https://veterinaryevidence.org/index.php/ve/issue/feed Veterinary Evidence 2021-09-16T16:41:02+01:00 Jennifer Morris editor@veterinaryevidence.org Open Journal Systems Veterinary Evidence is an online only, open access, peer-reviewed journal owned and published by RCVS Knowledge. It publishes content relating to evidence-based veterinary medicine (EBVM) and its application in veterinary practice to enhance the quality of care provided to patients. https://veterinaryevidence.org/index.php/ve/article/view/402 Do papillomaviruses cause feline cutaneous squamous cell carcinoma? 2021-09-16T16:41:02+01:00 Alexander Teh alexander.j.teh@gmail.com Mark Krockenberger mark.krockenberger@sydney.edu.au <p><strong>PICO question</strong></p> <p>In cats infected with papillomavirus, is the risk of developing&nbsp;feline cutaneous squamous cell carcinoma greater than cats that are not infected with papillomavirus?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Risk</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Eleven papers were critically reviewed, nine were case-control studies and two were experimental in vitro studies</p> <p><strong>Strength of evidence</strong></p> <p>Moderate</p> <p><strong>Outcomes reported</strong></p> <p>Infection of feline epithelial skin cells with <em>Felis catus </em>papillomavirus type 2 (FcaPV-2) is a risk factor for the development of feline cutaneous squamous cell carcinoma. The pathogenesis of FcaPV-2 infection and neoplastic transformation into malignant cells shares similar pathways to the human papillomavirus (HPV) model of pathogenesis and carcinogenesis with some differences</p> <p><strong>Conclusion</strong></p> <p>In conclusion, there is moderate strength of evidence in the literature to support a role of FcaPV-2 in the development of cutaneous squamous cell carcinomas in cats. Therefore, prevention of infection with FcaPV-2 should prevent some cancers</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="https://learn.rcvsknowledge.org/course/view.php?id=2" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-09-16T15:07:48+01:00 Copyright (c) 2021 Alexander Teh, Mark Krockenberger https://veterinaryevidence.org/index.php/ve/article/view/403 Does turkey tail as an adjuvant therapy improve the quality of life of canine lymphoma patients? 2021-09-10T12:23:54+01:00 Jacqueline Oi Ping Tong jactong48@gmail.com <p><strong>PICO question</strong></p> <p>In canine lymphoma, does the supplement of turkey tail&nbsp;<em>(Trametes versicolor)</em>&nbsp;as an adjuvant therapy lead to a better quality of life than those that do not?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>One prospective case series was critically appraised</p> <p><strong>Strength of evidence</strong></p> <p>Very weak</p> <p><strong>Outcomes reported</strong></p> <p>The case series assessed appetite and activity level of the canine lymphoma patients. They also measured gastrointestinal toxicity and the incidence of neutropenia</p> <p><strong>Conclusion</strong></p> <p>This prospective case series is insufficient to support the use of turkey tail to enhance the quality of life of canine lymphoma patients. A controlled study is required to evaluate whether the use of turkey tail supplement is useful</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="https://learn.rcvsknowledge.org/course/view.php?id=2" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-09-10T12:18:24+01:00 Copyright (c) 2021 Jacqueline Oi Ping Tong https://veterinaryevidence.org/index.php/ve/article/view/412 Trilostane monitoring in canine hyperadrenocorticism: can basal cortisol measurement replace the ACTH stimulation test? 2021-09-01T15:32:50+01:00 Theodora Tsouloufi theodora.tsouloufi@ed.ac.uk Ioannis Oikonomidis ioannis.oikonomidis@ed.ac.uk <p><strong>PICO question</strong></p> <p>In dogs with hyperadrenocorticism that are being treated with trilostane, does the measurement of basal cortisol levels have comparable diagnostic performance to the adrenocorticotropic hormone (ACTH) stimulation test?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Diagnosis (effectiveness of treatment monitoring)</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Four cross-sectional diagnostic accuracy studies were critically reviewed</p> <p><strong>Strength of evidence</strong></p> <p>Weak to moderate (level 2)</p> <p><strong>Outcomes reported</strong></p> <p>There is evidence of moderate strength suggesting that basal cortisol measured at 4–6 hours (and possibly 2–3 hours) post-trilostane can be a good test to exclude adrenal oversuppression, while its use is not suggested for diagnostic confirmation of oversuppression. There is evidence of weak strength that basal cortisol might be helpful for identifying dogs with inadequate adrenal suppression, but cannot be used to rule it out</p> <p><strong>Conclusion</strong></p> <p>Although the evaluation of the available evidence is difficult due to its heterogeneity, there is moderate