Glasgow Pain Scale Research Articles

Effect of acetaminophen on hepatic enzymes and renal analytes of ovary-hysterectomized dogs

Background: The treatment of pain in companion animals is of great importance nowadays. The presence of various drugs as alternative therapies for pain should be studied to improve the quality of life and well-being of patients in the small species clinic. For years, acetaminophen or also called acetaminophen has been misused in dogs and cats, producing toxic effects after administration at high doses. Objective: The present study aimed to evaluated the effects on renal and hepatic enzymes after pre- and post-surgical administration of acetaminophen in dogs undergoing ovarian hysterectomy surgeries, performed by students in their last semesters at the university, and to evaluate its effect as a trans- and post-surgical analgesic therapy. Methods: For this purpose, a dose of acetaminophen was administered 30 minutes before the procedure and 48 hours after surgery. Pain was assessed with the Glasgow Pain Scale during surgery and at 2, 6, 12 and 24 hours after the surgical procedure. To evaluate the effect on liver enzymes and renal analytes, blood studies were performed 7 days before surgery and 5 days after. Results: No significant changes in renal analytes and liver enzymes were observed after application of the drug every 6 and 8 hours for 48 hours. Furthermore, during the surgical procedure, anesthesia and analgesia remained stable, as well as a low score on the pain scale, indicating absence of postoperative pain, although the total surgery time was longer than usual. Conclusions: The use of acetaminophen at adequate doses does not produce hepatic and renal alterations, besides being an excellent analgesic in prolonged surgeries and postoperative pain.

Comparison of incisional, transverse abdominis plane, and rectus sheath blocks in dogs undergoing ovariohysterectomy.

To compare the analgesia provided by incisional (Incisional), transverse abdominis plane (TAP), and rectus sheath (RS) blocks in dogs submitted for ovariohysterectomy (OHE). 22 female mixed-breed dogs were allocated into 3 treatments of Incisional (n = 7), TAP (n = 7), and RS (n = 8) and underwent OHE from April 4 to December 6, 2022. After premedication with acepromazine (0.05 mg/kg) and morphine (0.5 mg/kg), anesthesia was induced (6 mg/kg) and maintained (0.4 mg/kg/min) with propofol. Each dog randomly received either an incisional (blind technique), TAP, or RS (ultrasound-guided) block. Intraoperative analgesia was assessed using cardiorespiratory variables. Postoperative analgesia was evaluated up to 6 hours after the operation with a Short Form of Glasgow Pain Scale (SF-GCPS) and Visual Analog Scale (VAS). Fentanyl was administered as a rescue analgesic when needed. During surgery, all data remained within normal limits without any significant differences. Fentanyl was administered to 1 dog in the Incisional and 1 in the TAP. Post-operatively, a single dose of fentanyl was given to 1 dog in the TAP and 1 in the RS. Four dogs in the Incisional and 3 in the RS received both doses of fentanyl. There was no significant difference regarding postoperative rescue analgesia among treatments. All 3 techniques demonstrated acceptable intra- and post-operative analgesia efficacy in dogs undergoing OHE. Further studies are warranted to confirm these findings.

Dexmedetomidine Alone or Combined With Morphine for Epidural Anesthesia in Bitches Undergoing Elective Ovariohysterectomy

The purpose of this study was to assess perioperative analgesia provided by the combination of epidural dexmedetomidine and morphine in bitches undergoing elective ovariohysterectomy. Twenty-four bitches were included in the study and allocated into 3 groups: GM, morphine 0.1 mg/kg; GD, dexmedetomidine 2 µg/kg; and GDM, dexmedetomidine and morphine at the same doses. All solutions were diluted in saline to a total of 0.36 mL/kg. Heart rate (HR), respiratory rate (FR) and systolic blood pressure (SAP) were recorded prior to epidural analgesia (TB), immediately following epidural analgesia (TEA), at surgical incision (TSI), at the first ovarian pedicle clamping (TOP1), at the second pedicle clamping (TOP2), at uterine stump clamping (TUC), at the start of abdominal cavity closure (TSC) and at the end of skin closure (TEC). Rescue analgesia with fentanyl was administered at 2 µg/kg IV if nociception corresponding to a 20% increase of any cardiorespiratory variables was noted. Postoperative pain assessment was performed using a modified composite Glasgow pain scale along the first 6 hours following the end of surgery. Numeric data were compared using ANOVA for repeated measures followed by Tukey test and ovarian ligament relaxation was analyzed using chi-square test under 5% significance. No differences were found on FR among times or groups, although HR showed significant differences between GM and GD at TSI, TOP1, TOP2, TSC and TEC and between GM and GDM at TEA and TSI (significantly lower HR values recorded in dexmedetomidine groups). Differences among time points were found on HR between TB and TEA in GD and on PAS between TOP1 and TSC in GM and between TOP1 and TUC in GDM (P < .05). Ovarian ligament relaxation was significantly more present in groups using dexmedetomidine, although the number of rescue analgesia administrations did not differ among groups. Kaplan-Meyer analysis failed to show significant differences on time of rescue analgesia administration among groups (P > .05). In conclusion, the combination of epidural dexmedetomidine and morphine is a more interesting choice for elective ovariohysterectomy in bitches for producing analgesia comparable to that of each drug alone, with noticeable relaxation of ovarian ligaments and lesser cardiovascular consequences.

