Validation of the UNESP-Botucatu pig composite acute pain scale (UPAPS).

The creation of species-specific valid tools for pain assessment is essential to recognize pain and determine the requirement and efficacy of analgesic treatments. This study aimed to assess behaviour and investigate the validity and reliability of an acute pain scale in pigs undergoing orchiectomy. Forty-five pigs aged 38±3 days were castrated under local anaesthesia. Behaviour was video-recorded 30 minutes before and intermittently up to 24 hours after castration. Edited footage (before surgery, after surgery before and after rescue analgesia, and 24 hours postoperatively) was analysed twice (one month apart) by one observer who was present during video-recording (in-person researcher) and three blinded observers. Statistical analysis was performed using R software and differences were considered significant when p<0.05. Intra and inter-observer agreement, based on intra-class correlation coefficient, was good or very good between most observers (>0.60), except between observers 1 and 3 (moderate agreement 0.57). The scale was unidimensional according to principal component analysis. The scale showed acceptable item-total Spearman correlation, excellent predictive and concurrent criterion validity (Spearman correlation ≥ 0.85 between the proposed scale versus visual analogue, numerical rating, and simple descriptive scales), internal consistency (Cronbach's α coefficient >0.80 for all items), responsiveness (the pain scores of all items of the scale increased after castration and decreased after intervention analgesia according to Friedman test), and specificity (> 95%). Sensitivity was good or excellent for most of the items. The optimal cut-off point for rescue analgesia was ≥ 6 of 18. Discriminatory ability was excellent for all observers according to the area under the curve (>0.95). The proposed scale is a reliable and valid instrument and may be used clinically and experimentally to assess postoperative acute pain in pigs. The well-defined cut-off point supports the evaluator´s decision to provide or not analgesia.

Validation of the Italian version of the UNESP-Botucatu unidimensional composite pain scale for the assessment of postoperative pain in cattle.

OBJECTIVE: The aim of this study was to validate the Italian version of the UNESP-Botucatu Unidimensional Composite Pain Scale (UCPS-IV) for assessing postoperative pain in cattle. STUDY DESIGN: Video analysis and psychometric testing. ANIMALS: A total of 40 Nellore cattle, age 2-3 years, weighing 365±51 kg. METHODS: An English version of the scale was translated to Italian and back translated to English to ensure semantic equivalence. A total of four Italian observers and the researcher who developed the original scale (considered as the gold standard) analysed videos of 40 cattle previously subjected to orchiectomy (recorded for each cattle at four predetermined timepoints during the perioperative period) unaware of the videos' timepoint. They assigned a pain score [ranging from no pain (0) to severe pain (10)] using the Italian version of the scale and verified the need for analgesic treatment for each animal. The obtained scores were subjected to psychometric validity, responsiveness and reliability tests. RESULTS: The factor analysis of the scale resulted in a one-factor solution. Significant changes in pain scores in response to surgery and analgesics confirmed not only the content and construct validity, but also responsiveness. The agreement between the researcher who developed the original scale and the blinded observers and the correlation between the pain scores determined by the scale and those determined by three classical unidimensional pain scales confirmed criterion and concurrent validity. Internal consistency of the scale was excellent. Inter- and intrarater reliability ranged from moderate to good and from moderate to very good for all scale items, respectively, supporting reproducibility and stability. The cut-off point for rescue analgesia calculated by the receiver operating characteristic curve was > 3. CONCLUSIONS AND CLINICAL RELEVANCE: The results confirm that the UNESP-Botucatu UCPS-IV appears to be a valid and reliable tool for the assessment of postorchiectomy pain in the bovine species. The determination of a cut-off point for rescue analgesia is also helpful for guiding analgesic therapy.

