title: Comparison of perioperative analgesic protocols for dogs undergoing tibial plateau leveling osteotomy.
abstract: OBJECTIVE
  To compare effects of 3 commonly used perioperative analgesic protocols (epidural injection, intra-articular injection, and intravenous [IV] injection) for management of postoperative pain in dogs after tibial plateau leveling osteotomy (TPLO).
  
  
  METHODS
  Prospective, randomized clinical trial.
  
  
  METHODS
  Fifty-six healthy dogs with naturally occurring cranial cruciate ligament rupture.
  
  
  METHODS
  Dogs were premedicated with IV hydromorphone and acepromazine and were randomly assigned to receive either E (preoperative epidural injection with morphine and bupivacaine), IA (pre- and postoperative intra-articular injections of bupivacaine), or C (neither epidural morphine and bupivacaine, nor intra-articular bupivacaine). All dogs were administered hydromorphone (0.05 mg/kg IV) at extubation and as needed to maintain comfort postoperatively. Patients were observed and monitored continuously for 24 hours and discomfort was assessed using visual analog pain scores (VASs), multifactorial pain scores (MPSs), and response to a pressure nociceptive threshold (PNT) measuring device. Time to 1st dose and the total doses of hydromorphone required to achieve adequate comfort for each dog were recorded.
  
  
  RESULTS
  No differences in measured indices of postoperative pain were observed between dogs of each treatment group; VAS (P=.190), MPS (P=.371), and PNT (P=.160). Time to 1st analgesic intervention was longer for Group E compared with Group C (P=.005) and longer for Group IA compared with Group C (P=.032). Although time to 1st intervention between Groups E and IA were longer for Group E, differences were not significant. To provide an adequate level of comfort, more analgesic interventions were administered to dogs in Group C compared with dogs in group E (P=.015). On average, more hydromorphone was administered to Group C compared with Group IA (P=.072) and to Group IA compared with Group E (P=.168), but statistical significance was not reached for these data.
  
  
  CONCLUSIONS
  In this study population, significant differences were seen in time to 1st hydromorphone dose between Groups E and IA compared with Group C. As well, more supplemental analgesia was administered to Group C compared with Group E to maintain the same level of postoperative comfort. Although differences between Groups E and IA tended to favor the epidural group, differences were minimal and not statistically significant.
  
  
  CONCLUSIONS
  Our results suggest that regardless of analgesic protocol, measured indices of pain in dogs after TPLO can be minimized if dogs are continuously observed and appropriately supplemented with parenteral opioids. However, the frequency of postoperative opioid dosing can be minimized and may be a factor when contemplating supplementary use of epidural or intra-articular injections as part of a balanced analgesic approach.
authors.affiliation: Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37901, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hoelzler
authors.forename: Ralph C
authors.initials: RC
authors.lastname: Harvey
authors.forename: David A
authors.initials: DA
authors.lastname: Lidbetter
authors.forename: Darryl L
authors.initials: DL
authors.lastname: Millis
mesh_terms: D000698:Analgesia / Q000379:methods / Q000662:veterinary*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use; D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D002045:Bupivacaine; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D007268:Injections, Epidural / Q000379:methods / Q000662:veterinary; D007269:Injections, Intra-Arterial / Q000379:methods / Q000662:veterinary; D007275:Injections, Intravenous / Q000379:methods / Q000662:veterinary; D009020:Morphine; D010027:Osteotomy / Q000379:methods / Q000662:veterinary; D010147:Pain Measurement / Q000662:veterinary; D010149:Postoperative Pain / Q000188:drug therapy / Q000662:veterinary*; D019990:Perioperative Care / Q000379:methods / Q000662:veterinary*; D011446:Prospective Studies; D012421:Rupture / Q000601:surgery / Q000662:veterinary; D013264:Stifle / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine