Randomised trial of perioperative tramadol for canine sterilisation pain management

Surgical sterilisation to manage free-roaming dog populations is widely used in many countries. However, few studies have examined optimal postoperative pain management regimens at low-resource, high-throughput veterinary clinics. The aim of this study was to examine the efficacy of two intravenous analgesic regimens, preoperative administration of meloxicam and tramadol, or meloxicam alone, in free-roaming dogs undergoing sterilisation. A total of 125 dogs were included, with 64 dogs in the meloxicam-tramadol arm and 61 dogs in the meloxicam-only arm in a non-inferiority study design. Pain levels in sterilisation surgery patients were assessed at four time points after surgery using the Colorado State University Canine Acute Pain Scale, a Visual Analogue Scale and a modified version of the Glasgow Composite Measure Pain Scale – Short Form. Non-inferiority was supported for each of the main scoring outcomes using non-inferiority margins of 0.5, 5 and 0.8, respectively. One dog from the meloxicam-tramadol group and four dogs in the meloxicam-only arm required rescue analgesia, with no difference between groups (P=0.21).The study demonstrated that meloxicam was effective in controlling postoperative pain in a high proportion of dogs. The addition of tramadol alongside meloxicam treatment was not found to be of clinical benefit.

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Postoperative Analgesic Effects of Laserpuncture and Meloxicam in Bitches Submitted to Ovariohysterectomy

Veterinary Sciences ◽

10.3390/vetsci7030094 ◽

2020 ◽

Vol 7 (3) ◽

pp. 94

Author(s):

Rubia M. Tomacheuski ◽

Marilda O. Taffarel ◽

Guilherme S. Cardoso ◽

Ana A. P. Derussi ◽

Marcos Ferrante ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Area Under The Curve ◽

Postoperative Pain Management ◽

Pain Scale ◽

Rescue Analgesia ◽

Analgesic Effects ◽

Pain Scores ◽

Chi Squared ◽

Perioperative Pain Management

Background: This prospective, randomised and blind study investigated the efficacy of laserpuncture for postoperative pain management in dogs. Method: Sixteen bitches were sedated with acepromazine and randomly treated before ovariohysterectomy with meloxicam 0.2 mg·kg−1 intramuscular or laserpuncture (wavelength 904 mm, frequency 124 Hz, potency 10 Joules, 100 s in each acupoint). Anaesthesia was performed with propofol, isoflurane/O2, and fentanyl. The Glasgow Composite Measure Pain Scale (GCMPS) and Dynamic Interactive Visual Analog Scale (DIVAS) were used to evaluate postoperative pain before and for 24 h after surgery. Morphine was administrated as rescue analgesia when pain scores were ≥3.33 (GCMPS). Differences between treatments, time points, and amount of rescue analgesia between groups were investigated by the Mann–Whitney test and the area under the curve (AUC) for GCMPS, Friedman, and Chi-squared tests, respectively (p < 0.05). Results: Dogs treated with laserpuncture presented lower GCMPS AUC for 24 h and lower GCMPS scores at 2 and 4 h postoperatively (p = 0.04). Three dogs treated with meloxicam required postoperatively rescue analgesia against none treated with laserpuncture. Conclusions: In this preliminary study, laserpuncture mitigated postoperative pain in dogs following ovariohysterectomy, and the technique is a promising adjunct to perioperative pain management in dogs undergoing soft tissue surgery.

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Laser Acupuncture for Postoperative Pain Management in Cats

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2015/653270 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Virgínia I. Marques ◽

Renata N. Cassu ◽

Felipe F. Nascimento ◽

Rafaela C. P. Tavares ◽

Giulliane C. Crociolli ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Postoperative Pain Management ◽

Pain Scale ◽

Laser Acupuncture ◽

Rescue Analgesia ◽

Pain Scores ◽

Laser Control ◽

Induction Of Anaesthesia ◽

Blinded Assessor

The aim of this study was to evaluate laser acupuncture as an adjuvant for postoperative pain management in cats. Twenty cats, undergoing ovariohysterectomy, were sedated with intramuscular (IM) ketamine (5 mg kg−1), midazolam (0.5 mg kg−1), and tramadol (2 mg kg−1). Prior to induction of anaesthesia, the subjects were randomly distributed into two groups of 10 cats: Laser: bilateral stomach 36 and spleen 6 acupoints were stimulated with infrared laser; Control: no acupuncture was applied. Anaesthesia was induced using intravenous propofol (4 mg kg−1) and maintained with isoflurane. Postoperative analgesia was evaluated by a blinded assessor for 24 h following extubation using the Dynamic Interactive Visual Analogue Scale and Multidimensional Composite Pain Scale. Rescue analgesia was provided with IM tramadol (2 mg kg−1), and the pain scores were reassessed 30 min after the rescue intervention. If the analgesia remained insufficient, meloxicam (0.2 mg kg−1IM, single dose) was administered. Data were analyzed usingt-tests, the Mann-Whitney test, and the Friedman test (P<0.05). The pain scores did not differ between groups. However, postoperative supplemental analgesia was required by significantly more cats in the Control (5/10) compared with the Laser group (1/10) (P=0.038). Laser acupuncture reduced postoperative analgesic requirements in cats undergoing ovariohysterectomy.

