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Potential benefits of using NSAIDs in cows undergoing caesarean section

Clinical Scenario

During a vets meeting at the large animal practice you work in you are debating with the partners whether you should use analgesia postoperatively in caesarean sections in dairy cows. You routinely give NSAIDs but some of your colleagues don't and havn't encountered any problems. You believe on welfare grounds that the cows need more analgesia than the local anaesthesia provided at the time of surgery. You wonder if there is any evidence supporting the beneficial effects of using NSAIDs in cows following caesarean section......

3-Part Question (PICO)

In [cattle undergoing caesarean section] does [using NSAIDs compared to not using NSAIDs] [decrease the signs of post operative pain]?

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

cow.mp. OR cows.mp. OR cattle.mp. OR bovine.mp. OR bovines.mp. OR bos.mp. OR exp Cattle/

AND

Caesar$.mp. OR Cesar$.mp. OR c section.mp. OR exp Cesarean Section/

AND

NSAID.mp. OR NSAIDs.mp. OR non steroidal anti inflammatory.mp. OR non steroidal anti inflammatories.mp. OR non steroidal antiinflammatory.mp. OR non steroidal antiinflammatories.mp. OR nonsteroidal anti inflammatory.mp. OR nonsteroidal anti inflammatories.mp. OR nonsteroidal antiinflammatory.mp. OR nonsteroidal antiinflammatories.mp. OR analgesia.mp. OR analgesias.mp. OR analgesic.mp. OR analgesics.mp. OR exp Anti-Inflammatory Agents, Non-steroidal/ OR exp Analgesics, Non-narcotic/ OR exp Analgesia/ OR exp Analgesics/

CAB Abstracts 1910 to Present using the OVID interface

cow.mp. OR cows.mp. OR cattle.mp. OR bovine.mp. OR bovines.mp. OR bos.mp. OR exp cows/ OR exp cattle/ OR exp Bos/

AND

Caesar$.mp. OR Cesar$.mp. OR c section.mp. OR exp caesarean section/

AND

NSAID.mp. OR NSAIDs.mp. OR non steroidal anti inflammatory.mp. OR non steroidal anti inflammatories.mp. OR non steroidal antiinflammatory.mp. OR non steroidal antiinflammatories.mp. OR nonsteroidal anti inflammatory.mp. OR nonsteroidal anti inflammatories.mp. OR nonsteroidal antiinflammatory.mp. OR nonsteroidal antiinflammatories.mp. OR analgesia.mp. OR analgesias.mp. OR analgesic.mp. OR analgesics.mp. OR exp non-steroidal antiinflammatory agents/ OR exp analgesics/

Search Outcome

MEDLINE

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

CAB Abstracts

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

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Summary of Evidence

Barrier et al

Title:

Administration of a NSAID (meloxicam) affects lying behaviour after caesarean section in beef cows.

Patient group:

110 Beef cattle that underwent non-elective standardised caesarean section from 8 veterinary practices.

63 received meloxicam pre-emtively and 47 recieved placebo.

Study Type:

Randomised controlled trial

Outcomes:
  • Time spend lying (%) per time period (0-8h, 8-16h, 16-24h, 24-32h, 32-40h, 40-48h, 48-68h)

  • Number of steps per hour per each time period (as above)

  • Actual time spent lying (%) per each time period (as above)

  • Average number of lying bouts (counts/hour) per time period (as above)

  • Pain at surgical site pre and post surgery using a 4-level scoring system

Key Results:
  • Cows that received meloxicam spent more time lying in 0-8 hours and 8-16 hours compared to the control group but this was not significant (p=0.55).
  • The time spent lying decreased over time for both groups.
  • Cows that received meloxicam had significantly more lying bouts in 0-8 hours, 8-16 hours and 16-24 hours than the control group (p=0.021)
  • The total number of lying bouts decreased over time for both groups
  • There was no effect of treatment on the average number of steps between groups (p=0.11).
  • All cows took more steps in 0-8h and 16-24h period (p<0.001).

 

Study Weaknesses:
  • The method of randomisation was not stated.
  • It is unclear if the person who administered the treatments or assessed the outcomes were blinded.It is stated that a 'blind randomised schedule' was used and a placebo was given to the control cows but not enough information is provided about either.
  • The breeds of all the cattle were not given (75.5% Charolias)
  • No sample size or power calculation was reported.
  • The level of statistical significance (p value) was not stated in the methods.
  • There was no detail given about the pain score used except that is was a 4-level scoring system and the results were not given.
  • The results of the clinical examination were not given. 
  • The basic data was not completely described.
  • The measures of lying bouts or number of steps taken have not been vaildated as a reliable indicator of pain in cows.
  • No information about side effects was given.
Attachment:
Evidence appraisalEvidence appraisal

Comments

Only one paper was found that studied one NSAID in cows undergoing caesarean section. It was a very selective group of cows that underwent limited calving interventions before the surgery was decide upon.The aim of the study found was to investigate if administration of the NSAID meloxicam prior to the commencement of surgery would alter behaviour, in particular lying behaviour, following caesarean section in beef cows. The hypothesis was that post surgery lying time in cows treated with pre-emptive meloxicam would be increased which may be indicative of greater comfort, The findings of this study showed that meloxicam treated cows lay significantly more often, however it is still unclear if lying behaviours are a valid and reliable indicator of pain in cows. In addition there are a number of methodological flaws in this study which may affect the generalisability and reliability of the results (see study weaknesses above).

The evidence base for the use of NSAIDS in cows following caesarean section is small. However this is known to be a painful procedure and NSAIDs have been shown to be efficacious analgesics in cows. Although this study does not definitively demonstrate that NSAIDs lead to a reduction in pain, it does not provide evidence that NSAIDs have no analgesic effect in cows undergoing caesarean.

Bottom line

There is limited evidence available about the use of NSAIDs as analgesia in cows undergoing caesarean section. Based on the evidence found, meloxicam may affect the lying behaviour in some cows which may reflect a reduction in pain.

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

Barrier, A. C. Coombs, T. M. Dwyer, C. M. Haskell, M. J. Goby, L, (2014).Administration of a NSAID (meloxicam) affects lying behaviour after caesarean section in beef cows.
Applied Animal Behaviour Science; 2014. 155:28-33

About this BET

First author:
Rachel Dean
Second author:
Katie Fitzgerald
Institution:

CEVM, School of Veterinary Medicine and Science, Universtiy of Nottingham

Search last performed:
2017-08-30 16:16:53
Original publication date:
2017-08-31 16:16:53
Last updated:
2017-08-31 16:16:53
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