Postoperative comparison

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of four perioperative analgesia protocols

EXOTIC
in dogs undergoing stifle joint surgery
Kerrie A. Lewis, DVM, MS; Richard M. Bednarski, DVM, MS; Turi K. Aarnes, DVM, MS;
Jonathan Dyce, MA, VetMB; John A. E. Hubbell, DVM, MS

Objective—To compare 4 analgesic protocols in dogs undergoing stifle joint surgery.

Design—Randomized, blinded, prospective clinical trial.
Animals—48 client-owned dogs that underwent stifle joint surgery.
Procedures—Dogs undergoing tibial plateau leveling osteotomy were randomly assigned
to receive a constant rate infusion of a combination of morphine, lidocaine, and ketamine;
a lumbosacral epidural with morphine and ropivacaine; both treatments (ie, constant rate
infusion and lumbosacral epidural); or only IM premedication with morphine. Indices of car-
diorespiratory function and isoflurane requirement were recorded at 5-minute intervals dur-
ing anesthesia. A validated sedation scoring system and the modified Glasgow composite
measure pain score were used to assess comfort and sedation after surgery and anesthe-
sia once the swallowing reflex returned and a body temperature of ≥ 36.7°C (98.1°F) was
attained. Pain and sedation scores were acquired at 60-minute intervals for 4 hours, then
at 4-hour intervals for 24 hours. Dogs with a postoperative pain score > 5 of 24 were given
morphine as rescue analgesia.
Results—No differences in heart rate, respiratory rate, systolic arterial blood pressure, end-
tidal PCO2, end-tidal isoflurane concentration, and vaporizer setting were detected among
groups. No differences in pain score, sedation score, rescue analgesia requirement, or time
to first rescue analgesia after surgery were detected.
Conclusions and Clinical Relevance—Pain scores were similar among groups, and all 4
groups had similar rescue analgesia requirements and similar times to first administration
of rescue analgesia. All 4 analgesic protocols provided acceptable analgesia for 24 hours
after stifle joint surgery. (J Am Vet Med Assoc 2014;244:1041–1046)

S tifle joint surgery in dogs is associated with con-

siderable postoperative pain.1–3 Opioids, N-methyl-
D-aspartate receptor antagonists, local anesthetics, and CRI
ABBREVIATIONS
Constant rate infusion
NSAIDs are classes of analgesic drugs that have been LE Lumbosacral epidural
administered to dogs both systemically and as part of MGCMPS Modified Glasgow composite measure
pain score
a regional anesthetic technique (epidural) to provide
MLK Morphine, lidocaine, and ketamine
relief from pain.4 Multimodal analgesia, the concurrent MR Morphine and ropivacaine
administration of multiple analgesic drugs and anal- TPLO Tibial plateau leveling osteotomy
gesic techniques, is a method of providing postopera-
tive pain relief. Multimodal analgesia is purported to
provide superior pain relief because the combination of to enhance efficacy.4,5 Morphine, an opioid analgesic, is
drugs that act via different pathways has the potential used by a variety of routes and methods to produce an-
algesia.5,6 Morphine infusion alone and in combination
From the Department of Veterinary Clinical Sciences, College of Veterinary with lidocaine and ketamine reduces the inhalation an-
Medicine, The Ohio State University, Columbus, OH 43210. Dr. Lewis’ pres- esthesia requirement in dogs.7,8
ent address is Institute of Veterinary, Animal and Biomedical Sciences, Col- The transfer of such studies to clinical medicine is
lege of Sciences, Massey University, Palmerston North 4442, New Zealand. difficult because the evaluation of the severity of pain
This manuscript represents a portion of a thesis submitted by Dr. Lewis to in dogs is complex.9–20 The MGCMPS is a validated pain
The Ohio State University College of Veterinary Medicine Department of
Veterinary Clinical Sciences as partial fulfillment of the requirements for scoring system that uses multiple indices associated with
a Master of Science degree. orthopedic pain, including the patient’s overall appear-
Supported in part by The Ohio State University College of Veterinary Med- ance, observation of gait, response to pressure on the
icine Canine Research Funds. surgical site, and overall demeanor of the patient.12,15 In-
Presented in abstract form at the 37th Annual Scientific Meeting of the terpretation of the MGCMPS is made more difficult be-
American College of Veterinary Anesthesia and Analgesia, San Antonio, cause sedation can alter the perception of the dog’s pain.
Tex, September 2012.
The authors thank Dr. Craig Lewis for assistance with statistical analyses To our knowledge, no clinical study has systemati-
and Dr. Valerie Nesser for technical assistance. cally compared the postoperative sedation and analge-
Address correspondence to Dr. Lewis ([email protected]). sia associated with morphine administration alone with

