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Comparison of the analgesic effects of meloxicam and carprofen administered

preoperatively to dogs undergoing orthopaedic surgery

Article  in  The Veterinary record · December 2004

DOI: 10.1136/vr.155.21.667 · Source: PubMed

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Comparison of the analgesic effects of

meloxicam and carprofen administered
preoperatively to dogs undergoing
orthopaedic surgery
F. G. Laredo, E. Belda, J. Murciano, M. Escobar, A. Navarro, K. J. Robinson,
R. S. Jones

Thirty-two dogs undergoing operations to repair a torn cranial cruciate ligament or a fractured long bone
were randomly allocated to one of two treatment groups in a study on postoperative pain. Sixteen of the
dogs were given 4 mg/kg carprofen and the other 16 were given 0·2 mg/kg meloxicam subcutaneously
before the operation. The signs of pain shown by the animals were assessed for 24 hours on a visual
analogue scale, a discontinuous scoring system, and a score based on five behavioural and physiological
variables. The dogs’ heart and respiratory rates and their mean arterial blood pressures were also measured
non-invasively at each assessment. Blood samples were taken before the surgery and 24 hours after it, and
the concentrations of urea and creatinine were measured in plasma. Both drugs were effective in relieving
the signs of pain for up to 24 hours in all the dogs. There were no significant changes in the concentrations
of urea and creatinine, and no adverse effects were reported during the postoperative period.

Veterinary Record (2004)
155, 667-671
F. G. Laredo, BVSc, PhD,
CertVA, MRCVS,
E. Belda, BVSc,
J. Murciano, BVSc, PhD,
M. Escobar, BVSc,
A. Navarro, BVSc,
Departamento de
Medicina y Cirugía
Animal, Universidad de
Murcia, Campus de
Espinardo, 30.100
Espinardo (Murcia),
Spain
K. J. Robinson, BVSc,
CertVA, MRCVS,
R. S. Jones, OBE, MVSc,
DrMedVet, DVSc, DVA,
DipECVA, FIBiol, FRSA,
FRCVS,
Department of
Anaesthesia, University of
Liverpool, Daulby Street,
Liverpool L69 3GA
IT is considered essential in veterinary practice to alleviate the
signs of pain in animals undergoing surgery, and for many
years opioids have been used as the single analgesic drug for
this purpose. New non-steroidal anti-inflammatory drugs
(NSAIDs) with preferential cyclo-oxygenase (COX)-2 inhibition
properties, such as carprofen and meloxicam, have been
developed and are used in the perioperative period (Reid and
Nolan 1991, Nolan and Reid 1993, Lascelles and others 1994a,
Mathews and others 2001, Slingsby and Waterman-Pearson
2001, 2002). It is becoming generally accepted that the pre-
emptive administration of a combination of analgesic drugs,
generally opioids and a NSAID, is an effective way of reducing
the severity and duration of postoperative pain (Dahl and
Kehlet 1993, Woolf and Chong 1993, Grisneaux and others
1999, Kay-Mugford and others 2000).
Carprofen, a weak inhibitor of COX enzymes, has been
found to provide good analgesia, without side effects, when
administered preoperatively to dogs undergoing a variety of
orthopaedic procedures (Nolan and Reid 1993, Lascelles and
others 1994a, Grisneaux and others 1999).
Meloxicam, a preferential COX-2 inhibitor (Dannhardt and
Keifer 2001), has recently been licensed for preoperative
use in dogs. Several studies have shown that it is a safe and effec-
tive drug for the provision of postoperative analgesia in dogs
(Mathews and others 2001) and cats (Slingsby and Waterman-
Pearson 2002) undergoing abdominal surgery, but there appears
to be no information on its analgesic effects when administered
preoperatively to dogs undergoing orthopaedic procedures.
The primary objective of this study was to compare the
efficacy of meloxicam and carprofen administered
preoperatively for the control of postoperative pain in dogs
undergoing orthopaedic procedures. The secondary objec-
tive was to evaluate the safety of the two drugs used in this
way by measuring the serum concentrations of urea and cre-
atinine before and 24 hours after the operations, to test for
potential nephrotoxic effects.
MATERIALS AND METHODS
Animals
Thirty-two dogs undergoing operations to repair a torn cran-
ial cruciate ligament or fractured long bone were used, and
each owner’s consent was obtained. The study was designed
as a randomised, double-blinded clinical study. The dogs were
of several breeds and both sexes, with no one breed or sex
predominating. All the dogs were classified according to their
physical status as ASA II or III. Diabetic animals, pregnant
bitches, dogs with diseases, animals receiving analgesic
or other anti-inflammatory drugs and dogs with coagu-
lopathies or other bleeding disorders were excluded from the
study.
Anaesthesia and analgesia
The choice of NSAID was determined by the allocation of a
computer-generated random number. The dogs were
assigned into two groups of 16 with the assessors blinded to
the allocation of the treatments. The dogs in the carprofen
group received 4 mg/kg carprofen (Rimadyl; Pfizer) and those
in the meloxicam group received 0·2 mg/kg meloxicam
(Metacam; Boehringer Ingelheim), both drugs being admin-
istered subcutaneously immediately after the animals had
been premedicated for surgery. They were premedicated with
a mixture of acepromazine (Calmo Neosan; Pfizer) at a dose
of 0·05 mg/kg and pethidine (Dolantina; Bayer) at a dose of
5 mg/kg, administered intramuscularly. After 30 minutes,
anaesthesia was induced with propofol (Rapinovet; Pitman-
Moore), administered intravenously at 4 to 6 mg/kg, and
maintained with halothane in 100 per cent oxygen delivered
by the appropriate circuit. The duration of the procedures was
recorded.
Assessment of sedation and pain
The data were recorded on standard case record forms. The
two assessors (F. G. L. and E. B.) were experienced in the use
of different pain and sedation scoring systems and in the
interpretation of the signs of pain in animals. The assessments
were made first before the dogs were premedicated, and then
one, two, four, 12 and 24 hours after they had been extubated.
Initial general observations were made with the animals
undisturbed; they were then approached and the cage door
opened to check how they reacted and behaved. Finally, the
dogs were gently handled and encouraged to walk, and the
injured area was palpated by applying firm pressure adjacent
to the wound, and also by flexing and extending the affected
limb; the contralateral limb was also examined. The overall

