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Four assessor-blinded randomised controlled trials. Moderate. Two studies found methadone to be associated with significantly lower postoperative pain scores than buprenorphine; one showed significantly different pain scores over the entire 8-hour postoperative period and one only at 10 minutes postextubation. One study found buprenorphine to be associated with lower postoperative pain scores at some time points postsurgery. One study found no significant difference in pain scores between methadone and buprenorphine. It can be concluded that using methadone in the anaesthetic protocol may provide better analgesia for cats undergoing ovariohysterectomy compared to buprenorphine. The two papers that used validated pain scoring both concluded that methadone was associated with lower pain scores at some points postoperatively. Although one of the studies concluded that buprenorphine is associated with lower postoperative pain scores, this paper provides only very weak evidence because an unvalidated pain scoring method was used. More evidence is needed to confidently recommend using one opioid over another. [ABSTRACT FROM AUTHOR]

Question In female cats undergoing routine ovariohysterectomy, is using methadone in the anaesthetic protocol associated with lower post-operative pain scores, compared to buprenorphine? Clinical bottom line The category of research question was: Treatment. The number and type of study designs that were critically appraised were: Four assessor-blinded randomised controlled trials. Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation: Moderate. The outcomes reported are summarised as follows… Two studies found methadone to be associated with significantly lower postoperative pain scores than buprenorphine; one showed significantly different pain scores over the entire 8-hour postoperative period and one only at 10 minutes postextubation. One study found buprenorphine to be associated with lower postoperative pain scores at some time points postsurgery. One study found no significant difference in pain scores between methadone and buprenorphine. In view of the strength of evidence and the outcomes from the studies the following conclusion is made… It can be concluded that using methadone in the anaesthetic protocol may provide better analgesia for cats undergoing ovariohysterectomy compared to buprenorphine. The two papers that used validated pain scoring both concluded that methadone was associated with lower pain scores at some points postoperatively. Although one of the studies concluded that buprenorphine is associated with lower postoperative pain scores, this paper provides only very weak evidence because an unvalidated pain scoring method was used. More evidence is needed to confidently recommend using one opioid over another.

PICO question In cats undergoing midline ovariohysterectomy, is the use of local anaesthesia with bupivacaine via intraperitoneal or subcutaneous injections, in comparison with the use of a control substance or other analgesic measure, associated with a reduction in postoperative pain score? Clinical bottom line The category of research question: Treatment. The number and type of study designs that were critically appraised: Three studies were critically appraised in this Knowledge Summary. They included two prospective, blinded, randomised, controlled clinical trials and one prospective randomised, blinded clinical trial. Strength of evidence: Weak. The outcomes reported: Bupivacaine does not eliminate postoperative pain in cats undergoing ovariohysterectomies; minimal evidence was found to suggest that it was better at reducing postoperative pain scores in comparison to other analgesics. However, bupivacaine may provide analgesic benefits to cats when administered via intraperitoneal or subcutaneous injections as local anaesthesia and in combination with other analgesic agents. The need for postoperative rescue analgesia was minimised when bupivacaine was administered prior to or during the ovariohysterectomy. Conclusion: When compared to a control, pain scores for the participating cats were lower after administration of bupivacaine, however, statistical significance was only reached in one of the studies. Additionally, other medications were found to lower the post operative pain score to a greater effect. However, bupivacaine administration is cheap and simple to perform, so it’s use as part of a multimodal analgesic protocol is supported. Confounding factors within the studies may have altered the perceived effectiveness of the analgesic properties of bupivacaine though, so further investigation involving larger cohorts with standardised controls would be prudent. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Gonadectomy in dogs is associated with changes in risks of a variety of non-infectious health conditions, but few studies have examined its effects on infectious disease outcomes. The objectives of our study were to estimate the causal effect of gonadectomy on the incidence rate of babesiosis diagnosis, and on the risk of severe babesiosis in diagnosed cases, in dogs 6 months and older seen at a veterinary academic hospital in South Africa from 2013 through 2020. To estimate the effect of gonadectomy on the incidence rate of babesiosis diagnosis in dogs, we conducted a case-control study with incidence density sampling of dogs seen through the hospital's primary care service, adjusting for sex, age, breed category and weight. We identified 811 cases and selected 3244 time-matched controls. To estimate the effect of gonadectomy on disease severity in dogs with babesiosis, we conducted a retrospective cohort study among all dogs with a diagnosis of babesiosis (n=923), including these 811 cases and a further 112 referred to the hospital, also adjusting for sex, age, breed category and weight. Gonadectomy substantially reduced the incidence rate of babesiosis (total effect incidence rate ratio [IRR] 0.5; 95 % confidence interval [CI] 0.41–0.60) and the risk of severe babesiosis among diagnosed dogs (total effect risk ratio [RR] 0.72; 95 % CI 0.60–0.86). Tipping point sensitivity analysis shows that these effect estimates are robust to unmeasured confounding bias. There was no evidence for modification of the effect of gonadectomy by sex, with effect estimates qualitatively similar for males and females for both outcomes. Compared to females, males had a higher incidence rate of babesiosis (IRR 1.74; 95 % CI 1.49–2.04) and a higher risk of severe disease (RR 1.12; 95 % CI 0.98–1.28). In conclusion, our study shows a robust protective effect of gonadectomy on the incidence and severity of babesiosis in both male and female dogs 6 months of age and older, and contributes important evidence to the debate on the overall risks and benefits of gonadectomy to dogs in this population. • Gonadectomy reduced the incidence rate of babesiosis in male and female dogs. • Gonadectomy also reduced the risk of severe babesiosis in both sexes. • We used a causal inference approach including DAGs for confounder adjustment. • Effect estimates were robust to unmeasured confounding and misclassification bias. [ABSTRACT FROM AUTHOR]

