Short-form Glasgow Composite Measure Research Articles

Clinical effects of perineural dexmedetomidine or magnesium sulphate as adjuvants to ropivacaine in dogs undergoing tibial plateau leveling osteotomy

The study aimed to compare the quality of perioperative analgesia, the motor block duration, and the effects on main cardiovascular parameters of dexmedetomidine (1 μg/kg/nerve block) or magnesium sulphate (2 mg/kg/nerve block) as adjuvants to 0.3% ropivacaine for sciatic and saphenous nerves block in dogs undergoing tibial plateau leveling osteotomy (TPLO). Dogs randomly received perineural dexmedetomidine-ropivacaine (D group), magnesium sulphate-ropivacaine (M group), or ropivacaine (C group). Fentanyl was administered in case of intraoperative nociception. Postoperative pain was assessed using the Short Form-Glasgow Composite Measure Pain Scale (SF-GCMPS) and VAS scale. The duration of motor blockade and intra- and postoperative cardiovascular parameters were also recorded. Group M required significantly more fentanyl than D group (p = 0.04). Group M had a significantly higher SF-GCMPS score than group C at 4 (p = 0.002) and 5 h after extubation (p = 0.01), and a significantly higher VAS score than group D at 3 h after extubation (p = 0.03), and at 4 h if compared to group C (p = 0.009). No significant differences regarding the duration of motor blockade were detected between groups (p = 0.07). The heart rate was significantly lower in group D than in M and C groups intraoperatively and during the first 1.5 h post extubation. The addition of dexmedetomidine or magnesium sulphate as adjuvants to perineural ropivacaine did not improve the quality of perioperative analgesia and did not prolong the motor blockade in dogs undergoing sciatic and saphenous nerves block for TPLO surgery.

Validation of the Portuguese Version of the Short-Form Glasgow Composite Measure Pain Scale (CMPS-SF) According to COSMIN and GRADE Guidelines.

We aimed to validate the CMPS-SF according to COSMIN and GRADE guidelines. Four trained evaluators assessed 208 videos (pre-operative-M1, peak of pain-M2, 1 h after the peak of pain and analgesia (rescue)-M3, and 24 h post-extubation-M4) of 52 dogs, divided into negative controls (n = 10), soft tissue surgeries (n = 22), and orthopedic surgeries (n = 20). The videos were randomized and blinded as to when they were filmed, and were evaluated in two stages, 21 days apart. According to confirmatory analysis, the CMPS-SF is a unidimensional scale. Intra-observer reliability was between 0.80 and 0.99 and inter-observer reliability between 0.73 and 0.86. Criterion validity was confirmed by the correlation between the CMPS-SF and other unidimensional scales (≥0.7). The differences between the scores were M2 ≥ M3 > M4 > M1 (responsiveness), and the scale presented construct validity (higher postoperative pain scores in dogs undergoing surgery versus control). Internal consistency was 0.7 (Cronbach's α) and 0.77 (McDonald's ω), and the item-total correlation was between 0.3 and 0.7, except for "A(ii)-Attention to wound". Specificity and sensitivity were 78-87% and 74-83%, respectively. The cut-off point for rescue analgesia was ≥5 or ≥4 excluding item B(iii) mobility, and the GRADE classification was high, confirming the validity of the scale.

A comparative analysis of opioid-free and opioid-sparing anaesthesia techniques for laparoscopic ovariectomy in healthy dogs

