Protrusion discale et épidurale - Expressions faciales et douleur- Analgésie multimodale

 


DOULEUR CHEZ LES CHIENS ET CHATS

1/ Epidural steroid and local anaesthetic injection for treating pain caused by coccygeal intervertebral disc protrusion in a dog

Aprea Francesco, Vettorato Enzo Vet. Anesth. Analg., In Press, Accepted Manuscript, Available online 8 June 2019

Résumé : 
This letter reports the use of a sacrococcygeal (S-Cc) epidural steroid injection (ESI) combined with a local anaesthetic in a dog with Cc intervertebral disc protrusion. This case suggests that ESI may be an effective alternative for the treatment of pain caused by S-Cc disc protrusion in dogs. Previously, ESI using methylprednisolone acetate (1 mg kg1) has been successfully employed to treat pain associated with degenerative lumbosacral stenosis in dogs (Janssens et al. 2009).


2/ Conceptual and methodological issues relating to pain assessment in mammals: The development and utilisation of pain facial expression scales

Krista M. McLennan, Amy L. Miller, Emanuela Dalla Costa, Diana Stucke, Matthew C. Leach Appl. Anim. Behav. Sci., In Press, Accepted Manuscript, Available online 12 June 2019

Résumé : Effective management of pain is critical to the improvement of animal welfare. For this to happen, pain must be recognised and assessed in a variety of contexts. Pain is a complex phenomenon, making reliable, valid, and feasible measurement challenging. The use of facial expressions as a technique to assess pain in non-verbal human patients has been widely utilised for many years. More recently this technique has been developed for use in a number of non-human species: rodents, rabbits, ferrets, cats, sheep, pigs and horses. Facial expression scoring has been demonstrated to provide an effective means of identifying animal pain and in assessing its severity, overcoming some of the limitations of other measures for pain assessment in animals. However, there remain limitations and challenges to the use of facial expression as a welfare assessment tool which must be investigated. This paper reviews current facial expression pain scales (“Grimace Scales"), discussing the general conceptual and methodological issues faced when assessing pain, and highlighting the advantages of using facial expression scales over other pain assessment methods. We provide guidance on how facial expression scales should be developed so as to be valid and reliable, but we also provide guidance on how they should be used in clinical practice.


3/ Multimodal analgesia for treatment of allodynia and hyperalgesia after major trauma in a cat

Mariela Goich, Alejandra Bascuñán, Patricio Faúndez J. Fel. Med. Surg. Open Reports, First Published, June 18, 2019

Résumé : A 2-year-old polytraumatized male cat was admitted to a teaching hospital for correction of a defective inguinal herniorrhaphy. Upon arrival, the cat showed signs of neuropathic pain, including allodynia and hyperalgesia. Analgesic therapy was initiated with methadone and metamizole; however, 24 h later, the signs of pain continued. Reparative surgery was performed, and a multimodal analgesic regimen was administered (methadone, ketamine, wound catheter and epidural anesthesia). Postoperatively, the cat showed signs of severe pain, assessed using the UNESP-Botucatu multidimensional composite pain scale. Rescue analgesia was initiated, which included methadone, bupivacaine (subcutaneous wound-diffusion catheter) and transversus abdominis plane block. Because the response was incomplete, co-adjuvant therapy (pregabalin and electroacupuncture) was then implemented. Fourteen days after admission, the patient was discharged with oral tramadol and pregabalin for at-home treatment.