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TABLE 1: Criteria used for scoring postoperative pain in dogs TABLE 2: Sex and mean (sd) age, bodyweight and duration of anaesthesia undergone by
16 dogs treated with 4 mg/kg carprofen and 16 treated with 0·2 mg/kg meloxicam before
Parameter Criteria Score undergoing surgery to repair a torn cranial cruciate ligament or fractured long bone

Heart rate ≤10% greater than preoperative Sex Duration of

value 0 Drug Age (months) Male Female Bodyweight (kg) anaesthesia (minutes)
11-30% greater than preoperative
value 1 Carprofen 24·8 (25·3) 10 6 24·1 (15·9) 175·1 (15·8)
31-50% greater than preoperative Meloxicam 21·7 (17·2) 9 7 22·9 (10·1) 167·4 (19·4)
value 2
>50% greater than preoperative
value 3
Respiratory pattern Normal 0
Mild abdominal 1 Devices), were recorded at each assessment.
Marked abdominal 2 All the animals were closely observed during the 24 hours
Vocalisation No crying 0 after the operation, and supplementary doses of morphine
Crying, responds to calm voice 1
Crying, no response to calm voice 2 (0·5 mg/kg) were available if it was considered that they were
Agitation Asleep 0 in severe pain, with a VAS pain score of greater than 55, or very
Mild 1 distressed; any dogs so treated were removed from the study.
Moderate 2
Severe 3
Response to None 0 Blood analyses
manipulation Minimal, tries to move away 1 Blood samples were taken before the dogs were anaesthetised
Turns head toward surgical areas, and 24 hours after the operation, and the concentrations of
vocalisation 2 urea and creatinine in plasma were measured with a bio-
Attempts to bite, howls 3
chemical autoanalyser (Cobas Mira Plus; ABX).

