Page 61 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir 1 . o minimi e the risk of post anaesthetic Long-term use: Many studies have been
renal complications, and considering the fact
performed to investigate e cacy of long term
NSAID administration, mostly in animals with
that a multimodal analgesic protocol should
always be preferred to a single-agent one, the osteoarthritis. Safety and tolerability are
author [FC] prefers to administer NSAIDs at the considered secondary outcomes in most
end of surgery, unless hypotension or studies, and this results in a signi cant
hypovolaemia have occurred, in which case di erence in de nition, incidence and severity of
NSAID administration is postponed, for an side e ects reported. A review of reported side
interval of time that is judged on a case-by-case e ects suggest that on larger samples, the
basis. Although the bene cial e ect of NSAI s incidence of side e ects is about for most
may be slightly reduced, this is o set by the NSAIDs, with greater incidence in elderly
decreased risk of complications. If it is decided animals and when small samples were
to administer NSAIDs preoperatively, it is considered (Luna et al., 7; onteiro Steagall
imperative to ensure that this is in agreement et al., 1 .
with the manufacturer’s indications, and The safety of long-term administration of
minimize the risk of hypotension by using carprofen (full dose) has been investigated for
appropriate monitoring and interventions. periods up to 84 days, demonstrating an
Concurrent administration of drugs that may improvement of lameness, which was greater in
compromise renal autoregulation and decrease dogs that had been lame for less than 6
blood pressure (for example ACE inhibitors) is months; side e ects re uiring interruption of the
an independent factor that increases the risk of treatment were observed in approximately
renal injury during anaesthesia, and it should be of dogs, with diarrhoea and vomiting being
considered an absolute contraindication for most common, and liver toxicosis being
pre-anaesthetic NSAID administration. observed in two dogs (Lipscomb et al., ;
Mansa et al., 7 .
E cacy and safety of mavacoxib and
he most relevant side e ects of NSAI s carprofen full dose, not minimum e ective
depend mainly on P inhibition, and include dose) have been compared in dogs with
renal (azotaemia, in more severe cases papillary oestheoarthritis for a period of 1 4 days, with
necrosis) and gastrointestinal (vomiting, both drugs improving clinical signs of the
diarrhoea, melaena, and ulcerations, more disease. Adverse e ects, mostly transient
fre uently pyloric and duodenal toxicity. P s gastrointestinal side e ects, were observed in
have a cytoprotective e ect in the stomach and approximately half of the dogs, and
gastrointestinal system. In the kidney, P s play approximately . of the dogs were excluded
an important role in regulating renal blood ow, from the study due to severe side e ects
especially in the presence of hypotension. P s possibly linked to the treatment (sepsis in a
are also involved in central nervous system mavacoxib-treated dog, gastrointestinal
function, embryo implantation, placental ulcerations in two carprofen-treated dogs)
development and platelet aggregation. Despite (Payne-Johnson et al., 1 .
the role of C in maintaining homeostasis, it Clinical e cacy and tolerability of cimicoxib
seems that greater inhibition of C over administered for days has been investigated
C 1 i.e. use of coxibs may confer greater in dogs with osteoarthritis, demonstrating
safety to NSAIDs, at least concerning improved locomotion, but the study was not
gastrointestinal side e ects Lobetti and oubert, designed to draw robust conclusions on side
; Parton et al., ; owers et al., 6; e ects urrell et al., 14 .
Frendin et al., 6; Craven et al., 7; ooten E cacy and adverse events after
et al., 8; owan et al., 11; ullins et al., robenacoxib or carpofen administration for 1
1 ; Surdyk et al., 1 ; onteiro Steagall et al., weeks in dogs with osteoarthritis have been
1 ; Surdyk et al., 1 ; Snow et al., 14 . compared, demonstrating similar e cacy.

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