2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats.

PRACTICAL RELEVANCE: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and are effective for the management of pain in cats. These Guidelines will support veterinarians in decision-making around prescribing NSAIDs in situations of chronic pain, to minimise adverse effects and optimise pain management. Information is provided on mechanism of action, indications for use, screening prior to prescription, use in the presence of comorbidities, monitoring of efficacy, and avoidance and management of adverse effects. CLINICAL CHALLENGES: The cat's unique metabolism should be considered when prescribing any medications, including NSAIDs. Chronic pain may be challenging to detect in this species and comorbidities, particularly chronic kidney disease, are common in senior cats. Management of chronic pain may be complicated by prescription of other drugs with the potential for interactions with NSAIDs. EVIDENCE BASE: These Guidelines have been created by a panel of experts brought together by the International Society of Feline Medicine (ISFM) and American Association of Feline Practitioners (AAFP). Information is based on the available literature, expert opinion and the panel members' experience.

Perceptions and opinions of pet caregivers in mainland and Hong Kong China about surgery, pain management, and anesthesia in dogs and cats.

Small animal caregivers' perceptions and previous life experiences play a pivotal role in patient care, making effective communication fundamental within the veterinary business. Despite the large and growing scale of the pet industry, data on small animal client-centered information about veterinary services in Mainland China (MC) and the Hong Kong Special Administrative Region (HKSAR) China are lacking. The objective of this study was to investigate the perceptions and opinions of small animal caregivers about surgery, pain management, and anesthesia in dogs and cats in these geographical regions through a validated online survey using content validity index. A total of 2080 valid answers were collected by convenience sampling over 45 days. Descriptive statistics were used to summarize data; the chi-square test and generalized linear models were used to test the associations between demographics and responses. Overall, caregivers appeared favorable toward the use of analgesia in their pets, with concerns over the potential adverse effects produced by analgesic drugs. Joint pain and ear infections were generally rated as conditions that would be less prone to require analgesia. Significant associations were observed for demographic factors such as gender, age, and geographical area, whether participants were healthcare providers, and whether their pets had undergone surgery before. Although many respondents expressed uncertainty in recognizing pain in their pets and administering analgesics, they also expressed a desire to learn and to be informed. This study highlights areas and factors that may determine the perceptions and opinions of small animal caregivers that form a unique human-animal bond in China. Client communication should be addressed on a case-by-case basis and adapted to the geographical area, as the individual background and demographics may have an ultimate impact on treatment goals and patient care.

Construct validity, responsiveness and reliability of the Feline Grimace Scale in kittens.

OBJECTIVES: The aim of the present study was to investigate the construct validity, responsiveness and reliability of the Feline Grimace Scale (FGS) in kittens. METHODS: A total of 36 healthy female kittens (aged 10 weeks to 6 months) were included in a prospective, randomized, blinded study. Video recordings of all kittens were made before and 1 and 2 h after ovariohysterectomy using an opioid-free injectable anesthetic protocol with or without multimodal analgesia. Additional recordings were taken before and 1 h after administration of rescue analgesia (buprenorphine 0.02 mg/kg IM) to painful kittens. Screenshots of facial images were collected from the video recordings for FGS scoring. Four observers blinded to treatment groups and time points scored 111 randomized images twice with a 5-week interval using the FGS. Five action units (AUs) were scored (ear position, orbital tightening, muzzle tension, whiskers position and head position; 0-2 each). Construct validity, responsiveness, and inter- and intra-rater reliability were evaluated using linear models with Benjamini-Hochberg correction, Wilcoxon signed-rank test and single intraclass correlation coefficients (ICCsingle), respectively (P <0.05). RESULTS: FGS total ratio scores were higher at 1 and 2 h after ovariohysterectomy (median [interquartile range, IQR]: 0.30 [0.20-0.40] and 0.30 [0.20-0.40], respectively) than at baseline (median [IQR]: 0.10 [0.00-0.30]) (P <0.001). FGS total ratio scores were lower after the administration of rescue analgesia (median [IQR] before and after rescue analgesia) 0.40 [0.20-0.50] and 0.20 [0.10-0.38], respectively (P <0.001). Inter-rater ICCsingle was 0.68 for the FGS total ratio scores and 0.35-0.70 for all AUs considered individually. Intra-rater ICCsingle was 0.77-0.91 for the FGS total ratio scores and 0.55-1.00 for all AUs considered individually. CONCLUSIONS AND RELEVANCE: The FGS is a valid and responsive acute pain-scoring instrument with moderate inter-rater reliability and good to excellent intra-rater reliability in kittens.

Randomised, prospective, blinded, clinical trial of opioid-free injectable anaesthesia with or without multimodal analgesia in kittens undergoing ovariohysterectomy.