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Post-operative pain management modalities employed in clinical trials for adult patients in LMIC: a systematic review

10.21203/rs.3.rs-54698/v1 ◽

2020 ◽

Author(s):

Gauhar Afshan ◽

Robyna Irshad Khan ◽

Aliya Ahmed ◽

Ali Sarfraz Siddiqui ◽

Azhar Rehman ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Pain Management ◽

Postoperative Pain ◽

Postoperative Pain Management ◽

Multimodal Analgesia ◽

Cochrane Library ◽

Clinical Practices ◽

Regional Analgesia ◽

Rescue Analgesia

Abstract Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results: Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries.

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An Interactive Pain Application (MServ) Improves Postoperative Pain Management

Pain Research and Management ◽

10.1155/2021/8898170 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Richard Gordon-Williams ◽

Andreia Trigo ◽

Paul Bassett ◽

Amanda Williams ◽

Stephen Cone ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Nursing Staff ◽

Pain Control ◽

Standard Care ◽

Severe Pain ◽

Postoperative Pain Management ◽

Pain Scale ◽

Opioid Prescription ◽

Patient Reported

Background. Most patients have moderate or severe pain after surgery. Opioids are the cornerstone of treating severe pain after surgery but cause problems when continued long after discharge. We investigated the efficacy of multifunction pain management software (MServ) in improving postoperative pain control and reducing opioid prescription at discharge. Methods. We recruited 234 patients to a prospective cohort study into sequential groups in a nonrandomised manner, one day after major thoracic or urological surgery. Group 1 received standard care (SC, n = 102), group 2 were given a multifunctional device that fed back to the nursing staff alone (DN, n = 66), and group 3 were given the same device that fed back to both the nursing staff and the acute pain team (DNPT, n = 66). Patient-reported pain scores at 24 and 48 hours and patient-reported time in severe pain, medications, and satisfaction were recorded on trial discharge. Findings. Odds of having poor pain control (>1 on 0–4 pain scale) were calculated between standard care (SC) and device groups (DN and DNPT). Patients with a device were significantly less likely to have poor pain control at 24 hours (OR 0.45, 95% CI 0.25, 0.81) and to report time in severe pain at 48 hours (OR 0.62, 95% CI 0.47–0.80). Patients with a device were three times less likely to be prescribed strong opioids on discharge (OR 0.35, 95% CI 0.13 to 0.95). Interpretation. Using an mHealth device designed for pain management, rather than standard care, reduced the incidence of poor pain control in the postoperative period and reduced opioid prescription on discharge from hospital.

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Transnasal Butorphanol Is Effective for Postoperative Pain Relief in Children Undergoing Myringotomy

Anesthesiology ◽

10.1097/00000542-199808000-00015 ◽

1998 ◽

Vol 89 (2) ◽

pp. 385-390 ◽

Cited By ~ 23

Author(s):

Ruth E. Bennie ◽

Leigh A. Boehringer ◽

Stephen F. Dierdorf ◽

Mark P. Hanna ◽

Lyn J. Means

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Postoperative Pain Management ◽

Face Mask ◽

Pain Scale ◽

Tube Placement ◽

Postoperative Pain Relief ◽

Controlled Study ◽

Postanesthesia Care Unit ◽

Rescue Analgesia

Background More than 70% of children require analgesics after bilateral myringotomy and tube placement (BMT). Because anesthesia for BMT is generally provided by face mask without placement of an intravenous catheter, an alternative route for analgesia administration is needed. Transnasal butorphanol is effective in relieving postoperative pain in adults and children. The effectiveness of transnasal butorphanol for postoperative pain management in children undergoing BMT was studied. Methods This double-blinded, placebo-controlled study compared the postoperative analgesic effects of transnasal butorphanol administered after the induction of anesthesia. Sixty children classified as American Society of Anesthesiologists physical status 1 or 2 who were aged 6 months or older and scheduled for elective BMT were randomized to receive transnasal placebo or 5, 15, or 25 microg/kg butorphanol. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) on arrival in the postanesthesia care unit and at 5, 10, 15, 30, 45, and 60 min. Results The CHEOP scores were significantly less in the 25 microg/kg transnasal butorphanol group compared with controls. Significantly fewer children received rescue analgesia in the 25 microg/kg transnasal butorphanol group compared with controls (n = 1 and 8, respectively; P = 0.02). Conclusions Transnasal butorphanol given in a dose of 25 microg/kg after induction of anesthesia provided adequate postoperative pain relief in children undergoing BMT.

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SHOULD THE ERECTOR SPINAE PLANE BLOCK BE APPLIED IN THE PAIN MANAGEMENT OF PERCUTANEOUS NEPHROLITHOTOMY?

