scholarly journals Comparison of epidural morphine and buprenorphine for hindlimb orthopaedic surgery in dogs

2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Thomas Towers
Keyword(s):  
Local Anaesthetic ◽  
Orthopaedic Surgery ◽  
Controlled Trial ◽  
Research Question ◽  
Epidural Injection ◽  
Individual Case ◽  
Clinical Expertise ◽  
Bottom Line ◽  
The Individual ◽  
Randomised Controlled

PICO question In dogs undergoing hindlimb orthopaedic surgery does epidural with local anaesthetic and buprenorphine provide equivalent intra- and postoperative analgesia as epidural with local anaesthetic and morphine?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed One double-blinded randomised controlled trial Strength of evidence Weak Outcomes reported Epidural analgesia with buprenorphine and bupivacaine may provide equivalent analgesia to more traditional morphine and bupivacaine epidural injection Conclusion There is weak evidence that buprenorphine may provide equivalent analgesia to morphine when combined with bupivacaine epidurally. The reduced regulatory requirements imposed on buprenorphine may sway some clinicians to utilise buprenorphine but further, higher powered, controlled trials are necessary to confirm equivalency   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.  

scholarly journals Are bisphosphonates a more effective treatment than intra-articular steroids in horses with distal hock osteoarthritis?

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Hannah Greene
Keyword(s):  
Retrospective Study ◽  
Randomised Controlled Trials ◽  
Research Question ◽  
Individual Case ◽  
Controlled Trials ◽  
Clinical Expertise ◽  
Bottom Line ◽  
The Individual ◽  
Randomised Controlled

PICO question In horses that are lame due to osteoarthritis of the distal tarsal joints (bone spavin), is intra-articular medication with corticosteroids compared to systemic bisphosphonate treatment more effective in long-term lameness reduction?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Three papers were critically reviewed. Two were randomised controlled trials, and one was a retrospective study. Strength of evidence Weak Outcomes reported There is insufficient evidence to support the use of systemic bisphosphonates over intra-articular corticosteroids to treat distal hock osteoarthritis in horses. Conclusion Horses with distal hock osteoarthritis should not be treated with systemic bisphosphonates until further blinded randomised controlled trials are completed. Additionally, supportive evidence for the use of intra-articular corticosteroids as a treatment for degenerative hock osteoarthritis is limited to a retrospective study where modest, short-term improvements are reported: 58% of horses improved after an average of 56 days (Labens et al., 2007). Evidence does not support significant improvement in long-term outcomes: 50% of horses improved after 4 months (Watts et al., 2016) and only 38% of horses improved after a mean follow-up period of 787 days (Labens et al., 2007).   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.  

scholarly journals Comparison of the safety of alfaxalone and propofol as anaesthetic induction agents in bitches un-dergoing c-section

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Benjamin Haythornthwaite
Keyword(s):  
Caesarean Section ◽  
Randomised Controlled Trials ◽  
Research Question ◽  
Individual Case ◽  
Controlled Trials ◽  
Clinical Expertise ◽  
Anaesthetic Induction ◽  
Bottom Line ◽  
The Individual ◽  
Randomised Controlled

PICO question In bitches and their puppies undergoing caesarean section, is an alfaxalone or a propofol induction safer?   Clinical bottom line Category of research question Risk The number and type of study designs reviewed Six papers were critically reviewed. There were two randomised controlled trials directly comparing alfaxalone and propofol inductions, two randomised controlled trials including a propofol induction in one of the experimental groups and two non-comparative studies. Strength of evidence Moderate Outcomes reported Propofol and alfaxalone can both be used safely for the anaesthesia of bitches and their puppies undergoing caesarean section. There is evidence that alfaxalone may provide better anaesthesia quality for the bitches, and the puppies may be delivered with higher indicators of puppy vitality following its use. Further research into the beneficial clinical outcomes of alfaxalone should be investigated. Conclusion The use of both propofol and alfaxalone for the induction of bitches undergoing caesarean section can be recommended.   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.  

scholarly journals Can sedation be used for equine lameness investigation?