ObjectiveTo compare the perioperative analgesic effects of an opioid-free (OFA) and an opioid-sparing (OSA) anaesthetic protocol in dogs undergoing laparoscopic ovariectomy. Study designProspective, randomized, blinded, clinical trial. AnimalsA group of 28 client-owned dogs. MethodsDogs were allocated to one of two groups. The OFA group was administered intramuscular (IM) dexmedetomidine 5 μg kg–1 and ketamine 1 mg kg–1, followed by two intraoperative constant rate infusions (CRIs) of dexmedetomidine (3 μg kg–1 hour–1) and lidocaine (1 mg kg–1 loading dose, 2 mg kg–1 hour–1). The OSA group was administered IM dexmedetomidine 5 μg kg–1, ketamine 1 mg kg–1 and methadone 0.2 mg kg–1, followed by two intraoperative saline CRIs. In both groups, anaesthesia was induced with intravenous (IV) propofol 2 mg kg–1 and diazepam 0.2 mg kg–1 and maintained with isoflurane. Rescue dexmedetomidine (0.5 μg kg–1) was administered IV if there was a 20% increase in cardiovascular variables compared with pre-stimulation values. Ketorolac (0.5 mg kg–1) was administered IV when the surgery ended. Postoperative analgesia was evaluated using the Short Form-Glasgow Composite Measure Pain Scale and methadone (0.2 mg kg–1) was administered IM if the pain score was ≥ 6/24. Statistical analysis included mixed analysis of variance, Chi-square test and Mann–Whitney U test. ResultsThere were no significant differences in the intraoperative monitored variables between groups. The OFA group showed a significantly lower intraoperative rescue analgesia requirement (p = 0.016) and lower postoperative pain scores at 3 (p =0.001) and 6 (p < 0.001) hours. No dogs were administered rescue methadone postoperatively. Conclusions and clinical relevanceAlthough both groups achieved acceptable postoperative pain scores with no need for further intervention, the analgesic efficacy of the OFA protocol was significantly superior to that of the OSA protocol presented and was associated with a lower intraoperative rescue analgesia requirement and early postoperative pain scores.

Comparison of intraperitoneal and incisional lidocaine or ropivacaine irrigation for postoperative analgesia in dogs undergoing major abdominal surgeries.

This study compared the postoperative analgesic efficacy of intraperitoneal and incisional lidocaine versus ropivacaine in dogs undergoing major abdominal surgeries. Dogs randomly received intraperitoneal lidocaine irrigation (4 mg kg-1, diluted to 5 ml kg-1, L group), ropivacaine (4 mg kg-1, diluted to 5 ml kg-1, R group) or 0.9% saline (5 ml kg-1, C group). Prior to skin closure, dogs received incisional lidocaine 2 mg kg-1 (group L), incisional ropivacaine 2 mg kg-1 (group R) or incisional saline 0.2 ml kg-1 (group C). Pain was assessed at different time points up to 24 hours after extubation, using the Short Form-Glasgow Composite Measure Pain Scale and VAS Scale. In group C, postoperative pain scores were significantly higher than in groups L and R from T0.5 to T6 (p < 0.05). In R group, postoperative pain scores were significantly lower than in groups L and C from T12 to T24 (p < 0.05). Rescue analgesia was administered to 5/11 dogs in L group, 1/10 dogs in R group and 8/10 dogs in C group. Groups L and R experienced a significantly lower postoperative pain during the first 6 hours after extubation, compared with group C. Ropivacaine provided lower postoperative pain scores than lidocaine and saline up to 24 hours after extubation. According to the obtained results, ropivacaine seemed to provide better and longer lasting postoperative analgesia compared with lidocaine. Therefore, intraperitoneal and incisional administration of ropivacaine in dogs undergoing major abdominal surgeries is recommended.

Complications associated with cerebrospinal fluid collection in dogs.

This study aimed to identify complications associated with cerebrospinal fluid (CSF) collection in dogs. This was a prospective, observational multicentre study using data collected from 102 dogs undergoing CSF collection for the investigation of neurological disease. CSF was collected from the cerebellomedullary cistern (CMC), lumbar subarachnoid space (LSAS) or both sites. Pre-, intra- and postprocedural data were collected. Descriptive statistics were performed to outline complications associated with CSF collection. CSF sampling was attempted on 108 occasions, and CSF was acquired on 100 occasions (92.6%). Collection from the CMC was more likely to be successful than that from the LSAS. No dogs exhibited neurologic deterioration following CSF collection. There was no significant difference between pre- and post-CSF collection short-form Glasgow composite measure pain scores in ambulatory dogs (p = 0.13). The scarcity of complications limited the ability to quantify the incidence of some potential complications reported elsewhere. Our results may be used to inform clinicians and owners that CSF sampling is associated with a low frequency of complications when performed by trained personnel.

