Peter W. Hellyer

AAHA/AAFP pain management guidelines for dogs & cats.

Pain management in dogs and cats has undergone a dramatic evolution in the past decade. Current approaches focus on anticipation and prevention of pain, as well as both pharmacologic and nonpharmacologic management techniques. The veterinary team plays an essential role in educating pet owners about recognizing and managing pain in their pets.

Student evaluations of teaching: perceptions of faculty based on gender, position, and rank

The current study explores the feelings and thoughts that faculty have about their student evaluations of teaching (SET). To assess the perceptions of SETs, all teaching faculty in one college at a western Land Grant University were asked to complete an anonymous online survey. The survey included demographic questions (i.e. gender; rank such as assistant, associate, and full professor; and positions like non-tenure track, tenure track, and tenured) as well as questions related to facultys feelings while reading their SETs. While minimal differences were found in responses based on rank or position, several differences were found based on faculty gender. Overall, female faculty appear to be more negatively impacted by student evaluations than male faculty. These gender differences support previous research that suggests males and females receive and react differently to personal evaluation. Resultant suggestions include modifying surveys from anonymous to confidential and offering professional development training for faculty.

Clinical evaluation of perioperative administration of gabapentin as an adjunct for postoperative analgesia in dogs undergoing amputation of a forelimb.

OBJECTIVE To evaluate perioperative administration of gabapentin as an adjunct for analgesia in dogs undergoing amputation of a forelimb. DESIGN Randomized, controlled trial. ANIMALS 30 client-owned dogs. Procedures-On the day before surgery, a baseline pain evaluation was performed in each dog by use of multiple pain assessment methods. Dogs then received gabapentin (10 mg/kg [4.5 mg/lb], PO, once, followed by 5 mg/kg [2.3 mg/lb], PO, q 12 h for 3 additional days) or a placebo. On the day of surgery, dogs were anesthetized and forelimb amputation was performed. Fentanyl was infused after surgery for 18 to 24 hours; use of other analgesics was allowed. In-hospital pain evaluations were repeated at intervals for 18 hours after surgery, and owners were asked to evaluate daily their dogs activity, appetite, and wound soreness for the first 3 days after discharge from the hospital. Results were analyzed by use of a repeated-measures ANOVA. RESULTS Pain evaluation scores did not differ significantly between gabapentin and placebo groups in the hospital or at home after discharge. CONCLUSIONS AND CLINICAL RELEVANCE As an adjunct to other analgesics and anesthetics, gabapentin, at the dose and frequency used in this study, did not provide a significant benefit for the management of acute perioperative pain in dogs undergoing forelimb amputation. The small sample size and number of other confounding factors, such as aggressive use of other analgesics, limited the likelihood of detecting a benefit of gabapentin. Other gabapentin doses or dosing regimens warrant further study.

Multicenter, randomized controlled trial of pain-related behaviors following routine neutering in dogs

OBJECTIVE To evaluate the degree of postoperative pain in dogs undergoing elective castration or ovariohysterectomy (OHE); determine whether an association exists between surgeon experience, incision length, or surgery duration and degree of postoperative pain; and determine whether analgesic treatment decreases expression of postoperative pain behaviors. DESIGN Randomized controlled clinical trial. ANIMALS 426 client-owned dogs undergoing OHE or castration. PROCEDURES Dogs underwent OHE or castration performed by an experienced veterinarian or a fourth-year veterinary student. Dogs were randomly assigned to 1 of 4 treatment groups: no perioperative analgesic treatment (n = 44), preoperative administration of morphine (144), preoperative administration of nalbuphine (119), and postoperative administration of ketoprofen (119). Dogs were evaluated while in the hospital before anesthesia and for 4 hours after surgery and once a day at home for 3 days after surgery. RESULTS Dogs in all 4 groups had significant increases in overall pain scores after surgery, compared with baseline scores. There were significant differences among groups, with control dogs having significantly higher increases in overall pain scores than dogs in the other groups. Factors that did not influence the frequency or severity of pain-related behaviors included breed, individual hospital, anesthetic induction protocol, surgeon experience, and duration of surgery. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that dogs expressed behaviors suggestive of pain following OHE and castration, that analgesic treatment mitigated the expression of pain-related behaviors, and that surgeon experience and surgery duration did not have any effect on expression of pain-related behaviors.