evidence that a basal cortisol measured at 4–6 hours (and possibly 2–3 hours) post-trilostane dose can be a good test to rule out adrenal oversuppression, but that it cannot be used to definitively diagnose oversuppression. The current evidence suggests that basal cortisol is less useful for identification of inadequate control. Based on one included study, neither ACTH-stimulated nor basal cortisol levels correlate optimally with the actual clinical response of the patient. In this context, it can be concluded that none of the currently used laboratory tests should be used as a sole monitoring tool in dogs with hyperadrenocorticism receiving trilostane and thus, the assessment of the clinical response is of utmost importance</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="https://learn.rcvsknowledge.org/course/view.php?id=2" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> 2021-09-01T14:39:48+01:00 Copyright (c) 2021 Dr Tsouloufi, Ioannis Oikonomidis https://veterinaryevidence.org/index.php/ve/article/view/439 Are glucocorticoids or NSAIDs effective in idiopathic feline urinary tract disease signs than no treatment or placebo? 2021-08-12T12:42:55+01:00 Lesca Monica Sofyan lesca.sofyan.xx@hotmail.com <p><strong>PICO question</strong></p> <p>In cats with idiopathic feline urinary tract disease (FLUTD), are glucocorticoid or non-steroidal anti-inflammatory drugs more effective than placebo or no treatment in reducing clinical signs attributable to cystitis?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Three randomised controlled trials have examined the efficacy of prednisolone or non-steroidal anti-inflammatory drugs (NSAIDs) in reducing the clinical signs of feline lower urinary tract disease compared to a placebo whilst one retrospective cohort study compared the reoccurrence of FLUTD in cats treated with meloxicam and without meloxicam</p> <p><strong>Strength of evidence</strong></p> <p>Weak</p> <p><strong>Outcomes reported</strong></p> <p>One small controlled trial compared prednisolone to a placebo and found no clinical differences in dysuria, microscopic haematuria, and occult blood for cats diagnosed with idiopathic non-obstructive feline lower urinary tract disease (FLUTD) hospitalised for 10 days. The study however had a very small sample size. Furthermore, the external validity of the study to similar patients discharged to their home environment is unclear.</p> <p>The second small controlled trial compared meloxicam to a placebo in cats diagnosed with obstructive FLUTD. Statistical analysis was applied to determine if there were significant differences in voiding behaviour, general demeanour, haematuria, food intake and abdominal pain as assessed by the veterinarians in charge during hospitalisation and owners at discharge. No statistically significant differences (P&gt;0.05) were calculated between the two treatment groups based on the owner questionnaire and veterinarian assessment but small samples in each treatment probably limited statistical power.</p> <p>The third small controlled trial compared the reoccurrence of feline idiopathic cystitis (FIC), related clinical signs and recurrent urinary obstruction in cats at 10 days, 1, 2 and 6 months after discharge when treated with phenoxybenzamine and alprazolam, with or without the addition of meloxicam. No statistically significant differences were found in the reoccurrence of obstructed or non-obstructed FIC for cats treated with either meloxicam or no meloxicam. However, full details of each intervention group were not sufficient to assess for balance of prognostic factors, subjective scoring of clinical signs was not detailed, and the study was underpowered for the actual obstruction rates reported.</p> <p>The fourth paper was a retrospective cohort study that examined the association of different treatment factors with 30 days reobstruction. The study found no significant association between the use of meloxicam and the rate of reobstruction but a number of confounders were present</p> <p><strong>Conclusion</strong></p> <p>Three small randomised controlled trials and a single retrospective cohort study failed to find a significant association between the use of glucocorticoids or NSAIDs with severity of FLUTD clinical signs or risk of reobstruction. Clinical outcome measures were heterogeneous and studies were significantly underpowered and/or at risk for bias and/or confounding. There is insufficient evidence to recommend the use of either drug category in decreasing time to resolution or severity of clinical signs in cases of idiopathic FLUTD or FIC</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="https://learn.rcvsknowledge.org/course/view.php?id=2" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-08-12T12:34:41+01:00 Copyright (c) 2021 Lesca Monica Sofyan https://veterinaryevidence.org/index.php/ve/article/view/407 Insulin choice in feline diabetes mellitus 2021-08-06T18:57:11+01:00 Yaiza Gomez Mejias yaizagomezmejias@yahoo.co.uk <p><strong>PICO question</strong></p> <p>In cats with diabetes mellitus, do protamine zinc insulin (PZI) and glargine show a similar effect in reducing clinical signs and hypoglycaemia episodes?