REVISTA

Valoración del dolor en cirugía ortopédica en perros

Valoración Valoración: 3 Estrellas

Descripción: Valoración por distintos métodos del dolor postquirúrgico en perros sometidos a cirugía ortopédica.

TITULO FUENTE ORIGINAL:

Validation of orthopedic postoperative pain assessment methods for dogs: a prospective, blinded, randomized, placebo-controlled study

AUTORES:

Rialland P, Authier S, Guillot M, Del Castillo JR, Veilleux-Lemieux D, Frank D, Gauvin D, Troncy E.

REVISTA ABREV.:

PLoS One.

AÑO:

2012

REFERENCIA:

7(11):e49480.

DOI:

10.1371/journal.pone.0049480.

RESUMEN ORIGINAL:

In the context of translational research, there is growing interest in studying surgical orthopedic pain management approaches that are common to humans and dogs. The validity of postoperative pain assessment methods is uncertain with regards to responsiveness and the potential interference of analgesia. The hypothesis was that video analysis (as a reference), electrodermal activity, and two... + Leer más

In the context of translational research, there is growing interest in studying surgical orthopedic pain management approaches that are common to humans and dogs. The validity of postoperative pain assessment methods is uncertain with regards to responsiveness and the potential interference of analgesia. The hypothesis was that video analysis (as a reference), electrodermal activity, and two subjective pain scales (VAS and 4A-VET) would detect different levels of pain intensity in dogs after a standardized trochleoplasty procedure.

In this prospective, blinded, randomized study, postoperative pain was assessed in 25 healthy dogs during a 48-hour time frame (T). Pain was managed with placebo (Group 1, n = 10), preemptive and multimodal analgesia (Group 2, n = 5), or preemptive analgesia consisting in oral tramadol (Group 3, n = 10). Changes over time among groups were analyzed using generalized estimating equations. Multivariate regression tested the significance of relationships between pain scales and video analysis.

Video analysis identified that one orthopedic behavior, namely 'Walking with full weight bearing' of the operated leg, decreased more in Group 1 at T24 (indicative of pain), whereas three behaviors indicative of sedation decreased in Group 2 at T24 (all p<0.004). Electrodermal activity was higher in Group 1 than in Groups 2 and 3 until T1 (p<0.0003). The VAS was not responsive. 4A-VET showed divergent results as its orthopedic component (4A-VETleg) detected lower pain in Group 2 until T12 (p<0.0009), but its interactive component (4A-VETbeh) was increased in Group 2 from T12 to T48 (p<0.001).

Concurrent validity established that 4A-VETleg scores the painful orthopedic condition accurately and that pain assessment through 4A-VETbeh and VAS was severely biased by the sedative side-effect of the analgesics. Finally, the video analysis offered a concise template for assessment in dogs with acute orthopedic pain. However, subjective pain quantification methods and electrodermal activity need further investigation.

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COMENTARIO DE Ignacio, Álvarez Gómez de Segura

Este estudio prospectivo en perros compara la capacidad para distinguir diferentes grados de dolor postquirúrgico sometidos a cirugía ortopédica (trocleoplastia) usando diferentes métodos de valoración del dolor durante 48 horas. Los métodos empleados son: análisis por video del comportamiento,... + Leer más

Este estudio prospectivo en perros compara la capacidad para distinguir diferentes grados de dolor postquirúrgico sometidos a cirugía ortopédica (trocleoplastia) usando diferentes métodos de valoración del dolor durante 48 horas.

Los métodos empleados son: análisis por video del comportamiento, actividad electrodérmica y dos escalas subjetivas: VAS y 4A-VET.

Se pautaron aleatoriamente tres tratamientos: analgesia preventiva multimodal con la aplicación de un parche de fentanilo, analgesia epidural, un antiinflamatorio no esteroideo y tramadol; analgesia preventiva solo con tramadol y un tercer grupo de placebo.El diseño fue ciego, es decir, los evaluadores no sabían qué perros recibian cada tratamiento.

En general se pudo distinguir mediante estos metodos que perros presentaban diferentes grados de dolor; especialmente claro con el analisis de video y la escala 4A-VET. La escala VAS y la actividad electrodérmica demostraron una escasa fiabilidad.

De forma sorprendente, en este estudio las escalas subjetivas le otorgaron mayor grado de dolor al grupo de analgesia polimodal cuando la hipotesis esperada es que fuera el grupo con menor dolor postoperatorio.

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