Randomized clinical trial comparing outcomes after fentanyl or ketamine-dexmedetomidine analgesia in thoracolumbar spinal surgery in dogs.

BackgroundOpioids are widely used for perioperative pain control in dogs undergoing spinal surgery, but alternatives may be required because data suggest that opioids exacerbate inflammation in the injured spinal cord and veterinary access to opioids may become more restricted in the future.ObjectivesTo compare recovery of ambulation and other functions between spinal cord‐injured dogs receiving peri‐operative fentanyl and those receiving a ketamine‐dexmedetomidine combination.AnimalsA total of 102 client‐owned dogs undergoing decompressive surgery for thoracolumbar intervertebral disc herniation.MethodsRandomized clinical trial. Dogs were randomized 1:1 to fentanyl or a ketamine‐dexmedetomidine combination for intra and postoperative analgesia. Primary outcome was time to recovery of ambulation; secondary outcomes were the postoperative Colorado Acute Pain Scale, the short‐form Glasgow Composite Measure Pain Scale, time to recovery of voluntary urination and time to unassisted eating.ResultsNo difference was found in time to recovery of ambulation between groups (adjusted sub‐hazard ratio, 0.83; 95% confidence interval [CI], 0.55‐1.24; P = .36) or in pain scores (Colorado: χ 2 = 14.74; P = .32; Glasgow: χ 2 = 6.61; P = .76). Differences in time to recovery of eating and urination were small but favored ketamine‐dexmedetomidine (adjusted odds ratios, 3.31; 95% CI, 1.53‐7.16; P = .002 and 2.43; 95% CI, 1.00‐5.96; P = .05, respectively).Conclusions and Clinical ImportanceThere was no evidence that, at the doses used, fentanyl impaired ambulatory outcome after surgery for thoracolumbar intervertebral disc herniation in dogs. Pain control appeared similar between groups. Secondary outcomes suggested minor benefits associated with ketamine‐dexmedetomidine. The ketamine‐dexmedetomidine combination appears to be a reasonable alternative to peri‐operative opioids.

Evaluation of cold atmospheric microwave plasma on skin physiological parameters and tolerability in dogs.

Cold atmospheric microwave plasma (CAMP) is a promising therapeutic option for treating skin infections and wounds. Changes in biophysical skin parameters and the tolerability in dogs after applying CAMP is unknown. This study aimed to evaluate the in vivo effects of CAMP on skin biophysical parameters [hydration, transepidermal water loss (TEWL) and surface temperature] and tolerability in dogs. Twenty client-owned dogs with normal skin. Cold atmospheric microwave plasma treatment was performed for 30 s and 1, 2 and 4 min, respectively, at different sites of normal canine skin in the inguinal area. Hydration, TEWL and surface temperature were measured five, three and three times, respectively, before and after CAMP application. After treatment, pain and adverse effects were evaluated using a modified Melbourne Pain Scale and the modified short form Glasgow Composite Measure Pain Scale (modified CMPS-SF). Transepidermal water loss values significantly decreased with 4 min of treatment, and hydration decreased significantly with 2 min of treatment. Temperature increased significantly with increasing treatment time. For other parameters, no significant changes were observed. No significant pain response or adverse effects were observed in most dogs, aside from mild erythema in the treatment area after 4 min. Cold atmospheric microwave plasma treatment was well-tolerated and did not significantly change canine skin biophysical parameters. CAMP achieves basic recommendations for safe use and is a potential therapeutic option for various skin diseases in dogs.