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>The number and type of study designs that were critically appraised was one. This study was a non-randomised retrospective trial. A systematic review was also found, which analyses the influence of insulin in diabetic remission</p> <p><strong>Strength of evidence</strong></p> <p>Weak</p> <p><strong>Outcomes reported</strong></p> <p>Compared to PZI, using glargine in recently diagnosed diabetic cats fed exclusively an ultra-low carbohydrate-high protein canned diet, may result in lower fructosamine and mean 12 hour blood glucose concentrations as well as less episodes of hypoglycaemia</p> <p><strong>Conclusion</strong></p> <p>In view of the strength of evidence and the outcomes from the study the following conclusion is made: in cats with diabetes mellitus where currently licensed insulin fails to result in a good glycaemic control, glargine may be considered</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-08-06T18:52:21+01:00 Copyright (c) 2021 Yaiza Gomez Mejias https://veterinaryevidence.org/index.php/ve/article/view/462 Tail docking and castrating lambs: does the administration of local anaesthetic or meloxicam reduce the pain response exhibited? 2021-07-30T10:50:40+01:00 Evangeline Dunthorne edunthorne13@gmail.com <p><strong>PICO question</strong></p> <p>In healthy lambs, does the administration of local anaesthetic reduce the pain response after castration and tail docking compared to the administration of meloxicam?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Three prospective randomised clinical trials (RCT) and one clinical trial without stated randomisation were critically reviewed</p> <p><strong>Strength of evidence</strong></p> <p>Moderate to strong evidence in terms of their experimental design due to having three RTCs which are all relatively recent research. However, their implementation is moderate to weak as they fail to prove the hypothesis</p> <p><strong>Outcomes reported</strong></p> <p>In all four studies there was improvement in the pain related behaviours post administration of anaesthesia or analgesia. There is conflicting evidence on meloxicam’s efficacy, but this could be a result of time spent observing outcomes, which relates to the drugs onset of action and time of peak concentration. Lidocaine has consistently shown a reduction in acute abnormal behaviours irrespective of equipment used</p> <p><strong>Conclusion</strong></p> <p>Based on the studies appraised in this Knowledge Summary there is not enough evidence to determine whether local anaesthesia is more effective than meloxicam at reducing the pain exhibited by lambs undergoing castration or tail docking. It has been shown that the use of local anaesthesia in the form of injectable lidocaine will reduce acute pain displayed during marking but there remains conflicting evidence for meloxicam with likely benefits occurring after several hours</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-07-30T10:44:10+01:00 Copyright (c) 2021 Evangeline Dunthorne https://veterinaryevidence.org/index.php/ve/article/view/372 Should doses exceeding 0.2 mg/kg of oral meloxicam be given to reduce surgical recovery time in rabbits and should twice daily administration be considered? 2021-07-22T14:19:36+01:00 Eleanor Best elliebest1001@gmail.com <p><strong>PICO question</strong></p> <p>In reducing surgical recovery time in rabbits (<em>Oryctolagus cuniculus)</em>, should doses exceeding 0.2 mg/kg of oral meloxicam be given and is twice daily administration more effective than a single daily dose?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Nine papers were critically reviewed, yet no studies were found to directly investigate the effects of twice daily dosing with meloxicam postoperatively in rabbits. There were five descriptive, non-comparative case series; two nonblinded parallel group randomised control trials; one blinded, placebo-controlled parallel group randomised trial and one prospective, randomised crossover trial</p> <p><strong>Strength of evidence</strong></p> <p>Weak</p> <p><strong>Outcomes reported</strong></p> <p>The current recommended oral dose of meloxicam in rabbits of 0.2–0.3 mg/kg once a day was consistently described as inadequate for postoperative analgesia following surgery (Delk et al<em>.</em>, 2014). Instead, higher doses of 1–1.5 mg/kg were required to reach a similar peak plasma concentration as found to be clinically effective in other species, such as canines, and provide a better degree of analgesia in rabbits (Montoya et al<em>.