Comparison of morphine, ketoprofen and Arnica montana 6x and 30x per oral transmucosal or subcutaneous route for control of postoperative pain in cats subjected to hysterectomy with bilateral salpingo-oophorectomy / Comparação de morfina, cetoprofeno e Arnica montana 6x e 30x por via transmucosa oral ou subcutânea para control e de dor pós-operatória em gatas submetidas à histerectomia e ooforectomia bilateral

ABSTRACT: The postoperative analgesic effect of Arnica montana (Arnica) was compared to morphine and ketoprofen in 50 cats following hysterectomy with bilateral salpingo-oophorectomy (HSO). Cats were randomly allocated to five groups (n=10) and were treated 30 minutes before surgery and over 72 hours with 1ml of Arnica 30x per subcutaneous (SC) route (GA30SC); Arnica 30x per oral transmucosal route (P.O.) (GA30PO); Arnica 6x P.O. (GA6PO); morphine 0.1mg kg-1 SC (GM) SID or ketoprofen 2mg kg-1 SC (GK) before and 1mg kg-1 after surgery. Sedation and postoperative pain were assessed by means of a dynamic and interactive visual analogue scale (DIVAS) and variable count scale (VCS) and hyperalgesia using an esthesiometer. Whenever the VAS and VCS scores attained 33% of the maximum value, rescue analgesia was performed with morphine 0.3mg kg-1 per the intramuscular (IM) route. Other variables assessed were vomiting, defecation, urination, body weight and wound healing. Vomiting only occurred in animals treated with morphine. The groups did not differ in defecation, urination, body weight or wound healing. Hyperalgesia was detected only on the occasions that the criterion for rescue analgesia was met. One animal in GK and one in GM required rescue analgesia, differing from groups GA30SC, GA30PO and GA6PO, in which 4, 4 and 5 animals, respectively, required rescue analgesia. It can be concluded that ketoprofen and morphine were more efficacious than Arnica and that there was no difference among the various potencies and routes of administration of Arnica for postoperative analgesia in cats undergoing HSO.

RESUMO: Comparou-se o efeito analgésico de Arnica em relação à morfina ou cetoprofeno, no período pós-operatório, de 50 gatas submetidas à ovariossalpingohisterectomia (OSH). As gatas foram divididas em cinco grupos (n=10) e tratadas aleatoriamente 30 minutos antes da cirurgia por 72 horas com 1ml de Arnica 30D por via subcutânea (SC) (GA30SC); Arnica 30D por via oral (VO) (GA30VO); Arnica 6D VO (GA6VO); 0,1mg kg-1 de morfina SC (GM) TID ou 2mg kg-1 de cetoprofeno SC (GC) antes e 1mg kg-1 após a cirurgia SID. Foram avaliadas a sedação e a dor pós-operatória, por meio de escala analógica visual (EAV), escala de contagem variável (ECV) e hiperalgesia, esta última pelo estesiômetro. Quando os escores da ECV e EAV atingiram 33% do valor máximo, realizou-se resgate analgésico com 0,3mg kg-1 de morfina por via intramuscular (IM). Observou-se ocorrência de vômito, defecação, micção, alteração de peso e a cicatrização. Exceto nos animais tratados com morfina, não houve vômito. Não houve diferença entre os grupos para defecação, micção, peso e cicatrização. A hiperalgesia foi observada apenas nos momentos do resgate analgésico. Um animal de GC e um de GM receberam resgate analgésico, o que diferiu dos grupos GA30SC, GA30VO e GA6VO, onde, respectivamente, 4, 4 e 5 animais necessitaram resgate analgésico. Conclui-se que o cetoprofeno e a morfina foram mais eficazes que a Arnica e que, quanto à Arnica, não houve diferença nem entre as dinamizações e entre as vias SC e oral para analgesia de gatas submetidas à OSH.

Acupuncture and pharmacopuncture are as effective as morphine or carprofen for postoperative analgesia in bitches undergoing ovariohysterectomy

ABSTRACT PURPOSE : To investigate the analgesic effect of acupuncture (AP) or micro-dose pharmacopuncture (PA), using carprofen or morphine, in bitches undergoing ovariohysterectomy (OHE). METHODS: Thirty five dogs were randomly assigned to five groups after sedation with acepromazine IM: AP, 0.5 mg.kg-1 of morphine subcutaneously (SC), 4 mg.kg-1 of carprofen SC, and PA with 0.05 mg.kg-1 of morphine or 0.4 mg.kg-1 of carprofen. Anaesthesia was induced with propofol and maintained with isoflurane. Pain was assessed after OHE by a blind observer for 24h, by dynamic visual analogue scale (DIVAS), Glasgow (CMPS-SF), Melbourne (UMPS) and Colorado University pain scale (CSU). Animals reaching 33% of the UMPS score received rescue analgesia with morphine IM. Non parametric data were analysed by Kruskal-Wallis or Friedman tests where applicable, followed by Dunn´s test. Parametric data were analysed by two way ANOVA, followed by Tukey test. RESULTS: There were no differences among groups in number of rescue analgesia. Except for the DIVAS score where animals treated with morphine had the lowest score compared with AP and carprofen, at 1h after surgery, there were no other differences among groups. CONCLUSION: Acupuncture or pharmacopuncture were equally effective as morphine or carprofen to control postoperative pain in bitches undergoing ovariohysterectomy.