Clinical effects of preemptive intra-articular lidocaine, dexmedetomidine and lidocaine-dexmedetomidine administration in dogs undergoing arthroscopy

This study investigated the perioperative effects of preemptive intra-articular lidocaine (L group), dexmedetomidine (D group) and lidocaine-dexmedetomidine (LD group) in dogs. Physiological variables were intraoperatively recorded at 5 min intervals starting from baseline (5 min before intra-articular injection). If nociception occurred, IV fentanyl was administered. Postoperative pain was assessed using the Short Form-Glasgow Composite Measure Pain Scale. Twenty-four dogs (eight in each group) were included in this prospective, randomized, masked clinical study.In the LD group, systolic arterial pressure significantly increased at T10 (P = 0.027), T15 (P = 0.021) and T20 (P = 0.022), compared with baseline. In the D and LD groups, mean arterial pressure significantly increased at T10 (P = 0.022; 0.024), T15 (P = 0.024; 0.09) and T20 (P = 0.019; 0.021), compared with baseline and diastolic arterial pressure significantly increased at T10 (P = 0.026; 0.047), T15 (P = 0.021; 0.023), T20 (P = 0.011; 0.012) and T25 (P = 0.019; 0.027), compared with baseline. In the LD group, heart rate significantly decreased at T5 (P = 0.031), T10 (P = 0.026) and T15 (P = 0.034), compared with baseline. Atrioventricular blocks appeared more frequently in the LD group than in L and D groups (P = 0.002). Group L received more fentanyl than the D and LD groups (P = 0.03). No differences in postoperative pain score were detected (P = 0.121). These findings suggested systemic absorption of intra-articular dexmedetomidine. Intra-articular lidocaine-dexmedetomidine was associated with a greater incidence of atrioventricular blocks. Intra-articular dexmedetomidine, alone and combined with lidocaine, provided better intraoperative analgesia than lidocaine in dogs undergoing arthroscopy, although the 12 h postoperative analgesic effect of the three treatments was similar.

The need for opioid in the postoperative analgesia of dogs undergoing hemilaminectomy due to intervertebral disc extrusion

ABSTRACT: The aim of this study was to evaluate the postoperative analgesic effect of protocols with and without the opioid methadone in dogs with intervertebral disc extrusion undergoing decompressive surgery. Sixteen paraplegic dogs with preserved nociception underwent hemilaminectomy/disc fenestration and were randomly assigned to two groups. The analgesic protocol consisted of methadone, meloxicam and dipyrone in Group I (G1), and meloxicam and dipyrone in Group II (G2). The animals were blindly assessed by two observers, using the visual analogue scale (VAS) and the short-form Glasgow Composite Measure Pain Scale (CMPS-SF). Assessments occurred every 2 hours during first 24 hours post-surgery, and every 4 hours afterwards. There was no statistical difference among groups regarding pain scores or analgesic rescues. Both analgesic protocols provided analgesia in the initial 48 hours postoperatively, demonstrating that opioids are not necessary in the postoperative period of dogs undergoing hemilaminectomy and disc fenestration.

Postoperative analgesic effects of Reiki therapy in bitches undergoing ovariohysterectomy

ABSTRACT: This study aimed to evaluate the effects of Reiki therapy on postoperative pain in bitches undergoing elective minimally invasive ovariohysterectomy (OVH). Thirty bitches were randomly assigned to three groups: Control, Placebo, or Reiki. All dogs received methadone as preanesthetic medication (PAM), meloxicam in the preoperative period, propofol for anesthetic induction, and isoflurane for anesthetic maintenance. Immediately after OVH, the dogs in the Reiki were submitted to a single session of Reiki therapy, dogs in the Placebo received simulated Reiki therapy from a non-therapist, and dogs in the Control received no treatment. All dogs were evaluated for pain using short-form Glasgow composite measure pain scale (CMPS-SF) and visual analog scale (VAS) before (M0) and 2 (M2), 4 (M4), 8 (M8), 12 (M12), and 24 hours (M24) after administration of PAM. Comparing the CMPS-SF scores between the groups, at M2 Reiki scores were lower than those of the Placebo and at M4 those in the Reiki were lower than those of the Control or Placebo groups. Comparing the VAS scores, at M4 and M8, Reiki scores were lower than those of the Control or Placebo groups. Additional analgesia (morphine 0.2 mg.kg-1 intramuscularly) was administered to three bitches in Control and to four bitches of the Placebo. Reiki did not require additional opioid analgesia in the postoperative period. It was concluded that Reiki therapy provided analgesic effect and contributed to improve postoperative comfort of bitches submitted to elective OVH.

