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Median pain and sedation assessment (Colorado State University Veterinary Teaching Hospital scale) in the same dogs as in Figures 1 and 2. In this proposed score on a scale of 0–25; increased scores were indicative of greater pain and deep sedation. ‡Time of the first analgesic rescue. *Significantly (p<0.05) different from value at 90 min.
Source publication
To measure the change in the minimum alveolar concentration of isoflurane (EtISO) associated with epidural nalbuphine and the postoperative analgesic requirements in dogs after ovariohysterectomy.
Twenty four healthy female dogs were randomly assigned to receive saline or nalbuphine at 0.3 or 0.6 mg/kg (n=8 for each group) administered via lumbosac...
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Aims and Objectives: The aim of the present study was to compare the laryngeal mask airway (LMA) insertion conditions using either nalbuphine - propofol or dexmedetomidine - propofol. Materials and Methods: Sixty female patients aged 25–35 years posted for interval tubal ligation were randomly allocated in two groups of 30 each. Group N received in...
Citations
... Additionally, adding nalbuphine to xylazine appears to enhance analgesia and decrease distress in dogs undergoing an uncomfortable or painful interference [31]. Epidural nalbuphine significantly lowered pain scores on the visual analogue system (VAS) and Colorado pain scales, and provided prolonged postoperative analgesia in dogs [32]. Nalbuphine and butorphanol are both mixed opioid agonist-antagonists with nearly similar pharmacological properties. ...
Goats have been used as animal models in many studies, and therefore, the need
for safer anesthesia for research or surgical intervention is gaining much attention. In this current study, we evaluated the quality of anesthesia and the immediate postoperative analgesia of a newer anesthetic combination nalbuphine–ketamine, compared with ketamine alone in xylazine-sedated goats. This combination has been shown to allow the calm, acceptable induction of anesthesia and recovery. In addition, goats anesthetized with nalbuphine–ketamine exhibited a significant decrease in total pain scores postoperatively compared with ketamine. This study concluded that adding
nalbuphine to ketamine improves the quality of anesthesia and reduces immediate postoperative pain in goats.
... Camels were allocated randomly to two treatment groups: the XY group (xylazine, 1.1mL/100 kg IV) and the NA-XY group (xylazine, 1.1mL/100 kg IV and nalbuphine, 1 mg/kg IV). The sedative, analgesic, behavioral, and clinical effects of XY and NA-XY combination were evaluated prior to administration (baseline) and at 5,15,30, 45, 60, 75, 90, and 120 minutes post-administration. The results showed that the NA-XY combination accelerates the onset of sedation and analgesia and prolongs the durations of both sedation (p < 0.001) and analgesia (p < 0.01). ...
... Recently, the analgesic effects of morphine and nalbuphine, a synthetic opiate with mixed agonist-antagonist actions, have been reported [5,6]. As a novel opioid κ receptor agonistantagonist, nalbuphine, can agitate the κ receptors to achieve a superior analgesic effect and antagonize the μ receptors to reduce the incidence of adverse reactions [7,8]. ...
This study examined the sedative, analgesic, behavioral, and clinical effects of a combination of xylazine (XY) and nalbuphine-xylazine (NA-XY) in camels. A total of five adult camels were used in a prospective randomized cross-over design with a wash out period of two weeks. Camels were allocated randomly to two treatment groups: the XY group (xylazine, 1.1mL/100 kg IV) and the NA-XY group (xylazine, 1.1mL/100 kg IV and nalbuphine, 1 mg/kg IV). The sedative, analgesic, behavioral, and clinical effects of XY and NA-XY combination were evaluated prior to administration (baseline) and at 5, 15, 30, 45, 60, 75, 90, and 120 minutes post-administration. The results showed that the NA-XY combination accelerates the onset of sedation and analgesia and prolongs the durations of both sedation ( p < 0.001) and analgesia ( p < 0.01). The behavioral parameters showed higher scores with a NA-XY combination than xylazine alone. Although a XY injection resulted in a significant decline in the heart and respiratory rate, the NA-XY combination group revealed a non-significant change in both clinical parameters compared to the baseline. In conclusion, the use of a NA-XY combination in camels improved the sedative and analgesic onset and duration with an improved outcome in the behavioral scores, as well as in both the heart and respiratory rates compared to XY alone.