Intravenous Acetaminophen Does Not Provide Adequate Postoperative Analgesia in Dogs Following Ovariohysterectomy.

Simple SummaryAcetaminophen is the most commonly used pain relief (analgesic) agent in humans worldwide and its use is becoming more frequent in dogs. However, limited evidence supports this use. This study aimed to investigate the analgesic effect of acetaminophen when administered as an intravenous injection post-operatively in female dogs. A total of 34 dogs were randomly divided into two groups and either administered acetaminophen or saline intravenously immediately after desexing. The dogs had their pain levels evaluated at 10, 20, 40, 60, 120, and 180 min after awakening from general anesthesia and the pain levels between groups were compared. Concurrently, the dogs had blood collected at 2, 5, 10, 40, and 80 min following injection of the acetaminophen. The blood was analyzed to quantify the levels of acetaminophen in the body. This study found that acetaminophen was no better than saline in providing analgesia in dogs following surgery. This study suggests that acetaminophen used alone may not be an appropriate post-operative analgesic agent for desexing procedures.(1) Objective: To investigate the analgesic effects of intravenous acetaminophen after intravenous administration in dogs presenting for ovariohysterectomy. (2) Methods: 14 ASA I client-owned female entire dogs. In this randomized, blinded, clinical study, dogs were given meperidine and acepromazine intramuscularly before induction of anesthesia with intravenous propofol. Anesthesia was maintained with isoflurane in oxygen. Intravenous acetaminophen 20 mg/kg or 0.9% NaCl was administered postoperatively. Pain assessments were conducted using the Glasgow Pain Scale short form before premedication and at 10, 20, 60, 120, and 180 min post-extubation or until rescue analgesia was given. The pain scores, times, and incidences of rescue analgesia between the groups was compared. Blood was collected before and 2, 5, 10, 20, 40, and 80 min after acetaminophen administration. Acetaminophen plasma concentration was quantified by liquid chromatography-mass spectrometry. The acetaminophen plasma concentration at the time of each pain score evaluation was subsequently calculated. (3) Results: There was no significant difference in pain scores at 10 min, highest pain scores, or time of rescue analgesia between groups. In each group, 3 dogs (43%) received rescue analgesia within 20 min. (4) Conclusions: Following ovariohysterectomy in dogs, there was no detectable analgesic effect of a 20 mg/kg dosage of intravenous acetaminophen administered at the end of surgery.

Intraperitoneal administration of lidocaine or tramadol alone or in combination on postoperative pain after ovariohysterectomy in dogs.

The present prospective randomized experimental study aimed to assess the intraperitoneal (ip) administration of lidocaine or tramadol, alone or in combination, on postoperative pain management following ovariohysterectomy in dogs. Eighteen healthy female mixed‐breed dogs, aged 1–2 years, weighed 16.7 ± 3.8 kg, were used. Animals were sedated with acepromazine (0.1 mg/kg, intramuscular). Forty minutes later, anaesthesia was induced through intravenous titration with diazepam (0.5 mg/kg) and ketamine (10 mg/kg) and maintained with isoflurane 1.5%. Afterwards, ovariohysterectomy was performed, and prior to the closure of the linea alba, animals received lidocaine containing epinephrine (8.8 mg/kg, ip) in group L, tramadol (4 mg/kg, ip) in group T and lidocaine containing epinephrine (8.8 mg/kg, ip) plus tramadol (4 mg/kg, ip) in the LT group. Cortisol, vital signs and pain scoring systems were evaluated at different time points. Vital signs did not change among the groups. Cortisol level in the LT group significantly decreased compared to the L and T groups one, three and six hours after surgery. Pain scores also did not change among the groups based on Sammarco and Simple descriptive (SDS) scoring method. However, pain scores in the LT group were higher than the two other groups according to the University of Melbourne pain scale (UMPS) and the short form of Glasgow pain scale (CMPS‐SF). According to the obtained results, the combination of lidocaine and tramadol seemed to be able to provide better analgesia compared with their separate administration. Therefore, combined intraperitoneal administration of lidocaine (8.8 mg/kg) and tramadol (4 mg/kg) with a final volume of (0.2 ml/kg) following ovariohysterectomy is recommended.

