Comparing paracetamol/codeine and meloxicam for postoperative analgesia in dogs: a non‐inferiority trial

Pacheco, Mariana; Knowles, Toby G; Slingsby, Louisa S; Taylor, Polly; Murrell, Joanna C

doi:10.1136/vr.105487

Cited by 7 publications

(7 citation statements)

References 29 publications

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“…As we did not find any significant differences, we suggest that no undesirable effects occurred during the anaesthetic study conditions. This is supported by the observation that no changes in clinical signs or clinical laboratory values were found 24 hours after acetaminophen administration, as described in recent experimental (Serrano-Rodríguez et al 2019;Gonz alez-Blanco et al 2020) andclinical (Hern andez-Avalos et al 2020;Pacheco et al 2020) studies.…”

Section: Discussionsupporting

confidence: 53%

Influence of general anaesthesia on the intravenous acetaminophen pharmacokinetics in Beagle dogs

Granados

Mengual

Navarrete‐Calvo

et al. 2021

Veterinary Anaesthesia and Analgesia

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Objective To determine if general anaesthesia influences the intravenous (IV) pharmacokinetics (PK) of acetaminophen in dogs.Study design Prospective, crossover, randomized experimental study.Animals A group of nine healthy Beagle dogs.Methods Acetaminophen PK were determined in conscious and anaesthetized dogs on two separate occasions. Blood samples were collected before, and at 5, 10, 15, 30, 45, 60 and 90 minutes and 2, 3, 4, 6, 8, 12 and 24 hours after 20 mg kg e1 IV acetaminophen administration. Haematocrit, total proteins, albumin, alanine aminotransferase, aspartate aminotransferase, urea and creatinine were determined at baseline and 24 hours after acetaminophen. The anaesthetized group underwent general anaesthesia (90 minutes) for dental cleaning. After the administration of dexmedetomidine (3 mg kg e1 ) intramuscularly, anaesthesia was induced with propofol (2e3 mg kg e1 ) IV, followed by acetaminophen administration. Anaesthesia was maintained with isoflurane in 50% oxygen (FE 0 Iso 1.3e1.5%). Dogs were mechanically ventilated. Plasma concentrations were analysed with high-performance liquid chromatography. PK analysis was undertaken using compartmental modelling. A Wilcoxon test was used to compare PK data between groups, and clinical laboratory values between groups, and before versus 24 hours after acetaminophen administration. Data are presented as median and range (p < 0.05).Results A two-compartmental model best described timeeconcentration profiles of acetaminophen. No significant differences were found for volume of distribution values 1.41 (0.94e3.65) and 1.72 (0.89e2.60) L kg e1 , clearance values 1.52 (0.71e2.30) and 1.60 (0.91e1.78) L kg e1 hour e1 or terminal elimination half-life values 2. 45(1.45e8.71) and 3.57 (1.96e6.35) hours between conscious and anaesthetized dogs, respectively. Clinical laboratory variables were within normal range. No adverse effects were recorded.Conclusions and clinical relevance IV acetaminophen PK in healthy Beagle dogs were unaffected by general anaesthesia under the study conditions. Further studies are necessary to evaluate the PK in different clinical contexts.

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Section: Discussionsupporting

confidence: 53%

Influence of general anaesthesia on the intravenous acetaminophen pharmacokinetics in Beagle dogs

Granados

Mengual

Navarrete‐Calvo

et al. 2021

Veterinary Anaesthesia and Analgesia

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“…Paracetamol (acetaminophen) is an NSAID that is thought to act on a sub-form of COX-1 present in the CNS. It has analgesic and antipyretic effects but little anti-inflammatory activity (Pacheco et al 2020). In the perioperative period, both oral and iv paracetamol have been found to be non-inferior to licensed NSAIDs in dogs undergoing soft tissue or orthopaedic surgery (Hernández-Avalos et al 2020).…”