... La cirugía ortopédica se caracteriza por generar una considerable estimulación nociceptiva (Fox, 2014), lo que puede aumentar el consumo de gases anestésicos; más aún, cuando los protocolos analgésicos carecen de un enfoque multimodal (Frazílio et al., 2014). Por otra parte, en el postoperatorio de estos pacientes, se evidencia un aumento del requerimiento de rescates analgésicos con opioides; evidenciando su grado de disconfort (Cardozo et al., 2014). ...
El bloqueo del plexo braquial es una técnica de anestesia locoregional útil para prevenir las descargas nociceptivas en cirugías distales al codo en el perro. Se expone el manejo anestésico realizado en tres caninos sometidos a osteosíntesis del radio; para ello se realizó el bloqueo del plexo braquial por medio de una técnica combinada de ultrasonido y electrolocalización, utilizando una mezcla anestésica de bupivacaína/lidocaína. Esto como parte de un protocolo analgésico multimodal que también incluyó acepromacina, morfina, meloxicam, propofol e isoflurano. Las variables cardiovasculares intraoperatorias evaluadas (frecuencia cardiaca y presión arterial media) se mantuvieron estables durante todo el procedimiento quirúrgico, motivo por el cual no se empleó analgesia de rescate en ningún caso. La puntuación de dolor postoperatorio valorada con la escala de Glasgow se mantuvo debajo de los límites indicativos de baja cobertura analgésica en todos los pacientes. El bloqueo locoregional empleado permitió minimizar el consumo de isoflurano y evitó el empleo de analgesia de rescate intraoperatoria, así como la necesidad de emplear analgesia suplementaria en el período postoperatorio evaluado. A pesar de la limitada resolución ecográfica del equipo de ultrasonido empleado, la respuesta analgésica obtenida sugiere que el bloqueo del plexo braquial por medio de la técnica combinada de ultrasonido y electrolocalización fue eficaz para prevenir el dolor perioperatorio en la realización de osteosíntesis de radio en los perros evaluados.
... Nalbuphine has been used for epidural analgesia in humans [13][14][15] and dogs [12,16]. To the authors' knowledge, nalbuphine epidural analgesia in donkeys has not been reported yet. ...
... The opiate receptor subtypes (:, 6 and F) and the advent of drugs with receptor-specific agonist and antagonist properties have further expanded the role of epidural opioids for the intra-operative and postoperative periods (Camann et al., 1991). Many of these drugs, such as methadone, tramadol and nalbuphine are used epidurally alone or in combination with local anesthetics in dogs for obtaining prolonged analgesia postoperatively (Vettorato et al., 2010;Bosmans et al., 2012;Campagnol et al., 2012;Frazilio et al., 2014). ...
... Nalbuphine is a low lipophilic semisynthetic opioid related to both oxymorphone and naloxone; it has relatively potent :-antagonist and 6-agonist activity. Nalbuphine administered epidurally reduces the intraoperative isoflurane requirement and provides prolonged postoperative analgesia after ovariohysterectomy in dogs (Frazilio et al., 2014). Our study showed a superior analgesic effect of epidural lidocaine/nalbuphine (5-8 h) compared with lidocaine alone (90 min) in dogs undergoing ovariohysterectomy. ...
