally using invasive, painful procedures. Peribulbar anaesthesia (PBA) is frequently used in people and domestic animals prior to ophthalmic surgeries to provide excellent perioperative analgesia. Our goal was to develop a PBA technique adapted to rat anatomy, improving the welfare of animals used as a model for glaucoma. Eighteen rat cadavers (n = 36 eyes) were used to establish the optimal needle insertion location. Five injection techniques using 0.1 mL/100 g lidocaine 2% and a contrast agent (1:1 volume ratio) were compared via computed tomography (CT). CT images were scored for injectate distribution at four locations: extraconal, intraconal, around the optic nerve and at the orbital fissure (scale 0-8, where 0 = none and 8 = excellent). Median scores using the dorso-medial-75° (5; range 2-6) and medial-canthus (4.5; range 2-8) injection techniques were not different from the dorso-medial-45° (4; range 3-6) technique and were higher (better distribution) compared with mid-ventral (3; range 2-5) and ventro-lateral (2; range 1-3) techniques. The two superior techniques were used in two experimental rats (n = 4 eyes) to determine the volume of bupivacaine 0.5% necessary to affect corneal touch threshold (CTT) and periocular skin sensitivity (PSS). A volume of 0.05 mL/100 g decreased CTT and PSS for several hours, while a larger volume produced excessively long effects. Dorso-medial-75° or medial-canthus PBA using 0.05 mL/100 g bupivacaine are likely to provide ocular and periocular analgesia in rats, with minor transient adverse effects.

Comparison of Two Surgical Techniques Based on the Semitendinosus Myocutaneous Flap in Cats

The objective of this experimental study was to compare the semitendinosus (ST) to the split-semitendinosus (SST) myocutaneous flap in covering distal limb skin defects in cats. Twenty-eight purpose-bred laboratory DSH cats were used and allocated into two groups (ST-group (A); n = 14, SST-group (B); n = 14). ST flaps, based on the distal muscle pedicle, and SST flaps, after longitudinal division of the muscle based on both muscle pedicles, were tested over skin defects created on the medial distal tibia. Clinical assessment, planimetry, CT-angiography (CTA) and histological examination were compared between groups. Days to complete flap healing between ST and SST-flaps (30.36 ± 9.1, 32.29 ± 5.44, respectively) and final total flap areas (68.36% ± 27.18, 51.83% ± 22.48, respectively) revealed no significant differences. On CTAs, the caliber of the distal caudal femoral vein on day 10 was statistically significant higher (p < 0.001) for group A and a significantly higher caliber of the distal caudal femoral artery on day 30 for group B (p = 0.021). Histology revealed statistically higher degeneration at 6 months (p = 0.047) for group A, and statistically higher fibrosis at 12 months (p = 0.019) for group B. Both ST and SST flaps had similar healing times and provided coverage of skin tibial defects in cats.

Ultrasound-guided lateral pericapsular hip desensitization of the articular branches of the cranial gluteal nerve: A canine cadaveric study and feasibility study in dogs

OBJECTIVE

To develop and assess the feasibility, as a diagnostic block, of an ultrasound-guided lateral pericapsular hip desensitization (L-PHD) technique in dogs.

STUDY DESIGN

Prospective, randomized, anatomical and feasibility study.

ANIMALS

A total of 11 canine cadavers and eight adult dogs scheduled for acetabular surgical denervation.

METHODS

After studying the ultrasound anatomy of the lateral aspect of the gluteal region and determining an acoustic window to perform an ultrasound-guided L-PHD in three canine cadavers, the right and left hemipelves of eight canine cadavers were injected in the interfascial plane located lateral (LL-PHD group) or medial (LM-PHD group) to the deep gluteal muscle, with 0.05 mL kg-1 of dye per hip on each cadaver. The staining of the pericapsular nerves was assessed by anatomical dissection. Then, the LM-PHD was performed using 2% lidocaine as a diagnostic block in dogs scheduled for acetabular surgical denervation. Positive predictive value (PPV) was calculated for those animals who had favorable outcomes after acetabular surgical denervation.

RESULTS

The ultrasound-guided LL-PHD and LM-PHD could be performed by inserting the needle lateral and medial to the deep gluteal muscle. Ultrasound-guided LL-PHD stained the cranial gluteal nerve and its muscular branches in all injections and partially stained the lumbosacral trunk in two out of eight cadavers. The LM-PHD selectively stained the articular branches of the cranial gluteal nerve in all but one cadaver. The PPV for LM-PHD successful test prediction was 85.7% (95% confidence interval: 48.6% to 98.6%).

CONCLUSIONS

and clinical significance Ultrasound-guided LM-PHD using 0.05 mL kg-1 of dye selectively stained the articular branches of the cranial gluteal nerve in canine cadavers. The LM-PHD technique is feasible and could be used as a diagnostic block before acetabular surgical denervation in dogs.

Using network analysis to detect associations between suspected painful health conditions and behaviour in dogs

Pain associated with chronic health conditions in non-human animals is an important animal welfare issue. To identify animals in pain and develop an understanding of the mechanisms by which pain affects behaviour, it is therefore important to establish the direct behavioural effects of painful health conditions. We reanalyse data from a cross-sectional survey that considered the presence or absence of a painful condition in dogs and quantified their affective predispositions using the Positive and Negative Activation Scale (PANAS). By applying ideas from network theory, we conceptualise pain as a stressor that exerts direct effects on a network of interacting behavioural variables, and subsequently estimated a network model of conditional dependence relations. Painful health conditions were positively conditionally associated with age (posterior mean partial correlation, ρ = 0.34; standard deviation [SD]=0.05), and negatively conditionally associated with the item 'your dog is full of energy' (ρ = -0.14; SD=0.06). In turn, the energy item was conditionally associated with other PANAS items which were marginally associated with pain, such as items representing ease of excitability and persistence in play. This suggests these marginal effects might be indirectly mediated via the energy item. Further, utilising the posterior predictive distribution we estimated that the median conditional probability (95% credible interval) of a painful health condition given an answer of 'strongly agree' on the energy item was 0.08 (0.05, 0.11), which increased to 0.32 (0.09, 0.58), given a response of 'strongly disagree'. This provides a potentially clinically useful interpretation of the conditional dependencies detected in the network.