Comparison of Intraoperative Nociception and Postoperative Acute Pain After Traditional or Minimally Invasive Ovariohysterectomy in Dogs

Background: Many variations of ovariohysterectomy techniques have been described, including the traditional one and minimally invasive procedures. Non-laparoscopic Snook hook technique is an alternative for performing minimally invasive ovariohysterectomy. Few studies have been carried out in order to assess pain in animals submitted to minimally invasive surgeries, especially involving one of the most performed surgical procedures in veterinary practice. The aim of this study was to evaluate surgical duration, intraoperative nociception and acute postoperative pain after traditional ovariohysterectomy or minimally invasive non-laparoscopic technique in dogs using Snook hook. The hypothesis is that non-laparoscopic minimally invasive ovariohysterectomy would be faster and less painful than the conventional technique.Material, Methods &amp; Results: Thirty dogs were divided into Traditional Group (TG = 15) and Minimally Invasive Group (MIG = 15). Heart rate, respiratory rate, systolic blood pressure, body temperature, oxyhemoglobin saturation, end-tidal carbon dioxide concentration (ETCO2) and end-tidal isoflurane concentration were evaluated before the surgery to start (M0), during incision (M1), clamping of the first ovarian pedicle (M2), second ovarian pedicle (M3), uterine cervix (M4), abdominal suture (M5) and at the end of surgery (M6). The modified Glasgow Pain Scale was used for acute postoperative pain assessment and Visual Analogue Scale (VAS) was used to assess the sensitivity of surgical wound. The level of significance established for all statistical analyzes was 5%. Statistical differences were not observed between groups considering total surgical time and postoperative acute pain intensity (P &gt; 0.05), in spite of MIG having shorter duration of surgery. There was no statistical difference between groups considering all intraoperative parameters except respiratory rate (TG &lt; MIG; P &lt; 0.05) and ETCO2 (MIG &lt; TG; P &lt; 0.05) at the moment of traction of the first ovarian pedicle (M2). Pain assessment by VAS showed statistical difference 24h after the end of surgery (TG &lt; MIG) (P &lt; 0.05). Discussion: Both procedures were similar regarding intraoperative nociception and acute postoperative pain. It is possible that the sensation of pain in both procedures was blocked by the effectiveness of analgesics, once they might cause an inhibition of painful behaviors limiting a possible difference in pain identification. Higher respiratory stress observed in MIG at M2 and higher pain score by VAS noted in MIG 24 h after the end of surgery can be justified by greater traction of ovarian pedicle, due to limited surgical access of minimally invasive technique. Minimally invasive ovariohysterectomy non-laparoscopic seems to be potentially faster, probably due to the smaller size of the abdominal incision, which takes less time to be closed. In the present study, both techniques were performed by an experienced surgeon, providing safe procedures, nevertheless it is important to emphasize that iatrogenic injury can be caused by surgeons not proficient in the Snook hook technique, considering the limited visualization of anatomical abdominal structures. Data obtained indicate that traditional ovariohysterectomy and non-laparoscopic Snook hook technique promote similar intraoperative nociception and acute postoperative pain, however minimally invasive procedure is potentially faster and with less surgical trauma.

Evaluation of post-operative pain and stress in dogs after elective ovariohysterectomy under hospitalization

Surgical procedures in pet animals are usually associated with some degree of stress and pain. Hospitalization is one stress-triggering factor. The present study aimed to evaluate the degree of stress and pain during hospitalization of female dogs submitted to elective ovariohysterectomy (OVH) and to investigate the influence of hospitalization on the stress of these animals. Fifteen young adult crossbreed female dogs were divided into two groups: eight animals without surgery (Group 1 - control) and seven animals submitted to surgery (Group 2 - OVH). Pain and stress were evaluated. Visual analogue scale (VAS), simple descriptive pain scale (SDS) and modified Glasgow pain scale (MGPS) were used. Serum cortisol (μg/dL) and glucose (mg/dl) were also measured. No statistical difference was observed for cortisol (μg/dL) between the two groups. Despite the absence of statistical difference between groups and times, mean serum cortisol (μg/dL) values exceeded the normal values for the canine species at various times evaluated. Hyperglycemia was only observed at T4 in the OVH group. It was concluded that the hospitalization of animals was more relevant in the establishment of stress than the surgical procedure and associated pain. The influence of stress was a relevant factor in the results of assessments carried out using the MGPS.

