Comparison of Intraoperative Nociception and Postoperative Acute Pain After Traditional or Minimally Invasive Ovariohysterectomy in Dogs
Background: Many variations of ovariohysterectomy techniques have been described, including the traditional one and minimally invasive procedures. Non-laparoscopic Snook hook technique is an alternative for performing minimally invasive ovariohysterectomy. Few studies have been carried out in order to assess pain in animals submitted to minimally invasive surgeries, especially involving one of the most performed surgical procedures in veterinary practice. The aim of this study was to evaluate surgical duration, intraoperative nociception and acute postoperative pain after traditional ovariohysterectomy or minimally invasive non-laparoscopic technique in dogs using Snook hook. The hypothesis is that non-laparoscopic minimally invasive ovariohysterectomy would be faster and less painful than the conventional technique.
Material, Methods & Results: Thirty dogs were divided into Traditional Group (TG = 15) and Minimally Invasive Group (MIG = 15). Heart rate, respiratory rate, systolic blood pressure, body temperature, oxyhemoglobin saturation, end-tidal carbon dioxide concentration (ETCO2) and end-tidal isoflurane concentration were evaluated before the surgery to start (M0), during incision (M1), clamping of the first ovarian pedicle (M2), second ovarian pedicle (M3), uterine cervix (M4), abdominal suture (M5) and at the end of surgery (M6). The modified Glasgow Pain Scale was used for acute postoperative pain assessment and Visual Analogue Scale (VAS) was used to assess the sensitivity of surgical wound. The level of significance established for all statistical analyzes was 5%. Statistical differences were not observed between groups considering total surgical time and postoperative acute pain intensity (P > 0.05), in spite of MIG having shorter duration of surgery. There was no statistical difference between groups considering all intraoperative parameters except respiratory rate (TG < MIG; P < 0.05) and ETCO2 (MIG < TG; P < 0.05) at the moment of traction of the first ovarian pedicle (M2). Pain assessment by VAS showed statistical difference 24h after the end of surgery (TG < MIG) (P < 0.05).
Discussion: Both procedures were similar regarding intraoperative nociception and acute postoperative pain. It is possible that the sensation of pain in both procedures was blocked by the effectiveness of analgesics, once they might cause an inhibition of painful behaviors limiting a possible difference in pain identification. Higher respiratory stress observed in MIG at M2 and higher pain score by VAS noted in MIG 24 h after the end of surgery can be justified by greater traction of ovarian pedicle, due to limited surgical access of minimally invasive technique. Minimally invasive ovariohysterectomy non-laparoscopic seems to be potentially faster, probably due to the smaller size of the abdominal incision, which takes less time to be closed. In the present study, both techniques were performed by an experienced surgeon, providing safe procedures, nevertheless it is important to emphasize that iatrogenic injury can be caused by surgeons not proficient in the Snook hook technique, considering the limited visualization of anatomical abdominal structures. Data obtained indicate that traditional ovariohysterectomy and non-laparoscopic Snook hook technique promote similar intraoperative nociception and acute postoperative pain, however minimally invasive procedure is potentially faster and with less surgical trauma.
Adin C.A. 2011. Complications of ovariohysterectomy and orchiectomy in companion animals. Veterinary Clinics: Small Animal Practice. 41(5): 1023-1039.
Al-gizawiy M.M. & Rudé E.P. 2004. Comparison of preoperative carprofen and postoperative butorphanol as postsurgical analgesics in cats undergoing ovariohysterectomy. Veterinary Anaesthesia and Analgesia. 31(3): 164-174.
Burrow R., Batchelor D. & Cripps P. 2005. Complications observed during and after ovariohysterectomy of 142 bitches at a veterinary teaching hospital. Veterinary Record. 157(26): 829-833.
Brondani J.T., Luna S.P.L. & Padovani C.R. 2011. Refinement and initial validation of a multidimensional composite scale for use in assessing acute postoperative pain in cats. American Journal of Veterinary Research. 72(2): 174-183.
Brondani J.T., Luna S.P.L., Minto B.W., Santos B.P.R., Beier S.L., Matsubara L.M. & Padovani C.R. 2013. Reliability and cut-off point related to the analgesic intervention of a multidimensional composite scale to assess postoperative pain in cats. Brazilian Journal of Veterinary and Animal Sciences. 65(1): 153-162.
Campagnol D., Teixeira Neto F.J., Monteiro E.R., Restitutti F. & Minto B.W. 2012. Effect of intraperitoneal or incisional bupivacaine on pain and the analgesic requirement after ovariohysterectomy in dogs. Veterinary Anaesthesia and Analgesia. 39(4): 426-430.
Cheng H., Chen B.P.H., Soleas I.M., Ferko N.C., Cameron C.G. & Hinoul P. 2017. Prolonged operative duration increases risk of surgical site infections: a systematic review. Surgical infections. 18(6): 722-735.
Corriveau K.M., Giuffrida M.A., Mayhew P.D. & Runge J.J. 2017. Outcome of laparoscopic ovariectomy and laparoscopic-assisted ovariohysterectomy in dogs: 278 cases (2003–2013). Journal of the American Veterinary Medical Association. 251(4): 443-450.
Coutinho A.F.O.S.V. 2012. Subjectivity on animal pain assessment. 79f. Lisboa, Portugal. Dissertation (Integrated Master in Veterinary Medicine) - Faculty of Veterinary Medicine, Technical University of Lisbon.
Coutinho A.J., Gasser B., Rodriguez M.G.K., Uscategui R.A.R., Santos V.J.C., Tiosso C.D.F., Barros F.F.P.C & Toniollo G.H. 2018. Comparison between single port videolaparoscopy and miniceliotomy with snock hook ovariohysterectomy techniques in bitches. Ciência Rural. 48(10): 1-9.
