University Of Melbourne Pain Scale Research Articles

Instrument shank-assisted ovariohysterectomy: a randomized clinical trial of surgical and pain alleviation efficiency of a single-person modified technique.

To evaluate a modified ovariohysterectomy (OHE) technique performed by a single person and compare it with the conventional method based on time efficiency, trauma, and postoperative pain. In a prospective, randomized, experimental study, 18 healthy, large, deep-chested, mixed-breed intact female dogs were randomly allocated to conventional (n = 9) and instrument shank-assisted (n = 9) groups. On the basis of video recordings, the various surgical step durations were analyzed: total surgery time (TST), pedicle intervention time (PIT), suspensory release time (SRT), shanking time (ShT), clamping time (ClpT), ligating time (LigT), and closure time (CT). The Glasgow composite pain scale short-form (GCMPS-SF), university of Melbourne pain scale (UMPS), and Visual Analogue Scales (VAS) were used to measure pain. C-reactive protein (CRP) fluctuation was also investigated. These evaluations were completed before and 6, 24, 48, and 72 h postoperatively. Instrument shank-assisted OHE was less time-consuming than conventional OHE (p = 0.005), improved PIT by 30.7% (6.44 min for both pedicles, p = 0.014), and correlated strongly with TST (ρ = 0.862, p = 0.003 and ρ = 0.955, p = 0.000, respectively). The two method's surgical step durations were also TST = 47.40 ± 9.9 vs. 34.70 ± 6.7 min, PIT = 20.96 ± 5.78 vs. 14.52 ± 3.73 min, SRT = 78.97 ± 69.10 vs. ShT = 20.39 ± 8.18 s (p = 0.035), ClpT = 50.66 ± 45.04 vs. 63.55 ± 37.15 s (p = 0.662), LigT = 12.82 ± 3.37 vs. 8.02 ± 3.11 min (p = 0.005), and CT = 16.40 ± 4.5 vs. 11.60 ± 2.5 min (p = 0.013), respectively. While both techniques inflicted pain on the animals, the novel approach resulted in a reduction of pain at T6 (GCMPS-SF, p = 0.015 and VAS, p = 0.002), T24 (UMPS, p = 0.003), and T48 (GCMPS-SF, p = 0.015 and UMPS, p = 0.050). Both methods exhibited a peak in CRP level after 24 h, which subsequently returned to baseline after 48 h. However, the shank-assisted method demonstrated a significantly lower reduction in CRP level at the 48-h compared to the other group (p = 0.032). Instrument shank-assisted technique permitted ovarian removal without an assistant, less damage to animals and reducing its time when compared to a conventional technique, and resulting in an alternative that causes less surgical stress and fatigue. Further research with a larger population size is required to determine the serum CRP levels as an alternative pain biomarker.

Comparison between the Effect of Lidocaine or Ropivacaine Hematoma Block and of Different Timings of Administration on Post-Operative Pain in Dogs Undergoing Osteosynthesis of Long-Bone Fractures.

We aimed to compare the efficacy of intra-operative lidocaine hematoma block (HB) to ropivacaine HB and to compare the efficacy of different timings of ropivacaine HB in controlling post-operative pain in dogs undergoing the osteosynthesis of long-bone fractures. We conducted a randomized, blinded, prospective clinical study. Forty-eight dogs with long-bone fractures were included and were randomly allocated to four groups: lidocaine (L), ropivacaine (Rmid), ropivacaine pre- (Rpre) and ropivacaine post- (Rpost) groups. The dogs in group L (n = 14) and in group Rmid (n = 11) received a lidocaine or ropivacaine HB, respectively, after fracture reduction and before osteosynthesis material placement. Rpre dogs (n = 11) received ropivacaine HB before fracture reduction, and Rpost dogs (n = 12) received ropivacaine HB after osteosynthesis material placement. Eight post-operative pain assessments were performed using the University of Melbourne Pain Scale (UMPS) and an algometer. Rescue analgesia was administered based on UMPS scoring. For data analysis, the Shapiro-Wilk test of normality, chi-square, Student t test and Split Plot analysis were used. The level of significance was set at α = 0.05. Rescue analgesia was administered to one dog in group L, one in group Rmid and one in group Rpost, with no significant differences detected. Compared to group Rmid, group L dogs exhibited significantly higher mean mechanical pain thresholds (p = 0.049) and lower mean UMPS scores (p = 0.001). Group Rpost dogs had statistically significantly higher mean pain thresholds compared to group Rmid (p = 0.009). When performed after fracture reduction and before osteosynthesis material placement, lidocaine HB seems to be more effective than ropivacaine HB in controlling post-operative pain in dogs undergoing osteosynthesis of long-bone fractures. The administration of ropivacaine HB after osteosynthesis material placement seems to be more effective than administration after fracture reduction and before osteosynthesis material placement or administration before fracture reduction in controlling post-operative pain in dogs undergoing osteosynthesis of long-bone fractures.

Contribution to the Study of Perioperative Factors Affecting the Restoration of Dog's Mobility after Femoral Head and Neck Excision: A Clinical Study in 30 Dogs.

This study aimed to compare postoperative analgesia and the time of limb weight bearing induced by the intraoperative administration of a local anesthetic at the site of the femoral head and neck excision (FHNE) in dogs, with and without the administration of preoperative epidural anesthesia. Additionally, the impact of postoperative opioid drug administration on weight-bearing time was examined. This randomized, blinded, prospective clinical study included 30 client-owned dogs. The dogs were randomly divided into three groups (A, B, C), each further divided into two subgroups (A1, A2, B1, B2, C1, C2). Group A received epidural anesthesia and ropivacaine at the ostectomy site, Group B received only ropivacaine, and Group C served as the control group. Subgroup 1 received a non-steroidal anti-inflammatory drug postoperatively, while Subgroup 2 had tramadol added to their regimen. Pain assessment was conducted using the University of Melbourne Pain Scale (UMPS) and an algometer. The study concluded that multimodal analgesia, utilizing all the aforementioned analgesic techniques, resulted in faster limb weight bearing for dogs undergoing FHNE.

Effect of gonadectomy on pain assessment in dogs undergoing orthopaedic stifle surgery

ObjectiveTo compare pain perception between gonadectomized and intact dogs. Study designBlinded, prospective, cohort study. AnimalsA group of 74 client-owned dogs. MethodsDogs were divided into four groups: group 1—female/neutered (F/N), group 2—female/intact (F/I), group 3—male/neutered (M/N) and group 4—male/intact (M/I). Premedication consisted of intramuscularly administered acepromazine (0.05 mg kg−1) and morphine (0.2 mg kg−1), and subcutaneously administered carprofen (4 mg kg−1). Anaesthesia was induced with propofol (1 mg kg−1 intravenously and supplementary doses to effect) and maintained with isoflurane in 100% oxygen. Intraoperative analgesia was achieved with fentanyl infusion (0.1 μg kg−1 minute−1). Pain assessments [using the University of Melbourne Pain Scale (UMPS) and an algometer at the incision site (IS), parallel to the incision site (NIS), and on the contralateral healthy limb] were performed preoperatively, and at 1, 2, 4, 6, 9 and 20 hours after extubation. The time-standardised area under the curve (AUCst) for measurements was calculated and compared by performing a one-way multivariate analysis of variance (manova). Statistical significance was set at p < 0.05. ResultsPostoperatively, F/N exhibited higher pain than F/I, with estimated marginal means (95% confidence intervals) AUCstISGroup1 909 (672–1146) versus AUCstISGroup2 1385 (1094–1675) (p = 0.014), AUCstNISGroup1 1122 (823–1420) versus AUCstNISGroup2 1668 (1302–2033) (p = 0.024) and AUCstUMPSGroup1 5.30 (4.58–6.02) versus AUCstUMPSGroup2 4.1 (3.2–5.0) (p = 0.041). Similarly, M/N showed higher pain than M/I with AUCstISGroup3 686 (384–987) versus AUCstISGroup4 1107 (871–1345) (p = 0.031) and AUCstNISGroup3 856 (476–1235) versus AUCstNISGroup4 1407 (1109–1706) (p = 0.026), and AUCstUMPSGroup3 6.0 (5.1–6.9) versus AUCstUMPSGroup4 4.4 (3.7–5.2) (p = 0.008). Conclusions and clinical relevance:Gonadectomy affects pain sensitivity in dogs undergoing stifle surgery. Neutering status should be taken into consideration when planning individualized anaesthetic/analgesic protocols.

Assessment of thermal response, cardiorespiratory parameters and post-operative analgesia in dogs undergoing ovariohysterectomy with different combinations of epidural analgesia and isoflurane

This study aimed to evaluate the thermal response of the eyelids and lacrimal gland of the left eye (LETG) through infrared thermography (IRT), cardiorespiratory parameters, and their association with nociception and pain in bitches undergoing elective ovariohysterectomy (OVH) anesthetized with isoflurane and epidural analgesia. Twenty-one healthy bitches of different breeds were randomized into three groups receiving epidural blocks: GL (n=7), lidocaine (2 mg Kg-1); GLF (n=7), lidocaine (2 mg Kg-1) and fentanyl (3 µg Kg-1); and GLM (n=7), lidocaine (2 mg Kg-1) with morphine (0.1 mg Kg-1). IRT and cardiorespiratory parameters were evaluated at baseline (Ebasal), thirty minutes before anesthetic premedication, and at different surgical events: first incision (EInc), ligature and section of the left (ELoV), and right (ERoV) ovarian pedicle, ligature, and re-section of the cervix (EUt), and skin suture (ESut). The assessment of acute pain in the immediate post-operative period was registered at E1h, E2h, and E3h using IRT, the Dynamic Interactive Visual Analogic Scale (DIVAS), and the University of Melbourne Pain Scale (UMPS) scales. The results showed a statistically significant decrease in the lower eyelid surface temperature (LELT) during EInc for GL (32.9°C ± 0.62), in comparison to GLF (34.2°C ± 0.62) and GLM (35.3°C ± 0.62) (P = 0.006). Regarding LETG, a significant increase (P = 0.03) in the IRT of Ebasal (36.8°C ± 0.63) and EInc (36.1°C ± 0.63) for GLM was observed in comparison to the thermographic values for both perioperative events and groups. The GLM showed a significant decrease in IRT values of ERoV at E3h in the upper and lower eyelids (P = 0.03 and P = 0.01, respectively). A progressive and significant reduction of the IRT values of LETG was also recorded in GLM, with differences in ERoV (35.2 °C ± 0.63) (P = 0.02) and E3h (35.3 °C ± 0.63) (P = 0.01). The cardiovascular parameters (SAP, DAP, and MAP) did not differ between treatments, but in GL, there was a significant difference (P = 0.01) during EInc and ESut, compared to Ebasal. In the body temperature, EInc and ESut gradually decreased in all treatment groups (P = 0.01). In conclusion, hemodynamic and cardiorespiratory stability was associated with IRT readings and the absence of nociception. Changes in superficial temperature in the immediate post-operative period were lessened using isoflurane and epidural analgesia of lidocaine alone or in combination with pure opioids. These findings were clinically validated to the DIVAS and UMPS acute pain assessment scales.

Premedication with acetazolamide: Is its use for postoperative pain and stress control after laparoscopic ovariectomy in dogs ruled out?

Studies in human medicine have concluded that acetazolamide reduces pain associated with carbon dioxide insufflation during laparoscopic surgery. However, there are no published reports regarding the use of acetazolamide for this purpose in companion animals, despite the increasing popularity of laparoscopic techniques in veterinary medicine due to their advantages over open surgeries. Thirty mixed-breed female dogs were included in the study and randomly assigned to one of three groups: OVE (median celiotomy ovariectomy; n = 10), OVEL (laparoscopic ovariectomy, n = 10) and OVELA (laparoscopic ovariectomy with acetazolamide preoperative administration; n = 10). Experienced surgeons performed all procedures, and the anaesthetic and analgesic protocols were identical for all animals. Acetazolamide was administered orally (at a dose of 25 mg/kg) 2 h prior to induction in the OVELA group. Postoperative pain was evaluated using serum cortisol, salivary cortisol, and the University of Melbourne Pain Scale (UMPS) Score. Any statistical differences were observed in the UMPS scores when the OVELA group was compared to the OVEL group at 1 h after surgery (p = 0.515), 12 h (p = 0.375) and 24 h (p = 0.242). Animals undergoing open surgery (OVE group) had significantly higher pain scores at all times after surgery when compared with OVEL and OVELA groups. A high positive correlation (r = 0.792; p = 0.01) was found between serum and saliva cortisol concentrations. Mean saliva cortisol concentration was not significantly lower for the OVELA group compared to the other groups. This study found evidence that preoperative administration of acetazolamide may be beneficial in managing postoperative pain in dogs after laparoscopic surgeries. However, further research with a larger sample size is needed to confirm this and to determine if acetazolamide should be included in a multimodal postoperative analgesia protocol for laparoscopic ovariectomy in dogs.

Evaluation of intraperitoneal administration of morphine on post-operative pain management after ovariohysterectomy in dogs.

The present prospective randomized experimental study was designed to assess pain control with intraperitoneal morphine following ovariohysterectomy in dogs. A group of 12 mixed breed female dogs, aged 1–2 years, weighing 19.95 ± 0.95 kg were included. Forty minutes after sedation with 0.05 mg/kg intramuscular acepromazine 1%, anaesthesia was induced with propofol (4 mg/kg). The dogs were connected to the inhalation anaesthesia circuit using isoflurane. Ovariohysterectomy was performed, and before the closure of linea alba, the animals received intraperitoneal morphine (0.5 mg/kg) (in group M) and saline (0.2 ml/kg) (in group S). No significant difference was detected in total protein and glucose levels between the groups, while the cortisol level in group M was significantly lower than group S 1, 3 and 6 h after surgery. Furthermore, the comparison of the rectal temperature, heart rates and respiratory rates showed no major differences. Additionally, no significant alterations were detected between the groups considering the changes in the pain scores with simple descriptive score, Glasgow, University of Melbourne pain scale, sedation status and Sammarco methods. Finally, three cases in group S and two cases in group M were given an intramuscular analgesic rescue dose of morphine. Although a significant decline was observed in cortisol levels following intraperitoneal morphine administration, there were no beneficial changes in the efficiency of post‐operative analgesia in status and clinical signs compared to the control group. Further studies are required to investigate intraperitoneal morphine effectiveness in post‐operative pain management.