Postoperative Analgesia Time in Dogs Submitted to Mastectomy and Anesthetized with Tumescent Solutions of Lidocaine or Ropivacaine

Background: Mastectomy, a procedure with high pain stimulation, is the treatment of choice for bitches with breast cancer. Tumescent anaesthesia is widely used for transoperative and postoperative analgesia in bitches submitted to mastectomy, because facilitates tissue divulsion, also contributing significantly for the rapid recovery of patients. Although, there is no consensus as to which local anesthetic to use and at what concentration it should be used. Herein was investigated which local anesthetics, lidocaine or ropivacaine, when used in tumescent solutions, could provide a more lasting analgesic effect in the postoperative period in bitches submitted to radical unilateral mastectomy.Materials, Methods &amp; Results: Sixteen bitches were sedated with chlorpromazine (0.3 mg/kg) and meperidine (3 mg/kg) followed by anesthesia with propofol and isofluorane. Then, bitches were randomly assigned to two groups (n= 8 each): LG group, infused with 15 mL/kg of tumescence solution containing 0.1% lidocaine; and RG group, infused with 15 mL/kg of tumescence solution with 0.1% ropivacaine. The study was conducted in a double-blind fashion. Control group did not include, because the patients would be submitted to severe or unbearable pain, according to the short-form of the Glasgow pain Scale (CMPS-SF). The heart (HR) and respiratory (ƒ) rates, and systolic blood pressure (SBP) were measured in the pre-operative period and immediately after extubation (Mextub) and at 0.5 h, 1 h, 2 h, 4 h, 8 h, and 12 h after the extubation. Analgesic efficacy was assessed using the CMPS-SF and von Frey filaments. Both groups showed higher means for HR at 0.5 h (167 ± 7 in LG; 170 ± 7 in RG) than at 4 h (117 ± 7 in LG; 120 ± 7 in RG). CMPS-SF revealed higher medians (P= 0.038) at the Mextub and 12 h time points for the LG [5 (3-6) and 1 (0-2)] than for the RG [5 (2-5) and 0 (0-1)].Discussion: Pain was excluded as a possible explanation for the difference presented for HR in both groups because, moderate pain is considered when more than two cardiorespiratory parameters show an increase of at least 20% in relation to baseline values, which did not occur in this study. Indeed, most animals were walking at 0.5 h after extubation and, in many cases, this occurred before the collection of data for the postoperative period. This may have influenced the results since exercise releases catecholamines and increases HR. Moreover at 4 h after extubation, most animals were asleep. As metabolism decreases during sleep, expected that HR would also decrease and that was indeed the case. Regarding CMPS-SF, the way the patients walks was the item that most contributed to the high score found for the Mextub time point because it's impossible to be performed seconds after extubation. As the reluctance to move occurred only immediately after extubation, the values obtained at the Mextub time point are more likely to be due to an anesthetic residual effect and not to the pain stimulus itself. When the groups were compared, the median values obtained at the LG were greater than RG at the Mextub and 12 h postoperative time points. There was no need for analgesic rescue differing from those in literature that reported the need for analgesic rescue in 50% of the animals. Those study established a CMPS-SF score of 3.3 as indicative for analgesic rescue whereas our research established a score of 7. Tumescence solutions with lidocaine or ropivacaine provide equivalent postoperative analgesia for at least 12 h.

Evaluation of Postoperative Analgesia of DexmedetomidineAlone or Associated to Morphineas Premedicants in Bitches Undergoing Ovariosalpingohisterectomy

