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Reed RA, Berghaus LJ, Reynolds RM, Holmes BT, Krikorian AM, Sakai DM, Ishikawa Y, Knych HK. The pharmacokinetics and pharmacodynamics of fentanyl administered via transdermal patch in horses. FRONTIERS IN PAIN RESEARCH 2024; 5:1373759. [PMID: 38571562 PMCID: PMC10987731 DOI: 10.3389/fpain.2024.1373759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Understanding the pharmacokinetics and pharmacodynamics of fentanyl in horses is crucial for optimizing pain management strategies in veterinary medicine. Methods Six adult horses were enrolled in a randomized crossover design. Treatments included: placebo, two 100 mcg/h patches (LDF), four 100 mcg/h patches (MDF), and six 100 mcg/h patches (HDF). Patches were in place for 72 h. Blood was obtained for fentanyl plasma concentration determination, thermal threshold, mechanical threshold, heart rate, respiratory rate, and rectal temperature were obtained prior patch placement and at multiple time points following patch placement for the following 96 h. Fentanyl plasma concentration was determined using LC-MS/MS. Data were analyzed using a generalized mixed effects model. Results Mean (range) maximum plasma concentration (Cmax), time to Cmax, and area under the curve extrapolated to infinity were 1.39 (0.82-1.82), 2.64 (1.21-4.42), 4.11 (2.78-7.12) ng/ml, 12.7 (8.0-16.0), 12.7 (8.0-16.0), 12 (8.0-16.0) h, 42.37 (27.59-55.56), 77.24 (45.62-115.06), 120.34 (100.66-150.55) h ng/ml for LDF, MDF, and HDF, respectively. There was no significant effect of treatment or time on thermal threshold, mechanical threshold, respiratory rate, or temperature (p > 0.063). There was no significant effect of treatment on heart rate (p = 0.364). There was a significant effect of time (p = 0.003) on heart rate with overall heart rates being less than baseline at 64 h. Conclusions Fentanyl administered via transdermal patch is well absorbed and well tolerated but does not result in an anti-nociceptive effect as measured by thermal and mechanical threshold at the doses studied.
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Affiliation(s)
- Rachel A. Reed
- Department of Large Animal Medicine, University of Georgia, Athens, GA, United States
| | - Londa J. Berghaus
- Department of Large Animal Medicine, University of Georgia, Athens, GA, United States
| | - Rose M. Reynolds
- Department of Large Animal Medicine, University of Georgia, Athens, GA, United States
| | - Brittany T. Holmes
- Department of Large Animal Medicine, University of Georgia, Athens, GA, United States
| | - Anna M. Krikorian
- Department of Large Animal Medicine, University of Georgia, Athens, GA, United States
| | - Daniel M. Sakai
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
| | - Yushun Ishikawa
- Sydney School of Veterinary Science, University of Sydney, Camperdown, NSW, Australia
| | - Heather K. Knych
- K.L. Maddy Equine Analytical Pharmacology Laboratory, School of Veterinary Medicine, University of California Davis, Davis, CA, United States
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA, United States
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Ortega McCormack JJ, Reed RA, Epstein KL, Camus MS, Knych HK. Longitudinal evaluation of fentanyl concentrations in equine plasma and synovial fluid following application of transdermal fentanyl patches over one carpal joint. Vet Surg 2023; 52:1150-1157. [PMID: 37537748 DOI: 10.1111/vsu.13990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/12/2023] [Accepted: 06/18/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To determine if transdermally delivered fentanyl can achieve greater concentrations of fentanyl in synovial fluid when applied over a synovial structure. STUDY DESIGN Randomized, experimental study. ANIMALS Six healthy adult horses. METHODS Each horse had two 100 μg/h fentanyl matrix patches applied on the dorsal aspect of one, randomly assigned, carpometacarpal joint (CMCJ) for 48 h. Whole blood and bilateral synovial samples from the intercarpal joint were obtained at 0, 2, 6, 12, 24, 36 and 48 h. Fentanyl concentrations were measured with liquid chromatography-mass spectrometry. RESULTS All subjects achieved detectable concentrations of fentanyl in both plasma and synovial fluid. Time to peak synovial and plasma concentration was 12 h. At 6 h, the synovial concentration in the untreated carpus (0.104 ng/mL ± 0.106) was lower than plasma fentanyl concentrations 0.31 ± 0.27 (p = .036). At 12 h, both treated (0.55 ng/mL ± 0.3) and untreated (0.53 ng/mL ± 0.28) synovial fluid fentanyl concentrations were lower than plasma (0.87 ng/mL ± 0.48) concentrations (p < .001 and p = .001, respectively). Synovial concentrations of fentanyl did not differ between treated and untreated joints (p > 0.608 for all time points). CONCLUSION Application of fentanyl matrix patches directly over the CMCJ did not result in increased fentanyl concentrations in the synovial fluid of the treated intercarpal joint in normal horses. CLINICAL SIGNIFICANCE There is likely no analgesic advantage to placing fentanyl patches directly over the affected joint, as it did not result in increased synovial concentrations at the tested site.
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Affiliation(s)
- John J Ortega McCormack
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Rachel A Reed
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Kira L Epstein
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Melinda S Camus
- Department of Pathobiology, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Heather K Knych
- KL Maddy Equine Analytical Pharmacology Lab, University of California, Davis, California, USA
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Aldrich LA, Upchurch DA, Roush JK. Blinded, randomized, placebo-controlled study of the efficacy of bupivacaine liposomal suspension using static bodyweight distribution and subjective pain scoring in dogs after tibial plateau leveling osteotomy surgery. Vet Surg 2023. [PMID: 37114870 DOI: 10.1111/vsu.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/12/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To compare the analgesic effect of surgical wound infiltration with liposomal bupivacaine (LB) to saline placebo in dogs after tibial plateau leveling osteotomy (TPLO). STUDY DESIGN Blinded, randomized, placebo-controlled clinical prospective study. ANIMALS Fifteen client-owned dogs receiving LB and 17 dogs receiving an equivalent volume of saline placebo, all with confirmed unilateral cranial cruciate ligament insufficiency. METHODS Preoperatively and up to 48 h after surgery, Glasgow Composite Measure Short Form (CMPS-SF) pain scores were assigned and using a weight distribution platform, static bodyweight distribution (%BWdist ) to the operated limb was measured. Postoperatively, dogs also received carprofen 2.2 mg/kg subcutaneously every 12 h. Rescue analgesia was provided. Treatment success was defined as not requiring rescue analgesia over the 48-h postoperative period. RESULTS There was no difference between treatment success, postoperative opioid consumption, CMPS-SF pain scores, or %BWdist in dogs that received surgical wound infiltration with LB compared with those receiving saline placebo, following TPLO. There was no linear correlation between CMPS-SF pain scores and %BWdist . CONCLUSION For the population of dogs that underwent TPLO and received postoperative carprofen at our institution, LB did not provide an analgesic effect discernable by success/failure analysis, CMPS-SF pain scores, or %BWdist measurement using a weight distribution platform, compared with saline placebo. CLINICAL SIGNIFICANCE LB may not provide detectable analgesia during the first 48 h for dogs recovering from TPLO and receiving only postoperative carprofen.
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Affiliation(s)
- Lauren A Aldrich
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - David A Upchurch
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - James K Roush
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
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Cattai A, Merlanti R, Bizzotto R, Lucatello L, Capolongo F, Franci P. Development and optimization of a fentanyl pharmacokinetic model for target-controlled infusion in anaesthetized dogs. Vet Anaesth Analg 2023; 50:31-40. [PMID: 35550343 DOI: 10.1016/j.vaa.2021.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 07/01/2021] [Accepted: 08/07/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate pharmacokinetics (PK) of fentanyl administered by target-controlled infusion (TCI), and to develop a PK model optimized by covariates for TCI in anaesthetized dogs. STUDY DESIGN Prospective clinical study. ANIMALS A group of 20 client-owned dogs with spinal pain undergoing anaesthesia for magnetic resonance imaging. METHODS Fentanyl was administered as an infusion to 20 anaesthetized dogs using a TCI system incorporating a previously described fentanyl two-compartment PK. Arterial blood samples were collected at specific time points during the infusion and over 60 minutes post-infusion for measurement of fentanyl plasma concentrations. The predictive performance of the Sano PK model was assessed by comparing predicted and measured plasma concentrations. A population PK analysis was then performed using a nonlinear mixed-effect modelling approach, allowing inter- and intra-individual variability estimation. Finally, a quantitative stepwise evaluation of the influence of various covariates such as weight, body condition score, size, size-related age, sex and type of premedication on the PK model was considered. RESULTS Overall predictive performance of the Sano PK set of variables was not clinically acceptable in anaesthetized dogs. Fentanyl PK was best described by a three-compartment model. Weight and sex were found to affect the volume of distribution of the central compartment. Addition of these two covariate/variable associations resulted in a reduction of the objective function value (OFV) from -340.18 to -448.34, and of the median population weighted residual and the median population absolute weighted residual from 16.1% and 38.6% to 3.9% and 20.3%, respectively. Fentanyl infusions at measured concentrations up to 5.4 ng mL-1 in sevoflurane-anaesthetized dogs resulted in stable anaesthesia and smooth recoveries without complications. CONCLUSIONS AND CLINICAL RELEVANCE A population three-compartment PK model for fentanyl TCI in anaesthetized dogs was developed. Weight and sex have been detected and incorporated as significant covariates.