PICO question In female dogs undergoing elective neutering via midline coeliotomy is ovariectomy superior to ovariohysterectomy in terms of anaesthetic duration, incision length, complications and postoperative pain? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed The number and type of study designs that were critically appraised were four prospective clinical trials (Peeters et al., 2011; Lee at al., 2013; Harris et al., 2013; and Tallant et al., 2016) and a retrospective cohort study (Okkens et al., 1997) Strength of evidence Critical appraisal of the selected papers meeting the inclusion criteria collectively provide weak evidence in terms of their experimental design and implementation Outcomes reported Okkens et al. (1997) found no occurrence of pyometra/endometritis in 135 dogs receiving ovariectomy (OVE) or ovariohysterectomy (OVH) over an 8–11 year follow-up period. This study also reported no significant difference in long-term postoperative complications in either group. Of the four prospective clinical trials one (Harris et al., 2013) had final year vet students perform the surgeries. This study found no difference in incision length, surgical time or incidence of intra-operative complications between techniques. However the relevance of this study to procedures performed by qualified veterinary surgeons is questionable. The remaining papers all evaluated incision length, surgical time and postoperative pain after surgeries performed by experienced vets. All three found mean incision length was shorter in the OVE group and two (Lee et al., 2013; and Tallant et al., 2016) found that surgical duration was shorter in the OVE group. Only one paper (Lee et al., 2013) revealed a significant difference in pain scoring between groups, with the OVE group having lower scores at 1, 2, 4 and 6 hours post-surgery. Lee at al. (2013) and Tallant et al. (2016) also recorded intra-operative complications, however none were noted in either group Conclusion In view of the strength of evidence and the outcomes from the studies the following conclusion is made; whilst the evidence does suggest OVE may be associated with some modest improvement in surgical time and incision length, due to the small sample sizes and varying techniques used, further studies are required before definitive conclusions can be made. There is currently insufficient evidence to determine if there is a difference in complication rates or postoperative pain between procedures. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Objectives: The aim of this study was to compare the quality of anaesthesia and analgesia between methadone and buprenorphine in combination with medetomidine after induction with intramuscular (IM) alfaxalone in cats undergoing ovariohysterectomy. Methods: Fifty-one female cats (American Society of Anesthesiologists status I–II), with a median age of 12 months (range 2–60 months), weighing a mean ± SD of 2.5 ± 0.5 kg, were recruited to the study. Cats were randomly allocated to receive medetomidine (600 µg/m2) and buprenorphine (180 µg/m2) (group MB) or medetomidine (500 µg/m2) and methadone (5 mg/m2) (group MM) IM. Anaesthesia was induced 15 mins later using alfaxalone (3 mg/kg) IM. Anaesthesia was maintained with isoflurane in oxygen. All cats received meloxicam preoperatively. Quality of premedication and induction and intraoperative physiological parameters were recorded. Atipamezole (50% of medetomidine dose) was administered at the end of surgery. Cats were assessed postoperatively by the same blinded observer using a simple descriptive scale, numeric rating scale, dynamic interactive visual analogue scale (DIVAS) and UNESP-Botucatu multidimensional composite pain scales, at 10, 20 and 30 mins post-extubation. Parametric and non-parametric data were compared using Student's t -test or Mann–Whitney U-tests, respectively. Results: Forty-one cats completed the study. No significant differences were detected between groups before or during anaesthesia. No cats required rescue analgesia. DIVAS scores at 10 mins were significantly less in the MM group compared with the MB. No differences between groups at any other time points were detected using the four metrology instruments. Conclusions and relevance: Both protocols provided good anaesthesia conditions for ovariohysterectomy in the cat. [ABSTRACT FROM AUTHOR]