clinical and behavioural responses were assessed to indicate
the degree of pain and sedation. One of the observers (E. B.)
used a discontinuous scoring system (DSS) and the other
(F. G. L.) used a visual analogue scale (VAS) assessment, and
they did not disclose their scores to each other. A final assess-
ment was made by using a system based on five behavioural
and physiological variables, and this final score was agreed by
the two assessors.
For the DSS, sedation was scored as follows: 0 fully alert and
able to stand and walk, 1 alert and able to maintain sternal
recumbency, 2 drowsy and unable to stand, 3 fast asleep; pain
was scored as follows: 0 complete analgesia, 1 good analge-
sia, 2 moderate analgesia with some overt signs of discomfort
which were made worse by firm pressure, 3 no analgesia with
obvious signs of persistent discomfort. The limits of the VAS
scale for pain were 0 no pain, and 100 worst possible postop-
erative pain, and for sedation 0 no sedation, 100 fast asleep.
The pain score system, based on five variables – relative
increase in heart rate, respiratory pattern, vocalisation, degree
of agitation and response to palpation (Pibarot and others
1997) – is explained in Table 1.
The heart and respiratory rate of each dog and a non-
invasive measurement of its mean arterial pressure made with
a calibrated oscillometric blood pressure monitor, provided
with cuffs of different sizes (Vet/BP model 6000; Sensor
100 Carprofen
Meloxicam
80
Sedation score
Statistical analysis
Data such as bodyweight, age and duration of anaesthesia
were compared by using a one-way analysis of variance.
Physiological measurements such as respiratory rate, heart
rate and mean blood pressure were compared by using a two-
way analysis of variance. The blood analyses were compared
by using t tests. The VAS scores for pain and sedation and the
pain scores based on five variables were compared by the
Kruskal-Wallis non-parametric test at each time point. A fre-
quency distribution analysis was carried out on the DSS results
with respect to time, drug and score by using the G-test (Sokal
and Rohlf 1995). A significance level of 5 per cent (P<0·05)
was used. The data were analysed by means of the SPSS 11.0
statistical package and expressed as means and standard devi-
ations (sd).
RESULTS
Thirty-two standard case record forms were completed.
Details of the dogs’ age, sex, mean bodyweight and mean
duration of anaesthesia are given in Table 2. There were no
significant differences between the two groups of animals
with regard to their age, weight, sex or duration of anaesthe-
sia. All the dogs were classified according to their physical sta-
tus as ASA II or III.
Figs 1 and 2 show the mean (sd) VAS scores for sedation
and pain for both groups. The VAS sedation scores were low
before surgery, increased to a high value one hour postopera-
tively, and then decreased steadily during the rest of the post-

100 Carprofen
60
90 Meloxicam
40 80 FIG 2: Mean (sd) virtual
70 analogue scale scores
for pain in 16 dogs
Pain score

20 60
treated with 4 mg/kg
50 carprofen and 16
0 40 treated with 0·2 mg/kg
0 1 2 4 12 24 30 meloxicam
Time (hours) preoperatively, at
20
FIG 1: Mean (sd) virtual analogue scale scores for sedation in intervals after the
16 dogs treated with 4 mg/kg carprofen and 16 treated with 10 operation to repair a
0·2 mg/kg meloxicam preoperatively, at intervals after the 0 torn cranial cruciate
operation to repair a torn cranial cruciate ligament or 0 1 2 4 12 24 ligament or fractured
fractured long bone Time (hours) long bone

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3 2 1 0 3 2 1 0
100 100
FIG 3: Discontinuous

Distribution of sedation scores (%)

scoring system scores 90

Distribution of pain scores (%)

for sedation in 16 dogs 80 80
treated with 4 mg/kg
70
carprofen and 16
treated with 0·2 mg/kg 60 60
meloxicam 50
preoperatively, showing
the frequency 40 40
distribution of the 30
sedation scores (0, 1, 2
20 20
and 3) for carprofen (C)
and meloxicam (M) at 10
intervals after the 0 0
operation to repair a
C M C M C M C M C M C M C M C M C M C M C M C M
torn cranial cruciate
{
{
{
{
{
{