Refinement and partial validation of the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in horses.

BACKGROUND: Quantification of pain plays a vital role in the diagnosis and management of pain in animals. In order to refine and validate an acute pain scale for horses a prospective, randomized, blinded study was conducted. Twenty-four client owned adult horses were recruited and allocated to one of four following groups: anaesthesia only (GA); pre-emptive analgesia and anaesthesia (GAA,); anaesthesia, castration and postoperative analgesia (GC); or pre-emptive analgesia, anaesthesia and castration (GCA). One investigator, unaware of the treatment group, assessed all horses at time-points before and after intervention and completed the pain scale. Videos were also obtained at these time-points and were evaluated by a further four blinded evaluators who also completed the scale. The data were used to investigate the relevance, specificity, criterion validity and inter- and intra-observer reliability of each item on the pain scale, and to evaluate construct validity and responsiveness of the scale. RESULTS: Construct validity was demonstrated by the observed differences in scores between the groups, four hours after anaesthetic recovery and before administration of systemic analgesia in the GC group. Inter- and intra-observer reliability for the items was only satisfactory. Subsequently the pain scale was refined, based on results for relevance, specificity and total item correlation. CONCLUSIONS: Scale refinement and exclusion of items that did not meet predefined requirements generated a selection of relevant pain behaviours in horses. After further validation for reliability, these may be used to evaluate pain under clinical and experimental conditions.

Acupuncture and pharmacopuncture are as effective as morphine or carprofen for postoperative analgesia in bitches undergoing ovariohysterectomy.

PURPOSE: To investigate the analgesic effect of acupuncture (AP) or micro-dose pharmacopuncture (PA), using carprofen or morphine, in bitches undergoing ovariohysterectomy (OHE). METHODS: Thirty five dogs were randomly assigned to five groups after sedation with acepromazine IM: AP, 0.5 mg.kg(-1) of morphine subcutaneously (SC), 4 mg.kg(-1) of carprofen SC, and PA with 0.05 mg.kg(-1) of morphine or 0.4 mg.kg(-1) of carprofen. Anaesthesia was induced with propofol and maintained with isoflurane. Pain was assessed after OHE by a blind observer for 24h, by dynamic visual analogue scale (DIVAS), Glasgow (CMPS-SF), Melbourne (UMPS) and Colorado University pain scale (CSU). Animals reaching 33% of the UMPS score received rescue analgesia with morphine IM. Non parametric data were analysed by Kruskal-Wallis or Friedman tests where applicable, followed by Dunn's test. Parametric data were analysed by two way ANOVA, followed by Tukey test. RESULTS: There were no differences among groups in number of rescue analgesia. Except for the DIVAS score where animals treated with morphine had the lowest score compared with AP and carprofen, at 1h after surgery, there were no other differences among groups. CONCLUSION: Acupuncture or pharmacopuncture were equally effective as morphine or carprofen to control postoperative pain in bitches undergoing ovariohysterectomy.

Validation of the UNESP-Botucatu unidimensional composite pain scale for assessing postoperative pain in cattle.