Background:Elective ovariossalpingohysterectomy is a common surgery that causes mild to moderate pain. Aiming at the treatment of pain in these patients, analgesia should be balanced from pre-anesthetic, transoperative and postoperative medication, with α-2-agonists and opioids being commonly used, especially dexmedetomidine that has sedation, relaxation muscle and analgesia. The aim of the present study was to evaluate the postoperative analgesic efficacy of dexmedetomidine alone and associated with morphine when used in the preanesthetic medication of bitches submitted to elective ovarian oysterectomy using the modified Glasgow pain scale and the Melbourne pain scale.Materials,Methods &amp; Results:Twenty bitches were used in this study, all of them submitted to ovarian oysterectomy, and were clinically healthy according to laboratory and clinical exams. During the experiment, bitches were randomly distributed into two groups, which received preanesthetic medication (MPA) with 5μg/kg dexmedetomidine alone (GD) or associated with 0.3 mg/kg morphine (GDM) intramuscularly (IM). In both groups, anesthetic induction with dose-effect propofol was performed and maintained with isoflurane diluted in 100% oxygen administered through a calibrated vaporizer and appropriate anesthetic system based on the weight of the animal and maintained on spontaneous ventilation. After stabilization of the patient the surgery was started, which lasted 45 min. The bitches were evaluated by the Modified Glasgow Scale (GSM), the Melbourne Scale (MS) and the Dobbins Sedation Scale (DS), previously administered MPA (T0) and the others performed in 1h (T1), 2h (T2), 4h (T3), 8h (T4), 12h (T5) and 24h (T6) after extubation. If the GSM score was greater than the value of 3.3 an analgesic rescue of 0.5 mg/kg of morphine intramuscularly would be administered. An increase in the scoring of pain scales in both groups can be observed from the T1, with significant difference only of the T1 in relation to the T0 in the GSM of the GDM. Two rescues were performed in T1 of GD and three rescues in T1 and a rescue in T3 of GDM. There was no significant difference between the groups in relation to this variable, as a result of P = 0.62.Discussion:Based on the results of this study, dexmedetomidinedoes not have adequate analgesic effect for use in preemptive analgesia of bitches submitted to elective OSH due to the high number of analgesic rescues. A small increase in GSM and MS scores from T1 can be expected compared to values prior to the surgical procedure since there was no nociceptive stimulation. This increase was only significant in T1 of GDM, moment of greatest rescue number (n = 3). The absence of significant difference between the groups proves that the analgesic effect of dexmedetomidine was not potentiated by the association with morphine at the dose and route used in this experiment. Although morphine is widely used and proven to be effective for the surgical procedure of ovariossalpingohysterectomy, both when used alone and in combination with other drugs, this fact has not been proven in the present study. This fact may have occurred due to the low dose of dexmedetomidine used or due to its short duration. Therefore, dexmedetomidine at the dose used as preanesthetic medication did not produce an adequate analgesic effect in the postoperative period of bitches submitted to elective ovariossalpingohysterectomy. The effects of the same were not potentiated by the association with morphine, at the dose used. Not being recommended for postoperative analgesic control of electiveovariossalpingohysterectomy in bitches. However, further studies are needed to better evaluate the analgesic effect of this α-2-agonist.

Agreement among anesthesiologists regarding postoperative pain assessment in dogs

ObjectiveTo establish evidence for the validity and reliability of three commonly used pain scales in dogs when assessed by video by specialists in anesthesia. Study designMixed-method test–retest observational study. SubjectsA group of six American College of Veterinary Anesthesia and Analgesia board-certified specialists and 31 postoperative dogs. MethodsThe evaluators scored 31 dogs using a visual analogue scale (VAS), numeric rating scale (NRS), and Glasgow pain scale (GPS). The evaluators individually scored the dogs using all three scales together and subsequently, at 3 month intervals, using each of the scales apart. Then, all evaluators in one room reviewed 23 of the videos. A camera was positioned for video and audio recording of discussion about the videos. Intra- and interobserver reliability was determined using a two-way random model intra-class correlation coefficient (ICC). ResultsLinear regression indicated a strong correlation among all scales when assigned together (VAS versus NRS, p < 0.0001, R2 = 0.93; VAS versus GPS, p < 0.0001, R2 = 0.59; and NRS versus GPS, p < 0.0001, R2 = 0.61) and apart (VAS versus NRS, p < 0.0001, R2 = 0.68; VAS versus GPS, p < 0.0001, R2 = 0.40; and NRS versus GPS, p < 0.0001, R2 = 0.47). Posture, appearance, vocalization, stiffness, interaction between the animal and a person and response to palpation were identified as important variables for assessing pain. Intra-observer reliability produced average ICC values of 0.90 for VAS, 0.89 for NRS and 0.85 for GPS. Interobserver reliability produced average ICC values when scores were assigned together (VAS: 0.93, NRS: 0.93 and GPS: 0.93) and when done separately (VAS: 0.91, NRS: 0.93 and GPS: 0.95). Conclusions and clinical relevanceThe preferred use of the VAS and NRS over the use of the GPS should be cautiously considered for research applications when experts are observers. Revisions of the GPS to clarify descriptors and remove or modify items that may not be associated with pain in dogs should be considered.

Combination of magnesium sulphate and ropivacaine epidural analgesia for hip arthroplasty in dogs