OBJECTIVES: This study compared an opioid-free injectable anaesthetic protocol with or without multimodal analgesia in kittens undergoing ovariohysterectomy. METHODS: In this prospective, randomised, blinded, clinical trial, 29 healthy kittens (mean ± SD weight 1.55 ± 0.46 kg; aged 10 weeks to 6 months) were included. Anaesthesia was performed with an intramuscular injection of ketamine (4 mg/kg), dexmedetomidine (40 µg/kg) and midazolam (0.25 mg/kg). In the multimodal group (MMG), cats (n = 14) received meloxicam (0.1 mg/kg SC) and intraperitoneal bupivacaine 0.25% (2 mg/kg), whereas the same volume of saline was administered in the control group (CG; n = 15). Atipamezole (0.4 mg/kg IM) was given 15 mins after ovariohysterectomy. Postoperative pain was assessed using the UNESP-Botucatu multidimensional feline pain assessment scale - short form. Rescue analgesia (buprenorphine 0.02 mg/kg IM in MMG/CG and meloxicam 0.1 mg/kg SC in CG) was administered if pain scores were ⩾4/12. Soft food intake (after 2 and 60 mins) was evaluated at specific time points postoperatively. Statistical analyses were performed with linear models and post-hoc pairwise comparison with Benjamini-Hochberg corrections (P <0.05). RESULTS: The prevalence of rescue analgesia was higher in the CG (n = 15/15) than the MMG (n = 1/14; P <0.001). Pain scores at 1 h, 2 h and 4 h postoperatively were higher in the CG (4.1 ± 2.8, 4.8 ± 3.0 and 5.3 ± 1.2, respectively) than in the MMG (1.6 ± 1.0, 1.1 ± 1.0 and 0.9 ± 0.8, respectively; P <0.001). Food intake (%) at 1 h postoperatively was higher in the MMG after 2 and 60 mins (10.4 ± 9 and 71.9 ± 29, respectively) than in the CG (1.4 ± 2 and 13.9 ± 7, respectively; P <0.001). CONCLUSIONS AND RELEVANCE: This opioid-free protocol using multimodal analgesia produced adequate postoperative pain relief, while almost eliminating the need for rescue analgesia in kittens undergoing ovariohysterectomy. Pain decreased food intake.

Reliability and Validity of UNESP-Botucatu Cattle Pain Scale and Cow Pain Scale in Bos taurus and Bos indicus Bulls to Assess Postoperative Pain of Surgical Orchiectomy.

Pain assessment guides decision-making in pain management and improves animal welfare. We aimed to investigate the reliability and validity of the UNESP-Botucatu cattle pain scale (UCAPS) and the cow pain scale (CPS) for postoperative pain assessment in Bos taurus (Angus) and Bos indicus (Nelore) bulls after castration. METHODS: Ten Nelore and nine Angus bulls were anaesthetised with xylazine-ketamine-diazepam-isoflurane-flunixin meglumine. Three-minute videos were recorded at -48 h, preoperative, after surgery, after rescue analgesia and at 24 h. Two evaluators assessed 95 randomised videos twice one month apart. RESULTS: There were no significant differences in the pain scores between breeds. Intra and inter-rater reliability varied from good (>0.70) to very good (>0.81) for all scales. The criterion validity showed a strong correlation (0.76-0.78) between the numerical rating scale and VAS versus UCAPS and CPS, and between UCAPS and CPS (0.76). The UCAPS and CPS were responsive; all items and total scores increased after surgery. Both scales were specific (81-85%) and sensitive (82-87%). The cut-off point for rescue analgesia was >4 for UCAPS and >3 for CPS. CONCLUSIONS: The UCAPS and CPS are valid and reliable to assess postoperative pain in Bos taurus and Bos indicus bulls.

Analgesic efficacy of an ultrasound-guided transversus abdominis plane block with bupivacaine in cats: a randomised, prospective, masked, placebo-controlled clinical trial.