BACKGROUND: The recognition and measurement of pain in cattle are important in determining the necessity for and efficacy of analgesic intervention. The aim of this study was to record behaviour and determine the validity and reliability of an instrument to assess acute pain in 40 cattle subjected to orchiectomy after sedation with xylazine and local anaesthesia. The animals were filmed before and after orchiectomy to record behaviour. The pain scale was based on previous studies, on a pilot study and on analysis of the camera footage. Three blinded observers and a local observer assessed the edited films obtained during the preoperative and postoperative periods, before and after rescue analgesia and 24 hours after surgery. Re-evaluation was performed one month after the first analysis. Criterion validity (agreement) and item-total correlation using Spearman's coefficient were employed to refine the scale. Based on factor analysis, a unidimensional scale was adopted. RESULTS: The internal consistency of the data was excellent after refinement (Cronbach's α coefficient = 0.866). There was a high correlation (p < 0.001) between the proposed scale and the visual analogue, simple descriptive and numerical rating scales. The construct validity and responsiveness were confirmed by the increase and decrease in pain scores after surgery and rescue analgesia, respectively (p < 0.001). Inter- and intra-observer reliability ranged from moderate to very good. The optimal cut-off point for rescue analgesia was > 4, and analysis of the area under the curve (AUC = 0.963) showed excellent discriminatory ability. CONCLUSION: The UNESP-Botucatu unidimensional pain scale for assessing acute postoperative pain in cattle is a valid, reliable and responsive instrument with excellent internal consistency and discriminatory ability. The cut-off point for rescue analgesia provides an additional tool for guiding analgesic therapy.

Refinement and initial validation of a multidimensional composite scale for use in assessing acute postoperative pain in cats.

OBJECTIVE: To refine and test construct validity and reliability of a composite pain scale for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy. SAMPLE POPULATION: 40 cats that underwent ovariohysterectomy in a previous study. PROCEDURES: In a previous randomized, double-blind, placebo-controlled study, a composite pain scale was developed to assess postoperative pain in cats that received a placebo or an analgesic (tramadol, vedaprofen, or tramadol-vedaprofen combination). In the present study, the scale was refined via item analysis (distribution frequency and occurrence), a nonparametric ANOVA, and item-to-total score correlation. Construct validity was assessed via factor analysis and known-groups discrimination, and reliability was measured by assessing internal consistency. RESULTS: Respiratory rate and respiratory pattern were rejected after item analysis. Factor analysis resulted in 5 dimensions (F1 [psychomotor change], posture, comfort, activity, mental status, and miscellaneous behaviors; F2 [protection of wound area], reaction to palpation of the surgical wound and palpation of the abdomen and flank; F3 [physiologic variables], systolic arterial blood pressure and appetite; F4 [vocal expression of pain], vocalization; and F5 [heart rate]). Internal consistency was excellent for the overall scale and for F1, F2, and F3; very good for F4; and unacceptable for F5. Except for heart rate, the identified factors and scale total score could be used to detect differences between the analgesic and placebo groups and differences among the analgesic treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Results provided initial evidence of construct validity and reliability of a multidimensional composite tool for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy.

Analgesic efficacy of perioperative use of vedaprofen, tramadol or their combination in cats undergoing ovariohysterectomy.

The analgesic efficacy of tramadol and/or vedaprofen was evaluated in cats submitted for elective ovariohysterectomy, using a randomised double blind placebo controlled design. Forty adult female cats (3.0+/-0.32kg; 1.8+/-0.7 years) were distributed into four groups. Vedaprofen PO (0.5mg/kg), tramadol SC (2mg/kg), both, or placebo was administered 1h before surgery and every 24 and 8h, respectively, for 72h after surgery. Pain score evaluated by interactive visual analogue and composite pain score and hyperalgesia by the von Frey filament test were recorded at 1, 2, 4, 6, 8, 12, 24, 28, 32, 48, 52, 56, 72, 96h and on the 7th day after surgery. Animals treated with combined vedaprofen and tramadol treatment did not need rescue analgesia, did not develop hyperalgesia, and their serum cortisol concentrations and pain scores were lower than placebo until 24 and 72h after surgery, respectively. Combined vedaprofen and tramadol treatment provided more effective postoperative analgesia and prevented hyperalgesia than when used on their own. Multimodal technique is a superior method of treating pain after feline ovariohysterectomy. This work also provides evidence for the benefits of analgesia for up to 3 days following ovariohysterectomy.