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Affiliation(s)
| | - Roberta Merlanti
- Department of Comparative Biomedicine and Food Science, Università degli Studi di Padova, Padua, Italy
| | | | - Lorena Lucatello
- Department of Comparative Biomedicine and Food Science, Università degli Studi di Padova, Padua, Italy
| | - Francesca Capolongo
- Department of Comparative Biomedicine and Food Science, Università degli Studi di Padova, Padua, Italy
| | - Paolo Franci
- Department of Veterinary Science, Università degli Studi di Torino, Turin, Italy
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Marques ÉJ, Monteiro ER, Herrera-Becerra JR, Tomazeli D, Rovaris IB, de Oliveira TF, Valle SDF, Alievi MM. Influence of Constant Rate Infusions of Fentanyl Alone or in Combination With Lidocaine and Ketamine on the Response to Surgery and Postoperative Pain in Isoflurane Anesthetized Dogs Undergoing Unilateral Mastectomy: A Randomized Clinical Trial. Top Companion Anim Med 2023; 52:100759. [PMID: 36587868 DOI: 10.1016/j.tcam.2022.100759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/03/2022] [Accepted: 12/24/2022] [Indexed: 12/30/2022]
Abstract
The aim of this study was to compare the effects of constant rate infusions (CRI) of fentanyl alone or combined with lidocaine and ketamine (FLK), on physiological parameters, isoflurane requirements and the number of postoperative analgesic rescues in dogs undergoing unilateral mastectomy. Twenty-two dogs were premedicated with acepromazine 0.02 mg/kg and morphine 0.5 mg/kg and anesthetized with propofol and isoflurane. Dogs were randomly assigned to 1 of 2 groups: Fentanyl group (fentanyl 5 µg/kg loading dose [LD] and 9 µg/kg/h CRI; n = 11); FLK group (fentanyl [same doses]; lidocaine 2 mg/kg LD and 3 mg/kg/h CRI; ketamine 1.0 mg/kg LD and 0.6 mg/kg/h CRI; = 11). Intraoperative evaluations were performed before the start of surgery and administration of the treatments (T0); three minutes after the LD (T1); during incision and tissue divulsion (T2); during closure of the surgical wound (T3). Meloxicam (0.1 mg/kg) was administered at T3. Blood samples were collected for determination of plasma concentrations of fentanyl, lidocaine and ketamine. Pain scores and the number of postoperative analgesic rescues with morphine (0.5 mg/kg) were evaluated for 24 hours postoperatively using the short form of the Glasgow Composite Measure Pain Scale. Compared to T0, significant decreases in heart rate (from 84 ± 28 to 53 ± 16 bpm in the Fentanyl group and from 93 ± 16 to 63 ± 15 bpm in FLK) and mean arterial pressure (from 61 ± 5 to 49 ± 10 mmHg in Fentanyl and from 59 ± 3 to 38 ± 6 mmHg in FLK) were observed at T1. Arterial hypotension was transient, with normalization of values at T2 and T3. The expired fraction of isoflurane did not differ significantly between the groups. Plasma concentrations of fentanyl, lidocaine and ketamine remained within the therapeutic range. Postoperatively, the number of dogs requiring analgesic rescue was significantly lower in the FLK (0/11, 0%) than in the Fentanyl group (5/11, 45%). In dogs administered morphine and meloxicam as part of the anesthesia protocol, an intraoperative CRI of FLK abolished the requirement for postoperative analgesic rescue for 24 hours in dogs undergoing mastectomy.
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Affiliation(s)
- Éder J Marques
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo R Monteiro
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - José R Herrera-Becerra
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Débora Tomazeli
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Inácio B Rovaris
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Tiago F de Oliveira
- Pharmacosciences Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Stella de F Valle
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcelo M Alievi
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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de Moura RS, Bittar IP, Gomes JH, de Oliveira YVR, de Sousa Filho GD, de Faria Soares GCF, Lima EM, Franco LG. Plasma concentration, cardiorespiratory and analgesic effects of ketamine-fentanyl infusion in dogs submitted to mastectomy. BMC Vet Res 2022; 18:225. [PMID: 35701767 PMCID: PMC9199142 DOI: 10.1186/s12917-022-03244-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 02/28/2022] [Indexed: 01/12/2023] Open
Abstract
Background The analgesic and cardiorespiratory effects of ketamine, fentanyl, or ketamine-fentanyl constant rate infusion (CRI) in dogs undergoing mastectomy were evaluated. Seventeen female dogs received CRI of ketamine (GK [n = 6]: bolus 0.5 mg/kg; CRI 20 µg/kg/min in intra- and postoperative periods], fentanyl (GF [n = 5]: bolus 20 µg/kg; intraoperative CRI 5 20 µg/kg/hour and postoperative CRI 2 20 µg/kg/hour), or combination of ketamine-fentanyl (GKF [n = 6]: aforementioned doses) for 8 h. Cardiorespiratory, blood gas analyses, plasma drug concentrations, sedation score (SS), Pain Scores were evaluated. Results The heart rate decreased in the GF and GKF (p < 0.04); the mean arterial pressure was lower in the GKF than in the GK at 35 min (p < 0.001). Maximum plasma concentrations were observed 5 min after bolus in the GK (2847.06 ± 2903.03 ng/mL) and GKF (2811.20 ± 1931.76 ng/mL). Plasma concentration in intraoperative period of ketamine was of > 100 ng/mL in 5/5 and 2/5 animals in the GKF and GK, respectively; and > 1.1 ng/mL of fentanyl in 4/5 and 3/5 in GKF and GF, respectively. Conclusion Ketamine with/without fentanyl provided analgesia without significant cardiorespiratory and guaranteed the minimal plasma levels with analgesic potential during the 8 h.
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Affiliation(s)
- Rauane Sousa de Moura
- Department of Veterinary Medicine, Federal University of Goiás, 74.690-900, Goiânia, GO, Brazil
| | - Isabela Plazza Bittar
- Department of Veterinary Medicine, Federal University of Goiás, 74.690-900, Goiânia, GO, Brazil
| | - Janainne Hilbig Gomes
- Department of Veterinary Medicine, Federal University of Goiás, 74.690-900, Goiânia, GO, Brazil
| | | | | | | | - Eliana Martins Lima
- Development and Technological Innovation in Drugs - FarmaTec, Research Center, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Leandro Guimarães Franco
- Department of Veterinary Medicine, Federal University of Goiás, 74.690-900, Goiânia, GO, Brazil.
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Cicirelli V, Aiudi GG, Mrenoshki D, Lacalandra GM. Fentanyl patch versus tramadol for the control of postoperative pain in canine ovariectomy and mastectomy. Vet Med Sci 2021; 8:469-475. [PMID: 34953046 PMCID: PMC8959330 DOI: 10.1002/vms3.691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The purpose of the present study was to evaluate the postoperative analgesic efficacy of fentanyl patches versus subcutaneous tramadol after canine ovariectomy, with and without unilateral mastectomy. MATERIALS AND METHODS A total of 40 female dogs were included in the present study, all of which were domesticated, healthy and 4-12 years of age. The animals were divided into four groups (n = 10 per group) based on the surgery and the analgesic protocol used: the TO group only underwent ovariectomy, and received postoperative tramadol; the TM group underwent both ovariectomy and mastectomy, and received postoperative tramadol; the FO group only underwent ovariectomy, and received fentanyl patches; and the FM group underwent both ovariectomy and mastectomy, and received fentanyl patches. Postoperative pain was evaluated every 4 h for 24 h using a numeric analogue scale (NAS) and a modified Glasgow Composite Measure Pain Scale Short Form (CMPS-SF). RESULTS The results of the present study showed that patients in all four groups tolerated postoperative surgical stress well. Analysis of variance for repeated measures did not show significant differences in the NAS scores and in Glasgow CMPS-SF between groups in terms of pain scores or rescue analgesia. CLINICAL SIGNIFICANCE These results indicated that the analgesic effect of the fentanyl patch was similar to that of subcutaneous (SC) tramadol in female dogs after ovariectomy, with and without unilateral mastectomy, suggesting that the fentanyl patch may represent a valid supplementary tool for the control of postoperative pain in animals after surgery.
