A systematic review of analgesia practices in dogs undergoing ovariohysterectomy

Abstract

Aim:This was a systematic review conducted to evaluate the analgesic drugs and techniques used in the management of pain in dogs undergoing ovariohysterectomy.Materials and Methods:Systematic searches in PubMed, Google Scholar, and ScienceDirect were conducted for peer-reviewed articles written in English and published from 1995 to 2015. The key search words were dogs, ovariohysterectomy, pain, and analgesics. This was followed by a manual search of the references within the primary data sources. Inclusion and exclusion of studies and data extraction were performed independently by two reviewers. All randomized studies evaluating the effects of analgesics during ovariohysterectomy in dogs were included.Results:A total of 31 trials met the criteria and were, therefore, included in the study. Data on the type of analgesic drugs used, the technique of administration, and the need for rescue analgesia were extracted from the papers. Individual analgesic protocols were used in 83.9% of the studies compared to multimodal drug therapy, which was used in 16.1% of the studies. Opioids were used in 39.0% of studies, nonsteroidal anti-inflammatory drugs (NSAIDs) in 19.4%, a combination of NSAIDs and opioids in 19.4%, local analgesics in 6.5%, and acupuncture in 3.2% of the studies. Drug administration was done using three approaches that included pre-operative (64.5%), post-operative (22.6%) as well as combined pre- and post-operative approach (12.9%). In 77.4% of the studies, administration of analgesics was done once, while in 12.9%, it was done as a 72-h post-operative course. 24-h and 48-h courses of post-operative pain therapy were done in 6.5% and 3.2% of the studies, respectively. About 57% of the dogs in the control groups required rescue analgesia as compared to 21.6% in the single and 11.3% in multimodal drug therapy groups. The requirement for rescue analgesics was highest in dogs treated using acupuncture (43.8%) and lowest in dogs treated using NSAID-opioid combination (8.6%). Fewer dogs among those that received pain medication preoperatively and postoperatively required rescue analgesia compared to those in groups given drugs before and after surgery only. More dogs (26.4%) among those given analgesics only once postoperatively required rescue analgesia as compared to those that received analgesics daily for 72 h (4.4%).Conclusions:This study provides evidence that opioids are the mainstream analgesic drugs used in managing acute post-operative pain in dogs’ post-ovariohysterectomy. In addition, multimodal drug therapy, particularly, NSAID-opioids combination is more effective for pain management than single drug administration. Administering analgesics both before and after surgery is associated with better outcomes and so is a protracted course of post-operative pain therapy. Although these practices should be encouraged, controlled studies should be conducted to conclusively determine the best practices for pain management in dogs undergoing ovariohysterectomy.

The US Opioid Epidemic and Its Impact on US General Practice Veterinarians

“…Of the 697 VIN members who completed the survey, 99.7% indicated they use, dispense, or prescribe opioids. This result is not surprising considering that opioids are a fundamental part of anesthetic protocols and acute pain management, especially in small animal patients (9, 16, 17). Buprenorphine, tramadol, and butorphanol were the most widely used opioids, reflecting the importance of these drugs in anesthetic, sedation, and acute pain management protocols as well as veterinarian comfort with using these opioids.…”

“…Buprenorphine, tramadol, and butorphanol were the most widely used opioids, reflecting the importance of these drugs in anesthetic, sedation, and acute pain management protocols as well as veterinarian comfort with using these opioids. Interestingly, morphine was used by 44.5% of respondents, probably reflecting morphine's efficacy for moderate to severe pain, good sedative properties, and affordability (9, 16–19).…”

Use of Spinal Anaesthesia with Anaesthetic Block of Intercostal Nerves Compared to a Continuous Infusion of Sufentanyl to Improve Analgesia in Cats Undergoing Unilateral Mastectomy

“…Multimodal anaesthesia, which was performed in the LR group, included drugs administered both systemically and regionally and is considered the most effective approach to providing pain relief [ 22 ]. This type of anaesthesia includes single drugs or drug combinations administered in varying dosages and routes and for various times; it is a less standardised approach but better suited to individual patients’ needs [ 23 ]. In particular, the LR group benefited from neuraxial anaesthesia, which included the administration of regional anaesthetic drugs in the epidural or subarachnoid space.…”

Presumptive buprenorphine associated intraoperative apnoea and prolonged recovery in a giant panda (Ailuropoda melanoleuca) during castration for testicular neoplasia

“…However the exaggerated response seen in this giant panda after only 10 mcg/kg meant that administration was stopped at this point. Meloxicam was also used in this case and has been shown to provide adequate analgesia in dogs after ovariohysterectomy,10 however the benefit of multimodal analgesia in treating postoperative pain is known to be very important,11 12 therefore buprenorphine was administered. It was also anticipated that it would be difficult to assess pain and administer further drugs once the panda was conscious, hence the addition of buprenorphine as part of a multimodal approach to analgesia.…”