Comparison of the efficacy and perioperative pain between vessel sealing and suture ligation for median celiotomy in canine ovariohysterectomy

Background and Aim: Vessel sealing (VS) is used widely in human medicine and veterinary practice during laparoscopic surgery; however, few studies have investigated VS in canine ovariohysterectomy (OHE) using the median celiotomy approach. This study aimed to compare the effect of VS and suture ligation (SL) on surgical time, blood loss, and perioperative pain in canine OHE through median celiotomy. Materials and Methods: Twenty-eight dogs were randomly and equally assigned into two groups that underwent surgery either by SL at both the ovarian pedicle and uterus or using a disposable VS device. The short form of the Glasgow composite pain scale (SF-GCPS) and the Colorado state university canine acute pain scale (CSU-CAP) were used to determine pain pre-operatively (baseline); at 30 min; and at 1, 2, 3, 4, 24, and 72 h post-operatively. Perioperative physiological parameters, surgical duration, and percentage of blood loss were recorded. Repeated measures analysis was performed to determine the differences in all parameters among time-related tasks and between both groups. A significant difference was defined at p < 0.05. Results: The duration from identification of the first ovary to uterus removal was shorter in VS than in SL (p < 0.05). No clinically relevant differences were found among physiological variables. Both groups showed higher SF-GCPS and CSU-CAP values after surgery compared with baseline. The SF-GCPS in SL at 1 h was higher than in VS (p < 0.05). Two dogs in the SL group required additional post-operative rescue analgesia. No differences were found between the groups in terms of blood loss. Conclusion: The use of a VS device in dogs undergoing OHE celiotomy decreased post-operative pain and shortened the perioperative time, making it an effective alternative technique for this common surgery. However, the VS device must be applied 2–3 times in the same location during the OHE procedure to prevent technical failure. This disposable device was reused up to 5 times for economic reasons without device failure. Soft tissue damage during OHE using the VS device should be investigated in a future prospective study.

Use of a semitendinosus myocutaneous flap for the coverage of hindlimb full-thickness skin defects in cats

BACKGROUND

The management of feline hindlimb full-thickness skin defects is challenging. On the other hand, the use of a semitendinosus (ST) myocutaneous flap for their coverage has not been reported.

OBJECTIVES

To describe the ST flap and compare it with second intention healing for managing hindlimb full-thickness skin defects.

METHODS

In 12 purpose-bred laboratory domestic short-haired cats, two wounds were made on each tibia. The wounds in group A (n = 12) were covered with ST flaps, and those in group B (n = 12) were left to heal by second intention. In both groups, clinical assessment scoring and planimetry were performed between one-30 d postoperatively. Computed tomography-angiography (CTA) was performed on days zero, 10, and 30, and histological examinations were performed on days zero and 14 and at 6 and 12 mon postoperatively.

RESULTS

Statistically significant differences in the clinical assessment scores were observed between groups A and B on days 14 (p = 0.046) and 21 (p = 0.016). On the other hand, the time for complete healing was similar in the two groups. CTA revealed significant differences in the muscle width (day 0 compared to days 10 and 30 [p = 0.001, p = 0.026, respectively], and days 10 to 30 [p = 0.022]), ST muscle density, and the caliber of the distal caudal femoral artery and vein (day 0 compared to day 10 [p < 0.001], and days 10 to 30 [p < 0.001]). Histologically significant differences in inflammation, degeneration, edema, neovascularization, and fibrosis were observed on day 14 compared to zero and 6 mon, but no differences were found between the time interval of 6 and 12 mon.

CONCLUSIONS

An ST flap can be used effectively to manage hindlimb full-thickness skin defects.

Initial psychometric evaluation of the Portuguese version of the Canine Brief Pain Inventory

OBJECTIVE

To perform the initial psychometric evaluation of the Portuguese version of the Canine Brief Pain Inventory (CBPI).

ANIMALS

A total of 100 dogs, 50 with bilateral hip osteoarthritis and 50 unaffected dogs.

PROCEDURES

The 2 groups of dogs were assessed using the CBPI. The English version of the CBPI (divided into a pain severity score and a pain interference score) was translated into Portuguese, and a copy of the translated version was completed by native Portuguese speakers' canine handlers. The results from the 2 groups were compared, and psychometric properties were evaluated. Construct validity was evaluated by assessing differences between animals with osteoarthritis and unaffected animals with the Mann-Whitney test. Further evaluation was performed with the Kaiser-Meyer-Olin measure of sampling adequacy, Eigenvalue, and scree-plot analysis. Internal consistency was tested with Cronbach α.

RESULTS

A significant difference was observed between dogs with osteoarthritis and unaffected dogs in pain severity and pain interference scores (P < .01 for both), one indication of construct validity. Cronbach α was 0.99, and a high interitem correlation was observed, showing strong internal consistency. One factor accounted for 92.3% of the total variance.

CLINICAL RELEVANCE

We presented the initial validation of the Portuguese version of the CBPI and its validity in the Portuguese language. It is an essential step in providing a valid tool for clinicians to assess pain in dogs with osteoarthritis. Further studies are required to determine if the present results can be replicated across samples with different characteristics and evaluate response to treatment.

A 2022 Systematic Review and Meta-Analysis of Enriched Therapeutic Diets and Nutraceuticals in Canine and Feline Osteoarthritis

With osteoarthritis being the most common degenerative disease in pet animals, a very broad panel of natural health products is available on the market for its management. The aim of this systematic review and meta-analysis, registered on PROSPERO (CRD42021279368), was to test for the evidence of clinical analgesia efficacy of fortified foods and nutraceuticals administered in dogs and cats affected by osteoarthritis. In four electronic bibliographic databases, 1578 publications were retrieved plus 20 additional publications from internal sources. Fifty-seven articles were included, comprising 72 trials divided into nine different categories of natural health compound. The efficacy assessment, associated to the level of quality of each trial, presented an evident clinical analgesic efficacy for omega-3-enriched diets, omega-3 supplements and cannabidiol (to a lesser degree). Our analyses showed a weak efficacy of collagen and a very marked non-effect of chondroitin-glucosamine nutraceuticals, which leads us to recommend that the latter products should no longer be recommended for pain management in canine and feline osteoarthritis.

Evidence-Based Application of Acupuncture for Pain Management in Companion Animal Medicine

The use of veterinary acupuncture for pain relief is expanding among small animal practitioners. Although acupuncture was developed as part of the medical system in Ancient China, research into the scientific basis of its effects is expanding rapidly. Acupuncture is very effective for analgesia on a local, segmental, and suprasegmental level. Many forms of acupuncture can be used independently or as part of a balanced multi-modal approach for the control of acute and chronic pain. In the hands of a skilled practitioner, acupuncture can be a safe and effective modality for treating pain in companion animals. This article outlines the mechanisms of action of acupuncture, its related neurophysiology and provides examples from the literature demonstrating its effectiveness.