OBJECTIVES: This randomised, prospective, masked clinical trial evaluated the postoperative analgesic efficacy of an ultrasound-guided transversus abdominis plane block (TAPB) with bupivacaine in cats undergoing ovariohysterectomy. METHODS: Thirty-two healthy adult female cats undergoing elective ovariohysterectomy were randomised to undergo TAPB with bupivacaine (treatment group [TG], n = 16) vs placebo (control group [CG], n = 16) in addition to preoperative analgesia with buprenorphine (0.02 mg/kg IM). All patients received a general anaesthetic and, before surgical incision, a bilateral two-point (subcostal and lateral-longitudinal) TAPB was performed using 1 ml/kg bupivacaine 0.25% (0.25 ml/kg/point) or saline. Each cat was assessed by a blinded investigator before premedication (0 h) and at 1, 2, 3, 4, 8, 10 and 24 h postoperatively using the UNESP-Botucatu Feline Pain Scale - short form. Buprenorphine (0.02 mg/kg IV) and meloxicam (0.2 mg/kg SC) were administered when pain scores were ⩾4/12. Ten hours postoperatively, meloxicam was administered to cats that did not receive rescue analgesia. Statistical analysis included Student's t-tests, Wilcoxon tests and χ2 tests, and a linear mixed model with Bonferroni corrections (P <0.05). RESULTS: Of the 32 cats enrolled, three in the CG were excluded from the analysis. The prevalence of rescue analgesia was significantly higher in the CG (n = 13/13) than in the TG (n = 3/16; P <0.001). Only one cat in the CG required rescue analgesia twice. Pain scores were significantly higher in the CG compared with the TG at 2, 4 and 8 h postoperatively. Mean ± SD pain scores were significantly higher in the CG, but not in the TG, at 2 (2.1 ± 1.9), 3 (1.9 ± 1.6), 4 (3.0 ± 1.4) and 8 h postoperatively (4.7 ± 0.6) than at 0 h (0.1 ± 0.3). CONCLUSIONS AND RELEVANCE: A bilateral ultrasound-guided two-point TAPB with bupivacaine in combination with systemic buprenorphine provided superior postoperative analgesia than buprenorphine alone in cats undergoing ovariohysterectomy.

Can cat caregivers reliably assess acute pain in cats using the Feline Grimace Scale? A large bilingual global survey.

OBJECTIVES: This study aimed to investigate if cat caregivers could reliably assess acute pain using the Feline Grimace Scale (FGS), and if participant demographics could affect scores. METHODS: An online survey in English and Spanish was advertised by International Cat Care and other platforms (March-May 2021) using convenience sampling. Eligible participants were caregivers >18 years old and non-veterinary health professionals. Participants and a group of eight veterinarians scored 10 images of cats with different levels of pain. Data were analysed using linear models and intraclass correlation coefficient (ICC; α <0.05). Interpretation of the ICC was <0.2 = poor; 0.21-0.4 = reasonable; 0.41-0.60 = moderate; 0.61-0.80 = good; and 0.81-1.0 = very good. RESULTS: A total of 3039 responses were received with 1262 completed answers from 66 countries (86%, 11.1% and 2.9% identified as female, male or other, respectively). Scores for each action unit (AU; ear position, orbital tightening, muzzle tension, whiskers change and head position) and their sum (FGS score) were not significantly different between caregivers and veterinarians, except for muzzle (caregivers 0.9 ± 0.0; veterinarians 0.7 ± 0.1; P = 0.035). The ICC single (caregivers) was 0.65, 0.69, 0.58, 0.37, 0.38 and 0.65, respectively, for AU ears, eyes, muzzle, whiskers, head and sum of scores. Demographic variables did not affect FGS scores. CONCLUSIONS AND RELEVANCE: Total FGS scores had good reliability when used by cat caregivers, regardless of demographic variables, showing the potential applicability of the instrument to improve feline pain management and welfare worldwide.

A randomized, prospective, masked clinical trial comparing an opioid-free vs. opioid-sparing anesthetic technique in adult cats undergoing ovariohysterectomy.

This study aimed to compare the analgesic effects of an injectable protocol using multimodal analgesia with or without opioids in cats undergoing ovariohysterectomy (OVH). Thirty-two healthy cats were enrolled in a prospective, blinded, randomized trial after the caregiver's written consent. Cats received a combination of ketamine (4 mg/kg), midazolam (0.25 mg/kg) and dexmedetomidine (40 µg/kg), and either buprenorphine (20 µg/kg) or saline (same volume as buprenorphine) intramuscularly [opioid-sparing (OSA) and opioid-free anesthesia (OFA) groups, respectively]. Intraperitoneal bupivacaine 0.25% (2 mg/kg) and meloxicam (0.2 mg/kg subcutaneously) were administered before OVH. Atipamezole (400 µg/kg intramuscularly) was administered at the end of surgery. Pain and sedation were evaluated using the Feline Grimace Scale (FGS) and a dynamic interactive visual analog scale, respectively. Intravenous buprenorphine was administered as rescue analgesia if FGS scores ≥ 0.39/1. Statistical analysis included repeated measures linear mixed models, Fisher's exact test and Bonferroni adjustments when appropriate (p < 0.05). Twenty-seven cats were included. The prevalence of rescue analgesia was lower in OSA (n = 0/13) than in OFA (n = 5/14) (p = 0.04). The FGS scores (least square means and 95% CI) were higher in OFA at 1 [2.0 (1.3-2.7)] and 2 h [2.2 (1.5-2.9)] than baseline [0.7 (0.0-1.4)], but not in OSA. Sedation scores were not significantly different between groups. Opioid-free injectable anesthesia was appropriate for some cats using a multimodal approach. However, a single dose of intramuscular buprenorphine eliminated the need for rescue analgesia and assured adequate pain management after OVH in cats.