</em>, 2004; and Delk et al., 2014). Although no studies were found evaluating twice daily administration of meloxicam, the available evidence suggests a dose exceeding 0.2–0.3 mg/kg daily is required for adequate postoperative analgesia in rabbits. Whether this increased dose could be given twice daily should be investigated, providing scope for future research</p> <p><strong>Conclusion</strong></p> <p>Further studies are required to directly assess the benefits of twice daily oral meloxicam. However, it is possible that a dose exceeding 0.2–0.3 mg/kg is required and therefore higher doses should be considered in these studies</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-07-22T14:09:59+01:00 Copyright (c) 2021 Eleanor Best https://veterinaryevidence.org/index.php/ve/article/view/525 Erratum to: Does UK licensed NSAID administration reduce signs of postoperative pain in calves castrated without local anaesthesia? 2021-07-19T15:19:05+01:00 Alexandra Bartlett abartlett7@rvc.ac.uk <p>The original version of the article has been corrected, please see the full text for details of the correction.</p> 2021-07-19T15:16:25+01:00 Copyright (c) 2021 Alexandra Bartlett https://veterinaryevidence.org/index.php/ve/article/view/456 Efficacy of EMLA™ cream for reducing pain associated with venepuncture in felines 2021-07-15T12:32:44+01:00 Erina Leask erina.leask@gmail.com <p><strong>PICO question</strong></p> <p>In adult cats undergoing a venepuncture procedure, does the application of a topical lidocaine based anaesthetic to the skin at the venepuncture site reduce the severity of signs associated with pain when compared to no topical anaesthetic?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Four papers were critically reviewed. Three were prospective, double-blind, randomised, controlled clinical trials, and one was a prospective, double-blind, controlled experimental trial</p> <p><strong>Strength of evidence</strong></p> <p>Moderate</p> <p><strong>Outcomes reported</strong></p> <p>The application of Eutectic Mixture of Local Anaesthetics (EMLA™) cream to clipped skin over the procedure site, a minimum of 30 minutes prior to the venepuncture procedure, significantly reduced the severity of pain-associated behaviours during jugular phlebotomy in healthy, conscious feline patients when compared to a placebo<sup>1,2</sup>. In felines sedated with dexmedetomidine and either methadone or nalbuphine, the administration of EMLA™ cream to clipped skin for 20 minutes significantly decreased the severity of pain responses during intravenous (IV) cephalic vein catheterisation when compared to no treatment<sup>3</sup>. In clinically unwell feline patients, the use of EMLA™ cream on clipped skin at the site of jugular catheterisation 60 minutes prior demonstrated reduced pain responses compared to a placebo, but further investigation with a larger sample size is required to verify statistical significance<sup>4</sup></p> <p><strong>Conclusion</strong></p> <p>The available evidence moderately supports the hypothesis that EMLA™ cream is an effective and noninvasive treatment for providing enhanced pain-relief during jugular and cephalic vein phlebotomy for the purposes of blood collection and catheterisation, respectively. The areas for treatment should be clipped free of hair, and the cream applied for a minimum of 30 minutes in non-sedated cats and 20 minutes in cats sedated with dexmedetomidine and either methadone or nalbuphine. Moreover, when applied to normal, intact skin and covered by an occlusive bandage to avoid ingestion, it is well supported by supplementary evidence that EMLA™ cream has a wide safety margin for topical use in cats<sup>4,5</sup></p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-07-15T12:22:46+01:00 Copyright (c) 2021 Erina Leask https://veterinaryevidence.org/index.php/ve/article/view/452 Does UK licensed NSAID administration reduce signs of postoperative pain in calves castrated without local anaesthesia? 2021-07-19T15:40:30+01:00 Alexandra Bartlett abartlett7@rvc.ac.uk <p><strong>There is an erratum to this paper published in&nbsp;<em>Veterinary Evidence</em> Vol 6, Issue 3 (2021): <a href="https://doi.org/10.18849/ve.v6i3.525" target="_blank" rel="noopener">https://doi.org/10.18849/ve.v6i3.525</a></strong></p> <p><strong>PICO question</strong></p> <p>In calves undergoing castration without local or general anaesthesia, do non-steroidal anti-inflammatory drugs (NSAIDs) licensed for use in cattle in the UK administered either before, during or after the procedure reduce signs of postoperative pain?