2021 ◽  
Vol 6 (2) ◽  
Author(s):  
Helene Termansen ◽  
Lucinda Meehan
Keyword(s):  
Clinical Studies ◽  
Research Question ◽  
Individual Case ◽  
Clinical Expertise ◽  
Adrenergic Agonists ◽  
Bottom Line ◽  
Small Magnitude ◽  
The Individual ◽  
Randomised Controlled ◽  
Study Designs

PICO question In horses undergoing lameness investigation, does sedation with a2-adrenergic agonists alone versus sedation with a2-adrenergic agonists in combination with butorphanol tartrate effect the degree of lameness?   Clinical bottom line Category of research question Diagnosis The number and type of study designs reviewed Six papers were critically reviewed. There were two crossover clinical studies, three crossover controlled clinical studies and a randomised controlled clinical study Strength of evidence Moderate Outcomes reported There was limited evidence to suggest that xylazine and romifidine in combination with butorphanol has an effect on forelimb lameness and that detomidine has an effect on hindlimb lameness. Most evidence suggests that xylazine alone or in combination with butorphanol has no effect on the lameness Conclusion In general, sedating a horse with an a2-adrenergic agonist alone or in combination with butorphanol tartrate does not change the baseline degree of lameness. Due to the large variation in the measurements, the small magnitude of few significant effects and the inconsistency of these significant findings, there is insufficient evidence to recommend avoiding the use of sedation in cases where it would increase the safety of those involved. However, regardless of protocol used, clinicians must appreciate the possibility of individual horse variation   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.  

scholarly journals In dogs with congestive heart failure, is torasemide superior to furosemide as a first line diuretic treatment?

2020 ◽  
Vol 5 (4) ◽  
Author(s):  
Leo Packham
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Research Question ◽  
Individual Case ◽  
Clinical Expertise ◽  
First Line ◽  
Bottom Line ◽  
Duration Of Action ◽  
The Individual ◽  
Randomised Controlled

PICO question In dogs with congestive heart failure, does the use of torasemide as a first line diuretic result in a superior survival time when compared to furosemide?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Five studies were critically appraised, they were all prospective randomised controlled trials Strength of evidence Moderate Outcomes reported There is currently a lack of studies looking at comparing furosemide directly with torasemide in patients with congestive heart failure. There are many similarly drawn conclusions from the studies: torasemide is not inferior to furosemide in the treatment of CHF, torasemide is comparable to furosemide at one tenth the dose (or less) and that torasemide may be more effective at diuresis than furosemide with a prolonged duration of action Conclusion There is currently no clear and obvious benefit for the use of torasemide, over furosemide, as a first line diuretic for dogs with congestive heart failure   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care

scholarly journals In dogs diagnosed with osteoarthritis, is meloxicam superior to carprofen for reducing patient discomfort?

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Lesca Monica Sofyan
Keyword(s):  
Research Question ◽  
Individual Case ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Patient Discomfort ◽  
Reaction Forces ◽  
The Individual ◽  
Randomised Controlled

PICO question In dogs diagnosed with osteoarthritis, is meloxicam superior to carprofen for reducing patient discomfort?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Only two papers have compared the efficacy between meloxicam and carprofen in the treatment of dogs diagnosed with osteoarthritis. Both of the papers were clinical, prospective and randomised trials. Strength of evidence Weak Outcomes reported One randomised controlled clinical trial compared the level of efficacy between meloxicam and carprofen in reducing pain and discomfort in dogs diagnosed with osteoarthritis1. Orthopaedic surgeons found dogs treated with either meloxicam or carprofen showed significant improvement in ground reaction forces (GRF). The study emphasised that dogs treated with meloxicam had GRF values that returned to normal baseline values, with owners also commenting on gait improvement. This study however, had a low sample size, did not use a validated metrology instrument for assessment by owners and the data used to assess GRF was not conclusive on all parameters to favour meloxicam. An additional study was evaluated but this also had very small case numbers, no control group and gave no detailed statistical analysis2. The paper descriptively suggests meloxicam to show a better response than carprofen but there was no scientific analysis or evidence to statistically support and validate this. Conclusion Both meloxicam and carprofen are validated as effective treatments for canine osteoarthritis but it cannot be suggested that meloxicam is superior to carprofen as the available evidence is weak. To accurately assess this, a future clinical study using validated metrology instruments, adequate sample sizes and proper statistical analysis is required.   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.  

scholarly journals Does Non-Steroidal Anti-inflammatories: Does carprofen or meloxicam have fewer gastrointestinal side effects?

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Aaron Harold Andrew Fletcher
Keyword(s):  
Side Effects ◽  
Research Question ◽  
Individual Case ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Mucosal Permeability ◽  
Significant Difference ◽  
Gastrointestinal Side Effects ◽  
The Individual ◽  
Randomised Controlled

PICO question In canines, does the oral administration of carprofen, when compared to meloxicam, result in fewer gastrointestinal side effects?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Three prospective randomised controlled trials were critically reviewed Strength of evidence Weak Outcomes reported Treatment with carprofen or meloxicam results in no significant difference in gastric lesion scoring, increased intestinal mucosal permeability or diminished small bowel absorptive capacity Conclusion There is insufficient evidence supporting preferential administration of carprofen or meloxicam to reduce gastrointestinal side effects   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care  

scholarly journals In mares with placentitis does the duration of antibiotic treatment affect foal outcome?