JAVMA, Vol 244, No. 9, May 1, 2014 Scientific Reports 1041

 that of morphine administered epidurally along with a multiparameter monitorh was attached to the previously
local anesthetic and morphine combined with lidocaine placed cuff for measurement of systolic, diastolic, and
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and ketamine as a CRI.2,21–24 The purpose of the study mean arterial blood pressure. End-tidal PCO2 (mm Hg)
EXOTIC

reported here was to determine whether the multimodal and end-tidal isoflurane concentration (vol%) were ob-
analgesic technique (ie, CRI of MLK and LE with MR) tained from the multigas gas analyzer display.h A lead II
provides superior postoperative analgesia to that of IM ECG was used to monitor heart rhythm. Body tempera-
administration of morphine alone (as a premedication), ture was measured with an oroesophageal thermistor
CRI of MLK alone, or LE with MR alone. probe. Dogs were mechanically ventilatedi at a rate of
6 to 8 breaths/min and tidal volume of 10 to 15 mL/kg
Materials and Methods (4.5 to 6.8 mL/lb) to maintain end-tidal PCO2 between
35 and 45 mm Hg. Mechanical ventilation was initiated
Animals—The Ohio State University Clinical Re- when the dogs were transferred to the surgical suite and
search Advisory Committee approved the study proto- was discontinued prior to transfer to the radiology suite
col. Client consent for enrollment in the study was ob- for postoperative radiography.
tained prior to surgery. Forty-eight adult client-owned Data were recorded every 5 minutes from anesthet-
dogs scheduled to undergo a TPLO of either stifle joint ic induction through termination of surgery. The du-
for a cranial cruciate ligament rupture were enrolled. ration of total anesthesia, total surgical time, and time
Dogs were considered healthy on the basis of findings that the endotracheal tube was removed were recorded.
on physical examination, hematologic evaluation, se- If a dog reacted to surgical stimulation (marked
rum biochemical analysis, and urinalysis. For sedation and sudden increase in heart rate, MAP, or both or
within 24 hours prior to surgery, the type and dose of movement) and anesthesia could not be maintained
drugs were recorded. with increasing isoflurane concentrations, hydromor-
phonej (0.02 mg/kg [0.009 mg/lb], IV) was given and
Anesthetic and surgical protocols—A physical ex- the dog was removed from the study.
amination was performed the day of the surgery. Rectal If dysphoria occurred during recovery, aceproma-
temperature, pulse, respiratory rate, body weight, mu- zine (0.02 to 0.05 mg/kg [0.009 to 0.023 mg/lb]) was
cous membrane color, hydration status, and American administered IV. Morphine (0.4 mg/kg, IM) was admin-
Society of Anesthesiologists preoperative status10 were istered as a rescue anesthetic to all patients with a post-
determined and recorded on the anesthetic record. operative pain score > 5 of 24. Patients were allowed to
Concurrent medications, including NSAIDs, were also have NSAIDs at any time during the study; the type of
recorded. NSAID, dosage, and times administered were recorded.
Food, but not water, was withheld for ≥ 12 hours The same surgeon (JD) performed all surgeries. An ar-
prior to anesthesia. Dogs were given acepromazinea throtomy was performed, and a TPLO was used to sta-
(0.02 to 0.1 mg/kg [0.009 to 0.045 mg/lb], IM; maxi- bilize the stifle joint.
mum dose, 3 mg) and morphineb (0.4 mg/kg [0.18 mg/
lb], IM) 20 minutes prior to IV catheter insertion. The Study design—A blinded, randomized parallel de-
