Comparison between methadone and buprenorphine within the QUAD protocol for perioperative analgesia in cats undergoing ovariohysterectomy

Abstract

Objectives The aim of this study was to investigate the analgesic efficacy of methadone vs buprenorphine within the QUAD protocol for anaesthesia in cats undergoing ovariohysterectomy. Methods One hundred and twenty cats were recruited to an assessor-blinded, randomised clinical trial. Cats received either methadone (5  mg/m2) or buprenorphine (180 µg/m2) combined with ketamine, midazolam and medetomidine intramuscularly. Anaesthesia was maintained with isoflurane in oxygen. Atipamezole was administered at extubation. Pain was assessed using the feline Composite Measure Pain Scale (CMPS-F), a dynamic interactive visual analogue scale (DIVAS) and mechanical nociceptive threshold (MNT). Sedation, pain, heart rate and respiratory rate were measured prior to QUAD administration, before intubation, and 2, 4, 6 and 8 h post-QUAD administration. If indicated by the CMPS-F, rescue analgesia was provided with 0.5 mg/kg of methadone administered intramuscularly. Meloxicam was administered after the last assessment. Differences in pain scores between groups were compared using a two-way repeated-measures ANOVA and requirement for rescue analgesia was compared using a χ2 test. Results Cats administered methadone had lower CMPS-F scores over time ( P = 0.04). Eighteen of 60 cats required rescue analgesia in the methadone group vs 29/60 in the buprenorphine group ( P = 0.028). All cats that received rescue analgesia required it within 6 h post-QUAD administration. There were no differences between groups in MNT or pain measured using the DIVAS. Conclusions and relevance Methadone produced clinically superior postoperative analgesia for the first 8 h after neutering than buprenorphine when used within the QUAD protocol.