Laparoscopic Versus Conventional Y-U Pyloroplasty in Dogs: A Comparative Study of Pain, Stress, and Duration

BACKGROUND: Background: Y-U pyloroplasty is a surgical approach that is used to relieve pyloric stenosis. The study of different aspects of laparoscopic Y-U pyloroplasty instead of conventional approaches seems to be an appropriate alternative for the development of such surgeries in animals, as pyloric stenosis is an uncommon but important disease. OBJECTIVES: The present study aimed to describe the laparoscopic Y-U pyloroplasty in small animals as a new surgical technique, and to compare the duration of surgery, level of surgical stress, and postoperative pain of this method with the conventional Y-U pyloroplasty. It is important to note that this is the first time that laparoscopic Y-U pyloroplasty was performed in dogs. METHODS: A total of eight intact male and female mixed breed dogs were randomly divided into two groups of conventional (n=4) and laparoscopic (n=4) pyloroplasty. Operation time, blood glucose concentration, plasma cor-tisol levels, gastric emptying time, pyloric lumen, and diameter and width of pyloric ring, as well as the University of Melbourne Pain Scale (UMPS) were measured in both groups during pre and postoperative intervals. RESULTS: As a result, the mean operation time for conventional group was significantly lower than that for lapa-roscopic group (38.75±3.15 min vs. 116.25±14.34 min, p <0.05). Blood glucose concentrations in both groups elevated rapidly until 3 hours after surgery and then decreased until 24 hours. Plasma cortisol level in laparoscopic group, however, elevated rapidly until 5 hours after surgery. On the other hand, pyloric diameter and width of pyloric ring significantly increased in both groups. The UMPS in dogs undergoing conventional Y-U pyloroplasty was significantly higher than that in those undergoing laparoscopic Y-U pyloroplasty (p <0.001). Furthermore, pain and gastric emptying time decreased in all dogs. CONCLUSIONS: This study suggests that laparoscopic Y-U pyloroplasty is an applicable minimal invasive sur-gery that is performed through small incisions for the treatment of pyloric stenosis in dogs.

Duration, Stress, and Pain Evaluation of Laparoscopic versus Conventional Heineke-Mikulicz Pyloroplasty

Pyloric stenosis is an uncommon but important gastric outflow disease. Heineke-Mikulicz (H-M) pyloroplasty is one of the pyloroplasty techniques used for the treatment of such diseases. A laparoscopic pyloroplasty is an effective and preferred alternative technique to conventional surgeries. This study aims to compare the duration of surgery, surgical stress level measurement, and postoperative pain in laparoscopic H-M pyloroplasty in normal dogs with a conventional pyloroplasty technique. Eight intact adult mixed breed dogs (5 females and 3 males) were used in this study. Animals were randomly divided into two groups of conventional open (n = 4) and laparoscopic (n = 4) H-M pyloroplasty. Blood glucose concentration, plasma cortisol level, as well as pyloric features including a pyloric lumen, pyloric diameter, pyloric width with ultrasonography, and gastric emptying time with contrast radiography and the University of Melbourne Pain Scale (UMPS) value, were measured in both groups. The mean operation time in the laparoscopic group was longer than that of the conventional group (55.00 ± 15.00 vs. 35.00 ± 4.56 min); however, this difference was not statistically significant. Blood glucose concentration in the laparoscopic group elevated rapidly until 3 hours after the operation and then decreased in 24 hours while blood glucose concentration in the conventional group slowly increased until 24 hours. The UMPS value at 3 hours after conventional H-M pyloroplasty was higher than that of laparoscopic H-M pyloroplasty (19.25 ± 0.75 vs. 6.50 ± 0.96, p < 0.001). Gastric emptying time significantly decreased in both groups. According to the results, in addition to reducing pain and stress, laparoscopic H-M pyloroplasty decreased gastric emptying time in all patients with no morbidity and appears to be a less invasive alternative technique for the management of gastric outflow disease.

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.

Clinical Use of The Parasympathetic Tone Activity Index As a Measurement of Postoperative Analgaesia in Dogs Undergoing Ovariohysterectomy.

