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Compendium July 2008 (Vol 30, No 7)

Abstract Thoughts — Analgesics for Canine Femoral and Pelvic Fracture Repairs

    Bergmann HM, Nolte I, Kramer S. Comparison of analgesic efficacy of preoperative or postoperative carprofen with or without preincisional mepivicaine epidural anesthesia in canine pelvic or femoral fracture repair. Vet Surg 2007;36:623-632.

    Abstract

    In this prospective clinical trial from veterinary schools in Germany and Switzerland, 18 dogs with femoral fractures and 27 dogs with pelvic fractures were randomly assigned to one of four treatment groups. Group 1 received carprofen subcutaneously before induction of anesthesia. Group 2 received carprofen immediately after extubation. Group 3 received carprofen before induction and a mepivicaine epidural block 15 minutes before incision. Group 4 received carprofen after extubation and a mepivicaine epidural block before incision. All dogs received carprofen subcutaneously for 4 days after surgery.

    Results of the study revealed that at various time points, dogs in groups 3 and 4 had lower pain scores compared with groups 1 and 2. No rescue analgesic was necessary in dogs in groups 3 and 4. At all time points, pain scores decreased significantly when compared with pretreatment values. Pain scores did not differ significantly between dogs in groups 1 and 2 nor between dogs in groups 3 and 4. The treatments had no effect on renal function and hemostatic variables. The authors concluded that epidural mepivicaine enhanced postoperative analgesia when carprofen was used before or after surgery, and no advantage was observed with preoperative carprofen administration.

    Commentary

    Fracture repair and analgesic therapies are common clinical issues for small animal practitioners regardless of whether a generalist or a specialist performs the surgery. The results of this study indicate that carprofen administered subcutaneously can provide some pain relief and is safe to use in trauma patients with normal blood values. Additionally, regional anesthesia through the use of epidural injection significantly enhances the "mild" NSAID-associated postoperative pain relief, especially when used in conjunction with opioid agonist premedication. The authors noted that epidural anesthesia was performed only if the lumbosacral space could be easily palpated in patients with pelvic fractures. Furthermore, dogs with preoperative elevations of blood urea nitrogen or creatinine or a prolonged bleeding time were not treated with carprofen and were excluded from the study.

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