dose of acepromazine was left to the discretion of the sign was used. Dogs were randomly assigned to receive
attending anesthesiologist and was based on the age CRI of a combination of morphineb (0.24 mg/kg/h [0.11
of the dog and its temperament. An 18- or 20-gauge mg/lb/h]), lidocainek (3 mg/kg/h), and ketaminel (0.6
catheterc was inserted into a cephalic vein for drug and mg/kg/h [0.27 mg/lb/h]); morphinem (0.2 mg/kg [0.09
crystalloid fluidd administration. Anesthesia was in- mg/lb]) and 1% ropivacainen (0.2 mg/kg) epidurally
duced with propofole (3 to 5 mg/kg [1.36 to 2.27 mg/ (total volume delivered, 1 mL/4.5 kg of body weight
lb], IV) given to effect, and the total dose was recorded. [1 mL/9.9 lb] to a maximum of 10 mL); or both (CRI
Dogs were orotracheally intubated and maintained with of MLK and LE with MR) or received no additional
isofluranef in oxygen by use of an out-of-circuit preci- analgesia other than IM premedication with morphine
sion vaporizer and a semiclosed circle anesthetic sys- (control). The CRI of MLK was begun after tracheal in-
tem. Initial vaporizer settings were adjusted according tubation and terminated at the end of surgical time.
to clinical interpretation of anesthetic depth. Lactated Epidural administration of MR was performed by
Ringer’s solution (5 mL/kg/h, IV) was administered a veterinarian or anesthesia technician immediately
from the time of catheter insertion until closure of the before the dogs were transferred to the surgical suite.
skin after surgery. The CRI of MLK was administered Epidural needleo placement at the L7-S1 space was en-
after tracheal intubation until the end of surgical time. sured by palpation of appropriate landmarks, followed
A Doppler probeg was placed over a peripheral artery by a loss of resistance technique.25 For dogs not re-
for pulse rate detection and an estimation of systolic ceiving epidural anesthesia, hair was clipped over the
arterial blood pressure with a sphygmomanometer and epidural site and the site was covered with a bandage
an appropriately sized cuff on the limb proximal to the in the immediate postoperative period to prevent bias
Doppler probe. The cuff size was determined by laying during pain scoring. Personnel collecting data were not
the long axis of the cuff along the thoracic antebrachium allowed contact with the patient until time 0 (first post-
and estimating the cuff width against the circumference operative pain score assessment) and also had no access
of the limb. Cuff width was chosen to be approximately to anesthetic records.
40% of the underlying limb circumference. Heart rate, Assessments were performed by 1 of 2 trained
respiratory rate, and Doppler pressure were recorded. evaluators. Pain and sedation assessments began after
When transferred to the surgical suite, an oscillomet- surgery when the patient had a body temperature of ≥
ric blood pressure monitor that was a component of a 36.7°C (98.1°F) and the swallowing reflex had returned

1042 Scientific Reports JAVMA, Vol 244, No. 9, May 1, 2014

(time 0). Pain and sedation scores were recorded at time groups (0.05 ± 0.02 mg/kg [0.023 ± 0.009 mg/lb] to
0, hourly for the first 4 hours, and then every 4 hours 0.06 ± 0.02 mg/kg [0.027 ± 0.009 mg/lb]). The dose of

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until 24 hours after surgery. An MGCMPS12,15 was used propofol was 4 mg/kg (1.82 mg/lb) for all groups. Mean
± SD heart rate, respiratory rate, systolic arterial blood