Intra-articular lidocaine plus bupivacaine in sheep undergoing stifle arthrotomy

OBJECTIVE To evaluate the effect of intra-articular (i.a.) lidocaine plus bupivacaine on post-operative pain in sheep undergoing stifle arthrotomy. STUDY DESIGN Randomized controlled experimental trial. ANIMALS Sixteen adult Rambouillet-cross ewes. METHODS Sheep were randomly assigned to one of two treatment groups. The lidocaine/bupivacaine group (L/B, n=8) received i.a. lidocaine (40 mg (2 mL)) prior to incision and i.a. bupivacaine (10 mg (2 mL)) post-closure, while the control group (n=8) received no i.a. injections. i.a. local anesthetics were an addition to the standard analgesic protocol of phenylbutazone (1 g orally, every 24 hours for 5 days) and transdermal fentanyl (equivalent to 15 mg), initiated 24 hours prior to surgery. A stifle arthrotomy was performed with the purpose of creating a full-thickness articular cartilage defect. Two observers blinded to treatment assessed sheep for total pain score using a numeric ranking scale that included: comfort, movement, and flock behavior. The first observation (T=0) was obtained the evening of surgery (3-7 hours post-operatively); subsequent observations occurred every 12 hours for 72 hours. Nonparametric statistical tests were used to evaluate differences between groups for total pain score. RESULTS L/B sheep had significantly lower total pain scores at T=0 than control sheep (p<0.05). No significant differences between treatments were noted at any subsequent time periods. There were no differences attributable to the use of different observers. CONCLUSIONS AND CLINICAL RELEVANCE i.a. lidocaine plus bupivacaine provided analgesia at 3-7 hours post-operatively. Use of i.a. lidocaine and bupivacaine is a simple, effective, yet inexpensive perioperative analgesic protocol for joint surgery in sheep.

A comparison of equine recovery characteristics after isoflurane or isoflurane followed by a xylazine–ketamine infusion

OBJECTIVE To determine whether infusion of xylazine (XYL) and ketamine (KET) for 30 minutes after isoflurane administration in horses would result in improved quality of recovery from anesthesia, without detrimental cardiopulmonary changes. STUDY DESIGN Randomized, blinded experimental trial. ANIMALS Seven healthy adult horses aged 6.4 +/- 1.9 years and weighing 506 +/- 30 kg. METHODS Horses were anesthetized twice, at least 1 week apart. On both occasions, anesthesia was induced by the administration of XYL, diazepam, and KET, and maintained with isoflurane for approximately 90 minutes, the last 60 minutes of which were under steady-state conditions (1.2 times the minimum alveolar concentration isoflurane). On one occasion, horses were allowed to recover from isoflurane anesthesia, while on the other, XYL and KET were infused for 30 minutes after termination of isoflurane administration. Heart rate, respiratory rate, arterial blood pressure, pH, and blood-gases were measured and recorded at set intervals during steady-state isoflurane anesthesia and XYL-KET infusion. Recovery events were timed and subjectively scored by one nonblinded and two blinded observers. Data were analyzed using a restricted maximum likelihood-based mixed effect model repeated measures analysis. RESULTS Infusion of XYL and KET resulted in longer recovery times, but there was no significant improvement in recovery quality score. CONCLUSIONS Under the conditions of this study, infusion of XYL and KET does not positively influence recovery from isoflurane anesthesia in horses. CLINICAL RELEVANCE This study does not support the routine use of XYL and KET infusions in horses during the transition from isoflurane anesthesia to recovery.

Correlations between acute radiation scores and pain scores in canine radiation patients with cancer of the forelimb

OBJECTIVE To determine whether there is a correlation between skin acute radiation score (ARS) and pain scores and to determine if skin ARSs can be used to predict future pain scores and increased need for analgesia in dogs undergoing radiation therapy for cancer of the forelimb. Study design Prospective observational study. ANIMALS Seven middle-aged dogs of various breeds with cancer of the forelimb. METHODS Each neoplasm was surgically removed and a histologic diagnosis was obtained. Curative intent radiation therapy was initiated 2(1/2)-4(1/2) weeks after surgery. Curative intent radiation therapy was delivered as prescribed. Two trained observers scored the dogs using a visual analog pain scale (VAS), Glasgow composite measure of pain scale, short form (GCMPS) and skin ARS prior to each days therapy. Daily scores were averaged and scatter plots were developed. Generalized estimating equation regressions were used to calculate standard error, 95% confidence interval, and p-values for each relationship. Confidence and prediction bands were plotted. RESULTS A statistically significant correlation between skin ARS and VAS and GCMPS pain scores was identified indicating that as the skin ARS increased so did the pain scores. A general correlation between VAS and GCMPS scores was observed. Early (fraction days 1-6) GCMPS scores were significantly influenced by anxiety behavior unrelated to pain. Skin ARS was found to predict precisely current and future presence of pain, but could only predict a range of potential future pain scores based on the pain management approach in use during this study. CONCLUSIONS Skin ARS can provide valuable information for initiating preemptive analgesia and intensifying pain management during curative intent radiation therapy. Daily pain scoring with an acceptable pain scale should be used in conjunction with the skin ARS to improve patient pain management. CLINICAL RELEVANCE Pain is an anticipated consequence of curative intent radiation therapy. Understanding the correlation between pain and skin ARS may facilitate more effective pain management.