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Twenty studies were critically appraised. All were controlled trials, of which 17 were randomised. Only NSAIDs licensed for use in cattle in the UK were included in the search strategy and in appraised papers</p> <p><strong>Strength of evidence</strong></p> <p>Moderate</p> <p><strong>Outcomes reported</strong></p> <p>Five studies reported an improvement in both physiological and behavioural indicators of postcastration pain following NSAID administration and a further eight reported improvements in either physiological or behavioural parameters. Seven studies found no improvements in pain indicators</p> <p><strong>Conclusion</strong></p> <p>There is moderate evidence to suggest that NSAID administration before, during or after castration is able to reduce the signs of postoperative pain in calves castrated without anaesthesia. The degree to which pain is reduced is variable and depends upon factors including but not limited to castration method, specific NSAID given, dosage, administration and calf age</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-07-08T10:12:12+01:00 Copyright (c) 2021 Alexandra Bartlett https://veterinaryevidence.org/index.php/ve/article/view/344 Comparison of alfaxalone versus propofol as anaesthetic induction agents in increasing the rate of survival and vigour of neonates 2021-06-30T12:24:17+01:00 Lesca Monica Sofyan lesca.sofyan.xx@hotmail.com Fernando Martinez-Taboada fernando.martinez@sydney.edu.au <p><strong>PICO question</strong></p> <p>In routine canine caesareans, is alfaxalone a superior anaesthetic induction agent than propofol in increasing the rate of survival and vigour of neonates?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Three randomised positive clinical trials have compared the efficacy between alfaxalone and propofol in routine canine caesarean sections for increased neonatal survival and vigour</p> <p><strong>Strength of evidence</strong></p> <p>Weak</p> <p><strong>Outcomes reported</strong></p> <p>Although two studies found alfaxalone to be associated with higher Apgar scores for neonates than propofol, each study nonetheless revealed positive vigour and high survival rates from the use of either alfaxalone or propofol. The evidence is too weak to suggest that one induction agent is superior to another. The selection between the two induction agents may not be the main concern in regard to neonatal depression and 24 hour survival post-delivery, provided that the entire canine caesarean protocol is thoroughly and carefully studied</p> <p><strong>Conclusion</strong></p> <p>The evidence is too weak to suggest that alfaxolone or propofol is superior to another during canine cesareans. There is no signifcant difference seen in neonatal survival rate and vigour when using either alfaxolone or propofol</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-06-30T10:55:00+01:00 Copyright (c) 2021 Lesca Monica Sofyan, Fernando Martinez Taboada https://veterinaryevidence.org/index.php/ve/article/view/401 In dogs with osteoarthritis, how effective is treatment with tramadol in providing analgesia? 2021-06-24T16:50:06+01:00 Adrian Wong adrian.m.wong@sydney.edu.au Fernando Martinez-Taboada fernando.martinez@sydney.edu.au <p><strong>PICO question</strong></p> <p>In dogs with osteoarthritis how effective is treatment with tramadol in reducing the severity of the clinical signs associated with pain when compared to no treatment?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Two papers were critically reviewed. There was one randomised crossover controlled trial and one non-randomised controlled trial</p> <p><strong>Strength of evidence</strong></p> <p>Strong</p> <p><strong>Outcomes reported</strong></p> <p>Budsberg et al. (2018) found no significant differences in the objective gait analyses (vertical ground reaction forces, and peak vertical force) between baseline and end of treatment, between tramadol and placebo. Similarly, there was no significant difference in the proportion of dogs with positive response based on the subjective Canine Brief Pain Inventory questionnaire (CBPI) between tramadol and placebo. The positive control of carprofen yielded significant differences to both placebo and tramadol in all outcomes measured.</p> <p>Malek et al. (2012) found no significant differences in the objective outcomes measured (gait analyses, and total daily activity) between tramadol and placebo. There were significant improvements in the subjective CBPI (total score, pain severity and pain interference score) between the baseline and end of treatment, within the tramadol group. However, there was no significant difference in the percentage change of the total score, pain severity or pain interference score between all treatment groups including tramadol and placebo</p> <p><strong>Conclusion</strong></p> <p>In dogs with osteoarthritis, the use of tramadol alone did not demonstrate any significant analgesic effects</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-06-24T11:20:49+01:00 Copyright (c) 2021 Adrian Wong, Fernando Martinez-Taboada https://veterinaryevidence.org/index.php/ve/article/view/373 Can sedation be used for equine lameness investigation? 2021-06-18T16:20:59+01:00 Helene Termansen termansen94@gmail.com Lucinda Meehan lucy.meehan@bristol.ac.uk <p><strong>PICO question</strong></p> <p>In horses undergoing lameness investigation, does sedation with a<sub>2</sub>-adrenergic agonists alone versus sedation with a<sub>2</sub>-adrenergic agonists in combination with butorphanol tartrate effect the degree of lameness?