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Affiliation(s)
- Vincenzo Cicirelli
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Giulio G Aiudi
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Daniela Mrenoshki
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Bari, Italy
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Effect of Fentanyl Infusion on Heart Rate Variability and Anaesthetic Requirements in Isoflurane-Anaesthetized Horses. Animals (Basel) 2021; 11:ani11102922. [PMID: 34679943 PMCID: PMC8532720 DOI: 10.3390/ani11102922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Controversy continues to surround the use of opioids in equine anaesthesia, with variable effects reported. This blinded clinical study aimed to investigate the influence of a low-dose fentanyl continuous rate infusion (CRI) on isoflurane requirements, parasympathetic tone activity (PTA), and anaesthetic parameters in horses during general anaesthesia. All of the twenty-two horses included in the research underwent a standard anaesthetic protocol. Eleven horses in the fentanyl group (Group F) received a loading dose of fentanyl at 6 µg/kg, followed by a CRI of 0.1 µg/kg/min during anaesthesia. A further 11 horses in the control group (Group C) received equivalent volumes of normal saline. Anaesthetic parameters and PTA index were recorded during anaesthesia. The achieved mean fentanyl plasma concentration was 6.2 ± 0.83 ng/mL. No statistically significant differences between groups were found in isoflurane requirements, MAP values, and mean dobutamine requirements. However, horses in Group F required a significantly lower dose of additional ketamine to maintain a sufficient depth of anaesthesia. Significantly higher PTA values were found in the fentanyl group. Further research is warranted to determine the limitations of PTA monitoring, and the influence of various anaesthetics on its values.
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Evaluation of the analgesic effect of fentanyl-ketamine and fentanyl-lidocaine constant rate infusions in isoflurane-anesthetized dogs undergoing thoracolumbar hemilaminectomy. Vet Anaesth Analg 2021; 48:407-414. [PMID: 33736938 DOI: 10.1016/j.vaa.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate anesthetic conditions and postoperative analgesia with the use of intraoperative constant rate infusions (CRIs) of fentanyl-lidocaine or fentanyl-ketamine in dogs undergoing thoracolumbar hemilaminectomy. STUDY DESIGN Prospective, randomized, blinded, clinical study. ANIMALS A total of 32 client-owned dogs. METHODS Dogs were premedicated with fentanyl (5 μg kg-1) administered intravenously (IV), anesthesia was induced with IV alfaxalone and maintained with isoflurane. Fentanyl (0.083 μg kg-1 minute-1) was infused IV with either ketamine (0.5 mg kg-1; then 40 μg kg-1 minute-1; group KF) or lidocaine (2 mg kg-1; then 200 μg kg-1 minute-1; group LF) assigned randomly. Heart rate, noninvasive arterial pressures, respiratory rate, esophageal temperature, end-tidal partial pressure of carbon dioxide and isoflurane concentration were recorded throughout anesthesia. Maintenance of anesthesia, recovery and postoperative pain (Glasgow Composite Pain Scale) were scored. Cardiopulmonary data were analyzed using a two-way anova with repeated measures, demographics of the two groups with a t test, and scores with Mann-Whitney U test, with p < 0.05. RESULTS All dogs recovered from anesthesia without complications. No significant difference was found between groups for cardiopulmonary variables, total anesthesia time, sedation score and requirement for postoperative sedation or for rescue analgesia. Anesthetic maintenance score was of lower quality in KF than in LF [median (interquartile range): 0 (0-0.5) versus 0 (0-0); p = 0.032)], but still considered ideal. Recovery score was higher and indicative of less sedation in LF than in KF [1 (1-1.5) versus 0.5 (0-1); p < 0.0001]. Pain score was higher in KF than in LF [2 (1-3) versus 1 (1-2); p = 0.0009]. CONCLUSIONS AND CLINICAL RELEVANCE Both CRIs of KF and LF provided adequate anesthetic conditions in dogs undergoing thoracolumbar hemilaminectomy. Based on requirement for rescue analgesia, postoperative analgesia was adequate in both groups.
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Skrzypczak H, Reed R, Brainard B, Sakai D, Barletta M, Quandt J, Smyth C, Ruch M, Knych H. The pharmacokinetics of a fentanyl matrix patch applied at three different anatomical locations in horses. Equine Vet J 2021; 54:153-158. [PMID: 33453066 DOI: 10.1111/evj.13424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Matrix fentanyl patches have not been investigated in horses and may represent an effective means of providing analgesia over an extended time period without venous catheterisation. OBJECTIVES To describe the pharmacokinetics of a matrix transdermal fentanyl patch in horses. STUDY DESIGN Randomised experiment, Latin-square design. METHODS Six adult horses were given each of three treatments with a 96-hour washout. For each treatment, two 100 µg/h matrix fentanyl patches were applied to the inguinal region (TXA), metacarpus (TXM) or ventral tail base (TXT) for 72 hours. Blood samples for fentanyl analysis were obtained and heart rate (HR), respiratory rate (RR) and rectal temperature (RT) were measured at various time points for 96 hours. Fentanyl plasma concentrations were measured with LC-MS/MS for pharmacokinetic analysis. A mixed-effects model was used to analyse pharmacodynamic variables. RESULTS The time to maximum plasma concentration, maximum plasma concentration and area under the curve extrapolated to infinity were 10 ± 3.79, 14.3 ± 5.13 and 10.3 ± 4.8 hours; 2.07 ± 0.74, 1.55 ± 0.53 and 2.07 ± 0.72 ng/mL; and 46.6 ± 9.3, 44.6 ± 6.0 and 46.2 ± 7.68 ng hours/mL for TXA, TXM and TXT respectively. There was no significant difference among groups. There was no significant change from baseline or among treatment groups with regard to HR, RR or RT (P > .1 for all). MAIN LIMITATIONS There was no intravenous treatment group for determination of bioavailability. CONCLUSIONS Fentanyl was rapidly absorbed and persisted in the plasma for up to 96 hours. No adverse effects of treatment on HR, RR or RT were observed. Further controlled prospective studies are needed to determine what plasma concentration, if any, of fentanyl achieves an analgesic effect in horses when administered via a transdermal patch system.
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Affiliation(s)
- Heather Skrzypczak
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Rachel Reed
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Benjamin Brainard
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Daniel Sakai
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Michele Barletta
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Jane Quandt
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Carly Smyth
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Melanie Ruch
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Heather Knych
- Department of Molecular Biosciences, University of California Davis School of Veterinary Medicine, Davis, CA, USA
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Mirschberger V, von Deimling C, Heider A, Spadavecchia C, Rohrbach H, Zeiter S. Fentanyl Plasma Concentrations after Application of a Transdermal Patch in Three Different Locations to Refine Postoperative Pain Management in Rabbits. Animals (Basel) 2020; 10:ani10101778. [PMID: 33019557 PMCID: PMC7601434 DOI: 10.3390/ani10101778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Fentanyl patches offer “stress free” postoperative pain management in rabbits. It has been shown that fentanyl uptake is dependent on exogenous and endogenous factors of the area where the patch is applied. The purpose of the study was to investigate three different locations (neck, inner and outer surface of the ear) to obtain reliable fentanyl plasma concentrations above those previously shown to be analgesic. The fentanyl plasma concentration was measured at several time points after patch application. In addition, the practicability of the proposed methods was evaluated. The group with application on the neck had the fastest uptake and equal to or over the analgesic plasma concentration for up to 72 h. The outer surface of the ear had slightly slower uptake and shorter analgesic duration whereas fentanyl uptake at the inner surface of the ear was insufficient to provide plasma analgesic concentration. The preparation of the neck proved to be the most laborious because of the thin and dense fur and the removal of the patch resulted in erythema. In conclusion, depending on how long potent analgesia is required, either the neck or the outer surface of the ear are suitable for patch application enabling “stress free” and reliable postoperative analgesia in rabbits. Abstract Transdermal patches allow a noninvasive and “stress free” analgesia in rabbits. As fentanyl uptake is dependent on exogenous and endogenous factors of the area where the patch is applied, this study investigated three different locations (neck, inner and outer surfaces of the ear) for fentanyl patch application to provide adequate and reliable fentanyl plasma concentrations above those previously shown to be analgesic. Fentanyl plasma concentration was measured at different time points (3, 6, 9, 12, 18, 24, 36, 48, 72, 96, 120 h) and rabbits were assessed for their general conditions and treatment-related side effects. Practicability of the proposed methods was evaluated. Following patch application on the neck, fentanyl plasma concentrations equal to or above the analgesic value were measured in all rabbits between 6 and 72 h. Comparable concentrations were reached between 9 and 48 h in all animals for the outer ear surface. However, for the inner ear surface, analgesic concentrations were not reached, even if practicability was considered the best for this location. Preparation of the neck skin was judged as the most cumbersome due to the clipping of the dense fur and patch removal resulted in erythema. In summary, the application of the fentanyl patch on the neck and outer ear surface allowed the reach of reliable plasma concentrations above the analgesic threshold in rabbits. When applied on the neck, fentanyl patches provided the longest duration of analgesic plasma concentrations, whereas patch application and removal were easier on the outer ear surface.
