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Agreement among anesthesiologists regarding postoperative pain assessment in dogs

      Abstract

      Objective

      To establish evidence for the validity and reliability of three commonly used pain scales in dogs when assessed by video by specialists in anesthesia.

      Study design

      Mixed-method test–retest observational study.

      Subjects

      A group of six American College of Veterinary Anesthesia and Analgesia board-certified specialists and 31 postoperative dogs.

      Methods

      The evaluators scored 31 dogs using a visual analogue scale (VAS), numeric rating scale (NRS), and Glasgow pain scale (GPS). The evaluators individually scored the dogs using all three scales together and subsequently, at 3 month intervals, using each of the scales apart. Then, all evaluators in one room reviewed 23 of the videos. A camera was positioned for video and audio recording of discussion about the videos. Intra- and interobserver reliability was determined using a two-way random model intra-class correlation coefficient (ICC).

      Results

      Linear regression indicated a strong correlation among all scales when assigned together (VAS versus NRS, p < 0.0001, R2 = 0.93; VAS versus GPS, p < 0.0001, R2 = 0.59; and NRS versus GPS, p < 0.0001, R2 = 0.61) and apart (VAS versus NRS, p < 0.0001, R2 = 0.68; VAS versus GPS, p < 0.0001, R2 = 0.40; and NRS versus GPS, p < 0.0001, R2 = 0.47). Posture, appearance, vocalization, stiffness, interaction between the animal and a person and response to palpation were identified as important variables for assessing pain. Intra-observer reliability produced average ICC values of 0.90 for VAS, 0.89 for NRS and 0.85 for GPS. Interobserver reliability produced average ICC values when scores were assigned together (VAS: 0.93, NRS: 0.93 and GPS: 0.93) and when done separately (VAS: 0.91, NRS: 0.93 and GPS: 0.95).

      Conclusions and clinical relevance

      The preferred use of the VAS and NRS over the use of the GPS should be cautiously considered for research applications when experts are observers. Revisions of the GPS to clarify descriptors and remove or modify items that may not be associated with pain in dogs should be considered.

      Keywords

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      References

        • Adami C.
        • Veres-Nyéki K.
        • Spadavecchia C.
        • et al.
        Evaluation of peri-operative epidural analgesia with ropivacaine, ropivacaine and sufentanil, and ropivacaine, sufentanil and epinephrine in isoflurane anesthetized dogs undergoing tibial plateau levelling osteotomy.
        Vet J. 2012; 194: 229-234
        • American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, & Joint Committee on Standards for Educational and Psychological Testing
        Standards for educational and psychological testing.
        AERA, Washington, DC2014
        • Barletta M.
        • Young C.N.
        • Quandt J.E.
        • Hofmeister E.H.
        Agreement between veterinary students and anesthesiologists regarding postoperative pain assessment in dogs.
        Vet Anaesth Analg. 2016; 43: 91-98
        • Bergmann H.M.
        • Nolte I.
        • Kramer S.
        Comparison of analgesic efficacy of preoperative or postoperative carprofen with or without preincisional mepivacaine epidural anesthesia in canine pelvic or femoral fracture repair.
        Vet Surg. 2007; 36: 623-632
        • Brod M.
        • Tesler L.E.
        • Christensen T.L.
        Qualitative research and content validity: developing best practices based on science and experience.
        Qual Life Res. 2009; 18: 1263-1278
        • Carsten R.E.
        • Hellyer P.W.
        • Bachand A.M.
        • LaRue S.M.
        Correlations between acute radiation scores and pain scores in canine radiation patients with cancer of the forelimb.
        Vet Anaesth Analg. 2008; 35: 355-362
        • Davila D.
        • Keeshen T.P.
        • Evans R.B.
        • Conzemius M.G.
        Comparison of the analgesic efficacy of perioperative firocoxib and tramadol administration in dogs undergoing tibial plateau leveling osteotomy.
        J Am Vet Med Assoc. 2013; 243: 225-231
        • Friton G.
        • Thompson C.M.
        • Karadzovska D.
        • et al.
        Efficacy and safety of oral robenacoxib (tablet) for the treatment of pain associated with soft tissue surgery in client-owned dogs.
        BMC Vet Res. 2017; 13: 197
        • Guillot M.
        • Rialland P.
        • Nadeau M.È.
        • et al.
        Pain induced by a minor medical procedure (bone marrow aspiration) in dogs: comparison of pain scales in a pilot study.
        J Vet Intern Med. 2011; 25: 1050-1056
        • Holton L.
        • Reid J.
        • Scott E.M.
        • et al.
        Development of a behaviour-based scale to measure acute pain in dogs.
        Vet Rec. 2001; 148: 525-531
        • Holton L.L.
        • Scott E.M.
        • Nolan A.M.
        • et al.
        Comparison of three methods used for assessment of pain in dogs.
        J Am Vet Med Assoc. 1998; 212: 61-66
        • Moran C.E.
        • Hofmeister E.H.
        Prevalence of pain in a university veterinary intensive care unit.
        J Vet Emerg Crit Care (San Antonio). 2013; 23: 29-36
        • Morton C.M.
        • Reid J.
        • Scott E.M.
        • et al.
        Application of a scaling model to establish and validate an interval level pain scale for assessment of acute pain in dogs.
        Am J Vet Res. 2005; 66: 2154-2166
        • Perez T.E.
        • Grubb T.L.
        • Greene S.A.
        • et al.
        Effects of intratesticular injection of bupivacaine and epidural administration of morphine in dogs undergoing castration.
        J Am Vet Med Assoc. 2013; 242: 631-642
        • Rothman M.
        • Burke L.
        • Erickson P.
        • et al.
        Use of existing patient-reported outcome (PRO) instruments and their modification: the ISPOR good research practices for evaluating and documenting content validity for the use of existing instruments and their modification PRO Task Force report.
        Value Health. 2009; 12: 1075-1083