Dental Pain in Cats: A Prospective 6-Month Study

Dental pathology is among the most ubiquitous diseases in cats of all ages. Dental pain is yet to be fully understood in cats and therefore its presence is often missed. To better understand feline dental disease as a pain trigger during routine examination and whether disease severity correlates to the degree of pain, a 6-month prospective study in a cats’ only veterinary hospital in Portugal was conducted. Sixty-four cats that randomly presented for different clinical procedures were evaluated. Dental and periodontal abnormalities (primary dental parameters, PDP), as well as clinical signs related to dental pain (secondary dental parameters, SDP), were assessed. All cats underwent an oral cavity examination, upon which, the Feline Acute Pain Scale from Colorado State University Veterinary Teaching Hospital (CPS), was used in order to assess pain. Six PDP (periodontal disease, gingival index, calculus index, tooth resorption, tooth fracture and missing teeth) and five SDP (mouth discomfort, halitosis, hypersalivation, difficulty in holding food and several attempts at prehension of food), were compared with CPS pain scores. All SDP were significantly associated to higher CPS pain scores (p < 0.05). The number of missing teeth was significantly associated to higher CPS pain scores (p < 0.0001). A trend was observed between higher CPS pain scores and tooth resorption (p = 0.08). This study concluded that cats with dental disease feel pain during clinical examination and the pain increases as the severity of the disease progresses.

Pharmacology, safety, efficacy and clinical uses of the COX-2 inhibitor robenacoxib

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.

Identification of canine osteoarthritis using an owner-reported questionnaire and treatment monitoring using functional mobility tests

Objectives

To investigate the diagnostic value of an owner‐completed canine osteoarthritis screening checklist to help identify previously undiagnosed osteoarthritis cases, and assess their response to carprofen treatment by monitoring pain and functional mobility.

Materials and Methods

Dogs (n=500) whose owners reported ≥1 positive response to the osteoarthritis checklist were examined to identify dogs with previously undiagnosed osteoarthritis. Eligible dogs (n=133) were evaluated for pain and video mobility analysis by Helsinki Chronic Pain Index and visual analogue scale scores, respectively, following carprofen treatment, administered for 30 days (n=95) or up to 120 days (n=38). Dogs were filmed at clinics performing activities (walking, jogging, sitting/lying, walking up and down stairs), and scored at days 0, 30 and 120 using visual analogue scale by an independent blinded expert.

Results

A diagnosis of osteoarthritis was confirmed by a veterinarian in 38% (188 of 500) of dogs. Balance of sensitivity and specificity across the original group of nine screening questions was optimised to approximately 88 and 71%, respectively, after elimination of three questions. Pain measured by Helsinki Chronic Pain Index and functional mobility improved over time in response to treatment with carprofen. Mean ability scores for activities significantly improved between days 0 and 30 for walking, jogging, sitting/lying and walking down stairs, and days 0 and 120 for sitting/lying and walking up stairs.

Clinical Significance

More osteoarthritis cases were identified in study dogs than previous prevalence estimates, indicating the screening checklist's potential to help identify for further evaluation cases that could otherwise remain undiagnosed. Improvements in function were demonstrated after carprofen treatment.

The Effect of Different Opioids on Acid-Base Balance and Blood Gas Analysis in Hospitalized Dogs

Pain management is central to veterinary practice, contributing to successful case outcomes and enhancement of the veterinarian-client-patient relationship. Analgesic drugs represent one of the pillars of the multimodal approach to acute and chronic pain management. In dogs, the most used opioids are methadone, buprenorphine and tramadol. Several episodes of hypoglycemia in people treated with tramadol and methadone have recently been described. The aim of this work is to evaluate the changes in the glycemic and acid-base balance induced by tramadol, methadone and buprenorphine in hospitalized dogs. A retrospective review of the medical records of dogs hospitalized for both medical and surgical reasons was performed. During 2018-2020, a total of 876 canine patients were treated with opioids, including 228 with tramadol, 273 with methadone and 375 with buprenorphine. Of all these dogs, only a small percentage met the inclusion criteria presented in the initial design. All the hospitalized animals were monitored daily through clinical examination and blood sampling. Blood samples were obtained before opioid administration (T0), and 24 h (T1) and 48 h (T2) after °pioid administration. The following parameters were evaluated: blood gas value (pH, pCO₂), acid-base state (cHCO₃), oxymetric values (ctHb, haematocrit), electrolyte values (K+, Na+, iCa, Cl-) and metabolic values (glucose, lactate, anion GAP K+c). The glycemic value in enrolled dogs showed a decrease over time, regardless of the type of opioid used, but remained within the physiological range. The highest average glycemic drop was recorded for methadone, between T0 and T1, followed by tramadol between T1 and T2, while buprenorphine recorded the highest overall glycemic drop between T0-T2 when compared to the other two opioids. Female dogs showed the greatest drop in glycemic value. Lactate concentration always presented values beyond the physiological range at an early stage, which then normalized quickly. Measurement of electrolyte concentrations showed a consistent increase in the values of iCa, Na and Cl. In hospitalized dogs treated with opioids monitoring of gas analytic parameters is important and more attention should be paid to patients hospitalized with certain metabolic and endocrine diseases.

2022 AAHA Pain Management Guidelines for Dogs and Cats

These updated guidelines present a practical and logical approach to the assessment and management of acute and chronic pain in canine and feline patients. Recognizing pain is fundamental to successful treatment, and diagnostic guides and algorithms are included for assessment of both acute and chronic pain. Particularly for chronic pain, capturing owner evaluation is important, and pain-assessment instruments for pet owners are described. Expert consensus emphasizes proactive, preemptive pain management rather than a reactive, "damage control" approach. The guidelines discuss treatment options centered on preemptive, multimodal analgesic therapies. There is an extensive variety of pharmacologic and nonpharmacologic therapeutic options for the management of acute and chronic pain in cats and dogs. The guidelines include a tiered decision tree that prioritizes the use of the most efficacious therapeutic modalities for the treatment of acute and chronic pain.

Indicators of Health-Related Quality of Life in Cats With Degenerative Joint Disease: Systematic Review and Proposal of a Conceptual Framework

Objectives: The assessment of health-related quality of life (HRQoL) is becoming increasingly important in companion animals. This study describes a systematic review and development of a proposed conceptual framework to assess HRQoL in cats with osteoarthritis (OA). Methods: The conceptual framework was developed according to published guidelines. A comprehensive search of the CAB Direct, Scopus, PubMed, and Web of Science databases was carried out for publications in English from inception to November 12, 2019. Search words used were "cat", "feline", "chronic pain", "pain", and "quality of life". Publications were selected if they were full-text and peer-reviewed, based on primary data, and identified or measured behavioral symptoms of chronic musculoskeletal pain in cats. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A data extraction form was developed from categories identified in the literature review and piloted on a small number of studies to ascertain the appropriateness for relevant data extraction. Categories were then finalized, and key domains were identified. The domains were then synthesized to develop a conceptual framework. Results: A total of 454 studies were identified, of which 14 met the eligibility criteria and were included in the meta-synthesis. All 14 were assessed to be of good quality. Seven domains related to HRQoL in cats with OA were thematically identified from the data: mobility, physical appearance, energy and vitality, mood, pain expression, sociability, and physical and mental wellbeing. The three main HRQoL domains were pain expression, mobility, and physical and mental wellbeing, which impacted all the others. Pain and mobility impacted all six other domains, with increased pain and decreased mobility negatively impacting physical appearance, energy and vitality, mood, sociability, and physical and mental wellbeing. Conclusions and Relevance: This is the first study to develop an evidence-based conceptual framework for the assessment of HRQoL in cats with OA. The proposed conceptual framework suggests that effective management of chronic pain in cats may improve their overall HRQoL.