EXOTIC
to assess pain scores. Variables assessed included vocal-
ization, attention to wound area, mobility, response to pressure, end-tidal PCO2, end-tidal isoflurane concen-
touch, demeanor, and posture. Dogs with pain scores > tration, vaporizer percentage at anesthetic induction,
5 (out of a possible total of 24) received morphine as and vaporizer percentage during the surgical period
rescue analgesia (0.4 mg/kg, IM). were not different among groups.
A validated sedation scoring system26 was used to Duration of anesthesia, duration of surgery, and time
assess sedation in all of the patients. Variables assessed to extubation were not different among groups. Dura-
included vocalization, posture, appearance, interactive tion of anesthesia among groups ranged from 135 ± 18
behaviors, response to restraint (restraint was defined as minutes to 145 ± 28 minutes. Duration of surgery among
the position typical for cephalic catherization: arm around groups ranged from 58 ± 7 minutes to 72 ± 25 minutes.
neck with forelimb outstretched), and noise response (4 Time to extubation among groups ranged from 16 ± 16
loud hand claps within 12 inches of the patient’s head). minutes to 43 ± 31 minutes. Some dogs in each group
The sedation score results were recorded but did not affect received rescue analgesia over the 24-hour postoperative
whether the patient received rescue analgesia. period (Figure 1). A Kaplan-Meier time to rescue anal-
gesia curve denoted the percentage of dogs without any
Statistical analysis—Data were tested graphically rescue analgesia remaining over time in each treatment
for normality (by visual inspection of histograms and group. Numbers of dogs requiring rescue analgesia, time
residual plots) and formally (by the Shapiro-Wilk test). to rescue analgesia administration, mean dose of rescue
If the data were not normally distributed, the data were analgesia, and number of rescue analgesia doses were not
transformed to normalcy or a nonparametric analysis different among groups (Table 1).
(Kruskal-Wallace test) was applied. The median and During the data collection phase, 53 dogs were
range were reported for data that were not normally originally enrolled. Five dogs were removed from the
distributed, and the mean ± SD was reported for data study prior to pain scoring. One dog was removed be-
that were normally distributed. Differences among cause of a skin infection over the surgical site. Three
pain scores were tested by means of a nested-factorial dogs were removed during surgery because of compli-
(ANOVA, only if successfully transformed to normalcy) cations related to the surgical procedure itself, which
design (4 treatment groups, fixed variable; 12 patients, did not impact the anesthetic episode. Lastly, 1 dog was
random variable nested within each group; 10 measure- removed after surgery because additional drugs were
ments from time 0, fixed variable [crossed with group inadvertently administered. Data from removed dogs
and applied to each patient]). Two-sided tests were were not included in the analysis. Data analysis was
used to allow the possibility of detecting unexpected re- performed on the 48 dogs enrolled in the study.
lationships, and α was set at 0.05. To determine which The maximum possible sedation score was 14.
protocols were different, appropriate multiple compari- Mean sedation scores ranged from 5.2 to 7.8 and were
sons procedures (Newman-Keuls procedure if the data not different among groups. Sedation decreased over
were normally distributed) were used for all significant time and at the same rate. The maximum pain score
differences between > 2 groups (or patients or times). possible was 24. Mean pain scores over time ranged
from 2.6 to 2.8, with no difference among groups for
Results the mean pain score (Table 2). Median and mean pain
scores among groups were not different over time. Pain
Seventeen breeds were represented in this study,
including 14 mixed-breed dogs, 6 Labrador Retrievers,
5 Golden Retrievers, 4 German Shepherd Dogs, 3 Great
Pyrenees, 3 Newfoundlands, 2 American Bulldogs, 2
Rottweilers, and 1 dog each for 9 other breeds (Ameri-
can Cocker Spaniel, Bearded Collie, Catahoula Leopard
Hound, Chow Chow, Dalmatian, Doberman Pinscher,
German Shorthair Pointer, Great Dane, and Siberian
Husky). Treatment groups did not differ significantly
with regard to American Society of Anesthesiologists
status, body weight, sex distribution, or age.
Dogs received 1 of 5 NSAIDs (carprofen, dera-
coxib, firocoxib, meloxicam, and piroxicam). On the
day prior to surgery, NSAIDs were administered per
usual instructions. The morning of surgery, NSAIDs
were withheld. After surgery, NSAIDs were adminis-
tered to all patients. Patients were receiving an NSAID
for a mean duration of > 10 days prior to entry into Figure 1—Kaplan-Meier curve for time to rescue analgesia (ie, frac-
the study. The distribution of NSAID use was not dif- tion of patients not requiring rescue analgesia) for 24 hours follow-
ferent among groups. Carprofen was the most com- ing surgery for 48 client-owned dogs that underwent a unilateral
TPLO and received a CRI of MLK (n = 12), an LE with MR (12), or
monly used NSAID. The dose of acepromazine used both CRI and LE protocols (12) or that received no additional anal-
for preoperative sedation was not different among gesia other than morphine premedication IM (control; 12).

