Correlation between visual analog scale, Melbourne pain scale and Von Frey filaments in post-operatory pain evaluation in bitches submitted to ovaryhysterectomy

A avaliação da dor em animais necessita da utilização de escalas de avaliação, que dependem da interpretação realizada por observadores. O objetivo do presente estudo foi avaliar a correlação entre a escala visual analógica (EVA), escala de Melbourne e os filamentos de Von Frey, na avaliação da dor pós-operatória em 42 cadelas adultas e saudáveis, submetidas à ovariossalpingohisterectomia (OSH). A dor pós-operatória foi avaliada por dois observadores cegos aos tratamentos analgésicos, em intervalos de uma hora, utilizando a EVA, a escala de Melbourne e os filamentos de Von Frey, aplicados ao redor da incisão cirúrgica. Foram considerados como critérios para realização da analgesia resgate uma pontuação de 50mm na EVA ou de 13 pontos na escala de Melbourne. A EVA revelou-se a escala mais sensível, uma vez que 100% dos animais receberam resgate seguindo esse método. Os valores obtidos na EVA e na escala de Melbourne determinaram boa correlação, com r=0,74, o que não ocorreu com os filamentos de Von Frey (r=-0,18). Já a correlação entre a escala de Melbourne e os filamentos de Von Frey foi de -0.37. Apesar de a EVA e a escala de Melbourne apresentarem boa correlação, sugere-se que se considere uma pontuação menor na escala de Melbourne como critério para administração de analgesia resgate.Pain evaluation in animals requires the use of evaluation scales, which depend on the interpretation made by observers. The present study aimed to evaluate the correlation between visual analog scale (VAS), Melbourne pain scale and Von Frey filaments in the evaluation of post-operatory pain in fourty two healthy adult bitches submited to ovariohysterectomy. Post-operatory pain was evaluated by two observers unaware of the analgesic protocol used, in one-hour intervals, using VAS, Melbourne pain scale and Von Frey filaments, applied around the surgical wound. A score of 50mm in VAS or 13 points in the Melbourne pain scale were considered as the criterion for analgesic administration. VAS and Melbourne pain scale showed a good correlation, with r=0.74. Correlation between VAS and Von Frey filaments was weak (r=-0.18). Correlation between Melbourne pain scale and Von Frey filaments was -0.37. VAS revealed to be the most sensitive scale. VAS and Melbourne pain scale showed a good correlation degree. It was concluded that a lower score in the Melbourne pain scale can be considered as criterion for analgesic administration

Cardiorespiratory and analgesic effects of ketamine via epidural route, intravenous continuous infusion or association of both, in dogs submitted to femoral osteosynthesis

A cetamina tem demonstrado efeito analgésico em doses subanestésicas, além da manutenção da estabilidade dos parâmetros fisiológicos. O estudo objetivou avaliar os efeitos cardiorrespiratórios e a analgesia pós-operatória da cetamina administrada por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur. Foram utilizadas 25 cadelas, hígidas, distribuídas aleatoriamente em quatro grupos: CEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural), CIV (lidocaína 2% via epidural e 1mg kg-1 de cetamina IV seguido de infusão contínua IV com 100µg kg min-1 da mesma), CIVEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural e 1mg kg-1 de cetamina IV, seguido de infusão contínua IV com 100µg kg min-1) e CON (anestesia epidural com lidocaína 2%). Avaliaram-se FC, f, PAS, PAM, PAD, T°C, tempo de bloqueio motor e analgesia pós-operatória por meio de escala analógica visual. Houve elevação da FC no CIV e diminuição desse parâmetro no CEP. As pressões arteriais mantiveram-se dentro dos valores fisiológicos e não foram observadas diferenças na f e T°C. O tempo de duração do bloqueio anestésico foi potencializado nos grupos que receberam cetamina epidural, diferindo significativamente em relação ao controle. O tempo para a analgesia resgate não diferiu entre os grupos. Conclui-se que a administração de cetamina pela via epidural, por infusão contínua intravenosa ou pela associação de ambas promoveu estabilidade cardiorrespiratória no período transcirúrgico, porém não foi capaz de prolongar a duração da analgesia pós-operatória em cães submetidos à osteossíntese de fêmur.Ketamine has demonstrated analgesic effects in subanesthetic doses, besides the maintenance of stability of physiological parameters. The study aimed to evaluate the cardiorespiratory effects and the post operative analgesia of ketamine via epidural route, intravenous continuous infusion or association of both, in dogs submitted to femoral osteosynthesis. Twenty-five healthy bitches were randomly assigned to four groups: CEP (2mg kg-1 of ketamine associated with lidocaine 2% via epidural route), CIV (lidocaine 2% via epidural route and 1mg kg-1 of ketamine IV, followed by IV continuous infusion of 100µg kg min-1 of ketamine), CIVEP (epidural anesthesia identical to CEP and ketamine infusion as in CIV) and CON (epidural anesthesia with lidocaine 2%). HR, RR, SAP, MAP, DAP and T°C, sensitive blockade time and post operative analgesia measured with visual analog scale were evaluated. There was an increase in HR in CIV and decrease of this parameter in CEP. Arterial pressures kept within physiological values and differences in RR and T°C were not observed. The anesthetic blockade time was augmented in the groups which received epidural ketamine, differing significantly in relation to the control. The time for rescue analgesia did not differ between the groups. It can be concluded the administration of ketamine via epidural route, intravenous continuous infusion or the association of both promoted cardiorespiratory stability during the operative period; however, it was not able to extend the duration of post operative analgesia in dogs submitted to femoral osteosynthesis

