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Postoperative comparison of four perioperative analgesia protocols in dogs undergoing stifle joint surgery

Kerrie A. Lewis DVM, MS1, Richard M. Bednarski DVM, MS2, Turi K. Aarnes DVM, MS3, Jonathan Dyce MA, VetMB4, and John A. E. Hubbell DVM, MS5
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  • 1 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
  • | 2 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
  • | 3 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
  • | 4 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
  • | 5 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

Abstract

Objective—To compare 4 analgesic protocols in dogs undergoing stifle joint surgery.

Design—Randomized, blinded, prospective clinical trial.

Animals—48 client-owned dogs that underwent stifle joint surgery.

Procedures—Dogs undergoing tibial plateau leveling osteotomy were randomly assigned to receive a constant rate infusion of a combination of morphine, lidocaine, and ketamine; a lumbosacral epidural with morphine and ropivacaine; both treatments (ie, constant rate infusion and lumbosacral epidural); or only IM premedication with morphine. Indices of cardiorespiratory function and isoflurane requirement were recorded at 5-minute intervals during anesthesia. A validated sedation scoring system and the modified Glasgow composite measure pain score were used to assess comfort and sedation after surgery and anesthesia once the swallowing reflex returned and a body temperature of ≥ 36.7°C (98.1°F) was attained. Pain and sedation scores were acquired at 60-minute intervals for 4 hours, then at 4-hour intervals for 24 hours. Dogs with a postoperative pain score > 5 of 24 were given morphine as rescue analgesia.

Results—No differences in heart rate, respiratory rate, systolic arterial blood pressure, end-tidal Pco2, end-tidal isoflurane concentration, and vaporizer setting were detected among groups. No differences in pain score, sedation score, rescue analgesia requirement, or time to first rescue analgesia after surgery were detected.

Conclusions and Clinical Relevance—Pain scores were similar among groups, and all 4 groups had similar rescue analgesia requirements and similar times to first administration of rescue analgesia. All 4 analgesic protocols provided acceptable analgesia for 24 hours after stifle joint surgery.

Abstract

Objective—To compare 4 analgesic protocols in dogs undergoing stifle joint surgery.

Design—Randomized, blinded, prospective clinical trial.

Animals—48 client-owned dogs that underwent stifle joint surgery.

Procedures—Dogs undergoing tibial plateau leveling osteotomy were randomly assigned to receive a constant rate infusion of a combination of morphine, lidocaine, and ketamine; a lumbosacral epidural with morphine and ropivacaine; both treatments (ie, constant rate infusion and lumbosacral epidural); or only IM premedication with morphine. Indices of cardiorespiratory function and isoflurane requirement were recorded at 5-minute intervals during anesthesia. A validated sedation scoring system and the modified Glasgow composite measure pain score were used to assess comfort and sedation after surgery and anesthesia once the swallowing reflex returned and a body temperature of ≥ 36.7°C (98.1°F) was attained. Pain and sedation scores were acquired at 60-minute intervals for 4 hours, then at 4-hour intervals for 24 hours. Dogs with a postoperative pain score > 5 of 24 were given morphine as rescue analgesia.

Results—No differences in heart rate, respiratory rate, systolic arterial blood pressure, end-tidal Pco2, end-tidal isoflurane concentration, and vaporizer setting were detected among groups. No differences in pain score, sedation score, rescue analgesia requirement, or time to first rescue analgesia after surgery were detected.

Conclusions and Clinical Relevance—Pain scores were similar among groups, and all 4 groups had similar rescue analgesia requirements and similar times to first administration of rescue analgesia. All 4 analgesic protocols provided acceptable analgesia for 24 hours after stifle joint surgery.

Contributor Notes

Dr. Lewis' present address is Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University Palmerston North 4442, New Zealand.

This manuscript represents a portion of a thesis submitted by Dr. Lewis to The Ohio State University College of Veterinary Medicine Department of Veterinary Clinical Sciences as partial fulfillment of the requirements for a Master of Science degree.

Supported in part by The Ohio State University College of Veterinary Medicine Canine Research Funds.

Presented in abstract form at the 37th Annual Scientific Meeting of the American College of Veterinary Anesthesia and Analgesia, San Antonio, Tex, September 2012.

The authors thank Dr. Craig Lewis for assistance with statistical analyses and Dr. Valerie Nesser for technical assistance.

Address correspondence to Dr. Lewis (k.a.lewis@massey.ac.nz).