JAVMA, Vol 244, No. 9, May 1, 2014 Scientific Reports 1043

 Table 1—Summary of rescue analgesia data for 48 client-owned dogs that underwent a unilateral TPLO
and received a CRI of MLK (n = 12), an LE with MR (12), or both CRI and LE protocols (12) or that re-
SMALL ANIMALS/

ceived no additional analgesia other than morphine premedication IM (control; 12).

EXOTIC

CRI of LE with Both CRI and Morphine

Variable MLK MR LE protocols only
No. of dogs requiring rescue analgesia 4 4 5 3
Mean time to rescue analgesia administration (h) 5.6 7 4.6 13.7
Mean dose of morphine as rescue analgesia (mg/kg) 0.4 0.4 0.4 0.4
Mean No. of rescue analgesia doses 2.8 2.3 1.6 3
Time of earliest rescue analgesia administration (h) 1 1 2 0

An MGCMPS and a sedation score were recorded at time 0, hourly for the first 4 hours, and then every
4 hours until 24 hours after surgery. A maximum score of 24 could be achieved. Dogs with pain scores > 5
received morphine as rescue analgesia (0.4 mg/kg, IM).

Table 2—Mean ± SD pain scores of the same dogs as in Table 1. all dogs that received rescue analgesia, and no dif-
ference in mean pain scores among the groups were
Total pain
Variable score found, although the SDs appeared smaller. No trend
was found in any group in rescue analgesia require-
All dogs (n = 48)
CRI of MLK (n = 12) 2.6 ± 1.9 ments for either the number of doses or the time to
LE with MR (n = 12) 2.6 ± 1.6 first rescue analgesia administration. In a study that
Both CRI and LE protocols (n = 12) 2.8 ± 1.6 examined the effects of perioperative analgesic pro-
Morphine only (n = 12) 2.8 ± 2.0 tocols (epidural injection, intra-articular injection,
Dogs not receiving rescue analgesia (n = 32) and IV injection) for management of postoperative
CRI of MLK (n = 8) 2.0 ± 0.9 pain in dogs after TPLO, Hoelzler et al24 found no
LE with MR (n = 8) 2.2 ± 1.0 differences in measured indices of postoperative pain
Both CRI and LE protocols (n = 7) 2.0 ± 1.1
Morphine only (n = 9) 2.1 ± 1.0 among groups (epidural, intra-articular, and IV) but
the epidural and intra-articular groups had longer
times to the administration of the first rescue analge-
sia, compared with the control group. Differences in
our study versus that study24 may be due to different
scores were plotted against a maximum score; no group epidural drug combinations, drug concentrations, or
had a mean pain score > 7. drug formulations. Hoelzler et al24 used a morphine
dose of 0.1 mg/kg, which was less than our dose of
0.2 mg/kg. The dose of local anesthetic used in the
Discussion
study by Hoelzler et al24 was greater than the local
Each of the 4 analgesic protocols provided ad- epidural anesthetic used in the present study. This
equate pain relief in this group of dogs after stifle lower dose of morphine and higher concentration
joint surgery on the basis of the number of dogs of local anesthetic could have accounted for some