10.22541/au.162210869.97761018/v1 ◽

2021 ◽

Author(s):

Şeyma Ünal ◽

Semih Başkan ◽

Betül GÜVEN AYTAÇ ◽

İsmail Aytaç

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Percutaneous Nephrolithotomy ◽

Length Of Hospital Stay ◽

Postoperative Pain Management ◽

Erector Spinae ◽

Controlled Study ◽

Control Group ◽

Rescue Analgesia ◽

Erector Spinae Plane Block

The Aim: This prospective, randomised controlled study aimed to investigate the efficacy and respiratory effects of postoperative pain management with erector spinae plane block (ESPB) in patients undergoing percutaneous nephrolithotomy surgery. Methods: A total of 60 ASA I-II patients aged 18–65 years, scheduled to undergo percutaneous nephrolithotomy (PCNL) were included. Patients were randomized either to the ESPB or control group. Ultrasound-guided ESPB with 15mL 0.5% bupivacaine at the T11 level was performed preoperatively using the in-plane technique in the ESP group. In both groups, 1gr of intravenous paracetamol was administered intraoperatively. Postoperative pain and agitation was evaluated using VAS, Dynamic VAS at 0, 6 and 24 hours and the Riker sedation-agitation scale at 0th Hours after surgery. Peak expiratory flow rate(PEFR) and SPO2 were measured in preoperative examination and at the 0th, 6th, 24th hours postoperatively. In the postoperative period, intravenous tramadol (100mg) was administered as a rescue analgesic when VAS ≥ 4. Time and number of the rescue analgesias, mobilization time and length of hospital stay were also recorded and analyzed. Results: A significantly lower VAS and DVAS were observed at 0th, 6th, 24th hours in the ESPB group (p < 0.05 for each timepoint). Also number of and time to rescue analgesia decreased in the ESPB group (p< 0.05 and 0.01 respectively). Postoperative/preoperative PEFR ratio was lower and there were more agitated patients in control group (p<0.05). Conclusion: ESPB may have additional clinical advantages while providing effective analgesia in patients who underwent PCNL comparing to intravenous analgesia.

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Validation of the Spanish version of the Parent's Postoperative Pain Management pain scale

Anales de Pediatría (English Edition) ◽

10.1016/j.anpede.2015.10.009 ◽

2016 ◽

Vol 84 (2) ◽

pp. 106-113

Author(s):

A.M. Ullan ◽

M. Perelló ◽

C. Jerez ◽

E. Gómez ◽

M.J. Planas ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Postoperative Pain Management ◽

Pain Scale ◽

Spanish Version

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Botulinum toxin type A as an adjunct in postoperative pain management in dogs undergoing radical mastectomy

Veterinary Record ◽

10.1136/vr.102993 ◽

2015 ◽

Vol 177 (15) ◽

pp. 391-391 ◽

Cited By ~ 4

Author(s):

S. Vilhegas ◽

R. N. Cassu ◽

R. C. Barbero ◽

G. C. Crociolli ◽

T. L. A. Rocha ◽

...

Keyword(s):

Botulinum Toxin ◽

Pain Management ◽

Postoperative Pain ◽

Botulinum Toxin Type A ◽

Radical Mastectomy ◽

Type A ◽

Postoperative Pain Management ◽

Botulinum Toxin Type ◽

Saline Control ◽

Rescue Analgesia

The aim of this randomised placebo-controlled, observer-blinded study was to evaluate the analgesic effects of botulinum toxin type A (BoNT-A) as an adjunct for postoperative pain control in dogs. Sixteen dogs undergoing bilateral radical mastectomy for treatment of mammary tumours were enrolled. Twenty-four hours before surgery, the subjects were distributed into two groups of eight dogs each: 7 iu/kg BoNT-A (BoNT-A) or saline (Control) was administered subcutaneously in each mammary gland. Following sedation with intramuscular 0.03 mg/kg acepromazine and 0.3 mg/kg morphine, anaesthesia was induced intravenously with 4 mg/kg propofol and maintained with isoflurane/O2. Postoperative analgesia was evaluated for 72 hours after extubation using the Visual Analogue Scale (VAS) and modified Glasgow Composite Measure Pain Scale (modified-GCMPS). Rescue analgesia was provided with intramuscular morphine (0.5 mg/kg). Data were analysed using analysis of variance, Tukey's test, Mann-Whitney U test and Friedman test (P<0.05). The pain scores were significantly lower in the BoNT-A than in the Control from 8 hours to 60 hours and from 12 hours to 60 hours after extubation, based on the VAS and modified-GCMPS, respectively. Rescue analgesia was required by significantly more dogs in the Control (7/8) compared with the BoNT-A (2/8) (P=0.022). Pre-emptive BoNT-A appears to be effective as an adjuvant for postoperative pain management in dogs undergoing bilateral radical mastectomy.

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