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Elizabeth Barter
Keyword(s):  
Antibiotic Treatment ◽  
Research Question ◽  
Individual Case ◽  
Controlled Trials ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Length Of Treatment ◽  
Diseased State ◽  
The Individual ◽  
Short Courses

PICO question In mares with placentitis does treatment with long-term antibiotics result in improved foal viability when compared to repeated short courses of 7 to 10 days?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed The literature search identified six publications that included length of antibiotic treatment and foetal outcome. The publications consisted of four non-randomised non-blinded controlled trials and two randomised non-blinded controlled trials Strength of evidence Collectively there was weak evidence to support either an intermittent or continuous antibiotic protocol in the treatment of placentitis in mares Outcomes reported The literature involved experimental induction of ascending placentitis with foal survival or viability as the outcome Conclusion Further research is required into the diagnosis of placentitis, length of treatment and choice of antibiotic/s to penetrate the uterus in a diseased state   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.  

scholarly journals The incidence of uterine pathology in ovariectomised bitches

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Maria Norell Candetoft
Keyword(s):  
Research Question ◽  
Case Series ◽  
Individual Case ◽  
Clinical Expertise ◽  
Retrospective Case ◽  
Bottom Line ◽  
Gynaecological Examination ◽  
Long Term Follow Up ◽  
The Individual ◽  
Study Designs

PICO question What is the incidence of postoperative uterine pathology in ovariectomised bitches compared to ovariohysterectomised bitches?   Clinical bottom line Category of research question Incidence The number and type of study designs reviewed Three retrospective case series Strength of evidence Weak Outcomes reported None of the reviewed case series found any uterine pathology for ovariectomised bitches in the long-term follow-up of several years, although none of the studies performed a proper gynaecological examination to confirm a lack of pathology Conclusion With the limited evidence available, it appears that leaving the uterus when gonadectomising bitches does not seem to have a high risk for developing pathology as long as the ovaries are completely removed.   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.  

scholarly journals For horses undergoing general anaesthesia, are rope recoveries or free recoveries better?

2021 ◽  
Vol 6 (3) ◽  
Author(s):  
Ffion Lloyd ◽  
Pamela Murison
Keyword(s):  
Cohort Study ◽  
General Anaesthesia ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Controlled Trial ◽  
Research Question ◽  
Individual Case ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Weak Evidence

PICO question In horses undergoing general anaesthesia, does assistance with ropes result in better recoveries when compared to no assistance (‘free’ recovery)?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed One randomised, non-blinded controlled trial and two retrospective cohort studies Strength of evidence Weak Outcomes reported The three studies reviewed arrive at different conclusions regarding the utility of rope assistance in recovery from general anaesthesia in horses, but examine very different populations. The randomised controlled trial provides weak evidence that rope assistance can shorten recovery and improve recovery quality in healthy (American Society of Anesthesiologists (ASA) I–II) horses. One retrospective cohort study provides weak evidence that rope assistance confers a reduction in fatality in both healthy and sick horses. The other retrospective cohort study provides weak evidence that rope assistance confers no benefit to horses undergoing emergency colic surgery. Both assisted and unassisted groups in each study had fatalities and all studies reported complications related to the rope recovery system Conclusion Insufficient evidence is available to permit a full recommendation regarding rope assistance during recovery from general anaesthesia in horses. Rope assistance may improve recovery time and quality in some horses. The decision to perform a rope-assisted recovery must be made considering individual patient, team and clinic factors. Rope assistance cannot prevent fatalities in recovery   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.  

scholarly journals In horses undergoing volatile anaesthesia, does intraoperative alpha-2-agonist infusion improve recovery?

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Alison Bennell
Keyword(s):  
Research Question ◽  
Individual Case ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Healthy Horse ◽  
Multiple Factors ◽  
Constant Rate ◽  
The Individual ◽  
Study Designs ◽  
Inform Decision Making

PICO question In horses undergoing volatile anaesthesia with isoflurane or sevoflurane, does administration of an alpha-2 agonist as a CRI compared to anaesthetic maintenance with volatile alone improve recovery quality?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Eight papers were critically appraised. All prospective, randomised clinical trials. 7/8 papers were blinded and 4/8 were crossover design Strength of evidence Moderate Outcomes reported One paper investigating detomidine and one on romifidine showed no improvement in recovery quality. 3/3 medetomidine papers and 2/3 dexmedetomidine papers showed a significant improvement in recovery quality in the alpha-2 agonist CRI group Conclusion In a healthy horse undergoing general anaesthesia with isoflurane or sevoflurane maintenance, an intra-operative constant rate of infusion (CRI) of medetomidine and dexmedetomidine can lead to better recovery quality when compared to horses who are maintained on isoflurane or sevoflurane alone   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.  

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