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Diagnosis</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Six papers were critically reviewed. There were two crossover clinical studies, three crossover controlled clinical studies and a randomised controlled clinical study</p> <p><strong>Strength of evidence</strong></p> <p>Moderate</p> <p><strong>Outcomes reported</strong></p> <p>There was limited evidence to suggest that xylazine and romifidine in combination with butorphanol has an effect on forelimb lameness and that detomidine has an effect on hindlimb lameness.</p> <p>Most evidence suggests that xylazine alone or in combination with butorphanol has no effect on the lameness</p> <p><strong>Conclusion</strong></p> <p>In general, sedating a horse with an a<sub>2</sub>-adrenergic agonist alone or in combination with butorphanol tartrate does not change the baseline degree of lameness. Due to the large variation in the measurements, the small magnitude of few significant effects and the inconsistency of these significant findings, there is insufficient evidence to recommend avoiding the use of sedation in cases where it would increase the safety of those involved. However, regardless of protocol used, clinicians must appreciate the possibility of individual horse variation</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-06-18T16:16:48+01:00 Copyright (c) 2021 Helene Termansen, Lucinda Meehan https://veterinaryevidence.org/index.php/ve/article/view/395 Uncomplicated gallbladder mucoceles – is it better for prognosis to perform cholecystectomy or medically manage? 2021-06-10T15:22:43+01:00 Rachel T. Griffiths grif0325@umn.edu Wanda J. Gordon-Evans wgordone@umn.edu <p><strong>PICO question</strong></p> <p>In dogs with an uncomplicated gallbladder mucocele, is the long-term survival when surgically managed superior, inferior, or equal to those medically managed?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment and prognosis</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Three papers were critically reviewed. All of the studies were retrospective analyses of medical records, two of which were cohort studies, and one which was a case control study</p> <p><strong>Strength of evidence</strong></p> <p>Weak</p> <p><strong>Outcomes reported</strong></p> <p>There is some evidence that surgical management of gallbladder mucoceles is associated with longer survival times than medically managed cases, although there is no direct analysis of uncomplicated vs complicated cases</p> <p><strong>Conclusion</strong></p> <p>We cannot clearly make a conclusion based on the available evidence. To date, there is only one retrospective analysis that directly compares the long-term survival of cases medically vs surgically managed, but this study does not separate uncomplicated vs complicated cases of gallbladder mucocele. In order to more accurately determine which type of treatment should be recommended for uncomplicated cases of gallbladder mucoceles, a prospective study comparing long-term survival with each treatment should be performed. These studies should also standardise medical management in order to more accurately compare survival time to surgical treatment</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-06-10T15:18:01+01:00 Copyright (c) 2021 Rachel T. Griffiths, Wanda J. Gordon-Evans https://veterinaryevidence.org/index.php/ve/article/view/368 Does medical or surgical treatment for aortic stenosis improve outcome in dogs? 2021-06-04T12:04:11+01:00 Julia Thomas jt16942@bristol.ac.uk Sophie Marshall sm16229@bristol.ac.uk Karin Gormley kg16729@bristol.ac.uk Georgia Conway gc16669@bristol.ac.uk Kieran Borgeat k.borgeat@bristol.ac.uk <p><strong>PICO question</strong></p> <p>In adult dogs with aortic stenosis does treatment with beta blockers compared with surgical intervention show a longer survival time with improved clinical parameters?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Eight studies were reviewed. One was a randomised controlled study, three were cohort studies, one was a case series and three were case reports</p> <p><strong>Strength of evidence</strong></p> <p>Moderate to weak</p> <p><strong>Outcomes reported</strong></p> <p>Intervention appeared to improve survival times ± physiological parameters when compared to no treatment at all. The severity of clinical signs was reduced, but the risk of sudden cardiac-related death was not diminished according to a number of papers. The direct comparison of surgical treatment with the use of beta blockers showed no significant difference in survival times or physiological parameters across all papers. There is not enough evidence available comparing the different beta blockers used for treatment to draw a meaningful conclusion as to which is more effective</p> <p><strong>Conclusion</strong></p> <p>Treatment of some form should be given to a dog diagnosed with aortic stenosis. This will improve clinical signs and there is evidence to say that it will prolong survival as well as improve quality of life.