The objective of this study was to evaluate the effectiveness of epidural methadone, tramadol or nalbuphine for postoperative analgesia in dogs. Thirty two healthy female dogs (ASA grade 1) undergoing ovariohysterectomy were randomly allocated into 4 treatments of 8 each: treatment 1 (control group) received 2% lidocaine (LD; 4 mg kgG-1), treatment 2 lidocaine and methadone (LDMT; 4 and 0.3 mg kgG-1, respectively), treatment 3 lidocaine and tramadol (LDTR; 4 and 2 mg kgG-1, respectively) and treatment 4 lidocaine and nalbuphine (LDNB; 4 and 0.3 mg kgG-1, respectively). The drugs were administered into the lumbosacral space, diluted in saline solution to a total volume of 0.36 mL kgG-1. Heart and respiratory rates, arterial pressures and peripheral SpO2 were evaluated during the peri-operative period until 240 min. Postoperative pain and sedation were measured after extubation until the first rescue analgesic and thereafter regularly for 18 h. The time to first rescue analgesia was significantly (p<0.05) prolonged in dogs in the LDMT group as compared to the control and LDTR or LDNB groups. Although all 3 drug combinations administered epidurally in dogs allowed ovariohysterectomy to be performed with sufficient analgesia, the analgesia was maintained longer with the combination of lidocaine and methadone.
The aim of this study was to compare the intra and postoperative analgesic effects of sacrococcygeal epidural levobupivacaine with those of lumbosacral levobupivacaine in feline ovariohysterectomy. Thirty-six cats were premedicated with intramuscular acepromazine (0.05 mg/kg) and meperidine (6 mg/kg). Anesthesia was induced with intravenous propofol and maintained with isoflurane in oxygen. The cats were randomly assigned one of the three treatments receiving 0.33% levobupivacaine (0.3 mL/kg) into the sacrococcygeal (S-C group, n=12) or lumbosacral (L-S group, n=12) epidural space, or the same volume of 0.9% saline solution into one of the epidural approaches (Control group, n=12). Intraoperatively, cardiorespiratory variables, end-tidal isoflurane concentration (FE´ISO), and fentanyl requirements were recorded. Postoperative pain was assessed by the UNESP (Universidade Estadual Paulista)-Botucatu multidimensional composite pain scale and the Glasgow feline composite measure pain scale up to 8 hr post-extubation. Morphine was administered as rescue analgesia. Overall FE´ISO and fentanyl requirements were lower in the L-S and S-C compared to the Control (P=0.002–0.048, respectively). There was no significant difference in the cardiorespiratory variables during anesthesia, postoperative pain and rescue analgesia among groups. The time to standing after anesthesia was prolonged in the L-S and S-C groups than in the Control (P<0.001). Lumbosacral and sacrococcygeal epidural levobupivacaine resulted in similar decreases in isoflurane requirements and intraoperative fentanyl supplementation in the cats, with no postoperative benefits.
This chapter provides an overview of cardiovascular physiology and pathophysiology, anesthetic agents, and cardiovascular patient evaluation, monitoring, and support during anesthesia to help the clinician prepare anesthetic plans for patients with mild to significant cardiovascular disease. Patients with cardiac disease should have some combination of preanesthetic electrocardiography, blood pressure (BP), thoracic radiographs, and echocardiogram depending on the type of cardiac disease. Systemic sedation that is appropriate for the patient's temperament and underlying disease in combination with locoregional analgesia may be sufficient for surgical analgesia in some cases. One major goal of adjunctive techniques or interventions is to increase cardiovascular stability and maximize CO and BP. Inotropes and vasopressors are drugs aimed at improving BP and perfusion by taking advantage of sympathetic nervous system receptor targets. The causes of heart failure or congestive heart failure are numerous and can be the result of a wide variety of cardiac diseases.
Objective
To evaluate the combinations of nalbuphine, butorphanol or morphine with acepromazine on the management of intraoperative and early postoperative pain in dogs anesthetized for ovariohysterectomy.
Study design
Prospective, randomized blinded clinical study.
Animals
A total of 48 healthy female dogs of different breeds, aged 1–6 years, weighing (mean ± standard deviation) 14.5 ± 4.8 kg.