Management of veterinary anaesthesia and analgesia in small animals: A survey of English-speaking practitioners in Canada

OBJECTIVE

To describe how small animal anaesthesia and analgesia is performed in English-speaking Canada, document any variation among practices especially in relation to practice type and veterinarian's experience and compare results to published guidelines.

DESIGN

Observational study, electronic survey.

SAMPLE

126 respondents.

PROCEDURE

A questionnaire was designed to assess current small animal anaesthesia and analgesia practices in English-speaking Canadian provinces, mainly in Ontario, Alberta and British Columbia. The questionnaire was available through SurveyMonkey® and included four parts: demographic information about the veterinarians surveyed, evaluation and management of anaesthetic risk, anaesthesia procedure, monitoring and safety. Year of graduation and type of practice were evaluated as potential risk factors. Exact chi-square tests were used to study the association between risk factors and the association between risk factors and survey responses. For ordinal data, the Mantel-Haenszel test was used instead.

RESULTS

Response rate over a period of 3 months was 12.4% (126 respondents out of 1 016 invitations). Current anaesthesia and analgesia management failed to meet international guidelines for a sizable number of participants, notably regarding patient evaluation and preparation, safety and monitoring. Nearly one third of the participants still consider analgesia as optional for routine surgeries. Referral centres tend to follow guidelines more accurately and are better equipped than general practices.

CONCLUSIONS AND CLINICAL RELEVANCE

A proportion of surveyed Canadian English-speaking general practitioners do not follow current small animal anaesthesia and analgesia guidelines, but practitioners working in referral centres are closer to meet these recommendations.

Attitudes and practices of veterinarians in Australia to acute pain management in cats

Objectives

Up-to-date information on the current practices and attitudes of veterinarians in Australia to acute pain management in cats was sought in 2017–2018 in the first nationwide survey in over 20 years.

Methods

An online survey was created, consisting of 54 questions in four sections, with 18 feline-specific questions. Veterinarians throughout Australia were invited to participate in the survey through advertisements in the veterinary press, electronic and regular mail, and through in-clinic visits and promotional materials.

Results

A total of 614 veterinarians completed the survey, with 513 (83.6%) completing the feline-specific section. The demographics of the respondents of this survey were an accurate representation of the registered veterinarians in Australia at the time. Multiple different opioids and non-steroidal anti-inflammatory drugs (NSAIDs) were widely available in practices to manage pain, with analgesic efficacy reported as the primary factor influencing drug selection. Opioids were most commonly used in the preoperative period and NSAIDs were most commonly used postoperatively. Despite the wide availability in clinic (>99%), only 55% of respondents reported regularly using local anaesthetic techniques in cats. Pain assessment of hospitalised patients was primarily performed by veterinarians (91.1%); however, 84.7% of respondents did not routinely use a validated pain scale.

Conclusions and relevance

Veterinary practitioners in Australia are adequately equipped with analgesic medication to treat pain in their patients. In the management of acute pain in cats, they frequently use a multimodal approach and practice a variety of analgesic protocols. Based on the results of this survey, potential areas for improvement in feline pain management include an increase in duration of postoperative analgesia and more routine use of validated pain scales, performed by nurses and veterinarians alike, to assess individual analgesic needs.

Anesthetic Considerations for Working Dogs

Working dogs pose unique concerns and challenges to the veterinary practitioner. In this article, the authors review the best practices and clinical pearls for anesthetizing working dogs for both routine and emergent procedures.

2021 AAFP Feline Senior Care Guidelines

The '2021 AAFP Feline Senior Care Guidelines' are authored by a Task Force of experts in feline clinical medicine and serve as an update and extension of those published in 2009. They emphasize the individual patient evaluation and the process of aging, with references to other feline practice guidelines for a more complete discussion of specific diseases. Focusing on each cat encourages and empowers the owner to become a part of the cat's care every step of the way. A comprehensive discussion during the physical examination and history taking allows for tailoring the approach to both the cat and the family involved in the care. Videos and analysis of serial historical measurements are brought into the assessment of each patient. These Guidelines introduce the emerging concept of frailty, with a description and methods of its incorporation into the senior cat assessment. Minimum database diagnostics are discussed, along with recommendations for additional investigative considerations. For example, blood pressure assessment is included as a minimum diagnostic procedure in both apparently healthy and ill cats. Cats age at a much faster rate than humans, so practical timelines for testing frequency are included and suggest an increased frequency of diagnostics with advancing age. The importance of nutrition, as well as senior cat nutritional needs and deficiencies, is considered. Pain is highlighted as its own syndrome, with an emphasis on consideration in every senior cat. The Task Force discusses anesthesia, along with strategies to allow aging cats to be safely anesthetized well into their senior years. The medical concept of quality of life is addressed with the latest information available in veterinary medicine. This includes end of life considerations like palliative and hospice care, as well as recommendations on the establishment of 'budgets of care', which greatly influence what can be done for the individual cat. Acknowledgement is given that each cat owner will be different in this regard; and establishing what is reasonable and practical for the individual owner is important. A discussion on euthanasia offers some recommendations to help the owner make a decision that reflects the best interests of the individual cat.

A pilot study of transdermal gabapentin in cats

Background

Clinical use of gabapentin has increased; transdermal delivery in cats is incompletely studied.

Objective

To evaluate if gabapentin permeates feline skin in vitro and in vivo and to determine if pain scores improve after administration.

Animals

In vitro: cadaver skin from 6 cats; phase 1: 8 young, healthy client‐owned cats; phase 2: 15 client‐owned geriatric cats.

Methods

In vitro, gabapentin applied every q12h to ear or cervical skin in diffusion cells. Samples collected at 0, 2, 4, 12, and 24 hours after application. Phase 1: Cats assigned to 1 of 4 groups: 5 mg/kg or 10 mg/kg applied q8h for 5 days to either ear or cervical skin. Serum samples collected predose, and after 1 and 5 days. Phase 2: 10 mg/kg applied q8h for 5 days. Two validated pain scores recorded predose, and after days 1, 5, and 8. Serum samples collected predose, and after days 1 and 5. Samples were frozen at −80°C for concentration analysis utilizing a validated high‐performance liquid chromatography mass‐spectrometry method.