ObjectiveThe aim of this study was to determine whether lumbosacral epidural administration of magnesium sulphate added to ropivacaine prolongs and improves perioperative analgesia, without adverse effects on motor block duration or hind limb neurological function, in dogs undergoing hip arthroplasty. Study designInvestigator-blind, controlled, randomized, prospective clinical trial. AnimalsA group of 20 client-owned dogs undergoing hip arthroplasty were allocated randomly to either group C (control, 1 mg kg−1epidural ropivacaine) or group M (magnesium, epidural injection of 1 mg kg−1 ropivacaine and 2 mg kg−1magnesium sulphate). MethodsAll dogs were premedicated with intramuscular acepromazine. General anaesthesia was induced with propofol and maintained with isoflurane in oxygen. Intraoperatively, nociception was assessed based on changes in heart rate, respiratory rate and mean arterial pressure above baseline values. Postoperatively, pain was evaluated with a Sammarco pain score, a Glasgow pain scale and a visual analogue scale (VAS). Tarlov’s scale was used to quantify motor block. All dogs were evaluated at recovery and then 1, 2, 3, 4, 5 and 24 hours after that. Rescue analgesia was provided during surgery with fentanyl and, postoperatively, with buprenorphine. Groups were compared using one-way repeated-measure analysis of variance followed by the Holm–Sidak method for multiple comparison or nonparametric tests when appropriate. ResultsThe two treatment groups did not differ (p > 0.05) with respect to intraoperative physiological variables, rescue analgesia, postoperative pain scores (Sammarco q = 1.00; Glasgow q = 3.10; VAS q = 0.50) and duration of the motor block (Tarlov’s q = 2.40). Conclusions and clinical relevanceThe addition of epidural magnesium to ropivacaine did not improve or prolong the analgesia provided by ropivacaine alone. Further studies are needed to determine whether an epidural magnesium dose of >2 mg kg−1 would exert better analgesia, without causing adverse effects, in dogs undergoing orthopaedic surgery.

Comparison of clinical effects of epidural levobupivacaine morphine versus bupivacaine morphine in dogs undergoing elective pelvic limb surgery

ObjectiveTo evaluate the efficacy, in terms of the amount of rescue analgesia required, and the clinical usefulness of epidural injection of morphine with bupivacaine or levobupivacaine for elective pelvic limb surgery in dogs during a 24-hour perioperative period. Study designProspective, blinded, randomized clinical study. AnimalsA group of 26 dogs weighing 31.7 ± 14.2 (mean ± standard deviation) kg and aged 54 ± 36 months. MethodsAll dogs were premedicated with methadone intravenously (0.2 mg kg–1) and anaesthesia induced with diazepam (0.2 mg kg–1) and propofol intravenously to effect. After induction of anaesthesia, dogs randomly received a lumbosacral epidural injection of morphine 0.1 mg kg–1 with either levobupivacaine 0.5% (1 mg kg–1; group LevoBM) or bupivacaine 0.5% (1 mg kg–1; group BM). Cardiovascular, respiratory and temperature values were recorded during the intra- and postoperative period. A visual analogue scale, subjective pain scale, sedation scale and the short form of the Glasgow pain scale were assessed every 6 hours after epidural injection during 24 hours. The ability to stand and walk, neurological deficits and other side effects were assessed at the same time points. The amount of rescue analgesia (sufentanil intraoperatively and methadone postoperatively) was recorded. ResultsNo statistically significant differences were found between groups for any of the recorded data, with the exception of the incidence of spontaneous urination and postoperative rescue analgesia requirement. In group LevoBM four dogs spontaneously urinated at recovery while none of the dogs in group BM did (p = 0.03) and seven dogs of group LevoBM required postoperative rescue analgesia versus none of the dogs in the BM group (p = 0.005). Conclusionsand clinical relevance Epidural LevoBM is a suitable alternative to BM in healthy dogs during elective pelvic limb surgery. Epidural BM produced more urinary retention but better pain control compared to the same concentration and dose of LevoBM in dogs.

Addition of magnesium sulphate to ropivacaine for spinal analgesia in dogs undergoing tibial plateau levelling osteotomy

The aim of this blinded, randomised, prospective clinical trial was to determine whether the addition of magnesium sulphate to spinally-administered ropivacaine would improve peri-operative analgesia without impairing motor function in dogs undergoing orthopaedic surgery. Twenty client-owned dogs undergoing tibial plateau levelling osteotomy were randomly assigned to one of two treatment groups: group C (control, receiving hyperbaric ropivacaine by the spinal route) or group M (magnesium, receiving a hyperbaric combination of magnesium sulphate and ropivacaine by the spinal route). During surgery, changes in physiological variables above baseline were used to evaluate nociception. Arterial blood was collected before and after spinal injection, at four time points, to monitor plasma magnesium concentrations. Post-operatively, pain was assessed with a modified Sammarco pain score, a Glasgow pain scale and a visual analogue scale, while motor function was evaluated with a modified Tarlov scale. Assessments were performed at recovery and 1, 2 and 3 h thereafter. Fentanyl and buprenorphine were administered as rescue analgesics in the intra- and post-operative periods, respectively.Plasma magnesium concentrations did not increase after spinal injection compared to baseline. Group M required less intra-operative fentanyl, had lower Glasgow pain scores and experienced analgesia of longer duration than group C (527.0 ± 341.0 min vs. 176.0 ± 109.0 min). However, in group M the motor block was significantly longer, which limits the usefulness of magnesium for spinal analgesia at the investigated dose. Further research is needed to determine a clinically effective dose with shorter duration of motor block for magnesium used as an additive to spinal analgesic agents.