IntroductionWhile the current tools to assess canine postoperative pain using physiological and behavioural parameters are reliable, an objective method such as the parasympathetic tone activity (PTA) index could improve postoperative care. The aim of the study was to determine the utility of the PTA index in assessing postoperative analgaesia.Material and MethodsThirty healthy bitches of different breeds were randomly allocated into three groups for analgaesic treatment: the paracetamol group (GPARAC, n = 10) received 15 mg/kg b.w., the carprofen group (GCARP, n = 10) 4 mg/kg b.w., and the meloxicam group (GMELOX, n = 10) 0.2 mg/kg b.w. for 48 h after surgery. GPARAC was medicated orally every 8 h, while GCARP and GMELOX were medicated intravenously every 24 h. The PTA index was used to measure the analgaesia–nociception balance 1 h before surgery (baseline), and at 1, 2, 4, 6, 8, 12, 16, 20, 24, 36, and 48 h after, at which times evaluation on the University of Melbourne Pain Scale (UMPS) was made.ResultsThe baseline PTA index was 65 ± 8 for GPARAC, 65 ± 7 for GCARP, and 62 ± 5 for GMELOX. Postoperatively, it was 65 ± 9 for GPARAC, 63 ± 8 for GCARP, and 65 ± 8 for GMELOX. No statistically significant difference existed between baseline values or between values directly after treatments (P = 0.99 and P = 0.97, respectively). The PTA index showed a sensitivity of 40%, specificity of 98.46% and a negative predictive value of 99.07%.ConclusionOur findings suggest that the PTA index measures comfort and postoperative analgaesia objectively, since it showed a clinical relationship with the UMPS.

Efficiency of Epidurally Injected lidocaine, lidocaine and Morphine or Lidocaine and Tramadol for Postoperative Analgesia in Dogs Following Orchiectomy and Ovariohysterectomy

The objective of this study was to evaluate and compare the postoperative analgesia provided by epidural lidocaine, lidocaine and morphine or lidocaine and tramadol in dogs following elective orchiectomy or ovariohysterectomy. Thirty-six clinically healthy dogs, classified as class I and II according to the American Society of Anesthesiologists classification system, were randomly allocated into three groups of 12 each, with six females and six males. The dogs received 4mg/kg of lidocaine combined with 0.01ml/kg of 0.9% NaCl, 0.1mg/kg of morphine or 1.0mg/kg of tramadol epidurally. Postoperative pain was assessed 4, 8, 12, 18 and 24 hours after epidural anaesthesia using the University of Melbourne pain scale (UMPS), by a single male observer who was blinded to the epidural protocol. According to the obtained results, evaluated epidural protocols provided sufficient and comparable postoperative analgesia throughout the complete 24-hours observation period. The appearance of vocalization or painful reaction to palpation of the wound surrounding tissue were absolutely absent. Values of 10 points, or higher, indicating the presence of moderate to severe pain and the necessity of additional analgesia, were not recorded. However, established quality of postoperative analgesia is probably not the sole result of epidural administration of drugs, but also analgesic activity of drugs used for general anaesthesia (xylazine and ketamine), and their mutual synergistic or additive effects.

Effects of epidural bupivacaine, bupivacaine-butorphanol and bupivacaine-morphine on postoperative analgesia for hind limb and pelvic orthopedic operations in dogs

The aim of this study was to compare the postoperative analgesic effects of epidural bupivacaine, bupivacaine-butorphanol and bupivacaine-morphine in hind limb and pelvic orthopedic operations in dogs. Three groups each containing 10 dogs were formed. Through the lumbosacral space, group B was administered bupivacaine, 1 mg kg-1; group BB was administered bupivacaine, 1 mg kg-1 and butorphanol, 0.25 mg kg-1; and group BM was administered bupivacaine, 1 mg kg-1 and morphine, 0.1 mg kg-1. Anaesthesia was induced with diazepam (0.2 mg kg-1) and propofol (5 mg kg-1) and maintenance with isoflurane in oxygen. Pain assessment was performed with the University of Melbourne Pain Scale (UMPS) by a blinded observer. Plasma cortisol levels were measured preoperatively and postoperatively. Postoperative pain scores were significantly lower at 2 hours in the group BM, and at 8 and 12 hours in the groups BB and BM compared to the group B (P=0.007). Group BM had a lower plasma cortisol level than the group B at 2 hours (P=0.002). Bupivacaine-butorphanol and bupivacaine-morphine use were shown to provide longer analgesia in the postoperative period; and the epidural administration of bupivacaine-butorphanol and bupivacaine-morphine was considered to be potentially useful in clinical practice.

Effectiveness of red propolis and Mikania glomerata in bitches´s surgical analgesia

The aim of this research was to evaluate the analgesia provided by red propolis and Mikania glomerata oral administration in 40 female dogs submitted to ovariohysterectomy (OH) compared to standard treatment with no steroidal anti-inflammatory ketoprofen. Through of a doble-blind and randomized study, the animals were divided in four different groups with 10 animals of treatments: control treatment with ketofen (CT), propolis treatment (PT), Mikania glomerata treatment (MT), and propolis-Mikania glomerata treatment (PGT). All pacients received one of these treatments two hours before OH and the pain evaluation was performed 1 (T1), 6 (T6), 12 (T12), and 24 hours (T24) after OH using University of Melbourne Pain Scale and the Glasgow Composite Measure Pain Scale. Glucose levels were also measured at the same times, except at 6 hours after OH (T6). All treatments achieved similar and satisfactory analgesia. During the experiment, only three animals were rescued, two belonging to the PT and another of the MT. Considering the lower rate of complications and no rescue necessity of in PGT and CT treatments, they were considered the most effective and safer. The combined treatment with propolis and Mikania glomerata could be a promising alternative method for OH surgery analgesia in bitches.