Pharmacokinetics of Bupivacaine Following Administration by an Ultrasound-Guided Transversus Abdominis Plane Block in Cats Undergoing Ovariohysterectomy.

Bupivacaine is commonly used for peripheral nerve block in veterinary medicine. This study described the pharmacokinetics of two doses of bupivacaine following administration by an ultrasound-guided transversus abdominis plane (TAP) block in cats undergoing ovariohysterectomy. Twelve healthy female adult cats were included in a randomized, prospective, blinded clinical trial. Anaesthetic protocol included acepromazine-buprenorphine-propofol-isoflurane-meloxicam. Each cat received 1 mL/kg of bupivacaine 0.2% or 0.25% (BUPI-2 and BUPI-2.5, respectively) via bilateral two-point TAP block before surgery (n = 6/group). Plasma concentrations of bupivacaine were detected using liquid chromatography-mass spectrometry. A one-compartment model and non-compartmental analysis described the pharmacokinetic parameters. Bupivacaine was detected up to 480 min (335 ± 76 in BUPI-2 and 485 ± 198 ng/mL in BUPI-2.5). For BUPI-2 and BUPI-2.5, maximum plasma concentrations were 1166 ± 511 and 1810 ± 536 ng/mL at 33 ± 14 and 47 ± 22 min, clearance was 5.3 ± 1.8 and 4.9 ± 1.5 mL/min/kg, and elimination half-life were 253 ± 55 and 217 ± 52 min, respectively. The two doses of bupivacaine via TAP block produced concentrations below toxic levels in cats. A dose of 2.5 mg/kg bupivacaine was safe to be administered using this block in healthy cats.

Multilingual validation of the short form of the Unesp-Botucatu Feline Pain Scale (UFEPS-SF).

Background: Pain is the leading cause of animal suffering, hence the importance of validated tools to ensure its appropriate evaluation and treatment. We aimed to test the psychometric properties of the short form of the Unesp-Botucatu Feline Pain Scale (UFEPS-SF) in eight languages. Methods: The original scale was condensed from ten to four items. The content validation was performed by five specialists in veterinary anesthesia and analgesia. The English version of the scale was translated and back-translated into Chinese, French, German, Italian, Japanese, Portuguese and Spanish by fluent English and native speaker translators. Videos of the perioperative period of 30 cats submitted to ovariohysterectomy (preoperative, after surgery, after rescue analgesia and 24 h after surgery) were randomly evaluated twice (one-month interval) by one evaluator for each language unaware of the pain condition. After watching each video, the evaluators scored the unidimensional, UFEPS-SF and Glasgow composite multidimensional feline pain scales. Statistical analyses were carried out using R software for intra and interobserver reliability, principal component analysis, criteria concurrent and predictive validities, construct validity, item-total correlation, internal consistency, specificity, sensitivity, the definition of the intervention score for rescue analgesia and diagnostic uncertainty zone, according to the receiver operating characteristic (ROC) curve. Results: UFEPS-SF intra- and inter-observer reliability were ≥0.92 and 0.84, respectively, for all observers. According to the principal component analysis, UFEPS-SF is a unidimensional scale. Concurrent criterion validity was confirmed by the high correlation between UFEPS-SF and all other scales (≥0.9). The total score and all items of UFEPS-SF increased after surgery (pain), decreased to baseline after analgesia and were intermediate at 24 h after surgery (moderate pain), confirming responsiveness and construct validity. Item total correlation of each item (0.68-0.83) confirmed that the items contributed homogeneously to the total score. Internal consistency was excellent (≥0.9) for all items. Both specificity (baseline) and sensitivity (after surgery) based on the Youden index was 99% (97-100%). The suggestive cut-off score for the administration of analgesia according to the ROC curve was ≥4 out of 12. The diagnostic uncertainty zone ranged from 3 to 4. The area under the curve of 0.99 indicated excellent discriminatory capacity of UFEPS-SF. Conclusions: The UFEPS-SF and its items, assessed by experienced evaluators, demonstrated very good repeatability and reproducibility, content, criterion and construct validities, item-total correlation, internal consistency, excellent sensitivity and specificity and a cut-off point indicating the need for rescue analgesia in Chinese, French, English, German, Italian, Japanese, Portuguese and Spanish.