Metamizol and Scopolamine for Conventional or Two-Port Laparoscopic-Assisted Ovariohysterectomy in Dogs

Background: Ovariohysterectomy (OVH) is one of the most appliedtechniques in Veterinary Medicine. Although some analgesic protocols are used after this procedure in order to control post operatory pain, there is a lack of knowledge of the efficacy after conventional and two port laparoscopic-assisted techniques in dog female. Although the combined formulation of metamizol and scopolamine is used, there is no knowledge about the efficacy and collateral effects in a 6 h regimen after OVH. The aim of this research was to evaluate the efficacy of metamizol and scopolamine to analgesia after two techniques of OVH in dog female.Materials, Methods & Results: Fifteen adults and healthy dog female were submitted to OVH, being eight to the conventional procedure and seven to video assisted technic with two ports. The patients received a combination of metamizol and scopolamine, 6-6 h during 48 h and were evaluated before surgery, 60 min after extubation and on 1 h interval during the first 8 h, and at 12, 18, 24, 36, 48 and 72 h after surgery. For this, the University of Melbourne Pain Scale (UMPS) and the short-form of the Glasgow Composite Measure Pain Scale (CMPS-SF) were applied by three evaluators blinded to surgical technic. Glucoses measurement was realized at 1, 6, 12, 24, 48 and 72 h after surgery. Analgesic rescue was not necessary for any animal. Punctuation of UMPS in GC decreases at 8 h and at 5 h, and to GV at 12 and 24 h. Difference between groups happened at 3 h with larger average to GV; at 48 h the punctuation in GC was lager. Considering CMPS-SF to CG, higher average was observed at 1 h and decreased at 2, 3, 8 and 18. At GV highest average points was verified at 1, 2 and 3 h and decreased at 5, 8 and 18 h. Correlation was strong and positive between each two evaluators. Animals of both groups had increased average glucose concentrations from baseline to after surgery and the values reduced to baseline after 24 h; difference between groups were observed at 1 h after surgery, with bigger average to GC. Three animals from the GC had postoperative emesis and one patient vomited after 3 h; other at 6 h and another at 36 and 48 h and owners related no vomiting or changes following hospital discharge. The time to first spontaneous food intake was earlier to GV and time to first defecation was no different between groups. Discussion: For the evaluation it was used the UMPS and CMPS-SF since it is know that pain assessment is better performed when multidimensional or composite scales are used. Considering the UMPS, 27 points is considered the most painful condition. In our study it was observed bigger average to GC at 1 h (4,5) and to GV at 2 and 3 h (5,0). According to CMPS-SF, higher punctuation to GC (7.0) was observed than GV (6,0) in a maximum of 24 points. Considering both scales, it could be suggested that the combination of metamizol and scopolamine promote good analgesic effect. The glucoses measurements and the first spontaneous food intake suggested that laparoscopic approaches results in less stress than the traditional procedures, as observed in other studies. Three animals of GC had postoperative emesis, and it signal can be associated to abdominal pain, as well nausea, vomiting, diarrhea and abdominal distention, probably because it is accepted that video surgery promotes less pain and stress than open procedures. The protocol was efficient to control pain after elective conventional and laparoscopic assisted OHV technique in dog female.

