Back to home page
This BET is in the process of being updated

Midline versus flank approach and pain in neutering of cats

Clinical Scenario

Dr Perry brings her 5 month old female domestic shorthair kitten, Kylie, in to be spayed. She has read on the internet that cats can be spayed midline or via the flank. She is very concerned about Kylie being in pain and asks you which is the least painful surgical option for Kylie. You wonder if one is less painful than the other...

3-Part Question (PICO)

In [female cats that are being neutered] does [a midline approach compared to a flank approach] [decrease pain following surgery]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

(cat.mp. OR cats.mp. OR feline.mp. OR felines.mp. OR queen.mp. OR queens.mp. OR felis.mp. OR felidae.mp. OR exp Cats/ OR exp Felis/ OR exp Felidae/)

AND

(spey.mp. OR speyed.mp. OR speying.mp. OR spay.mp. OR spayed.mp. OR spaying.mp. OR neuter.mp. OR neutered.mp. OR neutering.mp. OR ovariectomy.mp. OR ovariohysterectomy.mp. OR hysterectomy.mp. OR sterilised.mp. OR sterilized.mp. OR sterilisation.mp. OR sterilization.mp. OR de-sex.mp. OR de-sexed.mp. OR de-sexing.mp. OR desex.mp. OR desexed.mp. OR desexing.mp. OR gonadectomy.mp. OR exp Ovariectomy/ OR exp Sterilization, Reproductive/ OR exp Hysterectomy/)

AND

(midline.mp. OR flank.mp. OR linea alba.mp. OR laparotomy.mp. OR coeliotomy.mp. OR celiotomy.mp. OR lateral approach.mp. OR exp Laparotomy/)

CAB Abstracts 1910 to Present using the OVID interface

(cat.mp. OR cats.mp. OR feline.mp. OR felines.mp. OR queen.mp. OR queens.mp. OR felis.mp. OR felidae.mp. OR exp cats/ OR exp Felis/ OR exp Felidae/)

AND

(spey.mp. OR speyed.mp. OR speying.mp. OR spay.mp. OR spayed.mp. OR spaying.mp. OR neuter.mp. OR neutered.mp. OR neutering.mp. OR ovariectomy.mp. OR ovariohysterectomy.mp. OR hysterectomy.mp. OR sterilised.mp. OR sterilized.mp. OR sterilisation.mp. OR sterilization.mp. OR de-sex.mp. OR de-sexed.mp. OR de-sexing.mp. OR desex.mp. OR desexed.mp. OR desexing.mp. OR gonadectomy.mp. OR exp ovariectomy/ OR exp gonadectomy/ OR exp sterilization/ OR exp hysterectomy/)

AND

(midline.mp. OR flank.mp. OR linea alba.mp. OR laparotomy.mp. OR coeliotomy.mp. OR celiotomy.mp. OR lateral approach.mp. OR exp laparotomy/)

Search Outcome

MEDLINE

  • 72 papers found in MEDLINE search
  • 65 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 4 papers excluded as they are review articles/in vitro research/conference proceedings
  • 3 total relevant papers from MEDLINE

CAB Abstracts

  • 116 papers found in CAB search
  • 110 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 3 papers excluded as they are review articles/in vitro research/conference proceedings
  • 3 total relevant papers from CAB

Total relevant papers

3 relevant papers from both MEDLINE and CAB Abstracts

Comments

There are only two papers in the evidence summary table as Coe et al. Veterinary Record (2006) 159: 309-313 contains the same data set as Grint et al. Grint et al was selected for the BET as it was more relevant.

Summary of Evidence

Burrow et al. (2006) UK

Title: Prospective evaluation of postoperative pain in cats undergoing ovariohysterectomy by a midline or flank approach.
Patient group: Female cats undergoing ovariohysterectomy
Study Type: Randomised controlled trial
Outcomes:
  • Pain
Key Results:
  • No significant difference in pain between different approaches
  • Midline approach associated with a significantly longer surgery time. Longer surgery time significantly associated with reduced pain. However, midline approach and post-operative pain NOT significantly correlated
Study Weaknesses:
  • Small study group (20 cats)
  • Not blinded
  • No sample size calculation undertaken
Attachment:
No attachments.

Grint et al. (2006) UK

Title: Assessment of the influence of surgical technique on post operative pain and wound tenderness in cats following ovariohysterectomy.
Patient group: Female cats undergoing ovariohysterectomy
Study Type: Randomised controlled trial
Outcomes:
  • Pain and wound tenderness
Key Results:
  • No significant difference in post-operative pain as assessed by pain scoring
  • Wound tenderness significantly increased in flank approaches compared to midline
Study Weaknesses:
  • Small number of cats (46)
  • Not blinded
  • Different students doing surgery
  • Subjective outcome pain scores
Attachment:
No attachments.

Comments

Both studies suffer from the difficulties in blinding such a study and interpreting behavioural measures of pain in cats. The Burrow et al. study has a low power to detect differences.

Bottom line

There is no evidence that midline or flank approach has any correlation with increased post-operative pain in cats undergoing ovariohysterectomy, although wound tenderness was significantly greater after flank spay as compared to midline. In the absence of further evidence, surgeon preference and experience should be considered when choosing which approach to take.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Burrow R, Wawra E, Pinchbeck G, Senior M, Dugdale A (2006) Prospective evaluation of postoperative pain in cats undergoing ovariohysterectomy by a midline or flank approach. Veterinary Record 158: 657-660.

Grint NJ, Murison PJ, Coe RJ, Waterman Pearson AE (2006) Assessment of the influence of surgical technique on post operative pain and wound tenderness in cats following ovariohysterectomy. Journal of Feline Medicine and Surgery 8: 15-21.

About this BET

First author:
Jenny Stavisky
Second author:
Marnie Brennan
Institution:
CEVM, University of Nottingham
Search last performed:
2013-09-13 09:58:31
Original publication date:
2013-09-13 09:58:31
Last updated:
2013-09-13 09:58:31
About BETs?

A BET is a simple method of searching for and appraising evidence around a very specific clinical situation.

Read more …

Using BETs?

BETs don’t tell you what to do, they tell you about the evidence on a certain topic.

Read more …

Not a Vet?

This website has been designed to help vets use the best, most relevant, up to date science when they make decisions about their patients.

Read more …