requiring rescue analgesia. The quality of pain re- of the differences in outcomes between the 2 stud-
lief produced was equivalent in the 4 groups on the ies. Additionally, Hoelzler et al24 used 2 pain scoring
basis of the MGCMPS, and the degree of sedation methods, neither of which has been validated in as-
was similar. In this population of dogs undergoing sessing acute orthopedic pain.
stifle joint surgery, the use of multimodal analgesia Our pain score results are contrary to those from
(opioid-NSAID combination plus CRI of MLK, LE other studies21,27,28 comparing analgesia protocols in or-
with MR, or both CRI and LE protocols) did not thopedic procedures during the 24-hour postoperative
significantly improve comfort, compared with an period. Hendrix et al27 compared the analgesic effects of
opioid-NSAID combination alone. There was no epidurally administered morphine, bupivacaine hydro-
difference among groups in the number of dogs re- chloride, and both in combination versus sterile saline
quiring rescue analgesia, the time until first rescue (0.9% NaCl) solution in dogs undergoing various hind
analgesia was administered, mean cumulative dose limb orthopedic surgeries. All groups received an opi-
of rescue analgesia, or mean number of rescue anal- oid as a premedication, and the epidural administration
gesia doses administered. Some dogs in each group was performed after surgery. That study27 found that
required rescue analgesia at some point in the 24- pain scores are lower in dogs receiving the combina-
hour postoperative period. tion, that the time to administration of rescue analgesia
When comparing mean pain scores at each time is longer for dogs in the combination group, and that
point, we included all dogs regardless of whether the number of rescue analgesia boluses administered is
they received rescue analgesia. Several dogs in each lower in the combination groups than in dogs receiving
group received rescue analgesia within 1 to 2 hours saline solution. Those investigators used a greater lo-
after surgery, potentially minimizing pain scor- cal anesthetic concentration than that used in the pres-
ing differences among groups. The pain score SDs ent study, and their epidural combinations may have
were large in each group at each time point, and provided better analgesia and resulted in a difference in
this probably contributed to finding no difference pain scores among groups. The concentration of local
among groups. Data were reexamined after removing anesthetic in the epidural used in the present study was

1044 Scientific Reports JAVMA, Vol 244, No. 9, May 1, 2014

chosen to avoid paralysis, which could confound pain pain scoring.9,12 These factors include psychological and

SMALL ANIMALS/
scoring results but also increase the duration of effect behavioral status as well as administration of anxiolytics,
of the epidural. Hendrix et al27 also used a smaller mor- narcotics, and other agents. Methods of scoring pain in

