Adjuvant analgesics - Alternatives to opioid analgesia : ALPHA-2 AGONISTS

Adjuvant analgesics – Alternatives to opioid analgesia : ALPHA-2 AGONISTS

21 octobre 2019

DOULEUR CHEZ LES CHIENS ET CHATS

1/ Adjuvant Analgesics in Acute Pain Management

Hélène L.M. Ruel, DMV, MSc, Paulo V. Steagall, MV, MSc, PhD*

KEY POINTS

Theefficacyofgabapentinincombinationwithbuprenorphinehasbeendemonstratedaf- ter ovariohysterectomy in cats. Additional studies using gabapentin alone are required to evaluate its efficacy in dogs and cats.
The use of ketamine in clinical practice, including dosage regimens, drug combinations, advantages, disadvantages or limitations, anesthetic-sparing effects, and clinically rele- vant studies, is presented.
The analgesic efficacy of tramadol relies on the activity of cytochrome P 450 enzymes to produce its active metabolites (ie, O-desmethyltramadol). Dogs produce less concentra- tions of this metabolite and tramadol’s efficacy has been questioned in this species.
The use of tramadol in dogs should be judicious. Veterinarians should know the potential for analgesic failure and the clinical limitations of the drug in pain management.

2/ Alternatives to Opioid Analgesia in Small Animal Anesthesia: Alpha-2 Agonists

Alexander Valverde, DVM, DVSca,*, Alicia M. Skelding, DVM, MSc, DVScb

KEY POINTS

The sedation induced by alpha-2 agonists confounds the interpretation of analgesic ef- fects but is also a part of the general analgesic effect that involves supraspinal and spinal mechanisms.
Low systemic single doses can minimize sedative effects and provide analgesia, but it tends to be of short duration.
Alternatively, specific administration of low doses at the site of action (eg, spinal cord)can provide analgesia of longer duration with minimal sedation.