Pain burden, sensory profile and inflammatory cytokines of dogs with naturally-occurring neuropathic pain treated with gabapentin alone or with meloxicam.

Canine neuropathic pain (NeuP) has been poorly investigated. This study aimed to evaluate the pain burden, sensory profile and inflammatory cytokines in dogs with naturally-occurring NeuP. Twenty-nine client-owned dogs with NeuP were included in a prospective, partially masked, randomized crossover clinical trial, and treated with gabapentin/placebo/gabapentin-meloxicam or gabapentin-meloxicam/placebo/gabapentin (each treatment block of 7 days; total 21 days). Pain scores, mechanical (MNT) and electrical (ENT) nociceptive thresholds and descending noxious inhibitory controls (DNIC) were assessed at baseline, days 7, 14, and 21. DNIC was evaluated using ΔMNT (after-before conditioning stimulus). Positive or negative ΔMNT corresponded to inhibitory or facilitatory pain profiles, respectively. Pain scores were recorded using the Client Specific Outcome Measures (CSOM), Canine Brief Pain Inventory (CBPI), and short-form Glasgow Composite Measure Pain Scale (CMPS-SF). Data from baseline were compared to those of sixteen healthy controls. ΔMNT, but not MNT and ENT, was significantly larger in controls (2.3 ± 0.9 N) than in NeuP (-0.2 ± 0.7 N). The percentage of dogs with facilitatory sensory profile was similar at baseline and after placebo (61.5-63%), and between controls and after gabapentin (33.3-34.6%). The CBPI scores were significantly different between gabapentin (CBPI pain and CBPI overall impression) and/or gabapentin-meloxicam (CBPI pain and interference) when compared with baseline, but not placebo. The CBPI scores were not significantly different between placebo and baseline. The concentration of cytokines was not different between groups or treatments. Dogs with NeuP have deficient inhibitory pain mechanisms. Pain burden was reduced after gabapentin and/or gabapentin-meloxicam when compared with baseline using CBPI and CMPS-SF scores. However, these scores were not superior than placebo, nor placebo was superior to baseline evaluations. A caregiver placebo effect may have biased the results.

MRI-guided, transrectal, intraprostatic steam application as potential focal therapeutic modality for prostatic diseases in a large animal translational model: Afeasibility follow-up study.

Parallel to establishment of diagnostic surveillance protocols for detection of prostatic diseases, novel treatment strategies should be developed. The aim of the present study is to evaluate the feasibility and possible side effects of transrectal, MRI-targeted intraprostatic steam application in dogs as an established large animal translational model for prostatic diseases in humans. Twelve healthy experimental, intact, male beagle dogs without evidence of prostatic pathology were recruited. An initial MRI examination was performed, and MRI-targeted steam was applied intraprostatically immediately thereafter. Serum levels of C-reactive protein (CRP), clinical and ultrasonographic examinations were performed periodically following the procedure to assess treatment effect. Four weeks after treatment, all dogs underwent follow-up MRI examinations and three needle-core biopsies were obtained from each prostatic lobe. Descriptive statistics were performed. MRI-guided intraprostatic steam application was successfully performed in the study population. The first day after steam application, 7/12 dogs had minimal signs of discomfort (grade 1/24 evaluated with the short-form Glasgow Composite Measure Pain Scale) and no dogs showed any sign of discomfort by day 6. CRP elevations were detected in 9/12 dogs during the first week post steam application. Mild to moderate T2 hyperintense intraparenchymal lesions were identified during follow-up MRI in 11/12 dogs four weeks post procedure. Ten of these lesions enhanced mild to moderately after contrast administration. Coagulative necrosis or associated chronic inflammatory response was detected in 80.6% (58/72) of the samples obtained. MRI-targeted intraprostatic steam application is a feasible technique and displays minimal side effects in healthy dogs as translational model for human prostatic diseases. This opens the possibility of minimally invasive novel treatment strategies for intraprostatic lesions.

