The present and future of opioid analgesics in small animal practice

Simon, Bradley T; Steagall, Paulo V.

doi:10.1111/jvp.12377

Cited by 37 publications

(32 citation statements)

References 156 publications

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“…Recently however, an aqueous high concentration formulation of buprenorphine has been licensed for SC administration in cats in the USA (1.8 mg/mL, Simbadol, Zoetis, Pasippany, NJ). The SC dose is 10 times higher than previously recommended in cats [ 18 , 23 ], and provides 24 h of antinociception in thermal threshold tests [ 24 ]. So far, there are no published data on the clinical efficacy of this formulation.…”

Section: Discussionmentioning

confidence: 99%

Bioavailability of subcutaneous and intramuscular administrated buprenorphine in New Zealand White rabbits

et al. 2020

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Background Buprenorphine is one of the most used analgesics for postoperative pain in rabbits. The recommended dose in rabbits (0.01–0.05 mg/kg) is the same for intravenous (IV), intramuscular (IM), and subcutaneous (SC) administration, despite lack of pharmacokinetic data. Five male and five female New Zealand White rabbits (mean ± SD body weight 3.1 ± 0.3 kg) were administered 0.05 mg/kg buprenorphine by the IV, IM and SC routes and 0.1 mg/kg by the SC route, in a cross-over design with two-week wash-out periods between treatments. Blood was collected before, and up to 8 h post buprenorphine injection, for determination of serum levels by UPHLC-MS/MS. Results The area under the time concentration curve (AUC0-t) was lower after SC (398 ± 155 ng/mL/min) than IM (696 ± 168 ng/mL/min, p < 0.001) and IV (789 ± 189 ng/mL/min, p < 0.001) administration. The maximum serum concentration was lower after SC (2.2 ± 1.4 ng/mL) than after IM (11 ± 3.2 ng/mL) administration (p < 0.001). The bioavailability was lower after SC (50 ± 19%) than after IM (95 ± 21%) administration (p = 0.006). The elimination half-life was longer after SC (260 ± 120 min) than after IM (148 ± 26 min, p = 0.002) as well as IV (139 ± 33 min) injection (p < 0.001). An increase in the SC dose from 0.05 to 0.1 mg/kg resulted in an increase in the area under the time concentration curve of 50% in female (p = 0.022) and 165% in male rabbits (p < 0.001). The bioavailability did not change in the females (36 ± 14%, p = 0.6), whereas it increased in the males (71 ± 23%, p = 0.008). Conclusions The lower bioavailability of 0.05 mg/kg buprenorphine after SC administration could explain the lack of efficacy seen in clinical pain studies in rabbits, using this route. For immediate pain relief, IV or IM administration is therefore be recommended, whereas SC administration may be useful to sustain analgesic serum levels, once efficient pain relief has been achieved. The current data do not support an increase in dose to compensate for the lower SC bioavailability.

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Section: Discussionmentioning

confidence: 99%

Bioavailability of subcutaneous and intramuscular administrated buprenorphine in New Zealand White rabbits

et al. 2020

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“…With this vast increase in the assessment and treatment of perioperative pain in the past 20 to 25 years, practitioners must be cautious with opioid overdosing and adverse effects induced by other classes of analgesics, such as nonsteroidal anti‐inflammatory drugs (NSAID)s. This topic is beyond the scope of the review, but opioids have been associated with some deleterious effects (e.g. bradycardia, respiratory depression, aspiration pneumonia, dysphoria), which can be prevented or treated when appropriate (Simon & Steagall ).…”

Section: Factors Affecting Analgesic Administrationmentioning

confidence: 99%

“…This topic is beyond the scope of the review, but opioids have been associated with some deleterious effects (e.g. bradycardia, respiratory depression, aspiration pneumonia, dysphoria), which can be prevented or treated when appropriate (Simon & Steagall 2016 ).…”

Section: Historical Factorsmentioning

confidence: 99%

The lack of analgesic use (oligoanalgesia) in small animal practice

Simon

Scallan

Carroll

et al. 2017

J of Small Animal Practice

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Oligoanalgesia is defined as failure to provide analgesia in patients with acute pain. Treatment of pain in emergencies, critical care and perioperatively may influence patient outcomes: the harmful practice of withholding analgesics occurs in teaching hospitals and private practices and results in severe physiological consequences. This article discusses the prevalence, primary causes, species and regional differences and ways to avoid oligoanalgesia in small animal practice. Oligoanalgesia may be addressed by improving education on pain management in the veterinary curriculum, providing continuing education to veterinarians and implementing pain scales.

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“…Opioid analgesics are commonly administered as part of perioperative multimodal analgesia for acute pain management in veterinary medicine [5]. However, full agonists of μ-opioid receptors like hydromorphone, oxymorphone and fentanyl are not approved for use in companion animals.…”

Section: Introductionmentioning

confidence: 99%

The analgesic effects of buprenorphine (Vetergesic or Simbadol) in cats undergoing dental extractions: A randomized, blinded, clinical trial

et al. 2020

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This study aimed to evaluate the analgesic efficacy of two dosage regimens using two different concentrations of buprenorphine in cats undergoing dental extractions. Twenty-three cats with oral disease (8.2 ± 2.2 years old; 4.9 ± 0.9 kg) were included in a prospective, blinded, randomized clinical trial. Cats randomly received either Simbadol (1.8 mg/mL; 0.24 mg/kg, subcutaneously, every 24h: SG, n = 11) or Vetergesic (0.3 mg/mL; 0.02 mg/kg, intramuscularly, every 8h: VG, n = 12) throughout the study. They were admitted at day 0, underwent oral examination/radiographs/treatment under general anesthesia (buprenorphinepropofol-isoflurane-meloxicam-local anesthetic blocks) at day 1 and discharged at day 4. Sedation and pain were scored using the dynamic interactive visual analog scale (day 1) and the Glasgow Composite Measure Pain Scale-Feline (CMPS-F; up to postoperative 8 hours at day 1, 8 am, 4 pm and midnight at days 2 and 3, and 8 am at day 4), respectively. Rescue analgesia was administered with hydromorphone (0.05 mg/kg intravenously on day 1 or 0.1 mg/kg intramuscularly after day 2) when CMPS-F � 5. Resentment defined as any type of escape behavior associated with aversion to drug administration was recorded. Sedation and pain scores, the prevalence of rescue analgesia and resentment during drug administration were analyzed using linear mixed models and Fisher's exact test, respectively (p < 0.05). Pain and sedation scores were not significantly different between groups. Sedation scores were significantly higher up to postoperative 2 hours in both groups. Pain scores in SG and VG were significantly higher up to postoperative 8 hours and 8 am of day 2, respectively, than baseline. Prevalence of rescue analgesia and resentment were not significantly different between groups (SG: 27.3%, VG: 33.3% and SG: 0%, VG: 25%, respectively). Simbadol produced similar analgesic effects to Vetergesic without resentment during drug administration.

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The present and future of opioid analgesics in small animal practice

Cited by 37 publications

References 156 publications

Bioavailability of subcutaneous and intramuscular administrated buprenorphine in New Zealand White rabbits

Bioavailability of subcutaneous and intramuscular administrated buprenorphine in New Zealand White rabbits

The lack of analgesic use (oligoanalgesia) in small animal practice

The analgesic effects of buprenorphine (Vetergesic or Simbadol) in cats undergoing dental extractions: A randomized, blinded, clinical trial

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