Is there life without opioids? The anesthetic and analgesic effects of an opioid-free, multimodal, injectable protocol in cats undergoing ovariohysterectomy

Diep, Tung Thanh; Monteiro, Beatriz P.; Evangelista, Marina C.; Balleydier, Aurélien; Watanabe, Ryota; Ruel, H; Doodnaught, Graeme M.; Steagall, Paulo

doi:10.1016/j.vaa.2019.08.016

Cited by 6 publications

(18 citation statements)

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“…Opioids form the basis of a balanced analgesic protocol; however, as these drugs are not always available, 5 the use of other analgesic techniques, such as the use of local anesthetics, should be encouraged. Similar to previous studies, 4,6 in this study intratesticular and SC administration of lido-Table 4-Sedation scores in cats (n = 8 in each group) undergoing orchiectomy following injection of 7 mg/kg of ketamine combined with 10 µg/kg of dexmedetomidine, IM, each including local lidocaine infiltration, and at 3, 5, 10, 30, 60, and 120 minutes after IV administration of 1 mL of saline, 25 µg/kg of atipamezole, or 50 µg/kg of atipamezole in the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

“…1 The combination of ketamine and α 2 -adrenergic agonists, with or without opioids can be used to castration male cats. [2][3][4] As opioids are not always available, depending on the country, 5 the administration of intratesticular and SC lidocaine prior to orchiectomy appears to be an effective option in decreasing nociceptive responses to surgery. 4,6 The use of anesthetic protocols that optimize anesthetic recovery in cats is valuable.…”

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confidence: 99%

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Ketamine–dexmedetomidine combined with local anesthesia, with or without different doses of atipamezole in the postoperative period, for orchiectomy in cats

Gomes

Carvalho

Pimentel

et al. 2022

javma

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OBJECTIVE To evaluate the anesthetic and cardiopulmonary effects of ketamine–dexmedetomidine combined with local anesthesia, associated or not in the postoperative period with different doses of atipamezole, for orchiectomy in cats. ANIMALS 24 healthy cats. PROCEDURES Cats received ketamine (7 mg/kg) combined with dexmedetomidine (10 µg/kg) IM, and 1 mL of saline (group KDSAL), 25 µg/kg (group KDAT25), or 50 µg/kg (group KDAT50) of atipamezole IV, postoperatively. All cats received local anesthesia (2 mg/kg of lidocaine) intratesticular and SC. Physiologic variables were recorded at baseline and at time points during anesthesia. Ketamine rescue dose (1 mg/kg) was recorded. The quality of recovery, the degree of sedation, and side effects were evaluated postoperatively. RESULTS 2 cats received a single additional bolus of ketamine to perform local anesthesia. Heart rate was lower in KDSAL, KDAT25, and KDAT50 during anesthesia, compared with baseline. Hypertension was observed intraoperatively in all groups. The time to head up, pedal reflex regained time, time to sternal recumbency, and time to standing were shorter in KDAT25 and KDAT50 compared to KDSAL. Lower sedation scores were assigned sooner to KDAT25 and KDAT50 than KDSAL. All groups resulted in low recovery quality scores and no side effects. CLINICAL RELEVANCE At the doses used, ketamine–dexmedetomidine combined with local anesthesia allowed the performance of orchiectomy. Rescue dose of ketamine for performing local anesthesia may be required. This combination can result in hypertension. Both atipamezole doses shortened the anesthetic recovery, without differences among them, and side effects.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Ketamine–dexmedetomidine combined with local anesthesia, with or without different doses of atipamezole in the postoperative period, for orchiectomy in cats

Gomes

Carvalho

Pimentel

et al. 2022

javma

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“…2017) including discussion of alternative methods of pain control when analgesics are not available (Diep et al . 2020) and the use of validated pain scoring tools are needed to address the issue of oligoanalgesia.…”

