Dataset Information

Assessing the Analgesic Efficacy of Lumbosacral Epidural Morphine in Cats Undergoing Ovariohysterectomy: A Comparative Study of Two Doses.

ABSTRACT: Opioids are administered epidurally (PV) to provide trans- and postoperative analgesia. Twenty healthy female cats aged between 6 and 24 months and weighing between 2 and 3.7 kg, undergoing elective ovariohysterectomy (OVH), were induced with propofol (8 mg/kg), followed by continuous infusion (0.1-0.4 mg/kg/min). Three groups were defined: CG (0.1 mL/kg of iodinated contrast, n = 6), G0.1 (0.1 mg/kg of morphine, n = 7), and G0.2 (0.2 mg/kg of morphine, n = 7) per VP. All received 0.1 mL/kg of iodinated contrast per VP and injection water to obtain a total of 0.3 mL/kg. Heart rate (HR), systolic blood pressure (SBP), temperature, expired CO₂, oxygen saturation, and number of rescue analgesics were monitored. Postoperatively, a multidimensional scale was used to assess acute pain in cats for 12 h. The mean HR and SBP in the CG were higher at the time of maximum noxious stimulation and required fentanyl in all groups. Postoperatively, 83%, 28%, and 7% of the animals in CG, G0.1, and G0.2, respectively, received rescue analgesia. In cats undergoing OVH, epidural morphine at doses of 0.1 and 0.2 mg/kg did not prevent the need for intraoperative rescue analgesia but reduced the postoperative analgesic needed.

SUBMITTER: Martins LCT

PROVIDER: S-EPMC11358909 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Assessing the Analgesic Efficacy of Lumbosacral Epidural Morphine in Cats Undergoing Ovariohysterectomy: A Comparative Study of Two Doses.

Martins Ludimilla C T LCT Guimarães Jéssica B JB Ferraz Henrique T HT de Oliveira Flávia Augusta FA Gomes Leidiane de S LS Chafes Clóvis Júnior C CJC Santos Thalita de C C TCC Ogliari Kaline K de Moraes Reiner S RS Ribeiro Diego D Ramos Dirceu Guilherme de Souza DGS Rocha Thiago André S de S TASS Regalin Doughlas D

Veterinary sciences 20240809 8

Opioids are administered epidurally (PV) to provide trans- and postoperative analgesia. Twenty healthy female cats aged between 6 and 24 months and weighing between 2 and 3.7 kg, undergoing elective ovariohysterectomy (OVH), were induced with propofol (8 mg/kg), followed by continuous infusion (0.1-0.4 mg/kg/min). Three groups were defined: CG (0.1 mL/kg of iodinated contrast, n = 6), G0.1 (0.1 mg/kg of morphine, n = 7), and G0.2 (0.2 mg/kg of morphine, n = 7) per VP. All re ...[more]

PMID: 39195814

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Project description:Epidural anesthesia is commonly administered as part of balanced anesthesia for perioperative analgesia. The main goal of this randomized clinical trial was to compare the efficacy of two epidural approaches in dogs undergoing surgery for a perineal hernia. A secondary aim was to compare motor blockade. Intact ASA 1 and 2 male dogs, weighing ≤25 kg with no previous surgery for perineal hernia were enrolled. After premedication with IM acepromazine 0.02 mg/kg and butorphanol 0.3 mg/kg, general anesthesia was induced with propofol and maintained with sevoflurane in oxygen. Dogs were randomly allocated to receive either a lumbosacral (LS, n = 30) or a sacrococcygeal (SC, n = 26) epidural injection with ropivacaine 1% (0.2 mL/kg) under computed tomography guidance. Successful analgesia was defined as no need of intraoperative rescue analgesia (fentanyl 3 μg/kg IV). Clinical failure was defined as the need of more than two boluses of fentanyl/h each dog received meloxicam 0.2 mg/kg IV at the end of the surgery. The Glasgow Composite Pain Scale short form (GCPS-SF), tactile sensitivity, pressure pain thresholds and motor blockade were assessed at 4, 6, 8, and 24 h after the epidural injection. Methadone (0.2 mg/kg, IV) was administered if the GCPS-SF was ≥6/24 points. Differences between groups were analyzed with the Mann-Whitney U test, Student's t-test or Fisher's Exact test, as appropriate. Success rate was assessed for non-inferiority between groups. The non-inferiority margin was set at -10%. Epidural analgesia was successful in 24 dogs in group LS and 17 dogs in group SC (p = 0.243), resulting in success rates of 80 and 65% in LS and SC groups, respectively. The non-inferiority of group SC versus group LS was confirmed. Clinical failure was recorded in two dogs in group LS and one dog in group SC. No significant differences between groups were detected in the GCPS-SF score, tactile sensitivity, pressure pain thresholds, need of post-operative methadone, or motor blockade. Both epidural techniques are valuable analgesic options for perineal hernia repair in dogs.