2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats.

PRACTICAL RELEVANCE: Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. CLINICAL CHALLENGES: Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. EVIDENCE BASE: These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors' experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.

Clinical validation of the short and long UNESP-Botucatu scales for feline pain assessment.

BACKGROUND: The UNESP-Botucatu multidimensional feline pain assessment scale (UFEPS) is a valid and reliable instrument for acute pain assessment in cats. However, its limitations are that responsiveness was not tested using a negative control group, it was validated only for ovariohysterectomy, and it can be time-consuming. We aimed to evaluate the construct and criterion validity, reliability, sensitivity, and specificity of the UFEPS and its novel short form (SF) in various clinical or painful surgical conditions. METHODS: Ten client-owned healthy controls (CG) and 40 client-owned cats requiring pain management for clinical or surgical care (20 clinical and 20 surgery group (12 orthopedic and eight soft tissue surgeries) were recruited. Three evaluators assessed pain, in real-time, in clinical cases before and 20 min after rescue analgesia and in surgical cases before and up to 6.5 hours postoperatively, by using the visual analog, numerical ratio, and a simple descriptive scale, in this order, followed by the UFEPS-SF, UFEPS and Glasgow multidimensional feline pain (Glasgow CMPS-Feline) in random order. For the surgical group, rescue analgesia (methadone 0.2 mg/kg IM or IV and/or dipyrone 12.5 mg/kg IV) was performed when the UFEPS-SF score was ≥4 or exceptionally according to clinical judgement. If a third interventional analgesia was required, methadone (0.1-0.2 mg/kg IM) and ketamine (1 mg/kg IM) were administered. For the clinical group, all cats received rescue analgesia (methadone 0.1-0.2 mg/kg IM or IV or nalbuphine 0.5 mg/kg IM or IV), according to the clinician in charge, regardless of pain scores. Construct (1-comparison of scores in cats undergoing pain vs pain-free control cats by unpaired Wilcoxon-test and 2-responsiveness to analgesia by paired Wilcoxon test) and concurrent criterion validity (Spearman correlation of the total score among scales), inter-rater reliability, specificity and sensitivity were calculated for each scale (α = 0.05). RESULTS: Reliability ranged between moderate and good for the UFEPS and UFEPS-SF (confidence intervals of intraclass coefficients = 0.73-0.86 and 0.63-0.82 respectively). The Spearman correlation between UFEPS and UFEPS-SF was 0.85, and their correlation with Glasgow CMPS-Feline was strong (0.79 and 0.78 respectively), confirming criterion validity. All scales showed construct validity or responsiveness (higher scores of cats with clinical and postoperative pain vs healthy controls, and the reduction in scores after rescue analgesia). The sensitivity and specificity of the UFEPS, UFEPS-SF and Glasgow CMPS-Feline were moderate (sensitivity 83.25, 78.60% and 74.28%; specificity 72.00, 84.67 and 70.00%, respectively). CONCLUSIONS: Both UFEPS and UFEPS-SF showed appropriate concurrent validity, responsiveness, reliability, sensitivity, and specificity for feline acute pain assessment in cats with various clinical and orthopedic and soft tissue surgical conditions.

Feline procedural sedation and analgesia: When, why and how.

PRACTICAL RELEVANCE: Procedural sedation and analgesia (PSA) describes the process of depressing a patient's conscious state to perform unpleasant, minimally invasive procedures, and is part of the daily routine in feline medicine. Maintaining cardiopulmonary stability is critical while peforming PSA. CLINICAL CHALLENGES: Decision-making with respect to drug choice and dosage regimen, taking into consideration the cat's health status, behavior, any concomitant diseases and the need for analgesia, represents an everyday challenge in feline practice. While PSA is commonly perceived to be an uneventful procedure, complications may arise, especially when cats that were meant to be sedated are actually anesthetized. AIMS: This clinical article reviews key aspects of PSA in cats while exploring the literature and discussing complications and risk factors. Recommendations are given for patient assessment and preparation, clinical monitoring and fasting protocols, and there is discussion of how PSA protocols may change blood results and diagnostic tests. An overview of, and rationale for, building a PSA protocol, and the advantages and disadvantages of different classes of sedatives and anesthetics, is presented in a clinical context. Finally, injectable drug protocols are reported, supported by an evidence-based approach and clinical experience.

Anesthetic effects of ketamine-medetomidine-hydromorphone in dogs during high-quality, high-volume surgical sterilization program under field conditions.