Behavioral responses following eight anesthetic induction protocols in horses

OBJECTIVE To compare behavioral characteristics of induction and recovery in horses anesthetized with eight anesthetic drug protocols. STUDY DESIGN Randomized prospective experimental study. ANIMALS Eight horses, 5.5 ± 2.4 years (mean ± SD) of age, and weighing 505 ± 31 kg. METHODS After xylazine pre-medication, each of eight horses was anesthetized on four occasions using one of eight different anesthetic induction protocols which incorporated various combinations of ketamine (KET), propofol (PRO), and thiopental (THIO): THIO 8 mg kg-1; THIO 6 mg kg-1 + PRO 0.5 mg kg-1; THIO 4 mg kg-1 + PRO 1 mg kg-1; THIO 2 mg kg-1 + PRO 1.5 mg kg-1; KET 2 mg kg-1; KET 1.5 mg kg-1 + PRO 0.5 mg kg-1; KET 1 mg kg-1 + PRO 1 mg kg-1; KET 0.5 mg kg-1 + PRO 1.5 mg kg-1. Quality of induction and recovery were scored from 1 (poor) to 5 (excellent), and time taken to achieve lateral recumbency, first movement, sternal recumbency, and standing were evaluated. RESULTS Time taken to achieve lateral recumbency after drug administration differed significantly (p < 0.0001) among the various combinations, being shortest in horses receiving THIO-8 (mean ± SD, 0.5 ± 0.3 minutes) and longest in horses receiving KET-2 (1.4 ± 0.2 minutes). The best scores for induction quality were associated with KET-1.5 + PRO-0.5, and the worst scores for induction quality were associated with KET-2, although the difference was not significant. Time to first movement varied significantly among drug protocols (p = 0.0133), being shortest in horses receiving KET-2 (12.7 ± 3.6 minutes) and longest in horses receiving THIO-8 (29.9 ± 1.5 minutes). Horses receiving THIO-8 made the greatest number of attempts to attain sternal posture (6.5 ± 4.7) and to stand (1.6 ± 0.8). Horses in the THIO-8 treatment also received the poorest recovery scores (3.3 ± 1.0 and 3.0 ± 0.7 for sternal and standing postures, respectively). The best recovery scores were associated with combinations comprised mainly of propofol. CONCLUSIONS Combining propofol with either ketamine or thiopental modifies behaviors associated with use of the individual drugs. CLINICAL RELEVANCE Quality of early anesthesia recovery in horses may be improved by some combinations of propofol with either thiopental or ketamine.

A pilot investigation of the physical and psychological benefits of playing Pokmon GO for dog owners

Pilot information on the health behaviors and perceptions of adult, dog owning, Pokmon GO players in the US was gathered via an anonymous, on-line survey. A total of 269 participants provided details about their playing habits, daily exercise routines, and interactions with their family and dog, and how these were impacted by playing the game. Playing Pokmon GO affected the amount of time players spent with other people and pets, with 43.2% of respondents reporting an increased amount of time spent with family/household members and 52.3% reporting they spent more time with their dog. Additionally, 62.9% of participants reported spending more time walking their dog since starting to play. A statistically significant increase in amount of exercise obtained was found when comparing pre-to post-game levels. A number of respondents reported feeling less anxious leaving the house (38.6%), interacting with strangers (39.7%), and going to new places (39.4%) after they began playing Pokmon GO. In conclusion, playing Pokmon GO appears to positively impact all areas studied, suggesting a new opportunity to enhance both mental and physical health. Participants spent more time with family and pets after starting to play Pokmon GO.Increased amount of time walking their dog and exercising after starting to play.Anxiety about leaving the house was reduced after starting to play Pokmon GO.Reduced anxiety about interacting with strangers and visiting new places.Pokmon GO could be a new opportunity to enhance both mental and physical health.

Evaluation of infusions of xylazine with ketamine or propofol to modulate recovery following sevoflurane anesthesia in horses

OBJECTIVE To determine whether infusion of xylazine and ketamine or xylazine and propofol after sevoflurane administration in horses would improve the quality of recovery from anesthesia. ANIMALS 6 healthy adult horses. PROCEDURES For each horse, anesthesia was induced by administration of xylazine, diazepam, and ketamine and maintained with sevoflurane for approximately 90 minutes (of which the last 60 minutes were under steady-state conditions) 3 times at 1-week intervals. For 1 anesthetic episode, each horse was allowed to recover from sevoflurane anesthesia; for the other 2 episodes, xylazine and ketamine or xylazine and propofol were infused for 30 or 15 minutes, respectively, after termination of sevoflurane administration. Selected cardiopulmonary variables were measured during anesthesia and recovery. Recovery events were monitored and subjectively scored. RESULTS Cardiopulmonary variables differed minimally among treatments, although the xylazine-propofol infusion was associated with greater respiratory depression than was the xylazine-ketamine infusion. Interval from discontinuation of sevoflurane or infusion administration to standing did not differ significantly among treatments, but the number of attempts required to stand successfully was significantly lower after xylazine-propofol infusion, compared with the number of attempts after sevoflurane alone. Scores for recovery from anesthesia were significantly lower (ie, better recovery) after either infusion, compared with scores for sevoflurane administration alone. CONCLUSIONS AND CLINICAL RELEVANCE Xylazine-ketamine or xylazine-propofol infusion significantly improved quality of recovery from sevoflurane anesthesia in horses. Xylazine-ketamine or xylazine-propofol infusions may be of benefit during recovery from sevoflurane anesthesia in horses for which a smooth recovery is particularly critical. However, oxygenation and ventilation should be monitored carefully.