Results

Gabapentin was identified in all samples. Significant differences in gabapentin concentrations were observed from day 1 to day 5 (P < .02) and in pain scores from predose to day 5 (P < .05) and day 1 to day 5 (P < .05). No differences in pain scores were observed from predose to day 8 (P = .3).

Conclusions and Clinical Relevance

Gabapentin in a transdermal base penetrates feline skin in vitro, is absorbed systemically in cats, and may help decrease pain scores.

Aggressive behaviour is affected by demographic, environmental and behavioural factors in purebred dogs

Aggressive behaviour is an unwanted and serious problem in pet dogs, negatively influencing canine welfare, management and public acceptance. We aimed to identify demographic and environmental factors associated with aggressive behaviour toward people in Finnish purebred pet dogs. We collected behavioural data from 13,715 dogs with an owner-completed online questionnaire. Here we used a dataset of 9270 dogs which included 1791 dogs with frequent aggressive behaviour toward people and 7479 dogs without aggressive behaviour toward people. We studied the effect of several explanatory variables on aggressive behaviour with multiple logistic regression. Several factors increased the probability of aggressive behaviour toward people: older age, being male, fearfulness, small body size, lack of conspecific company, and being the owner's first dog. The probability of aggressive behaviour also differed between breeds. These results replicate previous studies and suggest that improvements in the owner education and breeding practices could alleviate aggressive behaviour toward people while genetic studies could reveal associated hereditary factors.

2021 AAHA/AAFP Feline Life Stage Guidelines

The guidelines, authored by a Task Force of experts in feline clinical medicine, are an update and extension of the AAFP-AAHA Feline Life Stage Guidelines published in 2010. The guidelines are published simultaneously in the Journal of Feline Medicine and Surgery (volume 23, issue 3, pages 211-233, DOI: 10.1177/1098612X21993657) and the Journal of the American Animal Hospital Association (volume 57, issue 2, pages 51-72, DOI: 10.5326/JAAHA-MS-7189). A noteworthy change from the earlier guidelines is the division of the cat's lifespan into a five-stage grouping with four distinct age-related stages (kitten, young adult, mature adult, and senior) as well as an end-of-life stage, instead of the previous six. This simplified grouping is consistent with how pet owners generally perceive their cat's maturation and aging process, and provides a readily understood basis for an evolving, individualized, lifelong feline healthcare strategy. The guidelines include a comprehensive table on the components of a feline wellness visit that provides a framework for systematically implementing an individualized life stage approach to feline healthcare. Included are recommendations for managing the most critical health-related factors in relation to a cat's life stage. These recommendations are further explained in the following categories: behavior and environmental needs; elimination; life stage nutrition and weight management; oral health; parasite control; vaccination; zoonoses and human safety; and recommended diagnostics based on life stage. A discussion on overcoming barriers to veterinary visits by cat owners offers practical advice on one of the most challenging aspects of delivering regular feline healthcare.

2021 AAHA/AAFP Feline Life Stage Guidelines

The guidelines, authored by a Task Force of experts in feline clinical medicine, are an update and extension of the AAFP-AAHA Feline Life Stage Guidelines published in 2010. The guidelines are published simultaneously in the Journal of Feline Medicine and Surgery (volume 23, issue 3, pages 211-233, DOI: 10.1177/1098612X21993657) and the Journal of the American Animal Hospital Association (volume 57, issue 2, pages 51-72, DOI: 10.5326/JAAHA-MS-7189). A noteworthy change from the earlier guidelines is the division of the cat's lifespan into a five-stage grouping with four distinct age-related stages (kitten, young adult, mature adult, and senior) as well as an end-of-life stage, instead of the previous six. This simplified grouping is consistent with how pet owners generally perceive their cat's maturation and aging process, and provides a readily understood basis for an evolving, individualized, lifelong feline healthcare strategy. The guidelines include a comprehensive table on the components of a feline wellness visit that provides a framework for systematically implementing an individualized life stage approach to feline healthcare. Included are recommendations for managing the most critical health-related factors in relation to a cat's life stage. These recommendations are further explained in the following categories: behavior and environmental needs; elimination; life stage nutrition and weight management; oral health; parasite control; vaccination; zoonoses and human safety; and recommended diagnostics based on life stage. A discussion on overcoming barriers to veterinary visits by cat owners offers practical advice on one of the most challenging aspects of delivering regular feline healthcare.

Prescription drug monitoring program policy reform: human and veterinary practitioner prescribing in West Virginia, 2008-2020

No study has examined Prescription Drug Monitoring Program (PDMP) data for West Virginia or among specialty practices, such as veterinary medicine. The objectives of this study were to conduct time series modeling to describe the PDMP policy reform impact on prescribing rates for human and veterinary providers. We obtained data from the WV PDMP for 2008 through 2020 for the number of opioid prescriptions filled and providers. We estimated prescribing rates for human and veterinary providers separately based upon the top five opioids prescribed by veterinarians. We estimated temporal effects using a Bayesian log-normal time series model for humans and veterinarians separately. Throughout the study period prescribing rates increased significantly for veterinarians, and decreased for human providers, particularly during 2018 after implementation of the Opioid Reduction Act. Findings provide novel insight into the differential impact of policy on specialty practices and highlight decreasing human opioid prescribing observed elsewhere.

Comparing the behaviour of dogs before and after enucleation due to glaucoma

PURPOSE

There is limited literature on owner's attitudes towards enucleation and behavioural changes after enucleation in dogs. The aim of this study is to investigate the owner's perception of canine enucleation as well as gain insight into the behavioural changes of dogs before and after enucleation due to glaucoma.

METHODS

This retrospective study involved a questionnaire sent to the owners whose dogs were diagnosed with glaucoma and underwent enucleation at the Queen Mother Hospital for Animals between June 2015 and January 2018. Owners were asked about their attitude towards enucleation, and to assess factors that affect their dogs' behaviours (appetite, general activity, playfulness and lethargy) at three time points: before enucleation, immediately after and 2 months after (TMA) enucleation.

RESULTS

Twenty-six of 45 questionnaires were completed and returned by the owners. TMA enucleation showed the most strongly positive responses indicating that owners perceived an improvement in the behaviours of their pets. 96% of participants were happy with their decision to go ahead with the surgery; and no participants regretted opting for enucleation.

CONCLUSION

The present study found expression of "normal" behaviour to increase after enucleation.