Background: Ligation of the mesovarium in female dogs may be cumbersome with risk of complications and is associated with intense noxious stimuli. A resorbable implant, a self-locking loop designed for surgery, was developed as an alternative to traditional ligation. The study aimed to test the feasibility of ligating the canine ovarian pedicle with the implant and to compare its performance to traditional suture ligation. Results: In total 45 intact female dogs destined for elective ovariohysterectomy and adoption were included. In 21 dogs the new resorbable implant was used to ligate the mesovarium, and in 24 control dogs traditional suture was used with one encircling ligature. Mean weight of implant dogs was 10.7 ± 5.6 kg (range 3.5-22.0), and mean weight of control dogs was 12.8 ± 6.4 kg, (range 4.1-27.0). The body weight of dogs did not differ between groups (P = 0.25). In total, 42 ovarian pedicles were successfully ligated with the implant. In one control dog, intraoperative haemorrhage from the left ovarian pedicle was diagnosed. The mesovarium was re-ligated and haemostasis was confirmed. All dogs recovered uneventfully. The ligation time of the mesovarium was significantly shortened (P = 0.02) by using the self-locking implant versus a single ligature (3'28'' ± 1'05'' and 5'29'' ± 3'54'', respectively). Total duration of surgery differed between the groups (P = 0.02) with a shortened duration of surgery when using the self-locking implant (15'56'' ± 2'47'' and 20'39'' ± 8'58'', study group versus control group, respectively). In both groups, duration of surgery and time required to ligate the ovarian pedicle were longer in larger dogs than smaller dogs. Conclusion: The results of this feasibility study suggested the implant can be used to ligate the canine mesovarium. Compared with traditional suture ligation, the results suggested that time to ligate the ovarian pedicle and duration of surgery were significantly reduced with the implant. More time was required to perform surgeries in larger dogs. [ABSTRACT FROM AUTHOR]

In the bitch, surgical sterilisation can be achieved by a number of different methods. Ovariohysterectomy via a midline coeliotomy is the method traditionally used in the UK. An alternative to ovariohysterectomy, which is being used more widely, is laparoscopic ovariectomy (LapOVE). Laparoscopic surgery involves the introduction of a camera and specialised instruments into the abdomen through small incisions, and is routinely used in human medicine. The benefits of laparoscopy include a faster return to normal activity and decreased post-operative pain, as well as a lower risk of haemorrhage and other recognised complications. Some complications, such as gas embolism and increased arterial CO[sub 2] levels, are specific to laparoscopy. Laparoscopy requires specialist equipment which carries a high start-up cost; this can deter many practitioners from offering it to their clients. In addition, significant increases in surgical time are documented with LapOVE. Due to the risk of complications and the specialist equipment required, it is imperative that veterinary nurses have complete and up-to-date knowledge regarding laparoscopic neutering in order to provide the best possible patient care. [ABSTRACT FROM AUTHOR]

