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Compendium January 2007 (Vol 29, No 1)

Abstract Thoughts—Pain Management In Dogs Undergoing Ovariohysterectomy

by Joseph Harari, MS, DVM, DACVS

    Pain Management in Dogs Undergoing Ovariohysterectomy

    Inoue T, Ko JC, Mandsager RE, et al: Efficacy and safety of preoperative etodolac and butorphanol administration in dogs undergoing ovariohysterectomy. JAAHA 42:178-188, 2006.

    Abstract: In this prospective, multiinstitutional clinical study from two veterinary schools and a specialty practice, the analgesic effects of preoperative etodolac and butorphanol treatments in 18 dogs undergoing ovariohysterectomy were evaluated.

    Dogs were assigned to three treatment groups: Six dogs received oral etodolac 1 hour before induction of anesthesia, a second group of six dogs was given intravenous butorphanol immediately following endotracheal intubation, and a third group received both drugs. Various parameters (e.g., blood pressure, isoflurane requirements, behavioral pain scores, plasma cortisol and glucose concentrations, mucosal bleeding times) were assessed. Anesthesia was induced using propofol and maintained using isoflurane during general anesthesia.

    Two experienced surgeons performed the ovariohysterectomies in the dogs, and following surgery, observers blinded to the treatments evaluated behavioral changes.

    The results indicated no differences between the treatment groups in several cardio­respiratory variables, isoflurane concentration, mucosal bleeding times, and renal indices. Plasma cortisol values were lower in the etodolac group and etodolac plus butorphanol group. The lowest pain behavioral scores were detected (monitoring period: 5 hours) in the group that received etodolac and butorphanol. The authors concluded that etodolac premedication (12 to 14 mg/kg PO) with or without butorphanol (0.4 mg/kg IV) was a safe and efficacious treatment in reducing postoperative pain associated with ovariohysterectomy in dogs receiving propofol induction and isoflurane anesthesia.

    Commentary: Pain management is an active concern of small animal practitioners, especially those involved in surgery. Although this study was limited by the small number of patients and the lack of a negative treatment control (which is difficult in a clinical trial involving a painful procedure), the data from these clinics describe the efficacious, safe, and antiinflammatory analgesic effect of etodolac. However, the "best" treatment in reducing acute postoperative pain as judged by behavior was administration of a combination of etodolac and butorphanol. These results are especially relevant because the authors evaluated commonly used drug protocols and a basic surgical procedure. As noted by the authors, hemostatic or renal complications were not detected by single use of the drugs in this study.

    Renal Biopsy: Methods and Complications

    Vaden SL, Levine JF, Lees GE, et al: Renal biopsy: A retrospective study of methods and complications in 283 dogs and 65 cats. J Vet Intern Med 19:794-801, 2005.

    Data from medical records for 283 dogs and 65 cats at four institutions were reviewed to determine complications and associated factors related to renal biopsy and factors affecting specimen quality to help improve procedures and specimen quality and reduce complication frequency. The following were evaluated: signalment, date and indication for biopsy, screening tests, level of training of person performing the biopsy, anesthesia, biopsy method, specimen tissue content, and complications.

    The most common indications for biopsy were proteinuria in dogs and renomegaly, renal mass, or other ultrasonographic abnormalities in cats. Senior clinicians, surgeons, or radiologists obtained most biopsy specimens, which contained only cortex and were of acceptable quality. Better quality was related to the use of ­general anesthesia and surgical method (wedge biopsy). Complications affected 13.4% of dogs and 18.5% of cats. The most common complication was severe hemorrhage; hydronephrosis and death were rare, and no clinical infection developed. Dogs with complications were likely to be 4 to 6 years of age or older than 9 years of age, weigh 11 lb (5 kg) or less, and have severe azotemia; cats were likely to have moderately high serum creatinine and urea nitrogen levels.

    Key Finding:

    • Renal biopsy is relatively safe, with a low frequency of severe complications and with the specimen quality and complication rate affected by hospital- and patient-related variables.
    NEXT: Clinical Snapshot (January 2007)


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