Homoimplante ortotópico conservado, associado à terapia soft laser na reparação tenopatelar em cão / Preserved orthotopic homologous implant associated with soft laser therapy in tenopatellar repair in the dog

Em busca de um método alternativo para reparação de lesões articulares envolvendo o segmento tenopatelar, 24 cães foram submetidos ao implante tenopatelar conservado em solução de glicerina a 98 por cento e distribuídos em dois grupos de igual número (grupos I e II). Os cães do grupo II foram submetidos à terapia laser Arseneto de Gálio nos primeiros 10 dias de pós-operatório. Os animais de cada grupo foram novamente distribuídos em subgrupos de igual número de acordo com a faixa de peso que foi entre 10 e 20kg e 21 e 30kg e períodos pós-operatórios (PO) de 60, 120 e 180 dias. A articulação do joelho foi imobilizada por fixação externa percutânea tipo II e permaneceu por um período de 30 dias de pós-operatório o que proporcionou uma adequada estabilidade articular para cicatrização. Foi notada em todos os animais dos grupos I e II, atrofia da musculatura da coxa sem recuperação da massa muscular até os períodos preestabelecidos de pós-operatório (PO) de 60, 120 e 180 dias. Na avaliação macroscópica, foi notada proliferação de tecido conjuntivo ao redor e sobre a patela implantada. Na análise radiográfica, foram observados diferentes estágios de reabsorção óssea do enxerto patelar e pela microscopia foram vistas em todos os grupos, trabéculas ósseas do enxerto em fase de reabsorções, margeadas por osteoclastos e preenchidas por tecido fibrovascular e neoformação óssea a partir de ossificação endocondral. Conclui-se que a técnica de implantação de segmento tenopatelar homógeno ortotópico conservado em glicerina a 98 por cento é apropriado para substituir segmento tenopatelar em cães pesando até 30kg.

Anestesia com cetamina, midazolam e óxido nitroso em cães submetidos à esofagoplastia cervical / Ketamine, midazolam and nitrous oxide anesthesia in dogs submitted to cervical esophagoplasty

Este estudo foi realizado para avaliar a anestesia intravenosa com cetamina e midazolam (K-M) em cäes ventilados mecanicamente com 66 por cento de óxido nitroso e 33 por cento de oxigênio ou 100 por cento de oxigênio. Foram utilizados 16 cäes sem raça definida, hígidos, com peso médio de 14,2 ± 3,78kg, submetidos a jejum sólido de 12 horas prévio ao procedimento. A anestesia foi induzida com a associaçäo de cetamina (10mg.kg-1) e midazolam (0,5mg.kg-1) administrados na mesma seringa por via intravenosa (IV). Para manutençäo anestésica, foi utilizada cetamina (5mg.kg-1) e midazolam (0,25mg.kg-1) administrados por via IV em intervalos de 10 minutos. Os animais foram distribuídos em dois grupos: N2O e O2. No grupo N2O, os cäes foram ventilados mecanicamente com 66 por cento de óxido nitroso e 33 por cento de oxigênio. No grupo O2, somente o oxigênio foi utilizado para ventilaçäo artificial. Em ambos os grupos, os animais foram submetidos à esofagoplastia cervical. As variáveis fisiológicas utilizadas para comparaçäo entre os grupos foram: freqüência cardíaca, pressöes arteriais sistólica, média e diastólica, saturaçäo de oxigênio da hemoglobina e temperatura corporal. A necessidade ou näo de doses adicionais da associaçäo cetamina e midazolam também foi registrada para comparaçäo. A análise estatística dos resultados näo demonstrou diferenças significativas nas variáveis fisiológicas entre os grupos. No grupo O2, foram necessárias doses maiores da associaçäo K-M para manutençäo anestésica nos 30 minutos iniciais (p<0,05). Conclui-se que a anestesia injetável com K-M, nas doses utilizadas neste estudo, com ou sem inclusäo de óxido nitroso, näo deprime a funçäo cardiovascular, näo causa hipotermia, promove induçäo tranqüila e recuperaçäo satisfatória com salivaçäo e produz adequado grau de analgesia e relaxamento muscular para realizaçäo de cirurgias no esôfago cervical em cäes. A inclusäo do óxido nitroso permite a utilizaçäo de doses menores da associaçäo cetamina-midazolam

Restauraçäo do diafragma de felino com enxerto autólogo de pericárdio / Reconstruction of feline diaphragm with autologous pericardium graft