Clinical, CT, and ultrasonographic features of canine and feline pleural and peritoneal carcinomatosis and sarcomatosis

Carcinomatosis and sarcomatosis describe the widespread dissemination of metastatic neoplastic cells throughout the body. Studies describing their clinical and imaging features in veterinary patients are limited. The objective of this retrospective, multicenter, cross-sectional study is to describe the clinical, ultrasonographic, and CT features of pleural and peritoneal carcinomatosis and sarcomatosis in dogs and cats to aid detection and differentiation of these lesions. Medical records and CT and ultrasonographic images were reviewed. Although a large degree of overlap was observed between the imaging features and clinical signs of canine and feline carcinomatosis and sarcomatosis, some distinguishing features were observed. Dogs were significantly more likely to present with abdominal pain compared to cats (P = .022), whereas cats more commonly presented with inappetence (P = .019). Dogs with sarcomatosis had a significantly heavier bodyweight than dogs with carcinomatosis (P = .005), largely due to a higher prevalence of splenic hemangiosarcoma in this patient cohort. Peritoneal effusion was more frequently observed in dogs with carcinomatosis compared to dogs with sarcomatosis (P = .021). Imaging and clinical features observed in this study may help to distinguish sarcomatosis and carcinomatosis lesions. Due to the large degree of overlap observed, cytological or histopathological analysis is recommended for definitive diagnosis.

Respiratory and antinociceptive effects of dexmedetomidine and doxapram in ball pythons (Python regius)

OBJECTIVE

To determine the effects of dexmedetomidine, doxapram, and dexmedetomidine plus doxapram on ventilation ([Formula: see text]e), breath frequency, and tidal volume (Vt) in ball pythons (Python regius) and of doxapram on the thermal antinociceptive efficacy of dexmedetomidine.

ANIMALS

14 ball pythons.

PROCEDURES

Respiratory effects of dexmedetomidine and doxapram were assessed with whole-body, closed-chamber plethysmography, which allowed for estimates of [Formula: see text]e and Vt. In the first experiment of this study with a complete crossover design, snakes were injected, SC, with saline (0.9% NaCl) solution, dexmedetomidine (0.1 mg/kg), doxapram (10 mg/kg), or dexmedetomidine and doxapram, and breath frequency, [Formula: see text]e, and Vt were measured before and every 30 minutes thereafter, through 240 minutes. In the second experiment, antinociceptive efficacy of saline solution, dexmedetomidine, and dexmedetomidine plus doxapram was assessed by measuring thermal withdrawal latencies before and 60 minutes after SC injection.

RESULTS

Dexmedetomidine significantly decreased breath frequency and increased Vt but did not affect [Formula: see text]e at all time points, compared with baseline. Doxapram significantly increased [Formula: see text]e, breath frequency, and Vt at 60 minutes after injection, compared with saline solution. The combination of dexmedetomidine and doxapram, compared with dexmedetomidine alone, significantly increased [Formula: see text]e at 30 and 60 minutes after injection and did not affect breath frequency and Vt at all time points. Thermal withdrawal latencies significantly increased when snakes received dexmedetomidine or dexmedetomidine plus doxapram, versus saline solution.

CONCLUSIONS AND CLINICAL RELEVANCE

Concurrent administration of doxapram may mitigate the dexmedetomidine-induced reduction of breathing frequency without disrupting thermal antinociceptive efficacy in ball pythons.

Treatment of the Clinical Symptoms of Osteoarthritis in the Elbow Joints of Dogs Using Nuclear Magnetic Resonance Therapy: A Randomized, Double-Blinded Trial

Objectives: To evaluate the effects of nuclear magnetic resonance therapy (MBST®) on the clinical symptoms of osteoarthritis (OA) in the elbow joints of dogs.

Methods: In this double-blind study, 28 dogs with lameness caused by OA in the elbow joint were randomly allocated to two groups: 14 dogs received nuclear magnetic resonance (NMR) therapy [treatment group (TG)], and 14 dogs received a placebo [placebo group (PG)] over a period of 7 consecutive days. Visual and objective gait analyses were performed before treatment (M1) and at 3 (M2) and 6 months (M3) after treatment. At M2 and M3 Symmetry indices (SI) of the peak vertical force (PVFz) and the vertical impulse (IFz), lameness scores, and pain scores were compared with their values at M1 to calculate the overall treatment effectiveness (OTE) score. We also documented additional pain medication and medical physiotherapy during the time of study. Finally, we measured the range of motion (ROM) in order to evaluate the functional development of the joint.

Results: The median OTE score of dogs in the TG indicates no change after 3 month and was improved after 6 months of treatment. There was an improvement of the median OTE score of dogs in the PG after 3 months of treatment. Further, the OTE scores of dogs in the PG were actually worse after 6 months.

Nevertheless, there were no significance differences in SIPVFz, SIIFz, ROM, and lameness- and pain scores between the TG and PG at M1, M2, and M3. When considering all collected parameters (excluding the ROM) to calculate the OTE, no significant difference between groups was measurable for the OTE.

Conclusion: There was a positive effect of NMR therapy (MBST®) on the treatment of OA in dogs. However, future studies should investigate the mechanisms underlying NMR therapy and the pathophysiology of OA to provide optimal treatments for patients.

Clinical Significance: Our results demonstrated that the response to NMR treatment was individualized for each dog. As an integral way of treating dogs with chronic OA, NMR therapy may be an alternative therapeutic approach to support traditional medications.

Feline musculoskeletal ageing: How are we diagnosing and treating musculoskeletal impairment?

PRACTICAL RELEVANCE

An understanding of the process of musculoskeletal ageing - which all senior and geriatric cats will experience - is vital to maintaining the health and welfare of our ageing cat population.

CLINICAL CHALLENGES

Assessment of the feline musculoskeletal system is not always straightforward. Diagnosis of impairment relies on input from owners and veterinarians in terms of visual observation, and clinical and orthopaedic examination, in addition to diagnostic imaging.

AUDIENCE

This review is written for the primary care veterinary team.

AIMS

The goals are to raise awareness and improve clinical diagnosis of musculoskeletal impairment as a result of ageing. The article also reviews therapeutic options and considers the evidence available for the prevention/deceleration of musculoskeletal ageing and impairment.

EVIDENCE BASE

There is good evidence of a high prevalence of osteoarthritis (OA) and degenerative joint disease (DJD) in older cats. There is also good evidence to indicate that functional impairment and chronic pain are sequelae of musculoskeletal disease. However, there is a paucity of information for what is best practice for the management and treatment of musculoskeletal impairment in a clinical situation. There is also a lack of evidence on how prevention of central stimulation of the nervous system caused by musculoskeletal impairment and, in turn the development of chronic pain, can be avoided.