Section: Sectionmentioning

confidence: 99%

2022 WSAVA guidelines for the recognition, assessment and treatment of pain

Monteiro

Lascelles

Murrell

et al. 2022

J of Small Animal Practice

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Animal sentience refers to the capacity of animals to feel both positive and negative emotions including that of pain. As veterinary health professionals, we have a medical and ethical duty to mitigate suffering from pain to the best of our ability. In 2014, the first Global Pain Council World Small Animal Veterinary Association (WSAVA) Guidelines for the Recognition, Assessment and Treatment of Pain was published and remains to this day one of the most relevant and widespread documents of its kind. The 2022 WSAVA Global Pain Management Guidelines evolves from the first document with updated scientific information reflecting major advances in veterinary pain medicine in the last decade. This document is designed to provide the user with easy-to-implement, core fundamentals on the successful recognition and treatment of pain in the day-to-day small animal clinical practice setting. It provides basic and practical information with an extensive reference list to guide those who want to further their knowledge on pain management. The 2022 WSAVA Global Pain Management Guidelines should be easily implemented regardless of practice setting and/or location for the promotion and advance of pain management and animal welfare. FIG 4. Peripheral sensitisation results in increased sensitivity around the lesion site. Affected patients may exhibit signs of hyperalgesia and allodynia. Adapted from Monteiro & Simon (2022). PGs Prostaglandins, NGF Nerve growth factor FIG 5. The constant noxious input (electrical signal) from the periphery to the spinal cord results in central sensitisation. Central sensitisation is the result from increased pain facilitation and decreased pain inhibition. Neuroplasticity and neuroimmune interactions also contribute to this phenomenon

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“…For example, the prevalence of rescue analgesia using an opioid-free anaesthetic protocol was lower in kittens than in adult cats after OVH. 19 Injectable anaesthesia using ketamine and alpha (α) 2adrenergic receptor agonists is commonly used in highvolume, high-quality spay-neuter programmes. [3][4][5][6]12,17,19,20 However, these protocols do not always include opioid analgesics, as veterinarians do not always have access to these drugs and volatile anaesthetics due to strict regulatory and bureaucratic constraints in many countries.…”

Section: Introductionmentioning

confidence: 99%

Randomised, prospective, blinded, clinical trial of opioid-free injectable anaesthesia with or without multimodal analgesia in kittens undergoing ovariohysterectomy

Malo

Cheng

Ruel

et al. 2023

Journal of Feline Medicine and Surgery

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Objectives This study compared an opioid-free injectable anaesthetic protocol with or without multimodal analgesia in kittens undergoing ovariohysterectomy. Methods In this prospective, randomised, blinded, clinical trial, 29 healthy kittens (mean ± SD weight 1.55 ± 0.46 kg; aged 10 weeks to 6 months) were included. Anaesthesia was performed with an intramuscular injection of ketamine (4 mg/kg), dexmedetomidine (40 μg/kg) and midazolam (0.25 mg/kg). In the multimodal group (MMG), cats (n = 14) received meloxicam (0.1 mg/kg SC) and intraperitoneal bupivacaine 0.25% (2 mg/kg), whereas the same volume of saline was administered in the control group (CG; n = 15). Atipamezole (0.4 mg/kg IM) was given 15 mins after ovariohysterectomy. Postoperative pain was assessed using the UNESP-Botucatu multidimensional feline pain assessment scale – short form. Rescue analgesia (buprenorphine 0.02 mg/kg IM in MMG/CG and meloxicam 0.1 mg/kg SC in CG) was administered if pain scores were ⩾4/12. Soft food intake (after 2 and 60 mins) was evaluated at specific time points postoperatively. Statistical analyses were performed with linear models and post-hoc pairwise comparison with Benjamini–Hochberg corrections ( P <0.05). Results The prevalence of rescue analgesia was higher in the CG (n = 15/15) than the MMG (n = 1/14; P <0.001). Pain scores at 1 h, 2 h and 4 h postoperatively were higher in the CG (4.1 ± 2.8, 4.8 ± 3.0 and 5.3 ± 1.2, respectively) than in the MMG (1.6 ± 1.0, 1.1 ± 1.0 and 0.9 ± 0.8, respectively; P <0.001). Food intake (%) at 1 h postoperatively was higher in the MMG after 2 and 60 mins (10.4 ± 9 and 71.9 ± 29, respectively) than in the CG (1.4 ± 2 and 13.9 ± 7, respectively; P <0.001). Conclusions and relevance This opioid-free protocol using multimodal analgesia produced adequate postoperative pain relief, while almost eliminating the need for rescue analgesia in kittens undergoing ovariohysterectomy. Pain decreased food intake.

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Is there life without opioids? The anesthetic and analgesic effects of an opioid-free, multimodal, injectable protocol in cats undergoing ovariohysterectomy

Cited by 6 publications

References 0 publications

Ketamine–dexmedetomidine combined with local anesthesia, with or without different doses of atipamezole in the postoperative period, for orchiectomy in cats

Ketamine–dexmedetomidine combined with local anesthesia, with or without different doses of atipamezole in the postoperative period, for orchiectomy in cats

2022 WSAVA guidelines for the recognition, assessment and treatment of pain

Randomised, prospective, blinded, clinical trial of opioid-free injectable anaesthesia with or without multimodal analgesia in kittens undergoing ovariohysterectomy

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