The influence of demeanor on scores from two validated feline pain assessment scales during the perioperative period

Buisman, Mandy; Hasiuk, Michelle M. M.; Gunn, Marta; Pang, Daniel S. J.

doi:10.1016/j.vaa.2016.09.001

Cited by 31 publications

(50 citation statements)

References 26 publications

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“…The drawback of this approach is how to be sure that the animals were in pain and not stressed. To reduce the bias, excessively shy and feral cats were excluded, knowing that demeanour influences the scores of feline-specific pain scales 10 . Future studies should investigate how changes in demeanour impacts the FGS.…”

Section: Discussionmentioning

confidence: 99%

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Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale

Evangelista

Watanabe

Leung

et al. 2019

Sci Rep

137

174

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Grimace scales have been used for pain assessment in different species. This study aimed to develop and validate the Feline Grimace Scale (FGS) to detect naturally-occurring acute pain. Thirty-five client-owned and twenty control cats were video-recorded undisturbed in their cages in a prospective, case-control study. Painful cats received analgesic treatment and videos were repeated one hour later. Five action units (AU) were identified: ear position, orbital tightening, muzzle tension, whiskers change and head position. Four observers independently scored (0–2 for each AU) 110 images of control and painful cats. The FGS scores were higher in painful than in control cats; a very strong correlation with another validated instrument for pain assessment in cats was observed (rho = 0.86, p < 0.001) as well as good overall inter-rater reliability [ICC = 0.89 (95% CI: 0.85–0.92)], excellent intra-rater reliability (ICC > 0.91), and excellent internal consistency (Cronbach’s alpha = 0.89). The FGS detected response to analgesic treatment (scores after analgesia were lower than before) and a cut-off score was determined (total pain score > 0.39 out of 1.0). The FGS is a valid and reliable tool for acute pain assessment in cats.

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Section: Discussionmentioning

confidence: 99%

“…Although validated, each of these tools have their own limitations such as time-consuming implementation, validity tested for a single type of pain stimulus (i.e. ovariohysterectomy), and confounding effects of cats’ demeanour and drugs on pain scores 8–10 .…”

Section: Introductionmentioning

confidence: 99%

Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale

Evangelista

Watanabe

Leung

et al. 2019

Sci Rep

137

174

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“…Cats with a baseline pain score of ≥ 2 using the SF-UBCPS were not included in the study. High baseline scores could indicate a mild degree of pain before the surgery, or an influence of the cat's demeanor (shy, fearful or feral) (Buisman et al, 2017). The FGS consists of five action units (ear position, orbital tightening, muzzle tension, whiskers change and head position), each one is scored from 0 to 2 (0 = action unit is absent; 1 = moderate appearance of the action unit, or uncertainty over its presence; and 2 = obvious appearance of the action unit) ( Fig.…”

Section: Sedation and Pain Assessmentmentioning

confidence: 99%

Clinical applicability of the Feline Grimace Scale: real-time versus image scoring and the influence of sedation and surgery

Evangelista

Benito

Monteiro

et al. 2020

PeerJ

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Background The Feline Grimace Scale (FGS) is a facial expression-based scoring system for acute pain assessment in cats with reported validity using image assessment. The aims of this study were to investigate the clinical applicability of the FGS in real-time when compared with image assessment, and to evaluate the influence of sedation and surgery on FGS scores in cats. Methods Sixty-five female cats (age: 1.37 ± 0.9 years and body weight: 2.85 ± 0.76 kg) were included in a prospective, randomized, clinical trial. Cats were sedated with intramuscular acepromazine and buprenorphine. Following induction with propofol, anesthesia was maintained with isoflurane and cats underwent ovariohysterectomy (OVH). Pain was evaluated at baseline, 15 min after sedation, and at 0.5, 1, 2, 3, 4, 6, 8, 12 and 24 h after extubation using the FGS in real-time (FGS-RT). Cats were video-recorded simultaneously at baseline, 15 min after sedation, and at 2, 6, 12, and 24 h after extubation for subsequent image assessment (FGS-IMG), which was performed six months later by the same observer. The agreement between FGS-RT and FGS-IMG scores was calculated using the Bland & Altman method for repeated measures. The effects of sedation (baseline versus 15 min) and OVH (baseline versus 24 h) were assessed using linear mixed models. Responsiveness to the administration of rescue analgesia (FGS scores before versus one hour after) was assessed using paired t-tests. Results Minimal bias (−0.057) and narrow limits of agreement (−0.351 to 0.237) were observed between the FGS-IMG and FGS-RT. Scores at baseline (FGS-RT: 0.16 ± 0.13 and FGS-IMG: 0.14 ± 0.13) were not different after sedation (FGS-RT: 0.2 ± 0.15, p = 0.39 and FGS-IMG: 0.16 ± 0.15, p = 0.99) nor at 24 h after extubation (FGS-RT: 0.16 ± 0.12, p = 0.99 and FGS-IMG: 0.12 ± 0.12, p = 0.96). Thirteen cats required rescue analgesia; their FGS scores were lower one hour after analgesic administration (FGS-RT: 0.21 ± 0.18 and FGS-IMG: 0.18 ± 0.17) than before (FGS-RT: 0.47 ± 0.24, p = 0.0005 and FGS-IMG: 0.45 ± 0.19, p = 0.015). Conclusions Real-time assessment slightly overestimates image scoring; however, with minimal clinical impact. Sedation with acepromazine-buprenorphine and ovariohysterectomy using a balanced anesthetic protocol did not influence the FGS scores. Responsiveness to analgesic administration was observed with both the FGS-RT and FGS-IMG.