ligament or fractured 0 1
long bone
operative period. Little sedation was observed in either group
by four hours after surgery. There were no significant differ-
ences between the sedation scores for the carprofen and
meloxicam groups at any time. The mean (sd) VAS pain scores
were low in the dogs treated with either carprofen or meloxi-
cam throughout the study, and there were no significant dif-
ferences between the groups at any time.
Figs 3 and 4 show the frequency distribution of the DSS
scores for pain and sedation for the two groups. The trends
for the DSS pain and sedation scores with respect to time were
similar to those described for the VAS scoring system. The
sedation and pain scores for the two groups were not signif-
icantly different at any time.
Fig 5 shows the mean (sd) pain scores for the two groups
based on the five variables. The trends of the pain scores with
respect to time were similar to those described for the VAS and
DSS scoring systems, and there were no significant differences
between the two groups at any time.
There were no significant differences between the two
groups of dogs in terms of their respiratory rate, heart rate
and mean arterial pressure at any time (Table 3). The mean
(sd) plasma concentrations of urea and creatinine before and
after the operations are shown in Table 4. There were no sig-
nificant differences between the two groups.
It was not necessary to provide a supplementary dose of
analgesia to any of the dogs in the trial.
DISCUSSION
It was decided to compare the efficacy of meloxicam with that
of carprofen because it has been shown that carprofen is effec-
tive in the control of postoperative orthopaedic pain (Nolan
13
12
11
10
FIG 5: Mean (sd) pain
scores based on five 9
8
Pain score
{
{
{
{
{
{
2 4 12 24 0 1 2 4 12 24
Time (hours) Time (hours)
FIG 4: Discontinuous scoring system scores for pain in
16 dogs treated with 4 mg/kg carprofen and 16 treated with
0·2 mg/kg meloxicam preoperatively, showing the frequency
distribution of the sedation scores (0, 1, 2 and 3) for
carprofen (C) and meloxicam (M) at intervals after the
operation to repair a torn cranial cruciate ligament or
fractured long bone
and Reid 1993, Lascelles and others 1994a, Grisneaux and
others 1999). Several studies have suggested that meloxicam
may be a safe and effective drug for the provision of postop-
erative analgesia in dogs (Mathews and others 2001) and cats
(Slingsby and Waterman-Pearson 2002) undergoing abdom-
inal surgery, but there appears to be no information on its use
as an analgesic after orthopaedic procedures in dogs.
An anaesthetic protocol that did not provide long-lasting
postoperative analgesia was selected deliberately. Pethidine
was chosen to provide a short period of intraoperative anal-
gesia, so that the only analgesic drugs acting after the opera-
tion were the NSAIDs under evaluation. A potential limitation
of this study was the absence of a control (placebo) group;
however, to include such a group would have been difficult to
justify ethically, and difficult to explain to the dogs’ owners
owing to the clinical nature of the trial. However, a compen-
sating strength of the trial is that there were no significant dif-
ferences between the two groups of dogs with respect to their
age, weight, sex and duration of anaesthesia.
The subcutaneous administration of carprofen and
meloxicam at the doses used provided similar postoperative
sedative and analgesic effects. The postoperative pain scores
observed in both groups were low, particularly when it is con-
TABLE 3: Mean (sd) respiratory rate, heart rate and mean
arterial pressure (MAP) of 16 dogs treated with 4 mg/kg
carprofen and 16 treated with 0·2 mg/kg meloxicam
preoperatively, at intervals after surgery to repair a torn cranial
Carprofen cruciate ligament or fractured long bone
Meloxicam
Time Respiratory rate Heart rate MAP
(hours) Drug (breaths/minute) (bpm) (mmHg)
0 Carprofen 32·7 (17·0) 113·2 (39·0) 94·5 (21·2)

variables in 16 dogs Meloxicam 24·6 (13·2) 117·8 (17·0) 95·7 (16·5)

treated with 4 mg/kg 7 1 Carprofen 21·5 (13·2) 103·1 (28·5) 103·5 (16·8)
carprofen and 16 6 Meloxicam 22·8 (6·6) 122·6 (34·9) 90·6 (19·7)
treated with 0·2 mg/kg 5 2 Carprofen 19·2 (6·1) 130·5 (26·4) 97·4 (13·1)
4 Meloxicam 21·7 (7·6) 123·3 (24·7) 108·6 (27·1)
meloxicam
4 Carprofen 23·3 (8·1) 99·9 (27·2) 98·7 (28·6)
preoperatively, at 3
Meloxicam 22·1 (7·5) 132·4 (34·8) 110·8 (34·8)
intervals after the 2 12 Carprofen 21·7 (5·6) 101·6 (22·1) 106·3 (4·2)
operation to repair a 1 Meloxicam 23·2 (7·6) 129·4 (23·2) 110·1 (20·0)
torn cranial cruciate 0 24 Carprofen 19·7 (6·8) 114·5 (9·7) 98·7 (26·1)
ligament or fractured 0 1 2 4 12 24 Meloxicam 22·3 (8·0) 120·7 (24·9) 110·7 (20·3)
long bone Time (hours)