Metamizol and Scopolamine for Conventional or Two-Port Laparoscopic-Assisted Ovariohysterectomy in Dogs

Background: Ovariohysterectomy (OVH) is one of the most appliedtechniques in Veterinary Medicine. Although some analgesic protocols are used after this procedure in order to control post operatory pain, there is a lack of knowledge of the efficacy after conventional and two port laparoscopic-assisted techniques in dog female. Although the combined formulation of metamizol and scopolamine is used, there is no knowledge about the efficacy and collateral effects in a 6 h regimen after OVH. The aim of this research was to evaluate the efficacy of metamizol and scopolamine to analgesia after two techniques of OVH in dog female.Materials, Methods &amp; Results: Fifteen adults and healthy dog female were submitted to OVH, being eight to the conventional procedure and seven to video assisted technic with two ports. The patients received a combination of metamizol and scopolamine, 6-6 h during 48 h and were evaluated before surgery, 60 min after extubation and on 1 h interval during the first 8 h, and at 12, 18, 24, 36, 48 and 72 h after surgery. For this, the University of Melbourne Pain Scale (UMPS) and the short-form of the Glasgow Composite Measure Pain Scale (CMPS-SF) were applied by three evaluators blinded to surgical technic. Glucoses measurement was realized at 1, 6, 12, 24, 48 and 72 h after surgery. Analgesic rescue was not necessary for any animal. Punctuation of UMPS in GC decreases at 8 h and at 5 h, and to GV at 12 and 24 h. Difference between groups happened at 3 h with larger average to GV; at 48 h the punctuation in GC was lager. Considering CMPS-SF to CG, higher average was observed at 1 h and decreased at 2, 3, 8 and 18. At GV highest average points was verified at 1, 2 and 3 h and decreased at 5, 8 and 18 h. Correlation was strong and positive between each two evaluators. Animals of both groups had increased average glucose concentrations from baseline to after surgery and the values reduced to baseline after 24 h; difference between groups were observed at 1 h after surgery, with bigger average to GC. Three animals from the GC had postoperative emesis and one patient vomited after 3 h; other at 6 h and another at 36 and 48 h and owners related no vomiting or changes following hospital discharge. The time to first spontaneous food intake was earlier to GV and time to first defecation was no different between groups. Discussion: For the evaluation it was used the UMPS and CMPS-SF since it is know that pain assessment is better performed when multidimensional or composite scales are used. Considering the UMPS, 27 points is considered the most painful condition. In our study it was observed bigger average to GC at 1 h (4,5) and to GV at 2 and 3 h (5,0). According to CMPS-SF, higher punctuation to GC (7.0) was observed than GV (6,0) in a maximum of 24 points. Considering both scales, it could be suggested that the combination of metamizol and scopolamine promote good analgesic effect. The glucoses measurements and the first spontaneous food intake suggested that laparoscopic approaches results in less stress than the traditional procedures, as observed in other studies. Three animals of GC had postoperative emesis, and it signal can be associated to abdominal pain, as well nausea, vomiting, diarrhea and abdominal distention, probably because it is accepted that video surgery promotes less pain and stress than open procedures. The protocol was efficient to control pain after elective conventional and laparoscopic assisted OHV technique in dog female.

Post-surgical Evaluation of the Analgesic Impact of Epidural Tramadol, when Associated with Levobupivacaine, in Bitches Undergoing Mastectomy and Ovariohysterectomy