Feasibility and efficacy of ultrasonographic and laparoscopic guidance for microwave ablation of clinically normal canine ovaries

OBJECTIVE

To determine the optimal energy profile for and to assess the feasibility and efficacy of ultrasonographic and laparoscopic guidance for microwave ablation (MWA) of clinically normal canine ovaries.

SAMPLE

44 extirpated ovaries from 22 healthy dogs.

PROCEDURES

In the first of 2 trials, 13 dogs underwent oophorectomy by routine laparotomy. Extirpated ovaries underwent MWA at 45 W for 60 (n = 11) or 90 (12) seconds; 3 ovaries did not undergo MWA and served as histologic controls. Ovaries were histologically evaluated for cell viability. Ovaries without viable cells were categorized as completely ablated. Histologic results were used to identify the optimal MWA protocol for use in the subsequent trial. In the second trial, the ovaries of 9 dogs underwent MWA at 45 W for 90 seconds in situ. Ultrasonographic guidance for MWA was deemed unfeasible after evaluation of 1 ovary. The remaining 17 ovaries underwent MWA with laparoscopic guidance, after which routine laparoscopic oophorectomy was performed. Completeness of ablation was histologically assessed for all ovaries.

RESULTS

2 ovaries were excluded from the trial 1 analysis because of equivocal cell viability. Six of 11 ovaries and 10 of 10 ovaries that underwent MWA for 60 and 90 seconds, respectively, were completely ablated. In trial 2, laparoscopic-guided MWA resulted in complete ablation for 12 of 17 ovaries. Dissection of the ovarian bursa for MWA probe placement facilitated complete ablation.

CONCLUSIONS AND CLINICAL RELEVANCE

Laparoscopic-guided MWA at 45 W for 90 seconds was feasible, safe, and effective for complete ablation of clinically normal ovaries in dogs.

Motivations and expectations for using cannabis products to treat pain in humans and dogs: a mixed methods study

BACKGROUND

Social media and academic literature suggest that more people are using cannabis to treat their own or their dog's chronic pain. This study identifies the reasons people use cannabis products to treat their own pain or their dog's pain and explores whether these products have fulfilled their expectations.

METHODS

An anonymous, online survey was used to collect quantitative and qualitative self-report data on respondents' perceptions, motivations and expectations about their or their dog's chronic pain and cannabis use. The analyses are based on U.S. adults who reported using cannabis products to treat their own (N = 313) or their dog's (N = 204) chronic pain. Quantitative responses from the two groups were compared using Chi-Square tests and qualitative data were analyzed using a thematic analysis.

RESULTS

Human patients and dog owners reported similar motivations for using cannabis products to treat chronic pain, with the more popular reasons being that cannabis products are natural, are preferred over conventional medication, are believed to be the best treatment or good treatment option for pain. Similar proportions of human patients and dog owners reported that the use of cannabis products fulfilled their expectations (86% vs. 82% respectively, χ2 (1, 200) = .59, p = .32). The qualitative data revealed that their expectations were met by reducing pain, increasing relaxation, and improving sleep, coping, functionality and overall well being. Additionally, the qualitative data suggests that cannabis products offer a return to normalcy and a restored sense of self to human and dog patients.

CONCLUSIONS

The results suggest that people choose cannabis products because they are natural and a possible solution to managing chronic pain when conventional medicines have not been effective. Most people report that their expectations regarding pain management are fulfilled by these products. More accurate assessments are vital, however, for understanding both the objective biomedical and subjective socioemotional benefits of cannabis products for effective pain management for human and dog patients. In addition, objective factual information regarding cannabis products for effective pain management in humans and dogs is needed. It is recommended that both physicians and veterinarians work towards feeling more comfortable proactively broaching the subject of cannabis use with additional training and education.

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.

Influência do tramadol associado à levobupicavaína epidural sobre a taxa de propofol e variáveis fisiológicas, em cadelas submetidas à mastectomia e à ovário-histerectomia

RESUMO Objetivou-se avaliar os efeitos fisiológicos e sobre o consumo do propofol, relativos à anestesia epidural com levobupivacaína isolada ou associada a diferentes doses de tramadol. Para tal, 18 cadelas foram pré-tratadas com acepromazina, utilizando-se propofol para indução e manutenção anestésicas. Conforme o protocolo epidural instituído, formaram-se três grupos (n=6) tratados com levobupivacaína isolada (1,5mg/kg) (GL) ou acrescida de 2mg/kg (GLT2) ou 4mg/kg (GLT4) de tramadol, respectivamente. As fêmeas foram submetidas à mastectomia e à ovário-histerectomia (OH), registrando-se as variáveis fisiológicas nos períodos pré (TB e T0) e transanestésicos (T10 a T70), bem como a taxa mínima de propofol necessária. Houve redução da FC para o GL e o GLT4 em relação ao GLT2 (T30 a T70), detectando-se, no GL, redução da PAS e da PAD em relação ao TB. Maiores taxas de infusão do propofol foram necessárias para o GL (0,70±0,12mg/kg/min) em relação ao GLT2 (0,50±0,19mg/kg/min) e ao GLT4 (0,50±0,19mg/kg/min). Conclui-se que o tramadol potencializou o propofol, ao ofertar analgesia, independentemente da dose administrada. Todos os protocolos testados foram seguros e eficazes em cadelas submetidas à mastectomia e à OH.

Pain in child patients: A review on managements

Pain has been known as one of the major universal health concerns about ill children, because of its morbidity and potential mortality. Pain suitable evaluation is a challenge in children because the verbalization is difficult. Low clinical information, few pediatric researches, and the worry of opioid side effects make difficult to provide satisfactory treatments. Many pharmacologic and non-pharmacologic strategies to manage pain exist for pediatric pain treatment. The purpose of this review article is to describe exhaustively pain mechanism, evaluation and management by review literature from January 2000 to January 2019 using PubMed, EMBASE, MEDLINE, LILACS databases. Pharmacological and integrative non-pharmacological therapies has been indicated in acute and chronic pain treatment. Opioids and opioid-sparing agents target nociceptive and neuropathic pain. With due attention to available results, an early combination of pharmacological and integrative non pharmacological treatments are indicated in children pain management.

Assessment of Veterinary Students' Responses to Questions Regarding Small Animal Pain Recognition and Analgesic Treatment Options

Pain recognition and treatment in companion animals are important aspects of veterinary medicine, yet the teaching of these concepts may not be adequate at all academic institutions. This study was designed to evaluate veterinary students' ability to recall signs of pain and specific analgesic drugs in dogs and cats. We hypothesized that students in the fourth, or final, year of their veterinary curriculum would have a better understanding of pain recognition and be able to recall more analgesic options. A brief, voluntary, and anonymous open question survey was made available to all veterinary students, years 1 to 4, at our institution. The questions included, "How does a cat/dog show signs of pain?" and "What pain medications are used in cats/dogs?" Survey responses were collated according to the students' year in the curriculum, and the most common responses for signs of pain and analgesic medications recalled by the students in both the cat and dog were compared for significant differences. Results showed that students in the class of 2017 (seniors) had no superior recall of analgesic medications or recognition of pain in cats or dogs compared to the other classes. Vocalization was the most common sign of pain recalled with at least 50% responses from all classes. Carprofen was the most commonly recalled analgesic for dogs (the difference between classes, p = .04). Meloxicam was the most commonly recalled analgesic for cats (the difference among classes, p < .001). Based on these results, areas of improvement were identified for our analgesic curriculum.