The effect of neuraxial morphine on postoperative pain in dogs after extrahepatic portosystemic shunt attenuation

ObjectiveTo investigate the analgesic effect of epidural morphine after surgical extrahepatic portosystemic shunt (EHPSS) attenuation. Study designRandomized clinical trial. AnimalsA total of 20 dogs with a congenital EHPSS. MethodsDogs were randomly allocated to be given either a single epidural dose of 0.2 mg kg–1 preservative-free morphine (group M) or not (group C) before surgery. All dogs were administered 0.3 mg kg–1 methadone intravenously (IV) as preanaesthetic medication. Pain scores were determined every 2 hours for the first 24 hours postoperatively using the short-form Glasgow Composite Measure Pain Scale (GCMPS-SF). Dogs with a GCMPS-SF pain score >4/20 or >5/24 received 0.1 mg kg–1 methadone IV as rescue analgesia and were reassessed 30 minutes later. If more than three doses of methadone were administered in a 2 hour period, alternative pain relief was provided and a treatment failure recorded. The GCMPS-SF pain scores and number of rescue analgesia injections were analysed over 24 hours. The last observation carried forward method was applied in case of treatment failure. Food consumption and time to first urination were recorded. Data were analysed using a Mann–Whitney U test and presented as median (minimum–maximum range), with significance set at p < 0.05. ResultsGroup M showed lower GCMPS-SF pain scores [15 (11–41) versus 31 (11–86); p = 0.023] and lower postoperative methadone requirements [0 (0–0.2) versus 0.25 (0–0.5) mg kg–1; p = 0.029] than group C. There were three treatment failures in group C only. Food consumption and time to first urination did not differ between groups. Conclusions and clinical relevanceEpidural morphine reduced the requirement for postoperative analgesia in this study population.

Proximal RUMM block in dogs: preliminary results of cadaveric and clinical studies

ObjectiveTo design and assess the perioperative analgesic efficacy of an ultrasound (US)-guided radial (R), ulnar (U), median (M) and musculocutaneous (Mc) nerve blocks, performed together in the axillary space by a single, in-plane approach. Study designAnatomical research and prospective clinical study. AnimalsA group of three dog cadavers and 15 client-owned dogs undergoing orthopaedic thoracic limb surgery. MethodsPhase 1: Anatomical dissection and US study of the axillary space were performed to design the US-guided proximal RUMM block. The technique was considered successful if a total volume of 0.15 mL kg–1 new methylene blue solution completely stained the four nerves in two cadavers for ≥2 cm. Phase 2: In 15 client-owned dogs undergoing orthopaedic thoracic limb surgery, the RUMM block designed in phase 1 was performed to provide analgesia using a total volume of 0.15 mL kg–1 of ropivacaine 0.5%. The block was considered effective if the intraoperative fentanyl requirement was <1.2 mcg kg–1 hour–1 and until the postoperative pain score was [short-form Glasgow Composite Measure Pain Scale (SF-GCMPS)] ≤5/20. ResultsPhase1: Detection of the four nerves was always feasible in a single US-window. The axillary artery and Mc nerve were used as landmarks. In-plane needling approach was feasible in both cadavers. All the nerves were completely stained for >2 cm. No intrathoracic dye spread was found. Phase 2: In 14/15 anaesthetized dogs, mean intraoperative fentanyl requirement was 0.25 ± 0.05 mcg kg–1 hour–1. Postoperatively, all dogs had SF-GCMPS ≤5/20 up to 8 hours. Conclusions and clinical relevanceThe US-guided proximal RUMM block performed at the axillary level with a single, in-plane needling approach using 0.15 mL kg–1 of ropivacaine 0.5% minimized fentanyl requirement during thoracic limb surgery, contributing to postoperative analgesia up to 8 hours after execution of the peripheral nerve block.