Devitt C.M., Cox R.E. & Hailey J.J. 2005. Duration, complications, stress, and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs. Journal of the American Veterinary Medical Association. 227(6): 921-927.
Fransson B.A. 2018. Ovaries and Uterus. In: Johnston S.A. & Tobias K.M. (Eds). Veterinary Surgery Small Animal. 2nd edn. St. Louis: Elsevier, pp.4893-4896.
Hancock R.B., Lanz O.I., Waldron D.R., Duncan R.B., Broadstone R.V. & Hendrix P.K. 2005. Comparison of postoperative pain after ovariohysterectomy by harmonic scalpel-assisted laparoscopy compared with median celiotomy and ligation in dogs. Veterinary Surgery. 34(3): 273-282.
Haskins S.C. 1996. Monitoring the anesthetized patient. In: Thurmon J.C., Tranqulli W.J. & Benson G.J. (Eds). Lumb & Jones’ veterinary anesthesia. 3rd edn. Baltimore: Lea & Febiger Book, pp.409-424.
Hellyer P., Rodan I., Brunt J., Downing R., Hagedorn J.E. & Robertson S.A. 2007. AAHA/AAFP pain management guidelines for dogs and cats. Journal of Feline Medicine & Surgery. 9(6): 466-480.
Jacobsen S., Jensen J.C., Frei S., Jensen A.L. & Thoefner M.B. 2005. Use of serum amyloid A and other acute phase reactants to monitor the inflammatory response after castration in horses: a field study. Equine Veterinary Journal. 37(6): 552-556.
Khalaj A., Bakhtiari J. & Niasari-Naslajl A. 2012. Comparison between single and three portal laparoscopic splenectomy in dogs. BMC Veterinary Research. 8(161): 1-4.
Lamont L.A., Tranquilli W.J. & Grimm K.A. 2000. Physiology of pain. Veterinary Clinics of North America: Small Animal Practice. 30(4): 703-728.
Mayhew P.D., Freeman L., Kwant T. & Brown D.C. 2012. Comparison of surgical site infection rates in clean and clean-contaminated wounds in dogs and cats after minimally invasive versus open surgery: 179 cases (2007–2008). Journal of the American Veterinary Medical Association. 240(2): 193-198.
Moon R.E. 1990. Respiratory monitoring. In: Miller R.D. (Ed). Anesthesia. 4th edn. New York: Churchill Livingstone, pp.1129-1163.
Mifilari R. & Vuono R.S. 2000. Ováriosalpingohisterectomia em cadelas e gatas: proposta de novos procedimentos. Revista de Educação Continuada CRMV-SP. 3(3): 28-32.
Murrel J.C., Psatha E.P., Scott E.M., Reid J. & Hellebrekers L.J. 2008. Application of a modified form of the Glasgow Pain Scale in a veterinary teaching center in the Netherlands. Veterinary Record. 162(13): 403-408.
Peeters M.E. & Kirpensteijn J. 2011. Comparison of surgical variables and short-term postoperative complications in healthy dogs undergoing ovariohysterectomy or ovariectomy. Journal of American Veterinary Medical Association. 238(2): 189-194.
Preckel B., Mullenhem J., Hoff J., Obal D., Heiderhoff M., Thamer V. & Schlack W. 2004. Haemodynamic changes during halothane, sevoflurane and desflurane anaesthesia in dogs before and after the induction of severe heart failure. European Journal Anaesthology. 21(10): 797-806.
Quessada A.M., Sousa A.A.R., Costa A.P.R., Sousa A.A.S. & Rocha R.R.C. 2009. Comparison among ovariohysterectomy techniques in bitches. Acta Scientiae Veterinariae. 37(3): 253-258.
Souza F.W., Brun M.V., Oliveira M.T., Feranti J.P.S., Corrêa R.K.R., Idalêncio R., Duda N.C.B., Quadros A.M. & Huppes R.R. 2014. Ovariohysterectomy for videosurgery (hybrid vaginal NOTES), celiotomy or mini-celiotomy in bitches. Ciência Rural. 44(3): 510-516.
Spain C.V., Scarlett J.M. & Houpt K.A. 2004. Long-term risks and benefits of early-age gonadectomy in dogs. Journal of the American Veterinary Medical Association. 224(3): 380-387.
Steagali P.V.M., Taylor P.M., Rodrigues L.C.C., Ferreira T.H., Minto B.W. & Aguiar A.J. 2009. Analgesia for cats after ovariohysterectomy with either buprenorphine or carprofen alone or in combination. Veterinary Record. 164(12): 359-363.
Teixeira Neto F.J., Carregaro A.B., Mannarino R., Cruz M.L. & Luna S.P. 2002. Comparison of sidestream capnograph and a mainstream capnograph in mechanically ventilated dogs. Journal of the American Veterinary Medical Association. 221(11): 1582-1585.
How to Cite
This journal provides open access to all of its content on the principle that making research freely available to the public supports a greater global exchange of knowledge. Such access is associated with increased readership and increased citation of an author's work. For more information on this approach, see the Public Knowledge Project and Directory of Open Access Journals.
We define open access journals as journals that use a funding model that does not charge readers or their institutions for access. From the BOAI definition of "open access" we take the right of users to "read, download, copy, distribute, print, search, or link to the full texts of these articles" as mandatory for a journal to be included in the directory.
La Red y Portal Iberoamericano de Revistas Científicas de Veterinaria de Libre Acceso reúne a las principales publicaciones científicas editadas en España, Portugal, Latino América y otros países del ámbito latino