Systemic and anti-nociceptive effects of prolonged lidocaine, ketamine, and butorphanol infusions alone and in combination in healthy horses

BACKGROUND: Prolonged drug infusions are used to treat horses with severe signs of pain, but can be associated with altered gastrointestinal transit. The purpose of this study was to determine the effects of prolonged constant rate infusions (CRI) of lidocaine (L), butorphanol (B), and ketamine (K) alone and in combination on gastrointestinal transit, behavior, and thermal nociceptive threshold in healthy horses. METHODS: Eight healthy adult horses were used in a randomized, cross-over, blinded, prospective experimental trial. Interventions were saline, L, K, B, LK, LB, BK, and LBK as an intravenous CRI for 96 hours. Drugs were mixed or diluted in saline; following a bolus, CRI rate was 0.15mL/kg/hr with drug doses as follows: L – 1.3 mg/kg then 3 mg/kg/hr; B – 0.018 mg/kg then 0.013 mg/kg/hr; K – 0.55 mg/kg then 0.5 mg/kg/hr. Two-hundred plastic beads were administered intragastrically by nasogastric tube immediately prior to the bolus. Feces were collected every 2 hours, weighed, and beads manually retrieved. Behavior was scored every 2 hours, vital parameters every 6 hours, and thermal nociceptive threshold every 12 hours for 96 hours. Drug concentrations in the LBK solution were tested every 6 hours for 72 hours. RESULTS: Four of 64 trials (3 LBK, 1 BK) were discontinued early due to signs of abdominal discomfort. There were no apparent differences between groups in vital parameters or thermal threshold. Transit time was delayed for LB and LBK with a corresponding decrease in fecal weight that was most severe in the final 24 hours of infusion. Significant changes in behavior scores, vital parameters, or thermal threshold were not observed. The concentration of each drug in the combined solution declined by less than 31% over the sampling period. CONCLUSIONS: Drug combinations containing butorphanol cause an apparent delay in gastrointestinal transit in healthy horses without substantially affecting somatic nociception at the doses studied. Combinations of lidocaine and ketamine may have less impact on gastrointestinal transit than infusions combined with butorphanol. Further work is needed to determine the effects of these drugs in painful or critically ill patients

Effect of cold compression therapy on postoperative pain, swelling, range of motion, and lameness after tibial plateau leveling osteotomy in dogs

Objective—To evaluate the effect of cold compression therapy (CCT) on postoperative pain, lameness, range of motion of the stifle joint, and swelling following tibial plateau leveling osteotomy (TPLO) in dogs. Design—Randomized, blinded, placebo-controlled clinical trial. Animals—34 client-owned dogs with unilateral deficiency of a cranial cruciate ligament undergoing TPLO. Procedures—Dogs were assigned to 2 groups. Group 1 (n = 17 dogs) received CCT in the 24-hour period following TPLO. Group 2 (n = 17 dogs) received no CCT. Degree of lameness, range of motion, and circumference of the stifle joint were measured before surgery and 1,14, and 28 days after surgery. A modified composite Glasgow pain scale, visual analogue scale, and pain threshold score were used to evaluate signs of pain before surgery and 1,14, and 28 days after surgery. Logistic regression and linear regression analysis were used to compare the measured variables. Results—No complications were observed, and all dogs tolerated CCT. Use of CCT resulted in lower values for the visual analogue scale and Glasgow pain scale and lower pain threshold scores; lower lameness scores; less swelling; and an increased range of motion 24 hours after surgery. At 14 days after surgery, there were no significant differences between groups. At 28 days after surgery, too few data sets were available for comparison. Conclusions and Clinical Relevance—CCT decreased signs of pain, swelling, and lameness and increased stifle joint range of motion in dogs during the first 24 hours after TPLO.This article is from Journal of the American Veterinary Medical Association 238 (2011): 1284, doi: 10.2460/javma.238.10.1284. Posted with permission.</p

Supplemental Material

Hospice and palliative care patient questionnaire</p

Caregiver brochure

‘Hospice and palliative care for your cat’.</p

Troubleshooting_prolonged_recovery – Supplemental material for AAFP Feline Anesthesia Guidelines

<p>Supplemental material, Troubleshooting_prolonged_recovery for AAFP Feline Anesthesia Guidelines by Sheilah A Robertson, Susan M Gogolski, Peter Pascoe, Heidi L Shafford, Jennifer Sager and Gregg M Griffenhagen in Journal of Feline Medicine and Surgery</p

Troubleshooting_tachycardia – Supplemental material for AAFP Feline Anesthesia Guidelines

<p>Supplemental material, Troubleshooting_tachycardia for AAFP Feline Anesthesia Guidelines by Sheilah A Robertson, Susan M Gogolski, Peter Pascoe, Heidi L Shafford, Jennifer Sager and Gregg M Griffenhagen in Journal of Feline Medicine and Surgery</p

Endotracheal_tube_placement – Supplemental material for AAFP Feline Anesthesia Guidelines

<p>Supplemental material, Endotracheal_tube_placement for AAFP Feline Anesthesia Guidelines by Sheilah A Robertson, Susan M Gogolski, Peter Pascoe, Heidi L Shafford, Jennifer Sager and Gregg M Griffenhagen in Journal of Feline Medicine and Surgery</p

Feline_anesthesia_Client_brochure – Supplemental material for AAFP Feline Anesthesia Guidelines

<p>Supplemental material, Feline_anesthesia_Client_brochure for AAFP Feline Anesthesia Guidelines by Sheilah A Robertson, Susan M Gogolski, Peter Pascoe, Heidi L Shafford, Jennifer Sager and Gregg M Griffenhagen in Journal of Feline Medicine and Surgery</p