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Affiliation(s)
| | | | - Anja Heider
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, 7265 Davos Wolfgang, Switzerland;
| | - Claudia Spadavecchia
- Vetsuisse Faculty, Department for Veterinary Medicine, University of Bern, 3012 Bern, Switzerland; (C.S.); (H.R.)
| | - Helene Rohrbach
- Vetsuisse Faculty, Department for Veterinary Medicine, University of Bern, 3012 Bern, Switzerland; (C.S.); (H.R.)
| | - Stephan Zeiter
- AO Research Institute Davos, 7270 Davos Platz, Switzerland; (V.M.); (C.v.D.)
- Correspondence: ; Tel.: +41-81-414-2311
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Buchholz T, Hildebrand M, Heider A, Stenger V, Arens D, Spadavecchia C, Zeiter S. Transdermal Fentanyl Uptake at Two Different Patch Locations in Swiss White Alpine Sheep. Animals (Basel) 2020; 10:ani10091675. [PMID: 32957484 PMCID: PMC7552603 DOI: 10.3390/ani10091675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Providing adequate and prolonged pain relief to sheep undergoing invasive orthopedic surgery while keeping side effects and stress for the animals at a minimum is challenging. Transdermal patches continuously releasing the synthetic opioid fentanyl through the skin, are a frequently used method in veterinary and human medicine. To refine the current analgesia protocol, we compared the uptake of fentanyl from a transdermal fentanyl patch applied at two different skin locations in sheep. The fentanyl plasma levels were measured at different time points over five days. The patch applied on the foreleg resulted in a faster fentanyl uptake with higher peaks and a longer time within or above the target fentanyl plasma concentration when compared to the one on the thorax. Additionally, it was easier to apply the patch at the foreleg than at the thorax. Our findings suggest that the fentanyl patch should be applied to the foreleg 3–6 h before the painful insult and that its effect should last at least 48 h. Abstract When using animals in biomedical research, investigators have the responsibility to ensure adequate analgesia. Currently, transdermal fentanyl patches (TFP) are often used to provide postoperative analgesia in large laboratory animals. The aim of this study was to compare the fentanyl uptake resulting from TFP applied at two different locations, namely the foreleg and the thorax, in healthy adult sheep. Twelve sheep received a TFP with an intended dosage of 2 ug/kg/h. Blood samples were taken at different time points over a period of five days and the fentanyl plasma levels were measured. The TFP applied on the foreleg allowed a faster fentanyl uptake with higher peaks and a longer time within or above the target concentration of 0.6–1.5 ng/mL, shown to be analgesic in humans, when compared to the one on the thorax. Assuming that the effective plasma concentration described for humans is providing analgesia in sheep as well, the present findings suggest that it should be sufficient to apply the TFP 3–6 h before the painful insult and that its effect should last at least 48 h. Furthermore, when TFP are used to provide postoperative analgesia in sheep, they should be placed on the foreleg rather than on the thorax.
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Affiliation(s)
- Tim Buchholz
- AO Research Institute Davos, 7270 Davos Platz, Switzerland; (T.B.); (M.H.); (V.S.); (D.A.)
| | - Maria Hildebrand
- AO Research Institute Davos, 7270 Davos Platz, Switzerland; (T.B.); (M.H.); (V.S.); (D.A.)
| | - Anja Heider
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, 7265 Davos Wolfgang, Switzerland;
| | - Valentina Stenger
- AO Research Institute Davos, 7270 Davos Platz, Switzerland; (T.B.); (M.H.); (V.S.); (D.A.)
| | - Daniel Arens
- AO Research Institute Davos, 7270 Davos Platz, Switzerland; (T.B.); (M.H.); (V.S.); (D.A.)
| | - Claudia Spadavecchia
- Vetsuisse Faculty, Department for Veterinary Medicine, University of Bern, 3012 Bern, Switzerland;
| | - Stephan Zeiter
- AO Research Institute Davos, 7270 Davos Platz, Switzerland; (T.B.); (M.H.); (V.S.); (D.A.)
- Correspondence: ; Tel.: +41-814-142-311
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Palomba N, Vettorato E, De Gennaro C, Corletto F. Peripheral nerve block versus systemic analgesia in dogs undergoing tibial plateau levelling osteotomy: Analgesic efficacy and pharmacoeconomics comparison. Vet Anaesth Analg 2019; 47:119-128. [PMID: 31806432 DOI: 10.1016/j.vaa.2019.08.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/19/2019] [Accepted: 08/20/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the perioperative effects and pharmacoeconomics of peripheral nerve blocks (PNBs) versus fentanyl target-controlled infusion (fTCI) in dogs undergoing tibial plateau levelling osteotomy (TPLO). STUDY DESIGN Randomized clinical study. ANIMALS A total of 39 dogs undergoing unilateral TPLO. METHODS After acepromazine and methadone, anaesthesia was induced with propofol and maintained with isoflurane. Dogs were allocated to group fTCI [target plasma concentration (TPC) 1 ng mL-1] or group PNB (nerve stimulator-guided femoral-sciatic block using 0.2 and 0.1 mL kg-1 of levobupivacaine 0.5%, respectively). If nociceptive response occurred, isoflurane was increased by 0.1%, and TPC was increased by 0.5 ng mL-1 in group fTCI; a fentanyl bolus (1 μg kg-1) was administered in group PNB. During the first 24 postoperative hours, methadone (0.2 mg kg-1) was administered intramuscularly according to the Short Form Glasgow Composite Pain Scale, or if pain was equal to 5/24 or 4/20 for two consecutive assessments, or if the dog was non-weight bearing. The area under the curve (AUC) of pain scores, cumulative postoperative methadone requirement, food intake and pharmacoeconomic implications were calculated. RESULTS Incidence of bradycardia (p = 0.025), nociceptive response to surgery (p = 0.041) and AUC of pain scores (p < 0.0001) were greater in group fTCI. Postoperatively, 16/19 (84.2%) and eight/20 (40%) dogs in groups fTCI and PNB, respectively, were given at least one dose of methadone (p = 0.0079). Food intake was greater in group PNB (p = 0.049). Although total cost was not different (p = 0.083), PNB was more cost-effective in dogs weighing >15 kg. CONCLUSIONS AND CLINICAL RELEVANCE Compared with group fTCI, incidence of bradycardia, nociceptive response to surgery, postoperative pain scores, cumulative methadone requirement were lower, and food intake was greater in group PNB, with an economic advantage in dogs weighing >15 kg.
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Affiliation(s)
- Nunzia Palomba
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
| | - Enzo Vettorato
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK.
| | - Chiara De Gennaro
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
| | - Federico Corletto
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
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14
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Effect of fentanyl on thermal and mechanical nociceptive thresholds in horses and estimation of anti-nociceptive plasma concentration. Vet J 2019; 249:82-88. [PMID: 31239171 DOI: 10.1016/j.tvjl.2019.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 05/12/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022]
Abstract
There are few investigations relating anti-nociception to plasma concentrations of fentanyl in horses. The study objective was to evaluate analgesic efficacy and duration in horses and determine the minimum anti-nociceptive plasma concentrations. Eight horses were treated with saline (P) and fentanyl (F2.5=2.5μg/kg; F5=5μg/kg; F10=10μg/kg) given IV over 5min, with a wash-out period of 10 days. To evaluate thermal (°C) and mechanical (N) nociceptive threshold single stimulations were applied prior to (baseline) and 10, 30, 60, 90, 120, 180, 240, 300, 360, 420, 540min and 22.5h after treatment. Plasma fentanyl concentrations were measured at specific time points. Locomotor activity, heart rate, respiratory rate and gastrointestinal sounds were recorded. Two-way repeated measures ANOVA and pairwise comparisons were used for data analysis (P<0.05). With treatment F10, there was a significant increase in thermal threshold above baseline (47.2ö4.1°C) at t10 (53.7ö4.2°C) and t30 (52.1ö5.6°C), whereas mechanical threshold increased considerably above baseline (3.7ö1.3N) only at t10 (6.6ö3.6N). Estimated mean minimum anti-nociceptive plasma concentration determined by thermal stimulation was 6.1-6.8ng/mL. Dose-dependent increased locomotion occurred, but no significant changes in heart rate, respiratory rate and gastrointestinal sounds were observed. Fentanyl IV at 10μg/kg produced anti-nociception for 10-30min and fentanyl plasma concentrations of ≥6.1-6.8ng/mL appear necessary to induce thermal anti-nociception. Dose-dependent increased locomotion was the main side effect observed.
