Randomized clinical trial comparing outcomes after fentanyl or ketamine-dexmedetomidine analgesia in thoracolumbar spinal surgery in dogs

J Vet Intern Med, 2022 · DOI: 10.1111/jvim.16514 · Published: September 1, 2022

Anesthesiology Neurology Veterinary Medicine

Simple Explanation

Opioids are commonly used for pain management during and after spinal surgery in dogs. However, there's concern that they might worsen inflammation in the injured spinal cord and that access to opioids for veterinary use may be restricted in the future. This study compared the recovery of dogs receiving either fentanyl (an opioid) or a combination of ketamine and dexmedetomidine after surgery for a herniated disc in the thoracolumbar spine. The study found no significant difference in the time it took for dogs to walk again between the two treatment groups. However, there were minor differences in the time it took for dogs to start eating and urinating on their own, favoring the ketamine-dexmedetomidine combination.

Study Duration

September 2019 and February 2022

Participants

102 client-owned dogs undergoing decompressive surgery for thoracolumbar intervertebral disc herniation

Evidence Level

Randomized clinical trial

Key Findings

1
There was no significant difference in the time to recovery of ambulation between dogs treated with fentanyl and those treated with ketamine-dexmedetomidine.
2
Pain control appeared similar between the two groups, as measured by pain scores.
3
Dogs treated with ketamine-dexmedetomidine showed slightly faster recovery of eating and urination compared to those treated with fentanyl.

Research Summary

This study compared the effects of fentanyl versus a ketamine-dexmedetomidine combination on recovery after spinal surgery in dogs with thoracolumbar intervertebral disc herniation. The primary outcome was time to recovery of ambulation, and secondary outcomes included pain scores, time to recovery of voluntary urination, and time to unassisted eating. The study concluded that fentanyl did not impair ambulatory outcome after surgery and that ketamine-dexmedetomidine is an appropriate alternative to fentanyl for postoperative pain control in dogs.

Practical Implications

Alternative Analgesic Options

Ketamine-dexmedetomidine can be considered a viable alternative to fentanyl for postoperative pain management in dogs undergoing thoracolumbar spinal surgery.

Opioid Restrictions

In areas where veterinary access to opioids is limited, ketamine-dexmedetomidine offers a suitable option for pain control after spinal surgery.

Recovery Considerations

While ambulation recovery was similar, clinicians should be aware of potential minor delays in appetite and urinary control with fentanyl use, and adjust post-operative care accordingly.

Study Limitations

1
The sample size calculation was based on rat studies and may not have been perfectly suited for detecting subtle differences in dogs.
2
An imbalance occurred in the numbers of dogs allocated to each treatment group due to errors in administering the randomized treatment.
3
Most dogs received methadone as premedication, which may have influenced the results.

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