OBJETIVO: Avaliar o uso de enxerto autólogo de pericárdio para correçäo de defeitos diafragmáticos em felinos. MÉTODOS: Foram utilizados doze gatos domésticos, adultos, sem raça definida, pesando entre dois e quatro quilogramas. O procedimento cirúrgico consistiu de toracotomia no 7º espaço intercostal esquerdo, remoçäo de um retalho do pericárdio de, aproximadamente, 2,0 x 4,0 cm e sutura desse em um defeito de tamanho aproximado criado no diafragma. Cinco animais foram observados por um período de 30 dias de pós-operatório e o restante em 60 dias, quando foram submetidos à eutanásia para observaçäo macroscópica e coleta de amostras para avaliaçäo histológica. RESULTADOS: Foi observada nos animais do grupo de 30 dias, substituiçäo parcial e no grupo de 60 dias, substituiçäo total do enxerto de pericárdio por tecido fibrovascular, permitindo o restabelecimento completo do diafragma. Macroscopicamente, foi verificada presença de aderência na cavidade torácica, com o pulmäo e pleura parietal e, na cavidade abdominal, com o fígado e omento, porém, sem comprometimento clínico das estruturas envolvidas. CONCLUSÄO: O enxerto autólogo felino pode ser utilizado para reparaçäo de defeitos diafragmáticos, pois suporta a diferença de pressäo presente, sendo substituído por tecido cicatricial, sem apresentar sinais clínicos e histológicos de rejeiçäo.

Alteraçöes cardiovasculares de gatos submetidos à toracotomia intercostal, pré-medicados com associaçäo de tramadol, butorfanol e atropina e anestesiados com propofol e halotano / Cardiovascular changes in cats submitted to intercostal thoracotomy, premedication with association tramadol, butorphanol, atropine, anesthetised with propofol and halothane

A toracotomia é um procedimento cirúrgico que produz estímulo doloroso intenso. O objetivo deste estudo foi avaliar o efeito cardiovascular da associaçäo tramadol, butorfanol e atropina na medicaçäo pré-anestésica de gatos anestesiados com propofol e halotano. Doze animais, SRD, machos ou fêmeas, com peso médio de 2,7 ñ 0,62kg receberam como medicaçäo pré-anestésica (MPA), a associaçäo de tramadol (2,0mg kg(-1)), butorfanol (0,4mg kg(-1)) e atropina (0,044mg kg(-1)), via intramuscular. Trinta minutos após MPA, a induçäo foi realizada com propofol (5,0mg kg(-1)) por via intravenosa. A manutençäo anestésica foi obtida com halotano e oxigênio 100 por cento sob ventilaçäo artificial manual. Os gatos foram submetidos à toracotomia intercostal para implante de um segmento autólogo de pericárdio no diafragma. As variáveis avaliadas foram: freqüência cardíaca (bpm), saturaçäo de oxigênio da hemoglobina (porcentagem), pressäo arterial sistólica (mmHg) e vaporizaçäo de halotano (porcentagem). As variáveis foram mensuradas 20 minutos após a MPA (TMPA), 10 minutos após induçäo e a cada 10 minutos até o final do procedimento cirúrgico (T10 a T100). Os dados obtidos foram analisados estatisticamente através de ANOVA e teste de Bonferroni (p<0,05). Os resultados demonstraram reduçäo na pressäo arterial sistólica e freqüência cardíaca, estatisticamente significativa (p<0,05), porém, se mantiveram dentro da faixa de variaçäo fisiológica para a espécie felina. Saturaçäo de oxigênio da hemoglobina manteve-se ao redor de 100 por cento em todos os tempos. A vaporizaçäo de halotano diminuiu significativamente do T30 ao T100, permanecendo na maior parte do tempo cirúrgico abaixo da concentraçäo alveolar mínima para gatos. Conclui-se que a associaçäo tramadol (2,0mg kg(-1)), butorfanol (0,4mg kg(-1)) e atropina (0,044mg kg(-1)), via intramuscular, como pré-medicaçäo, em gatos, anestesiados com propofol (5,0mg kg(-1) e halotano produz mínimas alteraçöes cardiovasculares, näo induz sedaçäo e promove analgesia satisfatória para realizaçäo de toracotomia intercostal lateral.