Cardiorespiratory Changes and Pain Response of Lift Laparoscopy Compared to Capnoperitoneum Laparoscopy in Dogs

ObjectiveTo compare intraoperative physiologic variables and post‐operative pain associated with lift laparoscopy and conventional capnoperitoneum laparoscopy.Study DesignProspective randomized case controlled study.AnimalsHealthy dogs (n = 30).MethodsDogs having laparoscopic ovariohysterectomy were randomly assigned to lift laparoscopy (n = 14) or capnoperitoneum (16) laparoscopy. Physiologic variables measured intraoperatively were documented. Postoperatively, pain response was assessed in a blinded fashion using the short Glasgow pain scale and von Frey filament aesthesiometry.ResultsLift laparoscopy was associated with less frequency of hypercapnia, required less anesthetic gas, and was not more time‐consuming or painful than capnoperitoneum laparoscopy.ConclusionsLift laparoscopy is a feasible alternative to capnoperitoneum laparoscopy, especially in dogs where pressurized capnoperitoneum is not desired.

Comparison of intrarectal ozone, ozone administered in acupoints and meloxicam for postoperative analgesia in bitches undergoing ovariohysterectomy

Since all analgesics currently available for use in dogs have been associated with some adverse effects, the search for an effective analgesic that does not cause harm is important. This study investigated the postoperative analgesic effects of ozone administered either intrarectally or into acupoints in bitches undergoing ovariohysterectomy (OH). Twenty-four healthy adult bitches were randomly assigned to one of the three treatments 10min after sedation, as follows: 0.2mg/kg of intramuscular (IM) meloxicam (M); rectal insufflation of 10mL of 30μg/mL ozone (OI), or acupoint injection of 0.5mL ozone (30μg/mL; OA). Following sedation with acetylpromazine, anaesthesia was induced with propofol and fentanyl and maintained with isoflurane/O2. Pain was assessed using the modified Glasgow pain scale (MGPS) and the visual analogue scale (VAS) on the day before surgery, before anaesthesia, and at 1, 2, 4, 6, 8, 12 and 24h after surgery. Rescue analgesia was performed using 0.5mg/kg of morphine IM if MGPS was >3.33 points.No statistically significant differences in pain scales were found among the three analgesic protocols or the time points in each group (P>0.05). Two dogs treated with OA required rescue analgesia. Meloxicam, rectal insufflation of ozone and ozone injected into acupoints provided satisfactory analgesia for 24h in bitches undergoing elective OH. Ozone had no measurable adverse effects and is an alternative option to promote pain relief.

Intraoperative antinociception and postoperative analgesia following epidural anesthesia versus femoral and sciatic nerve blockade in dogs undergoing stifle joint surgery

To compare analgesic efficacy of preoperative epidural anesthesia with efficacy of femoral and sciatic nerve blockade in dogs undergoing hind limb orthopedic surgery. Prospective randomized blinded clinical study. 22 dogs requiring stifle joint surgery. Dogs were premedicated with acepromazine and morphine, and anesthesia was induced with diazepam and propofol and maintained with sevoflurane in oxygen. Prior to surgery, a combination of 1.0% lidocaine solution with 0.25% bupivacaine solution was administered either into the lumbosacral epidural space (11 dogs) or perineurally along the femoral and sciatic nerves (11). Intraoperative nociception was assumed if heart rate or systolic blood pressure increased by > 10% from baseline, in which case fentanyl (2 μg/kg [0.9 μg/lb], IV) was administered as rescue analgesia. Following recovery from anesthesia, signs of postoperative pain were assessed every 30 minutes for 360 minutes from the time of local anesthetic administration via the modified Glasgow pain scale. Patients with scores > 5 (scale, 0 to 20) received hydromorphone (0.1 mg/kg [0.05 mg/lb], IV) as rescue analgesia and were then withdrawn from further pain scoring. Treatment groups did not differ significantly in the number fentanyl boluses administered for intraoperative rescue analgesia. Time to administration of first postoperative rescue analgesia was comparable between groups. Furthermore, there was no significant difference between groups in baseline pain scores, nor were there significant differences at any other point during the postoperative period. Femoral and sciatic nerve blocks provided intraoperative antinociception and postoperative analgesia similar to epidural anesthesia in dogs undergoing stifle joint surgery.