A preliminary investigation into personality and pain in dogs

Abstract Adherence to basic animal welfare standards involves effective monitoring and control of pain, especially in a veterinary setting. Assessment relies on behavioral and physiological indicators. However, individual differences in physiology mediate consistent individual differences in behavior, referred to as personality. Therefore, personality may confound measurements of pain. The current work is a preliminary investigation into whether extraversion and neuroticism are associated with differences in individual behavioral and physiological responses to pain. Twenty dogs were observed during recovery from routine castration in a clinical setting. Core temperature was recorded using infrared thermography on admission, 15 minutes after extubation and every 30 minutes thereafter, until the subject was collected by their owner. Behavior during recovery was scored using Short-Form Glasgow Composite Measure Pain Scale at the same intervals as infrared thermography readings. Personality was measured using Monash Canine Personality Questionnaire–Revised, and owners rated their dog's tolerance to pain on a 5-point Likert scale. Pain score did not have an association with eye temperature discrepancy or core temperature changes from control, indicating it may not predict affective response to pain. More highly extravert subjects had significantly higher pain scores ( P = 0.031), despite experiencing similar tissue damage. More extravert subjects showed significantly greater right eye temperature ( P = 0.035), suggesting hemispheric dominance. Neuroticism had no association with physiological or behavioral responses to pain. Finally, owners were not able to predict their dog's behavioral or physiological response to pain. These results indicate that personality may be a useful clinical tool for assessing individual differences in response to pain, whereas owners' ratings of their dog's response are not reliable.

Ultrasound-guided femoral and obturator nerves block in the psoas compartment in dogs: anatomical and randomized clinical study

ObjectiveTo evaluate intraoperative and postoperative efficacy of ultrasound (US)-guided femoral (FN) and obturator (ON) nerves block, in the iliopsoas muscle compartment (IPM), using an in-plane technique. Study designAnatomical research and randomized, prospective, ‘blinded’ clinical study. AnimalsSix dog cadavers and 20 client-owned dogs undergoing tibial plateau levelling osteotomy (TPLO) surgery. MethodsIn phase 1, anatomical dissections and US imaging of the IPM were performed to design an US-guided nerve block involving the FN and ON simultaneously. The technique was considered successful if new methylene blue solution injection (0.1 mL kg−1) stained FN–ON for ≥2 cm. In phase 2, the US-guided nerve block designed in phase 1, combined with US-guided sciatic nerve (ScN) block, was performed in 20 dogs undergoing TPLO surgery. Patients were assigned randomly to one of two treatment groups: ropivacaine 0.3% (R3, n=10) and ropivacaine 0.5% (R5, n=10) at a volume of 0.1 mL kg−1 for each nerve block. Intraoperative success rate (fentanyl requirement < 2.1 mcg kg−1 hour−1) and postoperative pain score [Short Form-Glasgow Composite Measure Pain Scale (SF-GCMPS) ≥ 5/20] were evaluated. ResultsIn phase 1, the US image of FN–ON was detected between L6 and L7. In-plane needling technique produced a staining of >4 cm in six of six cases. No abdominal or epidural dye spread was found. In phase 2, median fentanyl infusion rates were 0.5 (0.0–0.9) μg kg−1 hour−1 for R3 and 0.6 (0.0–2.2) μg kg−1 hour−1 for R5. At 9 and 11 hours after the peripheral nerve blocks, an SF-GCMPS ≥ 5 was observed for R3 and R5, respectively. Conclusions and clinical relevanceThe US-guided FN–ON block in the IPM, using an in-plane technique, combined with US-guided ScN block, provided sufficient analgesia to minimize the use of fentanyl during TPLO surgery. A longer postoperative analgesia was observed in group R5 compared with R3.

Effects of concurrent perioperative use of marbofloxacin and cimicoxib or carprofen in dogs.