Immobilizer Removable Articulate in Rehabilitation of Dogs Submitted to Tenorrhaphy Patellar

Background: In cases of patellar tendon ruptures, there is a need for primary repair by sutures aiming to restore the extensor mechanism of the knee and prevent degenerative sequelae. Even though the need for temporary immobilization of the joint reconstruction surgeries involving tendons and ligaments, seeks to avoid or minimize the undesirable effects of disuse without any interference at the surgical site. Thus, the objective of this research was to propose a model of joint immobilization adjustable in dogs undergoing patellar tenorrhaphy to allow, in the immediate postoperative period, the achievement of physical therapy modalities without interfering with the healing of the involved structures.Materials, Methods & Results: The dogs were randomly divided into two groups called fixed immobilization or GF (6 dogs) and adjustable or GA (5 dogs) immobilization. Once on plane and restrained in dorsal decubitus, lateral incision was performed on the right knee in dogs GF and GA for total section of the patellar tendon at its insertion 10 mm at the tibial crest. Immediately, it was made with tenorrhaphy modified Kessler suture pattern using monofilament nylon wire nº 1, followed by a Wolff point involving modified Kessler suture with the same type of wire. In both groups, the joint was immobilized femorotibiopatelar percutaneous external fixation biplanar at an angle of 110° for 30 days. The groups differed by the material used to connect the percutaneous pins, being employed in the GF acrylic resin, and in GA dogs was made adjustable apparatus which consisted of two stainless steel plates with rounded ends with three equally spaced holes 2.5 mm between them in the central part of the plate and the edge of 6mm, which is joined with the other plate by a nut and bolt and allowing to adjust the desired angle of the device. Were utilized four Steinmann pins 2.5 mm, two in the femur and two tibia, introduced perpendicularly to the bone. The assembled apparatus was encased in percutaneous pins and stuck with stainless steel nuts and lock washers causing immobilization of the knee joint, however adjustable in the period of application of physiotherapy protocol. The results demonstrated a reduction in measures in the period of 30 days, indicating that there was muscle atrophy. At 60 days post-operative values demonstrating increased muscle mass gain probably the bearing of the affected limb to the ground. In this study, was possible to observe that the values at 60 days did not return to the same found preoperatively, and the dogs GF and GA were on average 92.19% of the initial values. As for gait analysis, all dogs GF and GA were grade 5, 1 and 3 of lameness in the preoperative period and after 30 and 60 days after surgery, respectively.Discussion: The joint immobilization in dogs submitted to tenorrhaphy is required, however, the member cannot be used properly, which can lead to sequelae such as muscle atrophy from disuse and especially joint blockage. Currently in human medicine assisted rehabilitation in the immediate post-operative recovery involving the reconstruction of tendons and ligaments, without the need for joint immobilization is required, because patients are instructed to restrict the movements postoperatively. In veterinary medicine, however, it becomes risky this type of conduct, especially the lack of control the movements made by animals, arousing interest in this research to propose joint that could be undone each day to allow implementation of a method of immobilization physiotherapy and at the end of the session, the joint was immobilized again. According to the results, we can conclude that the temporary immobilization with adjustable articulating fixator in dogs submitted to patellar tenorrhaphy allows the use of a physical therapy protocol during the period of immobilization, without interfering with the healing of tendon anastomosis

A Graduação em Fisioterapia na Universidade Estadual do Centro-Oeste

A graduação na área da saúde vem sofrendo alterações constantes. Durante a década de 90, a Reforma Sanitária no Brasil estabeleceu novas estratégias para todos os cursos envolvidos na área de saúde. Na fisioterapia, uma das principais mudanças foi no sentido de enfatizar o processo ‘saúdedoença’ dentro de uma visão mais ampla, preconizando não só a cura e a reabilitação da doença, mas também a promoção da saúde e, principalmente, a prevenção da doença. A Universidade Estadual do Centro-Oeste (UNICENTRO), fortalecendo seu papel de servidora pública de ensino superior, propôs a implantação do curso de fi sioterapia procurando suprir a escassez de fi sioterapeutas em sua área de abrangência. O curso teve início no ano de 2000, com uma matriz curricular que contemplava as propostas de Diretrizes Nacionais para Cursos de Graduação em Fisioterapia de 1998. O Departamento de Fisioterapia (DEFISIO) vem reformulando a matriz curricular para sua adequação conforme as novas normas estabelecidas em consonância com o Ministério da Saúde para também contemplar modelo de assistência à saúde vigente. Visando propor ações e estratégias que estimulem um aumento na qualidade de ensino e fomentem a pesquisa científi ca na área, para posterior utilização na atuação profi ssional, foi realizada uma análise da trajetória do referido curso para entender a formação acadêmica do graduado em fi sioterapia na UNICENTRO. A coleta de dados teve seu embasamento na literatura existente, leis e pareceres emitidos por órgãos governamentais e em documentos que constam nos arquivos da Instituição

Ventriculectomia parcial mediante oclusão do influxo venoso cardíaco em cães Partial ventriculectomy through cardiac inflow occlusion in dogs