<br>More research into this area is essential. Controlled, randomised clinical trials should be carried out in order to find a reliable and strong recommendation for treatment. Ethical implications need to be considered when going forward with this, which is why the evidence pool is likely to be so limited currently</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-06-03T15:27:32+01:00 Copyright (c) 2021 Julia Thomas, Sophie Marshall, Karin Gormley, Georgia Conway, Kieran Borgeat https://veterinaryevidence.org/index.php/ve/article/view/383 Clinical governance and continuous Quality Improvement in the veterinary profession: A mixed-method study 2021-06-03T19:31:07+01:00 Tom Ling tling@randeurope.org Ashley Doorly ashley@rcvsknowledge.org Chris Gush chris@rcvsknowledge.org Lucy Hocking lhocking@randeurope.org <p>96% of the veterinary profession agrees that Quality Improvement (QI) improves veterinary care. While clinical governance is an RCVS professional requirement, over the last year only 60% spent up to 3 days on the Quality Improvement activities which allow clinical governance to take place. 11% spent no time on it at all. A lack of time, know-how and organisational support were among the barriers preventing its adoption in practice.</p> <p>Rather than being an individual reaction to a problem, Quality Improvement is a formal approach to embedding a set of recognised practices, including clinical audit, significant event audit, guidelines and protocols, benchmarking and checklists. This framework should be applied within a just culture where errors are redefined as learning opportunities, and precedence is given to communication, team-work and team-morale, patient safety, and distributed leadership.</p> <p>Addressing this gap will require evolution – rather than a revolution. Persistent packages, given enough time and addressing the whole flow of the patient journey, trump one-off ‘heroic’ and narrowly-focused interventions. Creating a rhythm of learning alongside stability of practice allows lessons to be absorbed and improvements routinised. Doing good things well is better than doing perfect things sporadically and helps address the widespread concern that there is insufficient time for QI by making the time commitment more predictable and manageable.</p> <p>The research provides a robust, evidence-based, roadmap for the entire sector including professional organisations, educators, those in management positions and care providers.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-05-12T12:17:45+01:00 Copyright (c) 2021 Tom Ling, Ashley Doorly, Chris Gush, Lucy Hocking https://veterinaryevidence.org/index.php/ve/article/view/358 Quality Improvement: origins, purpose and the future for veterinary practice 2021-05-05T16:12:55+01:00 Freya Rooke svxfr@exmail.nottingham.ac.uk John Burford svzjhb@exmail.nottingham.ac.uk Sarah Freeman sarah.freeman@nottingham.ac.uk Tim Mair tim.mair@btinternet.com Jo Suthers Jo.Suthers@bwequinevets.co.uk Marnie Brennan svzmb1@exmail.nottingham.ac.uk <p><strong>Introduction</strong></p> <p>Providing the highest quality veterinary care can often be a delicate balancing act: the client/owner’s wishes, financial parameters and emotional needs have to be considered, whilst also meeting the animal’s clinical needs. But what actually defines quality care? It is a term frequently used in both the human and veterinary healthcare literature, but often has little explanation or definition attached to it. ‘Quality’ in relation to care delivered is not a static concept and will hold different meanings to different individuals within a healthcare service. John Ruskin, a Victorian writer and critic of art and society observed: ‘Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skilful execution’.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-05-05T16:06:43+01:00 Copyright (c) 2021 Freya Rooke, John Burford, Sarah Freeman, Tim Mair, Jo Suthers, Marnie Brennan https://veterinaryevidence.org/index.php/ve/article/view/361 Do dogs with non-surgically managed cranial cruciate ligament disease have better outcomes with rehabilitation? 2021-04-23T09:56:33+01:00 Joshua Merickel Meric034@umn.edu Wanda Gordon-Evans wgordone@umn.edu <p><strong>PICO question</strong></p> <p>In dogs with cranial cruciate ligament disease treated non-surgically with rehabilitation, is the outcome inferior/equivalent/superior as measured by owner and/or veterinarian evaluation to dogs treated non-surgically without rehabilitation?