Pain Induced by a Minor Medical Procedure (Bone Marrow Aspiration) in Dogs: Comparison of Pain Scales in a Pilot Study

Abstract

Background: Bone marrow aspiration (BMA) is a clinical procedure frequently performed in dogs. Objective: To compare levels of pain intensity induced by 3 different BMA procedures using several pain scoring instruments.Animals: Sixteen healthy Beagles. Methods: A prospective experimental pilot study was conducted using blinded observers. Dogs were randomized into 3 groups: iliac BMA under sedation (Iliac-Sed, n = 4), sternum BMA under sedation (Stern-Sed, n = 4), and sternum BMA on conscious dogs without sedation (Stern-No-Sed, n = 8).Results: Using the SF-Glasgow pain scale, the overall pain score in the Stern-No-Sed group was lower than that in the Stern-Sed group (P = 0.04). Using the 4A-VET pain scale, the effects of procedures over time on pain scores did not differ between and within groups. An inactivity index indicated that the overall score for the Stern-No-Sed group was significantly lower than the scores for the Stern-Sed and Iliac-Sed groups (P 0.01). There was a significant association in pain assessment using the SF-Glasgow and 4A-VET pain scales (P = 0.0004). When comparing the SF-Glasgowscale to the 4A-VET pain scale, the scores for the Stern-No-Sed group were lower compared to those of the Stern-Sed scores (P = 0.03). Based on telemetered motor activity, the Iliac-Sed group may have experienced more discomfort during the postprocedural period.Conclusions and Clinical Importance: Dogs may experience mild to moderate pain after BMA procedures, and the sternal site should be preferred. The SF-Glasgow pain scale showed better interobserver reliability, but the 4A-VET scale was less biased by sedation.

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats

“…The 4AVet is another composite measure pain score for dogs, reportedly with more interobserver variability than the Glasgow short form, but less biased by sedation. 7,8 Simple, online, practice-friendly numerical rating scales (0 to 4) for acute canine and feline pain have been developed (but not yet validated) by Colorado State University. in cats, a currently validated assessment tool is the UNESPBotucatu Multidimensional Composite Pain Scale.…”

Bone marrow cytological evaluation in dogs with chronic kidney disease

“…A recent study regarding pain induced by bone marrow aspiration demonstrated that iliac aspiration seems to elicit more pain and that the sternum is the least invasive site for this procedure (Guillot et al, 2011). Although this was not the main objective of our study, we observed that the majority of the dogs (80.2%) tolerated sternal bone marrow aspiration with local anesthesia well; the highest level of discomfort was observed during the process of bone marrow suction.…”

“…All dogs were restrained in a sitting position to improve palpation and visualization of the sternum (Guillot et al, 2011) ( Figure 1A), and were systematically submitted to clipping and the skin antisepsis was performed with alcohol 70%. Local anesthesia with 0.2% lidocaine was performed in the skin and periosteum ( Figure 1B).…”

“…The sternum has historically not been aspirated in animals because of concerns regarding thoracic penetration (Moritz et al, 1993). However, the sternum has less soft tissue coverage than the ilium, femur, or humeral head, and the thinner cortex is readily accessible (Guillot et al, 2011). A recent research showed that aspiration of sternal bone marrow with hypodermic needles was feasible and safe in small dogs under anesthesia, and samples equivalent in quality to those from the humerus or ilium can be obtained from clinically normal dogs (Defarges et al, 2003).…”

Letter to the Editor

“…The objectives of our study were to compare the intensity of pain caused by 3 different BMA procedures in dogs, and to compare the results of different pain scales when used to assess this type of pain. 1 The primary hypothesis we wished to verify was whether we could adequately assess the pain associated with these procedures by using currently accepted pain scales. As sedation is well known to introduce bias in evaluations using pain scales, 3 a group of unsedated dogs was needed to assess the magnitude of the sedation effect.…”