Section: Other Anti-inflammatory Drugsmentioning

confidence: 99%

2022 WSAVA guidelines for the recognition, assessment and treatment of pain

Monteiro

Lascelles

Murrell

et al. 2022

J of Small Animal Practice

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Animal sentience refers to the capacity of animals to feel both positive and negative emotions including that of pain. As veterinary health professionals, we have a medical and ethical duty to mitigate suffering from pain to the best of our ability. In 2014, the first Global Pain Council World Small Animal Veterinary Association (WSAVA) Guidelines for the Recognition, Assessment and Treatment of Pain was published and remains to this day one of the most relevant and widespread documents of its kind. The 2022 WSAVA Global Pain Management Guidelines evolves from the first document with updated scientific information reflecting major advances in veterinary pain medicine in the last decade. This document is designed to provide the user with easy-to-implement, core fundamentals on the successful recognition and treatment of pain in the day-to-day small animal clinical practice setting. It provides basic and practical information with an extensive reference list to guide those who want to further their knowledge on pain management. The 2022 WSAVA Global Pain Management Guidelines should be easily implemented regardless of practice setting and/or location for the promotion and advance of pain management and animal welfare. FIG 4. Peripheral sensitisation results in increased sensitivity around the lesion site. Affected patients may exhibit signs of hyperalgesia and allodynia. Adapted from Monteiro & Simon (2022). PGs Prostaglandins, NGF Nerve growth factor FIG 5. The constant noxious input (electrical signal) from the periphery to the spinal cord results in central sensitisation. Central sensitisation is the result from increased pain facilitation and decreased pain inhibition. Neuroplasticity and neuroimmune interactions also contribute to this phenomenon

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“…While it has been described that people with FNHTR commonly respond to acetaminophen administration, there is no evidence supporting that finding 71 . A seminal veterinary review article 72 suggests that acetaminophen is contraindicated in veterinary patients due to hepatotoxicity although recent clinical trials in dogs suggest that safety in this species is less of a concern 73,74 . However, experimental evidence identifies unique risks of acetaminophen toxicity in cats due to impaired hepatic glucuronidation and sulfation and thus cats should never be treated with acetaminophen for any purpose (Figure 2).…”

Section: Domain 4: Treatmentmentioning

confidence: 99%

Association of Veterinary Hematology and Transfusion Medicine (AVHTM) transfusion reaction small animal consensus statement (TRACS). Part 3: Diagnosis and treatment

Odunayo

Nash²,

Davidow

et al. 2021

J Vet Emergen Crit Care

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Objective To systematically review available evidence to develop guidelines for diagnosis and treatment of transfusion‐associated reactions in dogs and cats. Design Standardized and systemic evaluation of the literature (identified through Medline via PubMed and Google Scholar searches) was carried out for identified transfusion reaction types in dogs and cats. The available evidence was evaluated using PICO (Population, Intervention, Comparison, Outcome) questions generated for each reaction type. The evidence was categorized by level of evidence (LOE) and quality (Good, Fair, or Poor). Guidelines, diagnostic, and treatment algorithms were generated based on the evaluation of the evidence. Consensus on the final guidelines was achieved through Delphi‐style surveys. Draft recommendations were disseminated through veterinary specialty listservs for review and comments, which were evaluated and integrated prior to final publication. Results Medline via PubMed and Google Scholar databases were searched. There were 14 Population Intervention Comparison Outcome questions identified and corresponding worksheets were developed focusing on the diagnosis and treatment of transfusion‐associated reactions in dogs and cats. Fourteen guidelines and four algorithms were developed with a high degree of consensus. Conclusions This systematic evidence evaluation process yielded recommended diagnostic and treatment algorithms for use in practice. However, significant knowledge gaps were identified, demonstrating the need for additional research in veterinary transfusion medicine.

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Comparing paracetamol/codeine and meloxicam for postoperative analgesia in dogs: a non‐inferiority trial

Cited by 7 publications

References 29 publications

Influence of general anaesthesia on the intravenous acetaminophen pharmacokinetics in Beagle dogs

Influence of general anaesthesia on the intravenous acetaminophen pharmacokinetics in Beagle dogs

2022 WSAVA guidelines for the recognition, assessment and treatment of pain

Association of Veterinary Hematology and Transfusion Medicine (AVHTM) transfusion reaction small animal consensus statement (TRACS). Part 3: Diagnosis and treatment

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