The postoperative analgesic effect of Arnica montana (Arnica) was compared to morphine and ketoprofen in 50 cats following hysterectomy with bilateral salpingo-oophorectomy (HSO). Cats were randomly allocated to five groups (n=10) and were treated 30 minutes before surgery and over 72 hours with 1ml of Arnica 30x per subcutaneous (SC) route (GA30SC); Arnica 30x per oral transmucosal route (P.O.) (GA30PO); Arnica 6x P.O. (GA6PO); morphine 0.1mg kg-1 SC (GM) SID or ketoprofen 2mg kg-1 SC (GK) before and 1mg kg-1 after surgery. Sedation and postoperative pain were assessed by means of a dynamic and interactive visual analogue scale (DIVAS) and variable count scale (VCS) and hyperalgesia using an esthesiometer. Whenever the VAS and VCS scores attained 33% of the maximum value, rescue analgesia was performed with morphine 0.3mg kg-1 per the intramuscular (IM) route. Other variables assessed were vomiting, defecation, urination, body weight and wound healing. Vomiting only occurred in animals treated with morphine. The groups did not differ in defecation, urination, body weight or wound healing. Hyperalgesia was detected only on the occasions that the criterion for rescue analgesia was met. One animal in GK and one in GM required rescue analgesia, differing from groups GA30SC, GA30PO and GA6PO, in which 4, 4 and 5 animals, respectively, required rescue analgesia. It can be concluded that ketoprofen and morphine were more efficacious than Arnica and that there was no difference among the various potencies and routes of administration of Arnica for postoperative analgesia in cats undergoing HSO. [ABSTRACT FROM AUTHOR]

The article discusses the ovariohysterectomy performed on three sexually mature female vampire bats (Desmodus rotundus) which were housed at the North Carolina Zoological Park. It notes that a ventral midline incision was performed into the abdominal cavity following the induction of isoflurane anesthetic gas. The surgeon who was wearing magnificent loop glasses was using simple micro-ophthalmic surgical packs and hemoclips in performing the surgical operation. The animals recovered with minimal adverse effects and were housed in a recovery chamber. Meloxicam was placed in their blood meal once daily for 1 week postoperatively.

• Ligation caudal to the cervix allowed for complete resection of glandular tissues. • Ligation at the proper ligament resulted in incomplete resection in 50 % of the samples. • Further research into the surgical technique should be pursued prior to its widespread use. Gonadectomies are the most commonly performed surgical procedures in dogs. The benefits and risks associated with gonadectomy in dogs have been broadly investigated. Due to concerns associated with ovariectomy, some pet-owners and veterinarians are considering surgical alternatives which terminate the capacity for reproduction without removal of the gonads to preserve functions of the gonadal hormones. The objective of this study was to determine the feasibility of complete resection of the glandular portion of the uterus with hysterectomy (HE). Using a prospective cadaveric and an ex-vivo design, uterine resection was performed cranially and caudally to the cervix, and at the proper ligament to simulate routine ovariohysterectomy and HE. Using microscopic evaluation procedures, there was identification of glandular tissue at the surgical margin of all samples resected cranially to the cervix and no glandular tissue in the samples resected caudally to the cervix. Half of the samples from the uterine horns contained glandular tissue. The results of the present study indicate ligation and transection of the uterus caudally to the cervix (as recommended for HE) allows for complete resection of glandular tissues, however, transection at the proper ligament may not. The clinical relevance of retention of para-ovarian uterine glandular tissue is unknown. Additional research is needed where there is investigation of the consequences and surgical technique for HE before there is widespread clinical use of this procedure. [ABSTRACT FROM AUTHOR]