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15
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Smith AA, Halliday LC, Lindeblad MO, Fortman JD. Evaluation of Analgesic Patches in Cynomolgus Macaques ( Macaca fascicularis). JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE 2019; 58:356-361. [PMID: 31010456 DOI: 10.30802/aalas-jaalas-18-000101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Opioids are widely used in veterinary and human medicine to manage pain. However, there is a paucity of information in the literature regarding the pharmacokinetics of opioid transdermal patches (TDP) in NHP. Therefore, to determine whether opioid TDP attain therapeutic concentrations in NHP, the pharmacokinetics of fentanyl (25 μg/h) and buprenorphine (10 and 20 μg/h) TDP were evaluated in naïve, adult, male cynomolgus macaques (n = 4) in a crossover study. Plasma opioid levels were determined by tandem liquid chromatography-mass spectrometry. The AUC0-inf for fentanyl and the low and high dose buprenorphine patches were 115 ± 14, 462 ± 74, and 778 ± 344 ng× h/mL, and the plasma half-lifes were 22 ± 4, 77 ± 27, and 42 ± 11 h, respectively. No adverse effects were noted throughout the study. Minimal therapeutic concentrations for fentanyl (0.2 ng/mL) and buprenorphine (0.1 ng/mL) were achieved in all macaques within 8 h of fentanyl and 24 h of buprenorphine TDP application. Therapeutic levels for the fentanyl and low- and high-dose buprenorphine patches were maintained for 96, 120, and 144 h, respectively. These findings suggest that 25-μg/h fentanyl patches should be replaced every 4 d, and the low- and high-dose buprenorphine patches should be replaced every 5 and 6 d, respectively. The results of this study show that fentanyl and buprenorphine patches achieve minimal therapeutic levels for clinically relevant periods of time and should be considered viable options for pain management in cynomolgus macaques.
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Affiliation(s)
- Alexandra A Smith
- Biologic Resources Laboratory, University of Illinois at Chicago, Chicago, Illinois;,
| | - Lisa C Halliday
- Biologic Resources Laboratory, University of Illinois at Chicago, Chicago, Illinois
| | - Matthew O Lindeblad
- Toxicology Research Laboratory, University of Illinois at Chicago, Chicago, Illinois
| | - Jeffrey D Fortman
- Biologic Resources Laboratory, University of Illinois at Chicago, Chicago, Illinois
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16
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Smith JS, Coetzee JF, Fisher IWG, Borts DJ, Mochel JP. Pharmacokinetics of fentanyl citrate and norfentanyl in Holstein calves and effect of analytical performances on fentanyl parameter estimation. J Vet Pharmacol Ther 2018; 41:555-561. [PMID: 29603262 DOI: 10.1111/jvp.12501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/14/2018] [Indexed: 11/30/2022]
Abstract
This study describes the pharmacokinetics of intravenously administered (i.v.) fentanyl citrate, and its primary metabolite norfentanyl in Holstein calves. Eight calves (58.6 ± 2.2 kg), aged 3-4 weeks, were administered fentanyl citrate at a single dose of 5.0 μg/kg i.v. Blood samples were collected from 0 to 24 hr. Plasma (nor)fentanyl concentrations were determined using liquid chromatography with mass spectrometry and a lower limit of quantification (LLOQ) of 0.03 ng/ml. To explore the effect of analytical performance on fentanyl parameter estimation, the noncompartmental pharmacokinetic analysis was then repeated with a hypothetical LLOQ value of 0.05 ng/ml. Terminal elimination half-life was estimated at 12.7 and 3.6 hr for fentanyl and norfentanyl, respectively. For fentanyl, systemic clearance was estimated at 2.0 L hr-1 kg-1 , volume of distribution at steady-state was 24.8 L/kg and extraction ratio was 0.42. At a hypothetical LLOQ of 0.05 ng/ml fentanyl half-life, volume of distribution at steady-state and clearance were, respectively, of 3.0 hr, 8.8 L/kg and 3.4 L kg-1 hr-1 . Fentanyl citrate administered i.v. at 5.0 μg/kg can reach levels associated with analgesia in other species. Pharmacokinetic parameters should be interpreted with respect to LLOQ, as lower limits can influence estimated parameters, such as elimination half-life or systemic clearance and have significant impact on dosage regimen selection in clinical practice.
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Affiliation(s)
- J S Smith
- Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA, USA
| | - J F Coetzee
- Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
| | - I W G Fisher
- Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA, USA
| | - D J Borts
- Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA, USA
| | - J P Mochel
- Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA, USA
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17
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Schnellbacher RW, Divers SJ, Comolli JR, Beaufrère H, Maglaras CH, Andrade N, Barbur LA, Rosselli DD, Stejskal M, Barletta M, Mayer J, Rodriguez P, Quandt JE. Effects of intravenous administration of lidocaine and buprenorphine on gastrointestinal tract motility and signs of pain in New Zealand White rabbits after ovariohysterectomy. Am J Vet Res 2018; 78:1359-1371. [PMID: 29182394 DOI: 10.2460/ajvr.78.12.1359] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare analgesic and gastrointestinal effects of lidocaine and buprenorphine administered to rabbits undergoing ovariohysterectomy. ANIMALS Fourteen 12-month-old female New Zealand White rabbits. PROCEDURES Rabbits were assigned to 2 treatment groups (7 rabbits/group). One group received buprenorphine (0.06 mg/kg, IV, q 8 h for 2 days), and the other received lidocaine (continuous rate infusion [CRI] at 100 μg/kg/min for 2 days). Variables, including food and water consumption, fecal output, glucose and cortisol concentrations, and behaviors while in exercise pens, were recorded. RESULTS Rabbits receiving a lidocaine CRI had significantly higher gastrointestinal motility, food intake, and fecal output and significantly lower glucose concentrations, compared with results for rabbits receiving buprenorphine. Rabbits receiving lidocaine also had a higher number of normal behaviors (eg, sprawling, traveling, and frolicking) after surgery, compared with behaviors such as crouching and sitting that were seen more commonly in rabbits receiving buprenorphine. Both groups had significant weight loss after surgery. Pain scores did not differ significantly between treatment groups. Significant decreases in heart rate and respiratory rate were observed on the day of surgery, compared with values before and after surgery. Rabbits in the lidocaine group had significantly overall lower heart rates than did rabbits in the buprenorphine group. CONCLUSIONS AND CLINICAL RELEVANCE A CRI of lidocaine to rabbits provided better postoperative outcomes with respect to fecal output, food intake, and glucose concentrations. Thus, lidocaine appeared to be a suitable alternative to buprenorphine for alleviating postoperative pain with minimal risk of anorexia and gastrointestinal ileus.
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Lovasz M, Aarnes TK, Hubbell JAE, Bednarski RM, Lerche P, Lakritz J. Pharmacokinetics of intravenous and transdermal fentanyl in alpacas. J Vet Pharmacol Ther 2017; 40:663-669. [DOI: 10.1111/jvp.12403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 02/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- M. Lovasz
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus Ohio USA
| | - T. K. Aarnes
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus Ohio USA
| | - J. A. E. Hubbell
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus Ohio USA
| | - R. M. Bednarski
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus Ohio USA
| | - P. Lerche
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus Ohio USA
| | - J. Lakritz
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus Ohio USA
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PHARMACOKINETIC EVALUATION OF A LONG-ACTING FENTANYL SOLUTION AFTER TRANSDERMAL ADMINISTRATION IN HELMETED GUINEAFOWL (NUMIDA MELEAGRIS). J Zoo Wildl Med 2016; 47:468-73. [PMID: 27468018 DOI: 10.1638/2015-0220.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to investigate the pharmacokinetics of a long-acting fentanyl solution in helmeted guineafowl ( Numida meleagris ) after transdermal administration. Twenty-one guineafowl received a single administration of 5 mg/kg of fentanyl transdermal solution. No adverse effects on behavior were appreciated. Plasma fentanyl concentrations were determined by liquid chromatography-mass spectrometry analysis of protein-precipitated samples. Mean maximum plasma concentration was 228.8 ng/ml at 4 hr. The mean plasma terminal half-life was 33.2 hr. At 168 hr the mean plasma concentration was 1.3 ng/ml. A single topical dose of 5 mg/kg appears to be safe for use in this species and maintained plasma concentrations above those reported to be analgesic in dogs for at least 7 days.
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Barletta M, Kleine SA, Hofmeister EH, Thoresen M, Peroni JF, Knych HK, Scharf AM, Quandt JE. Determination of the minimum alveolar concentration of isoflurane that blunts adrenergic responses in sheep and evaluation of the effects of fentanyl. Am J Vet Res 2016; 77:119-26. [DOI: 10.2460/ajvr.77.2.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Keating S, Kerr C, McDonell W, Valverde A, Johnson R, Knych H, Edginton A. Effects of acepromazine or dexmedetomidine on fentanyl disposition in dogs during recovery from isoflurane anesthesia. Vet Anaesth Analg 2015; 43:35-43. [PMID: 25943714 DOI: 10.1111/vaa.12271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 01/26/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe fentanyl pharmacokinetics during isoflurane anesthesia and on recovery from anesthesia with concurrent administration of acepromazine, dexmedetomidine or saline in dogs. STUDY DESIGN Experimental blinded, randomized, crossover study. ANIMALS Seven adult hound dogs. METHODS Dogs were administered intravenous (IV) fentanyl as a bolus (5 μg kg(-1)) followed by an infusion (5 μg kg(-1) hour(-1)) for 120 minutes during isoflurane anesthesia and emergence from anesthesia, and for 60 minutes after extubation during recovery from anesthesia. At the time of extubation, dexmedetomidine (2.5 μg kg(-1)), acepromazine (0.05 mg kg(-1)) or saline were administered IV. Venous blood was sampled during the maintenance and recovery periods. Fentanyl plasma concentrations were measured using high-performance liquid chromatography-mass spectrometry and population pharmacokinetic analyses were performed. RESULTS Mean fentanyl plasma concentrations were 1.6-4.5 ng mL(-1) during isoflurane anesthesia and 1.6-2.0 ng mL(-1) during recovery from anesthesia. Recovery from isoflurane anesthesia without sedation was associated with an increase in the volume of the central compartment from 0.80 to 1.02 L kg(-1). After administration of acepromazine, systemic clearance of fentanyl increased from 31.5 to 40.3 mL minute(-1) kg(-1) and the volume of the central compartment increased from 0.70 to 0.94 L kg(-1). Administration of dexmedetomidine did not significantly change fentanyl pharmacokinetics. Inter-individual variability for fentanyl parameter estimates in all treatments ranged from 2.2% to 54.5%, and residual error ranged from 6.3% to 13.4%. CONCLUSIONS AND CLINICAL RELEVANCE The dose rates of fentanyl used in this study achieved previously established analgesic plasma concentrations for the duration of the infusion. Despite alterations in fentanyl pharmacokinetics, differences in fentanyl plasma concentrations among treatments during recovery from anesthesia were small and were unlikely to be of clinical significance.