Background:Mammary tumors are the most common neoplasms in female dogs. Surgical removal of the mammary gland chain is considered the standard treatment and is usually performed along with ovariohysterectomy (OH) to suppress ovarian hormonal influence. Mastectomies cause moderate to severe pain and require preferential multimodal analgesic protocols. The aim of this study was to compare the postoperative analgesic efficacy and the recovery times on female dogs undergoing mastectomies and OH between those treated with epidural levobupivacaine alone and those treated with associated doses of tramadol and anesthetized with propofol.Materials, Methods &amp; Results:Eighteen female dogs were pretreated with acepromazine (0.03 mg/kg), using propofol (4 mg/kg)for induction andanesthesia maintenance. The dogs were randomly divided into three groups (n = 6) treated with epidural anesthesia with levobupivacaine alone at 1.5 mg/kg (GL) or associated with tramadol at doses of 2 mg/kg (GLT2) or 4 mg/kg (GLT4). After anesthesia,the mean propofol infusion rate for each groupwere calculed. During the postoperative period,the degree of analgesia according to the University of Melbourne Pain Scale for 6 hours were determined, considering seven time points for evaluation (M30, M60, M90, M120, M180, M240, and M360). Supplemental analgesia with morphine (0.5 mg/kg) to those dogs with scores ≥13 were provided. During the recovery period,the time intervals between the end of anesthesia, and the following events: extubation (EX), the first head movement (MC), and the establishment of sternal (PE) and quadrupedal (PQ) positions were measured. The data were subjected to the Friedman test for analysis of non-parametric variables within the same group and to the Mann–Whitney test for independent variables, comparing the mean scores between groups (statistical significance was set at P&lt;0.05). In the GL group, a higher mean propofol infusion rate than in either the GLT2 or GLT4 groups were found. The EX, PE, and PQ times were similar between the groups with a lower MC interval (P=0.041) for dogs in the GLT2 group. The pain assessment revealed higher scores for dogs in the GL group than for those in the GLT4 group (M30 to M120 and M360). Over time, the initial scores increased after M90 (GL group) and afterM120 (in all groups) andadditional analgesia were required only in GL dogs.Discussion:Mammary tumors were more frequent in middle-aged and elderly female dogs, corroborating current literary data. Regarding anesthesia recovery, no differences in the time for extubation and sternal and quadrupedal positions were found, probably due to similar propofol infusion times and to similar metabolism among the dogs, independent of the higher mean infusion rates used in the group treated only with the local anesthetic. The post-surgical analgesic evaluation revealed lower pain scores in the groups in which tramadol was associated with levobupivacaine, in agreement with studies reporting its analgesic potential to approach surgical pain at doses ranging from 1 to 4 mg/kg. However, even lower scores with the highest dose of the proposed opioid were detected, suggesting improved effectiveness for occupying opioid and monoaminergic pathway receptors. Considering the results, epidural anesthesia with levobupivacaine and tramadol seems to provide adequate post-surgical analgesia for a minimum period of 6 hours, and the best comfort is obtained with a dose of 4 mg/kg of opioid.

Effect of levobupivacaine, administered intraperitoneally, on physiological variables and on intrasurgery and postsurgery pain in dogs undergoing ovariohysterectomy

The aim of this study was to evaluate intraoperative and postoperative efficacy and cardiovascular effects of levobupivacaine compared with bupivacaine, administered intraperitoneally in dogs undergoing ovariohysterectomy surgery. Thirty female dogs were divided into three groups B, L, and E, each comprising ten subjects. All subjects received 5 mcg kg-1 dexmedetomidine and 0.3 mg kg-1 methadone intramuscularly, 4 mg kg-1 propofol intravenously, and isoflurane after intubation. After laparotomy, 2.5 mg kg-1 bupivacaine (B group), 2.5 mg kg-1 levobupivacaine (L group), and 0.9% saline solution (E group) were sprayed on ovarian stalks and on the neck of the uterus. Heart rate, respiratory rate, hemoglobin saturation (SpO2), noninvasive systolic blood pressure, carbon dioxide at the end of expiration (ETCO2), and concentration of inspired isoflurane were recorded. Evaluation of intraoperative analgesia was performed with a cumulative pain scale, whereas evaluation of postoperative analgesia was performed using the University of Melbourne Pain Scale. Intraoperative analgesia was significantly different among the groups P = 0.000; L group scores were lower than groups B and E. Total pain score, during the 24 hours after extubation, was significantly different between the groups. In fact, in groups B and L, scores were statistically lower than group E. In our study, there were no differences in anesthetic power between the two local anesthetics. No patients manifested side effects. Intraperitoneal anesthesia, with levobupivacaine represents an effective and safe method to control intraoperative and postoperative pain in abdominal surgery.

Effect of intrafragmentary bupivacaine (haematoma block) on analgesic requirements in dogs undergoing fracture repair

ObjectiveTo test the efficacy of intraoperative intrafragmentary administration of bupivacaine (haematoma block) in controlling postoperative pain in dogs undergoing osteosynthesis of long-bone isolated diaphyseal fractures. Study designRandomized, ‘blinded’, placebo-controlled, prospective study. AnimalsA total of 23 client-owned dogs with isolated long-bone fractures. MethodsDogs were allocated randomly to two groups: bupivacaine group (B) or placebo group (P). Group B dogs (n = 11) were administered an intraoperative intrafragmentary injection of 0.5% bupivacaine (1.1 mg kg–1) just before fracture fixation, whereas group P dogs (n = 12) were administered normal saline. Postoperative pain evaluations using the University of Melbourne Pain Scale (UMPS) and algometer were performed upon arrival to the recovery room and 1, 2, 4, 6, 8, 20 and 32 hours later. Algometer measurements were performed on: the incision site, a healthy region near the fracture line and the contralateral healthy limb. When the pain score exceeded 14 points in the UMPS, rescue analgesia was administered. The time-standardised area under the curve (AUCst) was used to compare UMPS scores and mechanical pain thresholds between the two groups. ResultsNone of the group B dogs required rescue analgesia, whereas eight of the 12 group P dogs did (p = 0.001). The pain threshold AUCst at the incision line was higher in group B [16.3 (2.9–41.6) N] than in group P [5.6 (2.5–17.4) N] (p = 0.029). The mean UMPS score AUCst was lower in group B (3.7 ± 1.8) than in group P (9.4 ± 4.6) (p = 0.016). In a small number of animals of both groups that were evaluated radiologically, adequate bone healing was noted. Conclusions and clinical relevanceAn intraoperative bupivacaine haematoma block is a simple, quick and effective method that can be used to aid in postoperative pain control in dogs submitted to long-bone osteosynthesis.