Methods
Dogs were randomly assigned into 4 groups to be administered nalbuphine (0.5 mg kg⁻¹; group N0.5); nalbuphine (1.0 mg kg⁻¹; group N1.0), butorphanol (0.4 mg kg⁻¹; group B0.4); or morphine (0.2 mg kg⁻¹; group M0.2) combined with acepromazine (0.02 mg kg⁻¹) intravenously prior to propofol and isoflurane for anesthesia. Heart rate (HR), respiratory rate, systolic arterial pressure and rectal temperature (RT) were recorded at time points during anesthesia. A dynamic interactive visual analog scale applied in three phases (DIVAS I, II and III) and the modified Glasgow composite measure pain scale were used to assess pain before premedication and 1, 2, 3, 4, 5 and 6 hours after extubation. Administration of rescue analgesia was recorded.
Results
HR was higher in N1.0 than in B0.4 (p = 0.020) at left ovarian pedicle ligation. RT decreased significantly by the end of surgery in N0.5 (p = 0.043) and B0.4 (p = 0.010). Rescue analgesia was administered postoperatively over 6 hours to eight, seven, nine and 10 dogs in groups N0.5, N1.0, B0.4 and M0.2, respectively (p = 0.57). DIVAS II was higher in B0.4 compared with N1.0 at 2 and 3 hours (p = 0.038 and p = 0.002, respectively) and N0.5 at 3 hours (p = 0.003).
Conclusions
and clinical relevance: At the doses used, all premedication protocols provided insufficient intraoperative analgesia, with minimal clinical differences between groups. No premedication provided satisfactory analgesia in the first 6 hours postoperatively.
Aim: This was a systematic review conducted to evaluate the analgesic drugs and techniques used in the management of pain in dogs undergoing ovariohysterectomy.
Materials and Methods: Systematic searches in PubMed, Google Scholar, and ScienceDirect were conducted for peer-reviewed articles written in English and published from 1995 to 2015. The key search words were dogs, ovariohysterectomy, pain, and analgesics. This was followed by a manual search of the references within the primary data sources. Inclusion and exclusion of studies and data extraction were performed independently by two reviewers. All randomized studies evaluating the effects of analgesics during ovariohysterectomy in dogs were included.
Results: A total of 31 trials met the criteria and were, therefore, included in the study. Data on the type of analgesic drugs used, the technique of administration, and the need for rescue analgesia were extracted from the papers. Individual analgesic protocols were used in 83.9% of the studies compared to multimodal drug therapy, which was used in 16.1% of the studies. Opioids were used in 39.0% of studies, nonsteroidal anti-inflammatory drugs (NSAIDs) in 19.4%, a combination of NSAIDs and opioids in 19.4%, local analgesics in 6.5%, and acupuncture in 3.2% of the studies. Drug administration was done using three approaches that included pre-operative (64.5%), post-operative (22.6%) as well as combined pre- and post-operative approach (12.9%). In 77.4% of the studies, administration of analgesics was done once, while in 12.9%, it was done as a 72-h post-operative course. 24-h and 48-h courses of post-operative pain therapy were done in 6.5% and 3.2% of the studies, respectively. About 57% of the dogs in the control groups required rescue analgesia as compared to 21.6% in the single and 11.3% in multimodal drug therapy groups. The requirement for rescue analgesics was highest in dogs treated using acupuncture (43.8%) and lowest in dogs treated using NSAID-opioid combination (8.6%). Fewer dogs among those that received pain medication preoperatively and postoperatively required rescue analgesia compared to those in groups given drugs before and after surgery only. More dogs (26.4%) among those given analgesics only once postoperatively required rescue analgesia as compared to those that received analgesics daily for 72 h (4.4%).
Conclusions: This study provides evidence that opioids are the mainstream analgesic drugs used in managing acute post-operative pain in dogs' post-ovariohysterectomy. In addition, multimodal drug therapy, particularly, NSAID-opioids combination is more effective for pain management than single drug administration. Administering analgesics both before and after surgery is associated with better outcomes and so is a protracted course of post-operative pain therapy. Although these practices should be encouraged, controlled studies should be conducted to conclusively determine the best practices for pain management in dogs undergoing ovariohysterectomy.