Project description:BackgroundPosterior spinal fusion for scoliosis is one of the most painful elective pediatric surgeries. Good postoperative pain control allows early ambulation and return of ability to tolerate oral intake. Options for analgesia in this patient population are suboptimal. We hypothesized that extended-release epidural morphine (EREM) would provide better pain control and less adverse effects compared to intrathecal (IT) morphine.MethodsThe primary outcome was total IV morphine consumption during 0-48 hours postoperatively. Secondary outcomes included time until first patient-controlled analgesia (PCA) demand, pain scores, and adverse opioid effects. After institutional review board approval, 71 subjects undergoing posterior spinal fusion for idiopathic scoliosis completed the study. The subjects were randomly allocated to 7.5 μg/kg IT morphine or 150 μg/kg EREM. The final IT morphine and EREM groups contained 37 and 34 subjects, respectively. Postoperative pain was treated with morphine PCA, ketorolac, oral oxycodone, and acetaminophen. Morphine consumption, pain scores, nausea and vomiting, pruritus, and respiratory depression were measured every 4 hours. Parents completed a caregiver questionnaire about their child's pain control regimen after the first postoperative day.ResultsThere was no difference in total morphine consumption over the first 48 hours between subjects in the EREM and IT morphine groups: median (range) 42.2 (5.5-123.0) and 34.0 (4.5-128.8) mg, respectively (P = .27). EREM and IT morphine groups had no difference in time until first PCA demand. Pain scores were no different between the groups from 8 to 24 hours after surgery. Compared to IT morphine, EREM subjects had lower pain scores from 28 to 36 hours after surgery. The reported incidence of pruritus was lower in the EREM subjects.ConclusionsThere was no difference in total morphine consumption or time until first PCA demand between the EREM and IT morphine groups. EREM provides a longer duration of analgesia after posterior spinal fusion for scoliosis and may be associated with less opioid-induced pruritus.

Project description:BackgroundBuprenorphine is used for canine postoperative pain management. This study aimed to describe the pharmacokinetics and evaluate the analgesic efficacy of buprenorphine (Simbadol, 1.8?mg/mL) administered by different routes in dogs undergoing ovariohysterectomy. Twenty-four dogs were included in a randomized, prospective, masked, clinical trial. Buprenorphine (0.02?mg/kg) was administered intravenously (IV), intramuscularly (IM) or subcutaneously (SC) (n?=?8/group) 0.5?h before general anesthesia with propofol-isoflurane. Carprofen (4.4?mg/kg SC) was administered after anesthetic induction and before ovariohysterectomy. Pain was scored using the short-form Glasgow composite pain scale for dogs (SF-GCPS). Dogs were administered morphine (0.25?mg/kg IV) when SF-GCPS scores were???5/20. Blood sampling was performed up to 720?min after drug administration. Plasma buprenorphine and norbuprenorphine concentrations were analyzed using liquid chromatography mass spectrometry. Pharmacokinetics of buprenorphine was described using a non-compartmental model (PK Solver 2.0). Statistical analysis was performed using linear mixed models and Fisher's exact test (p?<?0.05).ResultsPain scores were significantly higher than baseline after IV (0.5-2?h), IM (0.5-3?h) and SC (0.5-4?h) but not among groups. Prevalence of rescue analgesia was significantly higher in SC (7/8 dogs) than IV (2/8) but not different between IV and IM (3/8) or IM and SC. The frequency of rescue analgesia was not significantly different among groups (IV?=?2, IM?=?5 and SC?=?9). Norbuprenorphine was not detected. For IV, IM and SC administration, clearance was 1.29, 1.65 and 1.40?L/hour/kg, volume of distribution was 6.8, 14.2 and 40.1?L/kg, the elimination half-life was 3.7, 5.7, 22?h, and the area under the plasma concentration-time curved extrapolated to infinity was 15.7, 12.4 and 16.4?ng/mL/hour, respectively. Bioavailability for IM and SC was 62.6 and 40%, respectively. Maximum plasma concentrations of buprenorphine were 6.2 and 1.3?ng/mL at 0.14 and 0.33?h after IM and SC administration, respectively.ConclusionsThe route of administration influences the analgesic efficacy of buprenorphine in dogs. SC administration of buprenorphine failed to provide clinical analgesia due to erratic drug absorption. At the doses administered, the IV and IM routes are preferred for postoperative analgesia.