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Four papers were critically appraised. One paper reviewed was a prospective, randomised clinical trial. The remaining three papers were retrospective cohort studies</p> <p><strong>Strength of evidence</strong></p> <p>Weak</p> <p><strong>Outcomes reported</strong></p> <p>There are no studies available that directly compare dogs managed non-surgically with and without rehabilitation following cranial cruciate ligament injury. In one study, 66% of dogs treated non-surgically with rehabilitation are reported to have successful outcomes 1 year following initiation of treatment. For dogs managed non-surgically without rehabilitation, successful outcomes varied from 19%–90% of cases among several retrospective studies</p> <p><strong>Conclusion</strong></p> <p>There is evidence suggesting the addition of rehabilitation to conservative therapy is beneficial, but based on the current literature, it is impossible to say whether it is superior to conservative treatment without rehabilitation</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-04-23T09:47:38+01:00 Copyright (c) 2021 Joshua Merickel, Wanda Gordon-Evans https://veterinaryevidence.org/index.php/ve/article/view/399 Diagnostic accuracy of cytology for canine osteosarcoma compared to histopathology 2021-04-16T10:40:32+01:00 Ioannis Oikonomidis economidis.john@gmail.com Theodora Tsouloufi theodora.tsouloufi@ed.ac.uk <p><strong>PICO question</strong></p> <p>What is the sensitivity and specificity of cytology as a test for canine osteosarcoma when compared to histopathology as a gold standard?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Diagnosis</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>Overall, four diagnostic validity studies (two prospective and two retrospective) were critically appraised</p> <p><strong>Strength of evidence</strong></p> <p>Weak to moderate</p> <p><strong>Outcomes reported</strong></p> <p>There is evidence of moderate strength to support that cytology is highly sensitive and specific for diagnosing histologically confirmed osteosarcomas as mesenchymal malignant neoplasms (cytological diagnosis of sarcoma). Evidence of weak strength suggests that the sensitivity and specificity of cytology for identifying the exact histotype (cytological diagnosis of osteosarcoma) are low and high, respectively. Finally, there is currently evidence of weak strength indicating that the sensitivity and specificity of cytology are comparable to that of preoperative histopathology after incisional biopsy for the diagnosis of canine osteosarcoma</p> <p><strong>Conclusion</strong></p> <p>Based on the available evidence, the diagnostic accuracy of cytology in diagnosing histologically confirmed osteosarcomas as sarcomas is high, whereas a confident conclusion cannot be drawn regarding the diagnostic accuracy of cytology for the identification of the exact histotype (cytological diagnosis of osteosarcoma). There is currently scant evidence suggesting that cytology has comparable diagnostic accuracy to preoperative histopathology (i.e. after incisional biopsy) for the diagnosis of canine osteosarcomas, however, more studies are warranted to confirm these results</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-04-16T10:24:39+01:00 Copyright (c) 2021 Ioannis Oikonomidis, Theodora Tsouloufi https://veterinaryevidence.org/index.php/ve/article/view/325 The effect of pre-emptive incisional bupivacaine block on postoperative pain after coeliotomy in dogs 2021-03-31T09:11:42+01:00 Kiriaki Pavlidou kellypav@gmail.com Lysimachos G Papazoglou mkdvm@vet.auth.gr <p><strong>PICO question</strong></p> <p>Is there an effect on analgesia following coeliotomy in dogs after a block with local anaesthetics?</p> <p>&nbsp;</p> <p><strong>Clinical bottom line</strong></p> <p><strong>Category of research question</strong></p> <p>Treatment</p> <p><strong>The number and type of study designs reviewed</strong></p> <p>All the available evidence for this PICO question comes from clinical trials and one experimental/pharmacology study. All the studies were randomised; 5/7 were blinded clinical studies and 4/7 studies were prospective</p> <p><strong>Strength of evidence</strong></p> <p>Moderate</p> <p><strong>Outcomes reported</strong></p> <p>It is not clear if the use of a local anaesthetic including bupivacaine or lidocaine as incisional blocks minimises the postoperative pain especially in the first 24 hours, as the results are not statistically significant between the groups</p> <p><strong>Conclusion</strong></p> <p>In conclusion, bupivacaine or lidocaine can minimise the postoperative pain but more clinical trials are needed</p> <p>&nbsp;</p> <p><span style="color: #0000ff;"><a style="color: #0000ff;" href="http://www.ebvmlearning.org/apply/" target="_blank" rel="noopener">How to apply this evidence in practice</a></span></p> <p>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.</p> <p>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.</p> <p>&nbsp;</p> <p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access"> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed"></p> 2021-03-31T09:05:26+01:00 Copyright (c) 2021 Kiriaki Pavlidou, Lysimachos Papazoglou