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Affiliation(s)
- Stephanie Keating
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Carolyn Kerr
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Wayne McDonell
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Ron Johnson
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Heather Knych
- Department of Veterinary Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Andrea Edginton
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
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Marucio RL, Monteiro ER, Moroz LR, Fantoni DT. Postoperative analgesic effects of epidural administration of neostigmine alone or in combination with morphine in dogs undergoing orthopedic surgery of the pelvic limbs. Am J Vet Res 2014; 75:956-63. [DOI: 10.2460/ajvr.75.11.956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Martinez SA, Wilson MG, Linton DD, Newbound GC, Freise KJ, Lin TL, Clark TP. The safety and effectiveness of a long-acting transdermal fentanyl solution compared with oxymorphone for the control of postoperative pain in dogs: a randomized, multicentered clinical study. J Vet Pharmacol Ther 2013; 37:394-405. [PMID: 24344787 PMCID: PMC4265281 DOI: 10.1111/jvp.12096] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 11/05/2013] [Indexed: 11/28/2022]
Abstract
A prospective, double-blinded, positive-controlled, multicenter, noninferiority study was conducted to evaluate the safety and effectiveness of transdermal fentanyl solution (TFS) compared with oxymorphone for the control of postoperative pain in dogs. Five hundred and two (502) client-owned dogs were assigned to a single dose of TFS (2.7 mg/kg) applied 2–4 h prior to surgery or oxymorphone hydrochloride (0.22 mg/kg) administered subcutaneously 2–4 h prior to surgery and q6h through 90 h. Pain was evaluated over 4 days by blinded observers using a modified Glasgow composite pain scale, and the a priori criteria for treatment failure was a pain score ≥8 or adverse event necessitating withdrawal. Four TFS- and eight oxymorphone-treated dogs were withdrawn due to lack of pain control. Eighteen oxymorphone-treated, but no TFS-treated dogs were withdrawn due to severe adverse events. The one-sided upper 95% confidence interval of the difference between TFS and oxymorphone treatment failure rates was −5.3%. Adverse events associated with oxymorphone were greater in number and severity compared with TFS. It was concluded that a single administration of TFS was safe and noninferior to repeated injections of oxymorphone for the control of postoperative pain over 4 days at the dose rates of both formulations used in this study.
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Affiliation(s)
- S A Martinez
- College of Veterinary Medicine, Washington State University, Pullman, WA, USA
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Keating SCJ, Kerr CL, Valverde A, Johnson RJ, McDonell WN. Cardiopulmonary effects of intravenous fentanyl infusion in dogs during isoflurane anesthesia and with concurrent acepromazine or dexmedetomidine administration during anesthetic recovery. Am J Vet Res 2013; 74:672-82. [PMID: 23627379 DOI: 10.2460/ajvr.74.5.672] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the cardiopulmonary effects of IV fentanyl administration in dogs during isoflurane anesthesia and during anesthetic recovery with or without dexmedetomidine or acepromazine. ANIMALS 7 sexually intact male purpose-bred hound-type dogs aged 11 to 12 months. PROCEDURES Dogs received a loading dose of fentanyl (5 μg/kg, IV) followed by an IV infusion (5 μg/kg/h) for 120 minutes while anesthetized with isoflurane and for an additional 60 minutes after anesthesia was discontinued. Dogs were randomly assigned in a crossover design to receive dexmedetomidine (2.5 μg/kg), acepromazine (0.05 mg/kg), or saline (0.9% NaCl) solution (1 mL) IV after anesthesia ceased. Cardiopulmonary data were obtained during anesthesia and for 90 minutes after treatment administration during anesthetic recovery. RESULTS Concurrent administration of fentanyl and isoflurane resulted in significant decreases in mean arterial blood pressure, heart rate, and cardiac index and a significant increase in Paco2. All but Paco2 returned to pretreatment values before isoflurane anesthesia was discontinued. During recovery, dexmedetomidine administration resulted in significant decreases in heart rate, cardiac index, and mixed venous oxygen tension and a significant increase in arterial blood pressure, compared with values for saline solution and acepromazine treatments. Acepromazine administration resulted in significantly lower blood pressure and higher cardiac index and Po2 in mixed venous blood than did the other treatments. Dexmedetomidine treatment resulted in significantly lower values for Pao2 and arterial pH and higher Paco2 values than both other treatments. CONCLUSIONS AND CLINICAL RELEVANCE Fentanyl resulted in transient pronounced cardiorespiratory effects when administered during isoflurane anesthesia. During anesthetic recovery, when administered concurrently with an IV fentanyl infusion, dexmedetomidine resulted in evidence of cardiopulmonary compromise and acepromazine transiently improved cardiopulmonary performance.
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Affiliation(s)
- Stephanie C J Keating
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.
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KUKANICH B, CLARK TP. The history and pharmacology of fentanyl: relevance to a novel, long-acting transdermal fentanyl solution newly approved for use in dogs. J Vet Pharmacol Ther 2012; 35 Suppl 2:3-19. [DOI: 10.1111/j.1365-2885.2012.01416.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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FREISE KJ, LINTON DD, NEWBOUND GC, TUDAN C, CLARK TP. Population pharmacokinetics of transdermal fentanyl solution following a single dose administered prior to soft tissue and orthopedic surgery in dogs. J Vet Pharmacol Ther 2012; 35 Suppl 2:65-72. [DOI: 10.1111/j.1365-2885.2012.01407.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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FREISE KJ, SAVIDES MC, RIGGS KL, OWENS JG, NEWBOUND GC, CLARK TP. Pharmacokinetics and dose selection of a novel, long-acting transdermal fentanyl solution in healthy laboratory Beagles. J Vet Pharmacol Ther 2012; 35 Suppl 2:21-6. [DOI: 10.1111/j.1365-2885.2012.01399.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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SAVIDES MC, POHLAND RC, WILKIE DA, ABBOTT JA, NEWBOUND GC, FREISE KJ, CLARK TP. The margin of safety of a single application of transdermal fentanyl solution when administered at multiples of the therapeutic dose to laboratory dogs. J Vet Pharmacol Ther 2012; 35 Suppl 2:35-43. [DOI: 10.1111/j.1365-2885.2012.01410.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reed F, Burrow R, Poels KLC, Godderis L, Veulemans HAF, Mosing M. Evaluation of transdermal fentanyl patch attachment in dogs and analysis of residual fentanyl content following removal. Vet Anaesth Analg 2012; 38:407-12. [PMID: 21672129 DOI: 10.1111/j.1467-2995.2011.00628.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate whether the method used to attach matrix-type fentanyl patches influences the degree of skin attachment and the amount of active drug remaining in patches after use. STUDY DESIGN Prospective, randomised clinical study. STUDY POPULATION Fifteen adult dogs of mixed breeds. METHODS Two equally sized matrix-type fentanyl patches were attached to the dorsal third of the lateral thorax of fifteen dogs for 72 hours. The two patches were attached using different techniques: Method AD used an adhesive dressing in combination with a transparent film. Method TG used tissue adhesive applied to the edges of the patch. After 72 hours the patches were removed and the proportion of the patch attached at this time calculated. The residual content of the patches was analysed using a validated gas chromatography-mass spectrometery (GC-MS) analysis technique. RESULTS After 72 hours of continuous attachment, the mean proportion of drug uptake for method AD was 17.2 (SD ± 11.1)% and for method TG this was 16.9 (SD ± 7.3)%. The median proportion of attachment for method AD was 100% and for method TG was 95.6%. CONCLUSIONS The method of attachment did not significantly influence the uptake of fentanyl from matrix-type patches. The method of attachment resulted in a significant difference in the proportion of the patch attached 72 hours after placement, with method AD resulting in a greater median proportion of attachment than TG. CLINICAL RELEVANCE The method used to attach matrix-type fentanyl patches to dogs should not interfere with drug uptake. The residual fentanyl content remaining in these patches after 72 hours of continuous application is significant and could lead to intoxication if ingested by humans.