To investigate possible interactions visible on electroencephalogram recordings caused by concomitant administration of marbofloxacin and carprofen or cimicoxib in dogs without central nervous system disease. Totally 21 client-owned dogs undergoing different surgeries were included in a randomised, blinded, clinical study. Each dog was assigned to one of two groups treated with either carprofen or cimicoxib pre- and postoperatively. After anaesthetic induction both groups received marbofloxacin intravenously while recording an electroencephalogram. Offline electroencephalogram analysis included qualitative evaluation and Fast Fourier Transformation. Postoperative analgesia was evaluated for 24 hours and after 10 days with the short-form Glasgow Composite Measure Pain Scale. Statistical analysis included Wilcoxon signed rank test, Mann-Whitney U test and Student's t-test with α set at 5%. Marbofloxacin injection caused no effects on quantitative and qualitative electroencephalogram parameters in both groups. No differences in postoperative pain scoring were found between treatment groups. Concurrent use of marbofloxacin with either cimicoxib or carprofen did not induce neuroexcitatory activities in dogs without CNS disease directly after administration.

Comparison of the analgesic efficacy of perioperative firocoxib and tramadol administration in dogs undergoing tibial plateau leveling osteotomy

To evaluate the effects of perioperative oral administration of tramadol, firocoxib, and a tramadol-firocoxib combination on signs of pain and limb function after tibial plateau leveling osteotomy in dogs. Randomized, blinded, prospective clinical trial. 30 adult client-owned dogs with unilateral cranial cruciate ligament disease. Dogs were allocated into 3 treatment groups (tramadol, firocoxib, and a tramadol-firocoxib combination). Signs of pain (short-form Glasgow composite measure pain scale), serum cortisol concentrations, and limb function (pressure platform gait analysis) were recorded at several time points before surgery and through 3 days after surgery. Outcome measures were compared among groups. A significantly greater number of dogs in the tramadol group (8/10 dogs) had a pain score > 6 after surgery, compared with the other groups. No significant differences were detected in the pain scores between the firocoxib and the tramadol-firocoxib combination groups. There were no significant differences in serum cortisol concentrations among the 3 groups. Limb function was significantly decreased for dogs in the tramadol group on days 1 and 2 after surgery and in the firocoxib group on day 1 after surgery. Although limb function decreased for dogs in the tramadol-firocoxib combination group, the change was not significant for any day after surgery. Dogs that received firocoxib orally, alone or in combination with tramadol, had lower pain scores, lower rescue opiate administration, and greater limb function than dogs that received only tramadol. When used alone, oral administration of tramadol may not provide sufficient analgesic efficacy to treat dogs with pain after orthopedic surgical procedures.

Development of the short-form Glasgow Composite Measure Pain Scale (CMPS-SF) and derivation of an analgesic intervention score

AbstractThe Glasgow Composite Measure Pain Scale (CMPS) for dogs suffering acute pain, developed using psychometric methodology, measures pain to a level of precision suitable for clinical trials. However, for routine clinical use, where the emphasis is on speed, ease of use, and guidance for analgesia provision, a short form (CMPS-SF) was developed. The CMPS-SF comprises six behavioural categories with associated descriptive expressions (items): vocalisation (4), attention to wound (5), mobility (5), response to touch (6), demeanour (5) and posture/activity (5). Items are placed in increasing order of pain intensity and numbered accordingly. The observer chooses that item within each category which best describes the dog's behaviour and ranked scores are summed; the maximum pain score is 24, or 20 if mobility is impossible to assess. Veterinary surgeons in Glasgow, University College Dublin and North Carolina Veterinary Schools completed the CMPS-SF for 122 dogs undergoing post-operative care and thereafter were asked “Do you think this animal requires analgesia? Yes/No”. The population difference in median pain score, for dogs considered to require analgesia (seven) compared with those that did not (three), was highly statistically significant (P &lt; 0.001). Consideration of a clinical decision-point for analgesia gave an intervention level of 6/24, and 5/20 when section B (mobility assessment) could not be carried out. Difficulties in recognising pain contribute to the sub-optimal use of analgesics in veterinary practice. The CMPS-SF provides a practical means of assessing acute post-operative pain and provides guidance with regard to analgesic requirement, so improving pain management and welfare. The CMPS-SF can be downloaded from the Glasgow Pain and Welfare website at http://www.gla.ac.uk/vet/painandwelfare.