Evaluation of metamizole and carprofen as postoperative analgesics in canine total hip replacement [Elektronische Ressource] / von Andrea Stotz Rudolff

Andrea Stotz

Informations

• Publié par: ludwig-maximilians-universitat_munchen
• Publié le: 01 janvier 2011
• Nombre de lectures: 26
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Aus dem Zentrum für klinische Tiermedizin
der Tierärztlichen Fakultät
der Ludwig-Maximilians-Universität München

Arbeit angefertigt unter Leitung von: Univ.-Prof. Dr. med. vet. U. Matis


Evaluation of Metamizole and Carprofen as
postoperative analgesics in canine total hip
replacement


Inaugural-Dissertation
zur Erlangung der tiermedizinischen Doktorwürde
der Tierärztlichen Fakultät der Ludwig-Maximilians-Universität
München


von
Andrea Stotz Rudolff
aus Antofagasta

München 2011 Gedruckt mit der Genehmigung der Tierärztlichen Fakultät
der Ludwig-Maximilians-Universität München
















Dekan: Univ.-Prof. Dr. Braun

Berichterstatter: Univ.-Prof. Dr. Matis

Korreferent/en: Univ.-Prof. Dr. Ammer




Tag der Promotion: 12. Februar 2011










A mi familia


Contents IV
CONTENTS
I. INTRODUCTION......................................................................................1
II. LITERATURE ...........................................................................................2
1. Physiology of pain ......................................................................................2
1.1. Definition of pain .........................................................................................2
1.2. Nociception ..................................................................................................2
1.2.1. Peripheral receptors......................................................................................3
1.2.2. Afferent nerve fibres ....................................................................................4
1.2.3. Dorsal horn neurons .....................................................................................5
1.2.4. Ascending spinal tracts.................................................................................8
2. Pathophysiology of pain.............................................................................9
2.1. Causes of pain ..............................................................................................9
2.2. Types of pain..............................................................................................10
2.3. Sensitization (Wind up)..............................................................................11
3. Pain as a pathology...................................................................................12
4. Pain management .....................................................................................13
4.1. Descending control of pain ........................................................................13
4.2. Pain management .......................................................................................15
4.2.1. Opioids .......................................................................................................16
4.2.2. Nonsteroidal anti-inflammatory drugs (NSAIDs)......................................17
4.2.2.1. Mechanism of action .............................................................................. 17
4.2.2.1.1. Cyclooxygenase enzyme and prostaglandin synthesis...............................17
4.2.2.1.2. Nitric oxide synthase and COX inhibitors .................................................19
4.2.2.1.3. Endogenous opioid system.........................................................................20
4.2.2.2. COX selectivity...................................................................................... 21
4.2.2.3. NSAIDs drugs ........................................................................................ 22
4.2.2.3.1. Carprofen....................................................................................................22
4.2.2.3.2. Sodium Metamizole ...................................................................................23
5. Pain evaluation .........................................................................................27
5.1. Subjective methods ....................................................................................27
5.2. Objective methods......................................................................................29
5.2.1. Force plate analysis ....................................................................................29 Contents V
5.2.1.1. Kinetic..................................................................................................... 30
III. OBJECTIVES ..........................................................................................34
IV. MATERIAL AND METHODS...............................................................35
1. Patients ......................................................................................................35
2. Anaesthesia and analgesia .......................................................................35
3. Surgery ......................................................................................................36
4. Study design..............................................................................................36
5. Pain assessment ........................................................................................37
5.1. Pain scores..................................................................................................37
5.2. Force plate analysis ....................................................................................38
6. Statistical analysis ....................................................................................39
V. RESULTS..................................................................................................40
1. Pain scores.................................................................................................43
1.1. Rescue analgesia ........................................................................................43
1.2. Modified Melbourne pain score (mMPS) ..................................................46
1.3. Visual analogue scale (VAS) .....................................................................49
2. Ground reaction forces (GRF)................................................................52
2.1. Peak vertical force......................................................................................53
2.2. Vertical impulse .........................................................................................56
VI. DISCUSSION ...........................................................................................59
VII. ZUSAMMENFASSUNG .........................................................................68
VIII. SUMMARY...............................................................................................70
IX. BIBLIOGRAPHY ....................................................................................71
X. APPENDIX ...............................................................................................92
XI. ACKNOWLEDGEMENTS.....................................................................93
List of figures VI
LIST OF FIGURES
Figure 1: A simplified representation of nociceptive processing as a three-neuron
chain (LEMKE et al. 2004)................................................................... 3
Figure 2: Primary afferent pain transmission. ...................................................... 5
Figure 3: Pain pathways from the periphery to the brain. .................................... 7
Figure 4: The site of action of the major classes of analgesics as they affect
transduction, transmission, and modulation of nociceptive input and
the perception of pain.......................................................................... 16
Figure 5: Representation of cyclooxygenase activity. COX-1 is constitutively
expressed while COX-2 may be present by inflammatory processes. 19
Figure 6: Visual analogue scale (VAS) .............................................................. 29
Figure 7: Direction of the ground reaction forces (GRF) in healthy dogs.......... 31
Figure 8: Vertical force signals of the forelimb and the ipsilateral hind limb of a
dog at a trotting gait, separated into the loading and the unloading
intervals............................................................................................... 32
Figure 9: mMPS score before and after rescue analgesia................................... 45
Figure 10: VAS score before and after rescue analgesia. ..................................... 45
Figure 11: mMPS score over time for dogs in the group M and C....................... 48
Figure 12: VAS score over time for dogs in the group M and C.......................... 51
Figure 13: Peak vertical force ratio (op/nop%) of dogs in the groups M and C... 55
Figure 14: Vertical impulse ratio (op/nop%) of dogs in the groups M and C. ..... 58 List of tables VII
LIST OF TABLES
Table 1: Gender distribution in the groups.......................................................... 40
Table 2: Data of the patients................................................................................ 41
Table 3: Average body we