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​Purr-fecting Pain Management

Evaluation of the perioperative analgesic efficacy of buprenorphine, compared with butorphanol, in cats.

Warne L; Beths T; Holm M; Carter JE & Banquier SH (2014). JAVMA 245(2), 195-202
DOI: 10.2460/javma.245.2.195

HYPOTHESIS

A randomly allocated, 2 phase, blinded trial to assess the hypothesis that buprenorphine provides superior analgesia to butorphanol following ovariohysterectomy in the cat.

WHAT DID THE RESEARCH FIND?

0.02mg/kg buprenorphine administered IM at the time of premedication and repeated at the time of wound closure provides superior analgesia to butorphanol and the effects persist for at least 6 hours following feline OVH.

STUDY DESIGN

Healthy, client owned, domestic cats admitted for routine ovariohysterectomy (OVH) at a university teaching hospital were randomly allocated to receive either 0.02mg/kg buprenorphine intramuscularly (IM) or butorphanol (0.4mg/kg) IM together with medetomidine (15mcg/kg) IM prior to anaesthetic induction and surgery.

Phase 1

Animals admitted during Phase 1 of the trial received a single dose of either buprenorphine (4 cats) or butorphanol (6 cats) 30 minutes prior to induction.  Animals admitted to Phase 1 were administered 0.075mg/kg atipamezole 10 minutes after extubation.  This dose was chosen with the aim of antagonising the analgesic effects of the medetomidine.

Phase 2

Cats allocated to Phase 2 received buprenorphine (14 animals) or butorphanol (15 animals) as per Phase 1, followed by a second, identical, dose at the time of wound closure. 0.037mg/kg atipamezole was administered 10 minutes post extubation.  A lower dose of atipamezole was selected for Phase 2 as it was considered that the higher dose used in Phase 1 may have contributed to excessive excitement interfering with the pain scoring.

Anaesthesia

All animals were evaluated for quality of sedation 20 minutes after premedication. 30 minutes post premedication the patients induced with intravenous propofol administered to effect until intubation could be performed without a cough reflex.   Cats were maintained on isoflurane in oxygen.  Anaesthetic depth and physiological variables (ECG; heart rate; respiratory rate; end tidal carbon dioxide; oxygen saturation and oscillometric blood pressure) were assessed every 5 minutes during anaesthesia.

Pain assessment

Pain assessment, using the validated UNESP Botucatu multidimensional composite pain scale (pshychomotor changes; protection of the wound area; physiological variables; vocal expression of pain), was performed prior to premedication (baseline) and then at 20, 60, 120, 180, 240, 300 & 360 minutes following extubation. 

Rescue analgesia

Methadone (0.2mg/kg intravenously) plus meloxicam (0.2mg/kg subcutaneously) was administered if the total pain score was 9 or greater out of a maximum possible score of 28.  Animals receiving rescue analgesia were excluded from further participation in the study at that point. 

Animals that were still pain free following assessment at 6 hours post extubation were administered meloxicam (0.2mg/kg) subcutaneously.

The same anaesthetist, who was blind to the opioid administered, performed all sedation evaluations, intubations, monitoring and pain assessments.  The same surgeon performed all OVHs.

RESULTS

Phase 1

A total of 10 cats were allocated to Phase 1 (4 received buprenorphine and 6 were administered butorphanol) but this stage of the study was discontinued as all cats required rescue analgesia: 9 animals at 20 minutes post extubation, and one cat in the butorphanol group at 120 minutes.

The mean total pain score for each group at 20 minutes was as follows:

Buprenorphine (n=4): Median pain score of 13.5
Butorphanol (n=6): Median pain score of 14.5.

There was no significant difference between treatments.

Phase 2

30 cats were enrolled, 15 for each treatment group. 1 cat was excluded from the buprenorphine group as it had evidence of previous OVH.

At 20 minutes post extubation there was a significant difference (p=0.001) in pain scores:

Buprenorphine (n=14): Median pain score of 3.5
Butorphanol (n=15): Median pain score of 11

All cats allocated to the butorphanol group required rescue analgesia at 20 minutes post-extubation. No cat allocated to the buprenorphine treatment group required rescue analgesia at any timepoint.

DISCUSSION

The hypothesis that buprenorphine provides superior analgesia to butorphanol following ovariohysterectomy in the cat was not confirmed in Phase 1 as both drugs provided inadequate postoperative analgesia and rescue treatment was necessary.  However, Phase 2 confirmed the hypothesis, with 0.02mg/kg buprenorphine administered at premedication and again at wound closure providing significantly superior analgesia to 2 similarly timed treatments with butorphanol (0.4mg/kg each dose).

The inadequate analgesia following the single administration of 0.02mg/kg buprenorphine in Phase 1 may have been due to this dose being sub-analgesic or as a result of insufficient duration of action.  Therefore, a single dose of 0.04mg/kg buprenorphine may have provided acceptable analgesia.

WHAT DOES THIS MEAN?

0.02mg/kg buprenorphine administered IM at the time of premedication and repeated at the time of wound closure provides superior analgesia to butorphanol and the effects persist for at least 6 hours following feline OVH.

Article by
Dr. Karen Heskin
BVSc CertSAO MRCVS

Veterinary Technical Manager, Jurox UK

Originally published: Thursday, 25th October 2018

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