Postoperative analgesic effects of either a constant rate infusion of fentanyl, lidocaine, ketamine, dexmedetomidine, or the combination lidocaine-ketamine-dexmedetomidine after ovariohysterectomy in dogs

ObjectiveTo evaluate the postoperative analgesic effects of a constant rate infusion (CRI) of either fentanyl (FENT), lidocaine (LIDO), ketamine (KET), dexmedetomidine (DEX), or the combination lidocaine-ketamine-dexmedetomidine (LKD) in dogs. Study designRandomized, prospective, blinded, clinical study. AnimalsFifty-four dogs. MethodsAnesthesia was induced with propofol and maintained with isoflurane. Treatments were intravenous (IV) administration of a bolus at start of anesthesia, followed by an IV CRI until the end of anesthesia, then a CRI at a decreased dose for a further 4 hours: CONTROL/BUT (butorphanol 0.4 mg kg−1, infusion rate of saline 0.9% 2 mLkg−1 hour−1); FENT (5 μg kg−1, 10 μg kg−1hour−1, then 2.5 μg kg−1 hour−1); KET (1 mgkg−1, 40 μg kg−1 minute−1, then 10 μg kg−1minute−1); LIDO (2 mg kg−1, 100 μg kg−1 minute−1, then 25 μg kg−1 minute−1); DEX (1 μgkg−1, 3 μg kg−1 hour−1, then 1 μg kg−1 hour−1); or a combination of LKD at the aforementioned doses. Postoperative analgesia was evaluated using the Glasgow composite pain scale, University of Melbourne pain scale, and numerical rating scale. Rescue analgesia was morphine and carprofen. Data were analyzed using Friedman or Kruskal–Wallis test with appropriate post-hoc testing (p < 0.05). ResultsAnimals requiring rescue analgesia included CONTROL/BUT (n = 8), KET (n = 3), DEX (n = 2), and LIDO (n = 2); significantly higher in CONTROL/BUT than other groups. No dogs in LKD and FENT groups received rescue analgesia. CONTROL/BUT pain scores were significantly higher at 1 hour than FENT, DEX and LKD, but not than KET or LIDO. Fentanyl and LKD sedation scores were higher than CONTROL/BUT at 1 hour. Conclusions and clinical relevanceLKD and FENT resulted in adequate postoperative analgesia. LIDO, CONTROL/BUT, KET and DEX may not be effective for treatment of postoperative pain in dogs undergoing ovariohysterectomy.

Evaluation of preemptive dexketoprofen trometamol effect on blood chemistry, vital signs and postoperative pain in dogs undergoing ovariohysterectomy.

To investigate the postoperative analgesic effects of preemptive dexketoprofen trometamol in dogs subjected to ovariohysterectomy (OHE). Seventeen adult bitches of various breeds were used in this study. The dogs were randomly allocated into of two groups. Subjects in the dexketoprofen trometamol (DEX) group (n=10), received intravenous (i.v.) dexketoprofen trometamol, 1 mg/kg, 15 minutes before premedication, while those assigned to the control (C) group (n=7) were given no analgesics prior to premedication. Pain level was assessed by two researchers before the administration of anaesthesia (15 minutes before start) and 0, 1, 2, 4 and 6 hours after surgery. A modified University of Melbourne Pain Scale (UMPS) was used to evaluate pain in both groups. Serum cortisol level changed from 0 to 1 h and from 0 to 1 to 4 h were compared between the groups; the increase in the C group was statistically significant. The modified UMPS was applied to both groups at baseline and postoperative 1, 2, 4 and 6 h. According to this test, the values for DEX were significantly lower than controls at 4 and 6 h (p<0.001). Stable vital signs with unchanged biochemical parameters on dexketoprofen administration are a promising finding. The clinical advantage shown by the pain scale difference and the low serum cortisol levels should qualify dexketoprofen for preemptive pain management in dogs (Tab. 5, Fig. 2, Ref. 30).