EXOTIC
phine dose of 0.1 mg/kg for epidural administration, animals rely on the observer’s interpretation of animal
which was lower than our dose of 0.2 mg/kg. Differ- behavior.9–18 The MGCMPS has been validated for use in
ences from our study in opioid dosages and the associ- dogs with orthopedic pain. Smaller interobserver varia-
ated durations of analgesia could have accounted for tion has been shown, and results are less influenced by
the longer duration until the need for rescue analgesia sedation than other scoring systems.12,15 Large SDs were
in that study.27 Lastly, the surgical procedures were not seen within our groups, and consequently, this may have
standardized in that study27; various orthopedic proce- contributed to the lack of any differences. The addition
dures involving the hind limbs or pelvis were included. of an alternate pain scoring system may have been more
All dogs in the present study received NSAIDs prior sensitive in detecting differences in pain scores among
to admission for surgery, and all dogs were administered groups.11,17,18 Therefore, the administration of morphine
an NSAID after extubation or at 8:00 PM following their as a postoperative rescue analgesic in the present study
surgery. If they were receiving carprofen, they received might have influenced subsequent MGCMPS scores.
a subcutaneous injection at extubation. Carprofen was Sedation can affect pain scoring even though the
the most commonly administered NSAID. The other MGCMPS was shown to be less affected by sedation than
NSAIDs administered during the postoperative period other scoring systems.10,12,39,40 It is possible that all proto-
included meloxicam, piroxicam, deracoxib, and firo- cols used in the present study provided similar pain con-
coxib. The NSAID-associated anti-inflammatory and trol because all groups had similar low mean pain scores
analgesia properties could have contributed to masking during the 24-hour postoperative period. These 4 proto-
differences in analgesia among groups in our study. The cols are all commonly used for pain control for various
different types of NSAIDs and associated doses specific orthopedic procedures. Perhaps if we had monitored these
to each NSAID could have affected the results of this dogs for a longer period after surgery, we would have
study. All dogs in this study received NSAIDs for > 7 found significant differences among groups in long-term
days prior to surgery. Several studies5,29–37 have shown analgesic requirements. For example, epidurally admin-
the analgesic efficacy of NSAIDs used in conjunction istered morphine has been shown to provide analgesia
with opioids. Because NSAIDs take ≥ 7 days to wash for up to 24 hours.6,41 However, our study was designed
out38 and because our subjects were client-owned dogs, to compare analgesia in the 24-hour postoperative pe-
ethically, we elected to continue their NSAIDs before riod. All groups benefited from regular evaluation of pain
and after surgery. The additional NSAIDs administered and assessment of analgesia requirements throughout
to all patients in the present study could have further the 24-hour period. From our data, we can conclude that
supplemented analgesia, resulting in similar pain scores all 4 techniques provided similar, effective analgesia and
among groups. sedation for 24 hours after surgery.
Having multiple people perform epidural drug
administration may have influenced our results, given a. Acepromazine maleate, Vedco Inc, St Joseph, Mo.
that we did not confirm epidural needle placement with b. Morphine sulfate injection USP, West-Ward Pharmaceutical
Corp, Eatontown, NJ.
radiography. Everyone was similarly trained in the loss c. Surflo IV catheter, Terumo Medical Corp, Elkton, Md.
of resistance technique and used the same anatomic d. Lactated Ringer’s solution, Baxter Healthcare Corp, Deerfield, Ill.
landmarks to identify the location of needle entry. The e. Abbott Laboratories, North Chicago, Ill.
failure rate should have been similar among individu- f. Vetone, Boise, Idaho.
als, and no single individual performed the epidurals g. Ultrasonic Doppler flow detector, Parks Medical Electronics
exclusively in one group or the other. Factors such as Inc, Aloha, Ore.
h. Surgivet Multiparameter Monitor and Multigas Analyzer, Veteri-
volume of injectate, orientation of the needle bevel, nary Surgical Products, Waukesha, Wis.
type of needle, and variations in individual anatomy i. Surgivet Ventilator, Veterinary Surgical Products, Waukesha, Wis.
can influence the success and extent of drug distribu- j. Hydromorphone HCl, Hospira Inc, Lake Forest, Ill.
tion.25 Other than variations in individual anatomy, we k. Lidocaine HCl 2%, VetOne, Boise, Idaho.
controlled most of the other variables to the extent per- l. Fort Dodge Animal Health, Fort Dodge, Iowa.
mitted by the study design. m. Preservative-free morphine sulfate, 0.5 mg/mL, West-Ward
Pharmaceutical Corp, Eatontown, NJ.
All 4 analgesic protocols we used have been shown to n. APP Pharmaceuticals LLC, Schaumburg, Ill.
reduce intraoperative isoflurane requirement.7 It is for this o. Perisafe modified Tuohy point epidural needles, BD, Franklin
reason that we did not see a difference among groups in Lakes, NJ.
intraoperative cardiovascular data and anesthetic depth.
This project was not designed to be a minimum alveolar
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1046 Scientific Reports JAVMA, Vol 244, No. 9, May 1, 2014