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Affiliation(s)
- Frances Reed
- Small Animal Teaching Hospital, University of Liverpool, Neston, Cheshire, UK.
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Abelson AL, Armitage-Chan E, Lindsey JC, Wetmore LA. A comparison of epidural morphine with low dose bupivacaine versus epidural morphine alone on motor and respiratory function in dogs following splenectomy. Vet Anaesth Analg 2011; 38:213-23. [DOI: 10.1111/j.1467-2995.2011.00601.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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BELLEI E, RONCADA P, PISONI L, JOECHLER M, ZAGHINI A. The use of fentanyl-patch in dogs undergoing spinal surgery: plasma concentration and analgesic efficacy. J Vet Pharmacol Ther 2011; 34:437-41. [DOI: 10.1111/j.1365-2885.2010.01263.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Almeida RM, Escobar A, Maguilnik S. Comparison of analgesia provided by lidocaine, lidocaine-morphine or lidocaine-tramadol delivered epidurally in dogs following orchiectomy. Vet Anaesth Analg 2010; 37:542-9. [DOI: 10.1111/j.1467-2995.2010.00563.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pekcan Z, Koc B. The post-operative analgesic effects of epidurally administered morphine and transdermal fentanyl patch after ovariohysterectomy in dogs. Vet Anaesth Analg 2010; 37:557-65. [DOI: 10.1111/j.1467-2995.2010.00571.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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OHTA M, WAKUNO A, OKADA J, KODAIRA K, NAGATA SI, ITO M, OKU K. Effects of Intravenous Fentanyl Administration on End-Tidal Sevoflurane Concentrations in Thoroughbred Racehorses undergoing Orthopedic Surgery. J Vet Med Sci 2010; 72:1107-11. [DOI: 10.1292/jvms.09-0285] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Minoru OHTA
- Racehorse Clinic, Ritto Training Center, Japan Racing Association (JRA)
| | - Ai WAKUNO
- Racehorse Clinic, Ritto Training Center, Japan Racing Association (JRA)
| | - Jun OKADA
- Racehorse Clinic, Ritto Training Center, Japan Racing Association (JRA)
| | - Kazumichi KODAIRA
- Racehorse Clinic, Ritto Training Center, Japan Racing Association (JRA)
| | | | - Motoki ITO
- Racehorse Clinic, Ritto Training Center, Japan Racing Association (JRA)
| | - Kazuomi OKU
- Racehorse Clinic, Ritto Training Center, Japan Racing Association (JRA)
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Murrell JC, Mitchinson SL, Lesperance L, Sivakumaran S, Johnson CB. Electroencephalography during ovariohysterectomy in rats anaesthetized with halothane. Vet Anaesth Analg 2010; 37:14-24. [DOI: 10.1111/j.1467-2995.2009.00504.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sykes JM, Cox S, Ramsay EC. Evaluation of an osmotic pump for fentanyl administration in cats as a model for nondomestic felids. Am J Vet Res 2009; 70:950-5. [DOI: 10.2460/ajvr.70.8.950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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ARAGON CL, READ MR, GAYNOR JS, BARNHART MD, WILSON D, PAPICH MG. Pharmacokinetics of an immediate and extended release oral morphine formulation utilizing the spheroidal oral drug absorption system in dogs. J Vet Pharmacol Ther 2009; 32:129-36. [DOI: 10.1111/j.1365-2885.2008.01011.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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West E, Andreoni V, Keeley B, Self I, Jones B. Analgesic management of an eight-year-old Springer Spaniel after amputation of a thoracic limb. Ir Vet J 2009; 62:111-8. [PMID: 21851728 PMCID: PMC3113792 DOI: 10.1186/2046-0481-62-2-111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Analgesic agents were administered perioperatively to an eight-year-old Springer Spaniel undergoing amputation of its right thoracic limb. The amputation was carried out due to a painful, infiltrative and poorly differentiated sarcoma involving the nerves of the brachial plexus. A combination of pre-emptive and multimodal perioperative analgesic strategies was used; including intravenous (IV) infusions of fentanyl, morphine, lidocaine and ketamine.
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Affiliation(s)
- E West
- Small Animal Teaching Hospital, Leahurst, University of Liverpool, Neston CH64 7TE.
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Abstract
Control of cancer pain is within the capabilities of most veterinarians and is achievable in most animal patients that have cancer with techniques that are currently available. Great satisfaction can be derived from not only treating the pet's cancer but its pain. Incorporating pain management into oncology practice is good for the well-being of the pet, the owner, the staff, the veterinarians, and the practice.
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Strategies for Reducing the Complication of Orthopedic Pain Perioperatively. Vet Clin North Am Equine Pract 2008; 24:611-20, ix. [DOI: 10.1016/j.cveq.2008.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Sanchez LC, Elfenbein JR, Robertson SA. Effect of acepromazine, butorphanol, or N-butylscopolammonium bromide on visceral and somatic nociception and duodenal motility in conscious horses. Am J Vet Res 2008; 69:579-85. [PMID: 18447787 DOI: 10.2460/ajvr.69.5.579] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate effects of butorphanol, acepromazine, and N-butylscopolammonium bromide (NBB) on visceral and somatic nociception and duodenal motility in conscious, healthy horses. ANIMALS 6 adult horses. PROCEDURES Visceral nociception was evaluated by use of colorectal distention (CRD) and duodenal distention (DD) threshold. Somatic nociception was evaluated via thermal threshold (TT). Nose-to-ground height, heart rate, and respiratory rate were also measured. Each horse received each treatment in randomized order; investigators were not aware of treatments. Butorphanol was administered IV as a bolus (18 microg/kg) followed by constant rate infusion at 13 microg/kg/h for 2 hours, whereas acepromazine (0.04 mg/kg), NBB (0.3 mg/kg), and saline (0.9% NaCl) solution (2 mL) were administered IV as a bolus followed by constant rate infusion with saline solution (10 mL/h) for 2 hours. Variables were measured before and for 3 hours after treatment. Data were analyzed by use of a 3-factor ANOVA followed by a Bonferroni t test for multiple comparisons. RESULTS Nose-to-ground height decreased after acepromazine. Respiratory rate decreased after acepromazine and increased after butorphanol. Heart rate increased briefly after NBB. Some horses had an increase in TT after butorphanol and acepromazine, but there was not a significant treatment effect over time. Drug effect on DD or motility was not evident. The CRD threshold increased significantly at 5, 65, 155, and 185 minutes after acepromazine and from 5 to 65 minutes after NBB. CONCLUSIONS AND CLINICAL RELEVANCE Each drug caused predictable changes in sedation and vital signs, but consistent anti-nociceptive effects were not evident.
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Affiliation(s)
- L Chris Sanchez
- Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
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Krotscheck U, Boothe DM, Little AA. Pharmacokinetics of buprenorphine following intravenous administration in dogs. Am J Vet Res 2008; 69:722-7. [DOI: 10.2460/ajvr.69.6.722] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bergmann HM, Nolte I, Kramer S. Comparison of analgesic efficacy of preoperative or postoperative carprofen with or without preincisional mepivacaine epidural anesthesia in canine pelvic or femoral fracture repair. Vet Surg 2007; 36:623-32. [PMID: 17894588 DOI: 10.1111/j.1532-950x.2007.00314.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare analgesic efficacy of preoperative versus postoperative administration of carprofen and to determine, if preincisional mepivacaine epidural anesthesia improves postoperative analgesia in dogs treated with carprofen. STUDY DESIGN Blind, randomized clinical study. ANIMALS Dogs with femoral (n=18) or pelvic (27) fractures. METHODS Dogs were grouped by restricted randomization into 4 groups: group 1 = carprofen (4 mg/kg subcutaneously) immediately before induction of anesthesia, no epidural anesthesia; group 2 = carprofen immediately after extubation, no epidural anesthesia; group 3 = carprofen immediately before induction, mepivacaine epidural block 15 minutes before surgical incision; and group 4 = mepivacaine epidural block 15 minutes before surgical incision, carprofen after extubation. All dogs were administered carprofen (4 mg/kg, subcutaneously, once daily) for 4 days after surgery. Physiologic variables, nociceptive threshold, lameness score, pain, and sedation (numerical rating scale [NRS], visual analog scale [VAS]), plasma glucose and cortisol concentration, renal function, and hemostatic variables were measured preoperatively and at various times after surgery. Dogs with VAS pain scores >30 were administered rescue analgesia. RESULTS Group 3 and 4 dogs had significantly lower pain scores and amount of rescue analgesia compared with groups 1 and 2. VAS and NRS pain scores were not significantly different among groups 1 and 2 or among groups 3 and 4. There was no treatment effect on renal function and hemostatic variables. CONCLUSIONS Preoperative carprofen combined with mepivacaine epidural anesthesia had superior postoperative analgesia compared with preoperative carprofen alone. When preoperative epidural anesthesia was performed, preoperative administration of carprofen did not improve postoperative analgesia compared with postoperative administration of carprofen. CLINICAL RELEVANCE Preoperative administration of systemic opioid agonists in combination with regional anesthesia and postoperative administration of carprofen provides safe and effective pain relieve in canine fracture repair.