Effect of cold compression therapy on postoperative pain, swelling, range of motion, and lameness after tibial plateau leveling osteotomy in dogs

To evaluate the effect of cold compression therapy (CCT) on postoperative pain, lameness, range of motion of the stifle joint, and swelling following tibial plateau leveling osteotomy (TPLO) in dogs. Randomized, blinded, placebo-controlled clinical trial. 34 client-owned dogs with unilateral deficiency of a cranial cruciate ligament undergoing TPLO. Dogs were assigned to 2 groups. Group 1 (n = 17 dogs) received CCT in the 24-hour period following TPLO. Group 2 (n = 17 dogs) received no CCT. Degree of lameness, range of motion, and circumference of the stifle joint were measured before surgery and 1,14, and 28 days after surgery. A modified composite Glasgow pain scale, visual analogue scale, and pain threshold score were used to evaluate signs of pain before surgery and 1,14, and 28 days after surgery. Logistic regression and linear regression analysis were used to compare the measured variables. No complications were observed, and all dogs tolerated CCT. Use of CCT resulted in lower values for the visual analogue scale and Glasgow pain scale and lower pain threshold scores; lower lameness scores; less swelling; and an increased range of motion 24 hours after surgery. At 14 days after surgery, there were no significant differences between groups. At 28 days after surgery, too few data sets were available for comparison. CCT decreased signs of pain, swelling, and lameness and increased stifle joint range of motion in dogs during the first 24 hours after TPLO.

Evaluation of subcutaneous and oral administration of robenacoxib and meloxicam for the treatment of acute pain and inflammation associated with orthopedic surgery in dogs

To assess efficacy and tolerability of robenacoxib for control of pain and inflammation in dogs undergoing orthopedic surgery. 140 client-owned dogs. A multicenter, prospective, randomized, blinded field trial was conducted to compare robenacoxib (97 dogs) and meloxicam (43 dogs). After randomization, each dog received an initial dose (robenacoxib, 2 mg/kg; meloxicam, 0.2 mg/kg) via SC injection before surgery and daily doses (robenacoxib, 1 to 2 mg/kg; meloxicam, 0.1 mg/kg) administered orally for up to 15 days after surgery. Efficacy was assessed by veterinarians and owners via numeric rating scales and visual analogue scales. Safety was assessed on the basis of reported adverse events, clinical signs, results of hematologic and biochemical analyses, and buccal mucosa bleeding times. Treatment groups were balanced with respect to baseline and demographic data. Both treatments provided similar adequate pain control, as assessed with a modified Glasgow pain scale as the primary end point and supported by secondary end points in evaluations conducted by veterinarians and owners. For the primary end point, the ratio of the reciprocal of the scores for robenacoxib to meloxicam was 1.16 (95% confidence interval, 0.98 to 1.37). No dogs required rescue analgesia. Both treatments were associated with only minor adverse events, which were not necessarily related to the administered treatments and did not affect mucosal bleeding times. Robenacoxib provided efficacy and tolerability similar to those of meloxicam for the management of perioperative pain and inflammation in dogs undergoing orthopedic surgery.

Effects of infiltration of the incision site with bupivacaine on postoperative pain and incisional healing in dogs undergoing ovariohysterectomy

To determine the effects of infiltration of the incision site with bupivacaine hydrochloride as part of a multimodal analgesia protocol (incisional block) on postoperative analgesia and incisional healing. Randomized controlled clinical trial. 92 shelter-owned female dogs undergoing routine ovariohysterectomy. As part of a multimodal analgesic protocol for ovariohysterectomy, dogs received 1 of the following treatments at the incision site: no injection (26 dogs), preincisional infiltration with saline (0.9% NaCl) solution (12 dogs) or bupivacaine (21 dogs), or postincisional infiltration with bupivacaine (33 dogs). Postoperative pain was assessed with the Glasgow pain scale and response to mechanical stimulation with von Frey filaments. Incisions were monitored for signs of inflammation (edema, erythema, and discharge) and complications in wound healing. There was no difference in pain scores or response to mechanical stimulation over time among treatments. There were no significant differences in incisional edema or discharge among treatments. There was significantly more erythema in dogs that received preincisional infiltration with saline solution at 4 hours after surgery and less erythema in dogs that received postincisional infiltration with bupivacaine at 24 hours after surgery, compared with other treatments. The number of complications for dogs that had preincisional infiltration of bupivacaine was higher than for dogs that had other treatments; complications included excessive inflammation, splenic laceration, and herniation. No additional analgesic benefit was found in dogs that underwent local bupivacaine infiltration as part of a multimodal analgesic protocol for ovariohysterectomy.

Application of a modified form of the Glasgow pain scale in a veterinary teaching centre in the Netherlands

The Glasgow Composite Measure Pain Scale was developed to measure acute pain in dogs in a hospital setting. In this investigation a modified version of the scale was applied in...