Feline Neuropathic Pain

Neuropathic pain represents the extreme in maladaptive pain processing. In itself, it is a disease in which pain has become exaggerated in some combination of scope, severity, character, field, duration, and spontaneity. It is almost certainly an underappreciated, underdiagnosed cause of possible significant patient morbidity in cats. This article explores the basic mechanisms, recognition, known and suspect syndromes, and prospective treatment of feline maladaptive and neuropathic pain.

Neutering in dogs and cats: current scientific evidence and importance of adequate nutritional management

Neutering or spaying is a commonly recommended veterinary procedure. However, veterinarians are often confronted with conflicting findings and differences in concepts regarding practice and proper nutritional management after the procedure. The objective of the present review was to bring to light the most recent literature, summarise it and discuss the findings focusing on the risks and benefits of neutering in dogs and cats, and to determine the appropriate nutritional management for these animals.

Pain in child patients: A review on managements

Pain has been known as one of the major universal health concerns about ill children, because of its morbidity and potential mortality. Pain suitable evaluation is a challenge in children because the verbalization is difficult. Low clinical information, few pediatric researches, and the worry of opioid side effects make difficult to provide satisfactory treatments. Many pharmacologic and non-pharmacologic strategies to manage pain exist for pediatric pain treatment. The purpose of this review article is to describe exhaustively pain mechanism, evaluation and management by review literature from January 2000 to January 2019 using PubMed, EMBASE, MEDLINE, LILACS databases. Pharmacological and integrative non-pharmacological therapies has been indicated in acute and chronic pain treatment. Opioids and opioid-sparing agents target nociceptive and neuropathic pain. With due attention to available results, an early combination of pharmacological and integrative non pharmacological treatments are indicated in children pain management.

Pharmacokinetics of morphine in combination with dexmedetomidine and maropitant following intramuscular injection in dogs anaesthetized with halothane

The purpose of this study was to evaluate the pharmacokinetics of morphine in combination with dexmedetomidine and maropitant injected intramuscularly in dogs under general anaesthesia. Eight healthy dogs weighing 25.76 ± 3.16 kg and 3.87 ± 1.64 years of age were used in a crossover study. Dogs were randomly allocated to four groups: (1) morphine 0.6 mg/kg; (2) morphine 0.3 mg/kg + dexmedetomidine 5 μg/kg; (3) morphine 0.3 mg/kg + maropitant 1 mg/kg; (4) morphine 0.2 mg/kg + dexmedetomidine 3 μg/kg + maropitant 0.7 mg/kg. Blood samples were collected before, 15 and 30 min, and 1, 2, 3 4, 6 and 8 hr after injection of the test drugs. Plasma concentration of the drugs was determined by liquid chromatography-mass spectrometry. The elimination half-life (T_1/2 ) of morphine was higher and the clearance rate (CL) was lower when combined with dexmedetomidine (T_1/2  = 77.72 ± 20.27 min, CL = 119.41 ± 23.34 ml kg^-1  min^-1 ) compared to maropitant (T_1/2  = 52.73 min ± 13.823 ml kg^-1  min^-1 , CL = 178.57 ± 70.55) or morphine alone at higher doses (T_1/2  = 50.53 ± 12.55 min, CL = 187.24 ± 34.45 ml kg^-1  min^-1 ). Combining morphine with dexmedetomidine may increase the dosing interval of morphine and may have a clinical advantage.

Review of different methods used for clinical recognition and assessment of pain in dogs and cats

In light of the need to perform surgical techniques and the importance of animal welfare because of acute pain, the objectives of the veterinary anaesthetists are to manage muscle relaxation and adequate analgesia in order to conserve a balance in the autonomic nervous system, enhance the action of the parasympathetic system in the face of the emerging action of the sympathetic portion provoked by the surgeon, and maintain a balance among them. The aim of the present review is to describe different evaluation criteria for acute pain using unidimensional and multidimensional scales, correlating these findings to parasympathetic tone activity (PTA) and bispectral index (BIS) assessment, to conduct an objective evaluation of pain that patients (dog or cat) perceives, in order to administrate an adequate analgesic treatment in each case. In conclusion, this integral, objective evaluation will allow veterinarians – especially anaesthesiologists – to improve the management of pain in the patients.

The US Opioid Epidemic and Its Impact on US General Practice Veterinarians

Objective: To assess the impact of the human opioid epidemic and associated shortages in drug supply on US general practice veterinarians. Design: Cross-sectional study. Sample: Members of the Veterinary Information Network (VIN). Procedures: An electronic survey was used to examine veterinarians' views regarding opioid use in veterinary medicine and the impact of the opioid shortage on the provision of care. The survey was distributed via the VIN data collection portal from October 12-November 6, 2018. Results: 697 veterinarians completed the survey. Most (99.7%) reported using, dispensing or prescribing opioids in veterinary practice. The most commonly used opioids were buprenorphine, tramadol and butorphanol. While most veterinarians (83.3%) reported difficulty in ordering opioids over the last 6 months, this decreased to 59.0% in the last month. The most difficult drugs to obtain were hydromorphone, morphine, injectable fentanyl, and oxymorphone. The reported rate of difficulty in obtaining all these drugs lessened over time. However, the opioid shortage caused significant difficulty in providing appropriate pain management for 41.1% of participants, and affected the ability of 44.8% of respondents to provide optimal anesthesia. Conclusions and Clinical Relevance: Veterinarians' ability to provide opioids for their patients has been impacted by the opioid shortage, with a greater impact on full mu opioid agonists as compared to drugs like butorphanol, buprenorphine, and tramadol. The results confirm the important role of opioid analgesics in the delivery of modern veterinary medicine and highlight the importance of medical health professionals being able to access these critical medications.

First evidence for an association between joint hypermobility and excitability in a non-human species, the domestic dog

There is a well-established relationship between joint hypermobility and anxiety in humans, that has not previously been investigated in other species. A population of 5575 assistance dogs were scored for both hip hypermobility and 13 behaviour characteristics using previously validated methods. Our results suggest a positive association between hip joint hypermobility and emotional arousal in domestic dogs, which parallel results found in people.