Project description:ObjectiveTo evaluate whether an epidural steroid injection or gabapentin is a better treatment for lumbosacral radiculopathy.DesignA multicenter randomized study conducted between 2011 and 2014. Computer generated randomization was stratified by site. Patients and evaluating physicians were blinded to treatment outcomes.SettingsEight military, Veterans Administration, and civilian hospitals.Participants145 people with lumbosacral radicular pain secondary to herniated disc or spinal stenosis for less than four years in duration and in whom leg pain is as severe or more severe than back pain.InterventionsParticipants received either epidural steroid injection plus placebo pills or sham injection plus gabapentin.Main outcome measuresAverage leg pain one and three months after the injection on a 0-10 numerical rating scale. A positive outcome was defined as a ≥ 2 point decrease in leg pain coupled with a positive global perceived effect. All patients had one month follow-up visits; patients whose condition improved remained blinded for their three month visit.ResultsThere were no significant differences for the primary outcome measure at one month (mean pain score 3.3 (SD 2.6) and mean change from baseline -2.2 (SD 2.4) in epidural steroid injection group versus 3.7 (SD 2.6) and -1.7 (SD 2.6) in gabapentin group; adjusted difference 0.4, 95% confidence interval -0.3 to 1.2; P=0.25) and three months (mean pain score 3.4 (SD 2.7) and mean change from baseline -2.0 (SD 2.6) versus 3.7 (SD 2.8) and -1.6 (SD 2.7), respectively; adjusted difference 0.3, -0.5 to 1.2; P=0.43). Among secondary outcomes, one month after treatment those who received epidural steroid injection had greater reductions in worst leg pain (-3.0, SD 2.8) than those treated with gabapentin (-2.0, SD 2.9; P=0.04) and were more likely to experience a positive successful outcome (66% v 46%; number needed to treat=5.0, 95% confidence interval 2.8 to 27.0; P=0.02). At three months, there were no significant differences between treatments.ConclusionsAlthough epidural steroid injection might provide greater benefit than gabapentin for some outcome measures, the differences are modest and are transient for most people.Trial registration ClinicalTrials.gov Identifier: NCT01495923.

Project description:IntroductionThis study aimed to investigate the analgesic efficacy of perioperative electroacupuncture in fifty-six healthy female dogs undergoing ovariohysterectomy as part of a catch-neuter-release project.Materials and methodsTen minutes after sedation with 20 μg/kg medetomidine combined with 0.3 mg/kg butorphanol intramuscularly, the dogs were randomly allocated into two groups and received either electroacupuncture (EA, n = 27) or sham acupuncture (C, n = 29) treatment for 10 min (after sedation until the end of the surgery) at 6 different acupuncture points LI-4 (Large intestine 4), LIV-3 (Liver 3), ST-36 (Stomach 36), SP-6 (Spleen 6) bilateral. After administration of 0.2 mg/kg meloxicam and anesthesia induction with 2 mg/kg ketamine intravenously, ovariohysterectomy was performed by the same experienced surgeon using a midline surgical approach in dorsal recumbency. Pain was evaluated by two blinded and independent anesthetists using the Short Form of the Multimodal Glasgow Composite Pain Scale (mCMPS-SF) before sedation (T0), and three (T3), six (T6), and 24 h (T24) after anesthesia induction.ResultsPostoperative pain scores did not differ significantly between the groups (p = 0.36), but increased significantly three (T3) (p = 0.001) and six (T6) (p = 0.001) hours after surgery compared to before sedation and 24 h postoperative in both groups. Three hours after surgery (T3), 89.4% and six hours postoperatively (T6), 71.4% of the dogs in both groups exceeded the analgesic intervention threshold of the mCMPS-SF, indicating the need for rescue analgesia.DiscussionThe results of the study indicate that perioperative electroacupuncture treatment did not improve postoperative pain in dogs undergoing ovariohysterectomy. Therefore, a 10-min electroacupuncture treatment may be insufficient to provide effective postoperative analgesia. The pain assessment in feral dogs was notably impacted by anxious behavior, which may have influenced the final outcome The pain threshold was exceeded in ¾ of the dogs in the early postoperative phase (T3, T6), suggesting that the widely used anesthesia protocol consisting of butorphanol, ketamine and medetomidine in combination with meloxicam may not provide long-lasting and sufficient pain relief.

Dataset Information

Assessing the Analgesic Efficacy of Lumbosacral Epidural Morphine in Cats Undergoing Ovariohysterectomy: A Comparative Study of Two Doses.

Publications

Assessing the Analgesic Efficacy of Lumbosacral Epidural Morphine in Cats Undergoing Ovariohysterectomy: A Comparative Study of Two Doses.

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