A redução na função sistólica do ventrículo esquerdo em cães com insuficiência cardíaca congestiva está relacionada ao aumento de volume do ventrículo. A despeito dos avanços no tratamento conservador, o prognóstico é desfavorável com alta taxa de mortalidade. Este trabalho propôs um protocolo cirúrgico da redução ventricular para tratamento de cardiomiopatia dilatada em cães, a ventriculectomia parcial. A intervenção cirúrgica foi realizada sem circulação extracorpórea, mediante oclusão do influxo sangüíneo ao coração. Avaliou-se a execução da técnica à curto prazo, por eletrocardiograma, radiografia simples de tórax e biópsia cardíaca. Os resultados mostraram-se favoráveis pela fácil execução da técnica. Os animais sobreviveram ao período de sessenta dias de observação apresentando alterações eletrocardiográficas transitórias, redução da silhueta ventricular e cicatrização miocárdica normal.The reduction of the systolic function in the left ventricle of dogs with congestive heart failure is related to increased ventricular volume. Despite of the advances in conservative treatments to dilated cardiomiopathy, the prognosis is guarded with a high mortality rate. This research aimed to evaluate a surgical protocol of cardiac chamber reduction (partial ventriculectomy) to treat dilated cardiomiopathy in dogs, like the procedure realized in humans. The surgery was realized by mean inflow occlusion without cardiopulmonary by-pass. The dogs postoperative evolution of was evaluated in a short period by electrocardiogram, and simple thoracic radiography. Patients were observed for sixty days and during this period did´nt present hemodynamic alterations

Immobilizer Removable Articulate in Rehabilitation of Dogs Submitted to Tenorrhaphy Patellar

Background: In cases of patellar tendon ruptures, there is a need for primary repair by sutures aiming to restore the extensor mechanism of the knee and prevent degenerative sequelae. Even though the need for temporary immobilization of the joint reconstruction surgeries involving tendons and ligaments, seeks to avoid or minimize the undesirable effects of disuse without any interference at the surgical site. Thus, the objective of this research was to propose a model of joint immobilization adjustable in dogs undergoing patellar tenorrhaphy to allow, in the immediate postoperative period, the achievement of physical therapy modalities without interfering with the healing of the involved structures.Materials, Methods & Results: The dogs were randomly divided into two groups called fixed immobilization or GF (6 dogs) and adjustable or GA (5 dogs) immobilization. Once on plane and restrained in dorsal decubitus, lateral incision was performed on the right knee in dogs GF and GA for total section of the patellar tendon at its insertion 10 mm at the tibial crest. Immediately, it was made with tenorrhaphy modified Kessler suture pattern using monofilament nylon wire nº 1, followed by a Wolff point involving modified Kessler suture with the same type of wire. In both groups, the joint was immobilized femorotibiopatelar percutaneous external fixation biplanar at an angle of 110° for 30 days. The groups differed by the material used to connect the percutaneous pins, being employed in the GF acrylic resin, and in GA dogs was made adjustable apparatus which consisted of two stainless steel plates with rounded ends with three equally spaced holes 2.5 mm between them in the central part of the plate and the edge of 6mm, which is joined with the other plate by a nut and bolt and allowing to adjust the desired angle of the device. Were utilized four Steinmann pins 2.5 mm, two in the femur and two tibia, introduced perpendicularly to the bone. The assembled apparatus was encased in percutaneous pins and stuck with stainless steel nuts and lock washers causing immobilization of the knee joint, however adjustable in the period of application of physiotherapy protocol. The results demonstrated a reduction in measures in the period of 30 days, indicating that there was muscle atrophy. At 60 days post-operative values demonstrating increased muscle mass gain probably the bearing of the affected limb to the ground. In this study, was possible to observe that the values at 60 days did not return to the same found preoperatively, and the dogs GF and GA were on average 92.19% of the initial values. As for gait analysis, all dogs GF and GA were grade 5, 1 and 3 of lameness in the preoperative period and after 30 and 60 days after surgery, respectively.Discussion: The joint immobilization in dogs submitted to tenorrhaphy is required, however, the member cannot be used properly, which can lead to sequelae such as muscle atrophy from disuse and especially joint blockage. Currently in human medicine assisted rehabilitation in the immediate post-operative recovery involving the reconstruction of tendons and ligaments, without the need for joint immobilization is required, because patients are instructed to restrict the movements postoperatively. In veterinary medicine, however, it becomes risky this type of conduct, especially the lack of control the movements made by animals, arousing interest in this research to propose joint that could be undone each day to allow implementation of a method of immobilization physiotherapy and at the end of the session, the joint was immobilized again. According to the results, we can conclude that the temporary immobilization with adjustable articulating fixator in dogs submitted to patellar tenorrhaphy allows the use of a physical therapy protocol during the period of immobilization, without interfering with the healing of tendon anastomosis