OBJECTIVE: To describe the anesthetic and adverse effects of an injectable anesthetic protocol in dogs as part of a high-volume sterilization program under field conditions in Belize. STUDY DESIGN: Prospective, observational, field study. ANIMALS: A total of 23 female and eight male dogs (14.2 ± 7.7 kg; age ≥ 8 weeks). METHODS: Using a volume per kg-based dose chart, dogs were administered ketamine (4.5 mg kg-1), medetomidine (0.04 mg kg-1) and hydromorphone (0.09 mg kg-1) intramuscularly. After induction of anesthesia, an endotracheal tube was inserted and dogs were allowed spontaneous breathing in room air. Monitoring included peripheral oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), respiratory rate, rectal temperature and end-tidal carbon dioxide (Pe'CO2). Meloxicam (0.2 mg kg-1) was administered subcutaneously after surgery. Data were analyzed with linear models and chi-square tests (p < 0.05). RESULTS: Onset of lateral recumbency (3.4 ± 2 minutes) was rapid. Desaturation (SpO2 < 90%) was observed at least once in 64.5% of dogs and was more frequent in large dogs (p = 0.019). Hypercapnia (Pe'CO2 ≥ 50 mmHg; 6.7 kPa) was observed in 48.4% of dogs. MAP was 111 ± 19 mmHg, mean ± standard deviation. Hypertension (MAP ≥ 120 mmHg), bradycardia (HR ≤ 60 beats minute-1) and tachycardia (HR ≥ 140 beats minute-1) were observed in 45.2%, 16.1% and 3.3% of dogs, respectively. Hypotension and hypothermia were not observed. Sex was not significantly associated with any complication. Return of swallowing reflex and time to standing were 71 ± 23 and 152 ± 50 minutes after injection, respectively. Return of swallowing was significantly longer in large dogs. CONCLUSIONS AND CLINICAL RELEVANCE: At the doses used, ketamine-medetomidine-hydromorphone was effective in dogs for high-volume sterilization. In this field setting, adverse effects included hypoventilation, hypoxemia and prolonged recovery.

Anesthetic and analgesic effects of an opioid-free, injectable protocol in cats undergoing ovariohysterectomy: A prospective, blinded, randomized clinical trial.

This study evaluated the effects of ketamine-dexmedetomidine-midazolam as part of an opioid-free, multimodal protocol in cats undergoing ovariohysterectomy. In a prospective, blinded, randomized clinical trial, cats received either 1 of 2 doses of ketamine [5 mg/kg body weight (BW), n = 10, K5 or 7 mg/kg BW, n = 13, K7] with midazolam (0.25 mg/kg BW) and dexmedetomidine (40 µg/kg BW) intramuscularly, intraperitoneal bupivacaine (2 mg/kg BW) and subcutaneous meloxicam (0.2 mg/kg BW) after surgery. Buprenorphine (0.02 mg/kg BW, intravenously) was administered if pain scores exceeded intervention scores with 2 pain scoring systems. Similar prevalence of rescue analgesia was observed (K5 = 6/10; K7 = 7/13) with significantly lower requirements in kittens (2/8) than adults (11/15). Tachypnea (K5 = 7/10 and K7 = 9/13) and desaturation (K5 = 3/10 and K7 = 4/13) were the 2 most common complications. Age influenced the prevalence of rescue analgesia. Most adult cats required opioids for postoperative pain relief.

Effets anesthésiants et analgésiques d'un protocole injectable sans opioïde chez des chats soumis à une ovario-hystérectomie : essai clinique prospectif, randomisé, à l'aveugle. Lors de la présente étude nous avons évalué les effets de la combinaison kétamine-dexmedetomidine-midazolam comme élément d'un protocole multimodal sans opioïde chez des chats soumis à une ovario-hystérectomie. Dans un essai clinique prospectif, randomisé, à l'aveugle, des chats reçurent une des deux doses de kétamine [5 mg/kg poids corporel (BW), n = 10, K5 ou 7 mg/kg BW, n = 13, K7] avec du midazolam (0,25 mg/kg BW) et du dexmedetomidine (40 µg/kg BW) par voie intramusculaire, de la bupivacaine par voie intrapéritonéale (2 mg/kg BW) et du meloxicam sous-cutané (0,2 mg/kg BW) après la chirurgie. De la buprenorphine (0,02 mg/kg BW, par voie intraveineuse) fut administrée si les pointages de douleur excédaient les pointages d'intervention avec deux systèmes de pointage de la douleur. Une prévalence similaire d'analgésie de secours fut observée (K5 = 6/10; K7 = 7/13) avec des demandes significativement moindres chez les chatons (2/8) que chez les adultes (11/15). De la tachypnée (K5 = 7/10 et K7 = 9/13) et de la désaturation (K5 = 3/10 et K7 = 4/13) étaient les deux complications les plus fréquentes. L'âge influençait la prévalence de l'analgésie de secours. La plupart des chats adultes ont requis des opioïdes pour soulager la douleur post-opératoire.(Traduit par Dr Serge Messier).

Pain behaviors before and after treatment of oral disease in cats using video assessment: a prospective, blinded, randomized clinical trial.

BACKGROUND: Specific behaviors associated with pain in cats with oral disease have not been consistently studied. The aim of this exploratory study was to identify pain-induced behaviors in cats before and after treatment of oral disease using video assessment. Twenty-four cats (6 ± 3.3 years old; 4.9 ± 1.7 kg) were included in a prospective, blinded, randomized clinical trial. Cats were equally divided into minimal (G1: minimal dental treatment) or severe (G2: multiple dental extractions) oral disease groups. After acclimation at day 0, they underwent oral examination, radiographs, scaling, and dental extractions under general anesthesia (anesthetic protocol: acepromazine, hydromorphone, propofol, isoflurane, meloxicam, and local anesthetic blocks; day 1), and were discharged at day 6. Cats were filmed remotely for 10 min using a wide-angle glass lens camera before surgery (baseline) and throughout the study at different time points (36 h of video recording). The videos consisted of four parts namely general, playing, feeding and post-feeding behaviors. A board-certified behaviorist evaluated the duration/frequency of different behaviors based on an ethogram, which were analyzed using linear mixed models and a generalized linear model, respectively (p < 0.05). RESULTS: In comparison with baseline, duration of "not pawing the face" was significantly shorter at day 3 in G2. These cats spent significantly longer time "standing" and "laying" at days 3 and 6, respectively; G1 spent significantly less time "walking" and "standing" at days 3 and 4, respectively and significantly longer time "immobile" at day 3. Duration of "no/slow tail movement" was significantly longer in G2 than G1 at day 5. Duration of "pawing the ribbon" (playing) was significantly shorter in G2 than G1 at day 1. Feeding and post-feeding behaviors with soft food were not significantly different between groups or over time. Frequency of "difficulty grasping dry food" was significantly higher in G2 than G1 up to day 6. Frequency of post-feeding "head shaking" was significantly higher in both groups at day 6 when compared with baseline. CONCLUSIONS: This study identified pain-induced behaviors in cats undergoing treatment of oral disease. These behaviors may be used to differentiate painful versus pain-free cats in clinical practice.

Clinical applicability of the Feline Grimace Scale: real-time versus image scoring and the influence of sedation and surgery.

BACKGROUND: The Feline Grimace Scale (FGS) is a facial expression-based scoring system for acute pain assessment in cats with reported validity using image assessment. The aims of this study were to investigate the clinical applicability of the FGS in real-time when compared with image assessment, and to evaluate the influence of sedation and surgery on FGS scores in cats. METHODS: Sixty-five female cats (age: 1.37 ± 0.9 years and body weight: 2.85 ± 0.76 kg) were included in a prospective, randomized, clinical trial. Cats were sedated with intramuscular acepromazine and buprenorphine. Following induction with propofol, anesthesia was maintained with isoflurane and cats underwent ovariohysterectomy (OVH). Pain was evaluated at baseline, 15 min after sedation, and at 0.5, 1, 2, 3, 4, 6, 8, 12 and 24 h after extubation using the FGS in real-time (FGS-RT). Cats were video-recorded simultaneously at baseline, 15 min after sedation, and at 2, 6, 12, and 24 h after extubation for subsequent image assessment (FGS-IMG), which was performed six months later by the same observer. The agreement between FGS-RT and FGS-IMG scores was calculated using the Bland & Altman method for repeated measures. The effects of sedation (baseline versus 15 min) and OVH (baseline versus 24 h) were assessed using linear mixed models. Responsiveness to the administration of rescue analgesia (FGS scores before versus one hour after) was assessed using paired t-tests. RESULTS: Minimal bias (-0.057) and narrow limits of agreement (-0.351 to 0.237) were observed between the FGS-IMG and FGS-RT. Scores at baseline (FGS-RT: 0.16 ± 0.13 and FGS-IMG: 0.14 ± 0.13) were not different after sedation (FGS-RT: 0.2 ± 0.15, p = 0.39 and FGS-IMG: 0.16 ± 0.15, p = 0.99) nor at 24 h after extubation (FGS-RT: 0.16 ± 0.12, p = 0.99 and FGS-IMG: 0.12 ± 0.12, p = 0.96). Thirteen cats required rescue analgesia; their FGS scores were lower one hour after analgesic administration (FGS-RT: 0.21 ± 0.18 and FGS-IMG: 0.18 ± 0.17) than before (FGS-RT: 0.47 ± 0.24, p = 0.0005 and FGS-IMG: 0.45 ± 0.19, p = 0.015). CONCLUSIONS: Real-time assessment slightly overestimates image scoring; however, with minimal clinical impact. Sedation with acepromazine-buprenorphine and ovariohysterectomy using a balanced anesthetic protocol did not influence the FGS scores. Responsiveness to analgesic administration was observed with both the FGS-RT and FGS-IMG.