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MESH Headings
- Analgesics/administration & dosage
- Analgesics/pharmacology
- Anesthesia, Epidural/methods
- Anesthesia, Epidural/veterinary
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/pharmacology
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/pharmacology
- Carbazoles/administration & dosage
- Carbazoles/pharmacology
- Dogs
- Double-Blind Method
- Female
- Femoral Fractures/surgery
- Femoral Fractures/veterinary
- Injections, Subcutaneous/veterinary
- Male
- Mepivacaine/administration & dosage
- Mepivacaine/pharmacology
- Pain Measurement
- Pain, Postoperative/drug therapy
- Pain, Postoperative/prevention & control
- Pain, Postoperative/veterinary
- Pelvic Bones/injuries
- Postoperative Care/methods
- Postoperative Care/veterinary
- Premedication
- Preoperative Care/methods
- Preoperative Care/veterinary
- Prospective Studies
- Treatment Outcome
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Affiliation(s)
- Hannes M Bergmann
- Small Animal Clinic, School of Veterinary Medicine, Bischofsholer Damm 15, Hannover, Germany
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Sanchez LC, Robertson SA, Maxwell LK, Zientek K, Cole C. Effect of Fentanyl on Visceral and Somatic Nociception in Conscious Horses. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb03066.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Fentanyl citrate is a potent opioid that can be delivered by the transdermal route in cats and dogs. Publications regarding transdermal fentanyl patches were obtained and systematically reviewed. Seven studies in cats and seven studies in dogs met the criteria for inclusion in this review. Dogs achieved effective plasma concentrations approximately 24 hours after patch application. Cats achieved effective plasma concentrations 7 hours after patch application. In dogs, transdermal fentanyl produced analgesia for up to 72 hours, except for the immediate 0- to 6-hour postoperative period. In cats, transdermal fentanyl produced analgesia equivalent to intermittent butorphanol administration for up to 72 hours following patch application.
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Affiliation(s)
- Erik H Hofmeister
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia 30602, USA
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Egger CM, Glerum L, Michelle Haag K, Rohrbach BW. Efficacy and cost-effectiveness of transdermal fentanyl patches for the relief of post-operative pain in dogs after anterior cruciate ligament and pelvic limb repair. Vet Anaesth Analg 2007; 34:200-8. [PMID: 17444933 DOI: 10.1111/j.1467-2995.2006.00310.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether transdermal fentanyl patches provided cost-effective post-operative analgesia in dogs with pelvic limb injuries. STUDY DESIGN Prospective, randomized, blinded clinical trial. ANIMALS Twenty-four dogs undergoing repair of ruptured cranial cruciate ligaments or pelvic limb fractures. METHODS Dogs were randomly assigned to one of two groups: those receiving transdermal fentanyl patches (group F) and those receiving injectable morphine for control of post-operative pain (group M). Patients in both treatment groups were monitored for adequacy of analgesia and alterations in physiological variables. Plasma fentanyl concentrations were measured in Group F. Rescue morphine was given if a dog was deemed uncomfortable. The time of first rescue morphine, the total amount, and number of doses of morphine administered over 72 hours was quantified and compared for each group. RESULTS There was no significant treatment effect on any of the parameters, except for serum cortisol concentration, which was significantly lower overall in group F (p = 0.01). Pain scores peaked at 6 hours post-extubation and were higher than baseline from 2 to 20 hours post-extubation. Cortisol concentrations were the highest at time 0 (extubation) and were significantly higher than baseline until 2 hours post-extubation. Pain scores correlated with fentanyl plasma concentrations (p = 0.0001 and p = 0.01, respectively), but the correlation was low (r = 0.26 and r = 0.16, respectively). No correlation was found between serum cortisol concentrations and pain scores in either group. Fentanyl cost and total cost for pain management were considerably higher for group F. CONCLUSIONS Fentanyl patches did not provide better analgesia or a reduced requirement for rescue opioid compared with intramuscular morphine. CLINICAL RELEVANCE When considering overall costs to the client for comparable analgesic intervention, fentanyl patches increased rather than decreased cost during the first 24 hours post-operatively.
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Affiliation(s)
- Christine M Egger
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, USA.
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Schmiedt CW, Bjorling DE. Accidental prehension and suspected transmucosal or oral absorption of fentanyl from a transdermal patch in a dog. Vet Anaesth Analg 2007; 34:70-3. [PMID: 17238966 DOI: 10.1111/j.1467-2995.2006.00302.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 100-microg hour(-1) transdermal fentanyl patch was applied to a 29-kg, 6-year-old, intact male mixed breed dog to help manage postoperative pain after total ear canal ablation and lateral bulla osteotomy. Two days later, the dog was found extremely sedated, and the reservoir of the transdermal patch was open. It was suspected that the dog ingested the contents of the reservoir of the transdermal patch and absorbed the fentanyl across its oral mucosa or through the gastrointestinal tract resulting in an overdose. The patch was removed, blood was drawn to determine serum fentanyl levels, and the dog recovered without incident. This clinical case documents the potential for neurologic sequelae, and bradycardia when fentanyl patches are used in animals to relieve postoperative pain.
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Affiliation(s)
- Chad W Schmiedt
- Department of Surgical Sciences, College of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706-1102, USA.
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Abstract
The use of topical pharmaceutical formulations is increasingly popular in veterinary medicine. A potential concern is that not all formulations are registered for the intended species, yet current knowledge strongly suggests that simple extrapolation of transdermal drug pharmacokinetics and pharmacodynamics between species, including humans, cannot be done. In this review, an overview is provided of the underlying basic principles determining the movement of topically applied molecules into and through the skin. Various factors that may affect transdermal drug penetration between species, between individuals of a particular species and regional differences in an individual are also discussed. A good understanding of the basic principles of transdermal drug delivery is critical to avoid adverse effects or lack of efficacy when applying topical formulations in veterinary medicine.
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Affiliation(s)
- P C Mills
- School of Veterinary Science, University of Queensland, Brisbane, Qld 4072, Australia.
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50
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Sano T, Nishimura R, Kanazawa H, Igarashi E, Nagata Y, Mochizuki M, Sasaki N. Pharmacokinetics of fentanyl after single intravenous injection and constant rate infusion in dogs. Vet Anaesth Analg 2006; 33:266-73. [PMID: 16764592 DOI: 10.1111/j.1467-2995.2005.00266.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the plasma concentration and define the pharmacokinetic characteristics of fentanyl (10 microg kg(-1)) administered as a single intravenous (IV) injection followed by: (a) no further drug; or (b) a constant rate infusion (CRI) of fentanyl 10 microg kg(-1) hour(-1) lasting 1, 3 or 4 hours in dogs. Animals Fourteen healthy adult beagles (seven males and seven females). EXPERIMENTAL DESIGN Randomized cross-over design. MATERIALS AND METHODS Dogs were randomly assigned to four treatment groups. Drugs were administered to each dog in a randomized cross-over design with at least a 14-day washout interval between experiments. All dogs received an IV loading dose of fentanyl (10 microg kg(-1)). One group received no further fentanyl. In others, the loading dose was followed by a CRI of fentanyl (10 microg kg(-1) hour(-1)) for 1, 3 or 4 hours. Blood samples were collected and plasma fentanyl concentrations determined using high-performance liquid chromatography-mass spectrometry. Plasma pharmacokinetic estimates were obtained by plotting plasma concentrations versus time data and by fitting the change in concentration to a pharmacokinetic model, using a purpose-built program written by the Graduate School of Pharmaceutical Sciences (Kyoto University) in Visual Basic (VBA) on Excel (Microsoft Corporation). RESULTS Plasma fentanyl concentration decreased rapidly after single IV injection: the plasma concentration-time curve best fitted a two-compartment model. Pharmacokinetic variables for IV injection were characterized by a short distribution half-time (t1/2alpha was 4.5 minutes), a relatively long elimination half time (t1/2beta was 45.7 minutes), a large volume of distribution (approximately 5 L kg(-1)) and high total body clearance (77.9 mL minute(-1) kg(-1)). Stable plasma fentanyl levels were obtained in all CRI groups although pharmacokinetic variables were influenced by the duration of administration. CONCLUSIONS AND CLINICAL RELEVANCE While this study clarified the pharmacokinetic features of rapid IV fentanyl injection and CRI in dogs, the plasma concentration achieving analgesia was not and so further research is needed. Further studies on the effects of other sedatives and/or anaesthetics on fentanyl's disposition are also required as the drug is commonly used with other agents.
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Affiliation(s)
- Tadashi Sano
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.
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