Research PaperA comparison of four methods of analgesia in cats following ovariohysterectomy
Introduction
Most veterinarians agree that ovariohysterectomy causes postoperative pain in cats (Lascelles et al. 1999). Practitioners are often reluctant to administer perioperative analgesics, however, because of lack of familiarity with available drugs, concerns about side effects, or frustration with the need for record keeping of controlled substances (Lascelles et al. 1999; Wright 2002). The ideal analgesic would be inexpensive, easy to administer, readily available, long-lasting, and effective. It should have few side effects; and would require no special licensing or storage. Besides opioids and alpha-2 adrenoreceptor agonists, options for controlling perioperative pain in cats include oral and injectable nonsteroidal anti-inflammatory drugs (NSAIDs), such as ketoprofen (Ketofen; Fort Dodge Animal Health, Fort Dodge, IA, USA) and carprofen (Rimadyl; Pfizer Animal Health, Exton, PA, USA), and local anesthetics, such as bupivacaine (Bupivacaine HCl; Abbott Labs, North Chicago, IL, USA) (Hellyer & Gaynor 1998; Lamont 2002). The use of these drugs is attractive because they meet many of the above criteria.
Administration of systemic or local analgesics before surgery may reduce an animal's need for postoperative pain intervention. Stimulation of peripheral nociceptors with surgical trauma can induce peripheral hypersensitivity and upregulation of central neuronal activity, resulting in a prolonged and intensified pain response with further stimulation of the site (Lascelles et al. 1998; Lamont 2002). Once neural pathways are sensitized, the physiologic and behavioral responses to pain may persist, even when the nerves themselves are blocked or transected (Lascelles et al. 1998). Pre-emptive analgesic administration prevents this central sensitization, thus effectively limiting pain perception. Reports of the effectiveness of pre-emptive analgesia in cats are limited (Lascelles et al. 1997; Cambridge et al. 2000; Slingsby & Waterman-Pearson 2002).
The purpose of this study was to evaluate the effectiveness of preoperative administration of oral carprofen, subcutaneous ketoprofen, and regional infiltration block with bupivacaine in preventing pain in cats after ovariohysterectomy. We hypothesized that each of these drugs would reduce pain-associated behavior scores comparable to that of cats treated preoperatively with butorphanol.
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Materials and methods
Fifty-two healthy (ASA1) female cats weighing >2.2 kg were included in the study, with 13 cats in each group. The study protocol was approved by the Institutional Animal Care and Use Committee, and permission was obtained from the cats' caregivers before participation. Age of most cats was unknown, although all were suspected to be at least 6 months of age; two cats were at least 5 years old. Health status of the cats was evaluated by physical examination and measurement of preoperative packed
Results
Of the 52 cats included in the study, two cats (one from the butorphanol group and one from the carprofen group) were excluded after surgery because of anemia secondary to accidental overdose of IV fluids (up to 66 mL kg−1 total dose over a 2-hour period). A third cat was given ketoprofen instead of bupivacaine. Therefore, 14 cats received ketoprofen; the remaining groups each contained 12 cats. Mean surgery time was 12.1 ± 3.9 minutes (median, 10 minutes) and mean anesthesia time was 30.0 ±
Discussion
In this study, significant increases from baseline in VAS and IVAS scores were seen within 1 or 2 hours after surgery. However, scores four or more hours after surgery were not significantly different from baseline for any group. The average surgery time in this study (12 minutes) was relatively short compared with previous studies, in which surgery duration ranged from 27 to 60 minutes (Slingsby and Waterman-Pearson, 1998, Slingsby and Waterman-Pearson, 2000; Smith et al. 1999; Ansah et al.
Acknowledgement
Funded by the Bernice Barbour Foundation, Inc., Wellington, Florida.
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2010, Journal of Feline Medicine and SurgeryCitation Excerpt :A number of other clinical studies have investigated the postoperative effects of buprenorphine and butorphanol, and results are consistent with the laboratory data. Unfortunately, there are few placebo controlled studies and many include other analgesics such as ketamine, well known for its pre-emptive analgesic effect, making it difficult to assess the effect of the opioid.36,38,49 Most reports indicate a relatively short duration of effect of butorphanol, with the period of analgesia lengthened by repeated dosing.39–41