The influence of the choice of preemptive analgesia on long‐term postsurgical pain after tibial plateau leveling osteotomy in dogs

Abstract

Objective: To evaluate the prevalence of chronic postsurgical pain (CPSP) after tibial plateau leveling osteotomy (TPLO) in dogs and to determine the influence of preemptive locoregional analgesia on CPSP. Study design: Retrospective study. Animals: One hundred twenty client-owned dogs. Methods: Medical records of dogs that underwent TPLO between 2012 and 2016 were reviewed for demographic information and type of preemptive analgesia. Owners were contacted to retrospectively assess the quality of life of their dogs by using the Helsinki Chronic Pain Index (HCPI) before and 6 months after surgery and at the time of questioning. An HCPI score > 12 was considered indicative of CPSP. Medical records were reviewed for demographic information and type of preemptive analgesia. A cumulative logit model was used to assess correlation of type of perioperative analgesia, HCPI, and demographic data. Results: The HCPI score was consistent with CPSP in 41 of 101 dogs with long-term follow-up (2.9 ± 1.5 years after surgery). Chronic postsurgical pain was documented in 11 of 32 and 13 of 28 dogs that received a spinal or epidural injection, respectively, or in 28 of 80 and 25 of 67 dogs with sciatic-femoral block at 6 months or with long-term follow-up after TPLO, respectively (P > .05). A negative correlation was found between HCPI and both weight and age 6 months after surgery. Only weight remained negatively correlated 2.9 years after surgery. Conclusion: Forty-one percent of dogs that were evaluated exhibited HCPI values compatible with CPSP long-term after TPLO, regardless of the type of preemptive analgesia. Increased body weight was a negative prognostic factor for CPSP development. Clinical significance: Additional studies are required to evaluate CPSP development after TPLO.

Incidence of postoperative administration of opioids in dogs undergoing a tibial plateau leveling osteotomy after intra-operative liposomal bupivacaine administration with or without morphine epidural

“…Patients undergoing a TPLO benefit from a multimodal pain management protocol. There is overwhelming evidence that patients who receive opioids in combination with epidurals, peripheral nerve blocks, or administration of intra-articular opioids consistently demonstrate that they are more comfortable in the PO period [ 1 , 13 , 17 – 22 ]. In the present study, dogs undergoing a TPLO for a ruptured CrCL who received both an epidural and PLB had a significantly diminished incidence of PO opioid injections when compared to dogs who received PLB alone.…”

“…Epidural administration of opioids and local anesthetics are employed to prevent central sensitization to pain by mitigating the nociceptive input to the dorsal horn of the spinal cord at the level of the nerve root [ 13 ]. Not only do epidurals provide effective pain control postoperatively, they also are associated with fewer adverse effects that are appreciated when the same drug is given IV [ 8 , 13 ].…”

Long‐term outcome in dogs with cranial cruciate ligament disease evaluated using the canine orthopaedic index

“…11,12,[19][20][21] Treatment outcome in dogs with CCLD has been evaluated in several ways, for example, by using force plate gait analysis, visual gait observation, orthopaedic and physiotherapeutic examination, radiography for evaluation of OA progression and owner questionnaires. 8,17,[22][23][24][25][26][27][28][29] Owner questionnaires based on behaviour are considered one of the most reliable tools for assessment of chronic pain in dogs. [30][31][32] There are several questionnaires available, such as the canine orthopaedic index (COI), the Helsinki chronic pain index (HCPI), the Liverpool osteoarthritis in dogs, the canine brief pain inventory (CBPI) and the Bologna healing stifle injury index (BHSII).…”

“…Treatment outcome in dogs with CCLD has been evaluated in several ways, for example, by using force plate gait analysis, visual gait observation, orthopaedic and physiotherapeutic examination, radiography for evaluation of OA progression and owner questionnaires 8,17,22–29 . Owner questionnaires based on behaviour are considered one of the most reliable tools for assessment of chronic pain in dogs 30–32 .…”

Psychometric Testing and Validation of the Italian Version of the Helsinki Chronic Pain Index (I-HCPI) in Dogs with Pain Related to Osteoarthritis

“…The answers are then tied to a value (0 to 4) and summed to give a total index, ranging from 0 to 44 [ 14 ]. The HCPI has been used in several studies to assess pain in OA dogs [ 15 , 16 ], monitor the effect of medical therapy [ 14 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], surgical intervention [ 33 , 34 ], or rehabilitation [ 35 ], and is being regarded as an external criterion for the validation of other CMIs [ 36 ].…”