Prevalence of and covariates associated with the oculocardiac reflex occurring in dogs during enucleation.

OBJECTIVE: To determine the prevalence of and covariates associated with the oculocardiac reflex (OCR) occurring in dogs during enucleations. SAMPLE: 145 dogs that underwent enucleation at 2 veterinary teaching hospitals between January 2010 and June 2015. PROCEDURES: Information was collected from the medical records of included dogs regarding age and body weight at hospital admission, breed (for classification of brachycephalic status), and whether they had received anticholinergic drugs or a retrobulbar nerve block (RNB) prior to enucleation. An OCR was considered to have occurred if there was a sudden decrease of ≥ 30% in heart rate from the baseline value (mean heart rate prior to the sudden decrease) during surgery in the absence of intraoperative administration of opioids or α2-adrenoceptor agonists. Associations were explored between the collected data and the prevalence of OCR by means of binomial logistic regression. RESULTS: 4.8% (7/145) of dogs had an OCR noted during enucleation. Dogs that received a preoperative RNB (n = 82) had significantly lower odds of an OCR being observed than dogs that received no preoperative RNB (OR, 0.12). No association with OCR was identified for age or brachycephalic conformation or for preoperative administration of anticholinergic drugs. CONCLUSIONS AND CLINICAL RELEVANCE: These findings suggested that preoperative administration of an RNB, but not preoperative administration of anticholinergic drugs, was associated with a lower prevalence of OCR in dogs during enucleations.

Chronic pain in cats: Recent advances in clinical assessment.

PRACTICAL RELEVANCE: Chronic pain is a feline health and welfare issue. It has a negative impact on quality of life and impairs the owner-cat bond. Chronic pain can exist by itself or may be associated with disease and/or injury, including osteoarthritis (OA), cancer, and oral and periodontal disease, among others. CLINICAL CHALLENGES: Chronic pain assessment is a fundamental part of feline practice, but can be challenging due to differences in pain mechanisms underlying different conditions, and the cat's natural behavior. It relies mostly on owner-assessed behavioral changes and time-consuming veterinary consultations. Beyond OA - for which disease-specific clinical signs have been described - little is known regarding other feline conditions that produce chronic pain. RECENT ADVANCES: Knowledge of the subject has, however, greatly improved in the past few years, informed by study of the mechanisms of pain in cats with OA and the development of pain scales that can be used by owners or veterinarians. Pain scales may facilitate the diagnosis and follow-up evaluation of chronic painful conditions, providing a basis for therapeutic decision-making. Assessment of quality of life is also recommended in cats with chronic pain, and its improvement can be used as a positive outcome in response to therapy. AIMS: This article reviews recent advances and presents the challenges and some future perspectives on clinical chronic pain assessment. The most common feline chronic conditions associated with pain are also described.

Acute pain in cats: Recent advances in clinical assessment.

PRACTICAL RELEVANCE: Pain assessment has gained much attention in recent years as a means of improving pain management and treatment standards. It has become an elemental part of feline practice with ultimate benefit to feline health and welfare. Currently pain assessment involves mostly the investigation of sensory-discriminative (intensity, location and duration) and affective-motivational (emotional) domains of pain. Specific behaviors associated with acute pain have been identified and constitute the basis for its assessment in cats. RECENT ADVANCES: The publication of pain scales with reported validation - the UNESP-Botucatu multidimensional composite pain scale and the Glasgow feline composite measure pain scale - and species-specific studies have advanced our knowledge on the subject. Facial expressions have also been shown to be different between painful and non-painful cats, and very recently the Feline Grimace Scale has been validated as a tool for acute pain assessment. CLINICAL CHALLENGES: Despite recent advances, several challenges still exist. For instance, the effects of disease and sedation on pain scoring/ assessment are unknown. Also, specific painful conditions (eg, dental pain) have not been systematically investigated. The development and validation of instruments for pain assessment by cat owners is warranted, as these tools are currently lacking. AIMS: This article reviews the use, advantages, disadvantages and limitations of the two validated pain scales, and presents a practical, stepwise approach to feline pain recognition and assessment using a dynamic and interactive process. The authors also offer perspectives regarding current challenges and future directions.