Pain and analgesia following onychectomy in cats: a systematic review

Objectives To systematically review published studies evaluating pain associated with onychectomy in cats, and to assess the efficacy of the analgesic therapies applied. Databases used Four sources were used to identify manuscripts for review. Databases searched were those of the National Library of Medicine, EMBASE and CAB International. In addition, pertinent references in the bibliographies of included articles were retrieved. Results Twenty manuscripts published in refereed journals were reviewed. These included papers reporting 18 clinical trials and two studies conducted in conditioned research cats. Twelve analgesics were evaluated, including seven opioids, four non-steroidal anti-inflammatory drugs and one local anesthetic. Nine studies involved a direct comparison of analgesic agents. Limb use was abnormal when measured at 2 and 12 days following onychectomy, and neither fentanyl patch nor butorphanol administration resulted in normal use of the surgical limb. In another study, cats evaluated at 6 months after this surgery were not lame. Differing surgical techniques were compared in six studies; the results indicated that pain scores were lower after laser surgery than after scalpel surgery. The difficulties associated with assessing pain in cats and the lack of sensitivity of the evaluation systems utilized were highlighted in many of the studies. Huge variations in dose and dosing strategies had significant impacts on drug efficacy. Statistically significant differences among treatments were found in most studies; however, no clearly superior analgesic treatment was identified. A combination of meloxicam or robenacoxib with an opioid may provide more effective analgesia and should be evaluated.