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“…33 Interrater reliability was confirmed before starting this study and the concurrent use of demeanor and sedation scales allowed identification of factors known to con found these scales. 26,33,34 The effect of postoperative hypothermia on pain scores in cats has not been studied. Klune et al 35 established that postoperative hypothermia interferes with pain scoring in rats using the Rat Grimace Scale.…”

Section: Discussionmentioning

confidence: 79%

“…Pain and seda tion were both assessed in the current study but not until 2 h after the end of surgery. Sedation has been identified as a confounding factor that inflates pain scores collected using the UB MCPS, 33 and it is likely that cats in the study by Warne et al 7 were still sedated this soon after the end of surgery and atipamezole administration. 34 To our knowledge, there are no other studies that combined the triple drug combination used here with an intratesticular lidocaine block and a nonsteroidal anti inflammatory drug perioperatively.…”

Section: Discussionmentioning

confidence: 99%

A randomized clinical trial comparing butorphanol and buprenorphine within a multimodal analgesic protocol in cats undergoing orchiectomy

Moser

Hasiuk

Armstrong

et al. 2019

Journal of Feline Medicine and Surgery

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Objectives The aim of this study was to compare the effects of butorphanol and buprenorphine, as part of a multimodal analgesic protocol, on recovery and analgesia in cats undergoing orchiectomy. Methods In a prospective, randomized, blind clinical trial, 47 adult male cats were randomly assigned to receive either butorphanol (0.3 mg/kg, n = 24) or buprenorphine (0.02 mg/kg, n = 23) in combination with dexmedetomidine (25 μg/kg) and alfaxalone (2 mg/kg) as a single intramuscular injection for the induction of general anesthesia. Isoflurane carried in oxygen was supplemented as needed during orchiectomy. All cats received lidocaine (2 mg/kg intratesticular), meloxicam (0.3 mg/kg SC) and atipamezole (125 μg/kg IM) postoperatively. Pain and sedation scales were applied at baseline, and 2, 4 and 6 h postoperatively. Time to achieve sternal recumbency and to begin eating were also recorded. Results Pain scale scores were low and showed no difference between the treatment groups at all time points ( P ⩾0.99, all time points). Four cats exceeded the analgesia intervention threshold for rescue analgesia (butorphanol, n = 3; buprenorphine, n = 1). There was no difference in sedation scores between groups at any time point ( P >0.99, all time points). Significantly more cats in the buprenorphine group (n = 12) required isoflurane than in the butorphanol group (n = 2) ( P = 0.0013; relative risk 6.3, 95% confidence interval [CI] 1.8–23.5). There was no significant difference in time to achieve sternal recumbency ( P = 0.96, 95% CI –20 to 20) between groups or in return to eating ( P = 0.48, 95% CI –92.0 to 113.5), with most cats eating within 1 h of surgery (butorphanol, 79%; buprenorphine, 83%). Conclusions and relevance There were no significant differences in analgesia or recovery between butorphanol and buprenorphine treatment groups as part of a multimodal injectable anesthetic protocol. Butorphanol is associated with superior depth of anesthesia, facilitating injectable anesthesia.

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The influence of demeanor on scores from two validated feline pain assessment scales during the perioperative period

Cited by 31 publications

References 26 publications

Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale

Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale

Clinical applicability of the Feline Grimace Scale: real-time versus image scoring and the influence of sedation and surgery

A randomized clinical trial comparing butorphanol and buprenorphine within a multimodal analgesic protocol in cats undergoing orchiectomy

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