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TABLE 4: Mean (sd) plasma concentrations of urea and
creatinine, before anaesthesia and 24 hours after extubation,
of 16 dogs treated with 4 mg/kg carprofen and 16 treated with
0·2 mg/kg meloxicam before surgery to repair a torn cranial
cruciate ligament or fractured long bone
Urea Creatinine
Drug (mmol/litre) (µmol/litre)
Laboratory reference range 7·14-17·8 44·2-132·6
Carprofen
Preoperative 6·99 (2·07) 71·6 (9·72)
Postoperative 6·22 (2·01) 82·2 (23·0)
Meloxicam
Preoperative 6·75 (3·81) 68·1 (20·3)
Postoperative 5·44 (3·38) 84·9 (19·5)
sidered that the orthopaedic procedures performed are often
associated with severe pain. None of the dogs required any
additional analgesia during the trial. The results therefore sug-
gest that the preoperative administration of meloxicam is a
safe and effective method for controlling postoperative pain
after orthopaedic procedures in dogs. Its analgesic effects were
not significantly different from those of carprofen, which has
been shown to be very effective in the control of pain after
orthopaedic procedures (Nolan and Reid 1993, Lascelles and
others 1994a, Grisneaux and others 1999).
Pain assessments made immediately after surgery may be
difficult to interpret because of changes associated with recov-
ery from anaesthesia, such as residual sedation or shivering
(Mathews and others 2001). Similar anaesthetic protocols
were used in all the animals to reproduce the same experi-
mental conditions in the two groups. The sedation scores
were low at four hours after anaesthesia for both groups and
decreased markedly during the postoperative period. It is
therefore unlikely that the pain scores recorded were seriously
affected by any residual sedation.
The quantitative measurement of clinical pain presents
major problems. It is accepted that if analgesics are to be used
effectively in a clinical setting, their efficacy should be assessed
under clinical conditions (Lascelles and others 1994a). In
order to assess the efficacy of analgesic drugs under clinical
conditions, different scoring systems have been advocated.
The subjective VAS sedation and pain scoring system has been
used extensively in similar investigations (Nolan and Reid
1993, Balmer and others 1998, Lascelles and others 1998,
Slingsby and Waterman-Pearson 2001, 2002). Descriptive
scales such as the DSS pain and sedation scoring system have
also been used (Taylor and Houlton 1984, Lascelles and oth-
ers 1994a). The VAS scoring system has been shown to corre-
late well with discontinuous scoring systems in man, dogs and
other species (Woodforde and Merskey 1972, Welsh and oth-
ers 1993, Lascelles and others 1994b). Physiological markers
of pain, such as plasma catecholamines or cortisol, have been
used to try to assess postoperative pain objectively in dogs.
However, several studies have found it difficult to correlate the
levels of catecholamines with the degree of pain, owing to the
fact that they are also indicative of the stress of recovery from
anaesthesia, and serum cortisol concentration seems to be
more highly correlated with postoperative pain (Pibarot and
others 1997, Reese and others 2000). Simple pain-scoring
systems were used in this study to determine the degree of
postoperative sedation and pain.
One of the observers used the VAS assessment and the other
used the DSS assessment, and it has been claimed that both
these methods are subjective; furthermore, the DSS can arti-
ficially augment the apparent effect of analgesics and the VAS
can produce more variable results (Holton and others 1998b).
The problems of variability associated with the VAS assess-
ments were avoided by using one experienced observer whose
visual acuity and motor coordination had been confirmed
(Holton and others 1998b, Slingsby and Waterman-Pearson
2002); this assessor was able to reproduce scores to within
3 mm. The results obtained by both scoring systems were
similar, and no significant differences between the pain and
sedation scores recorded with meloxicam and carprofen were
observed at any time.
Other scales, based on an assessment of behavioural and
physiological measurements, have been used to evaluate the
degree of postoperative pain in dogs. One of these, a system
based on five variables, adapted by Pibarot and others (1997),
was used to try to compensate for the potential subjectivity of
the results obtained by the other scales. Good correlations
have been obtained between the pain scores determined by
this method and the levels of cortisol (Pibarot and others
1997, Grisneaux and others 1999). The two assessors both
used this method after one had used the VAS system and the
other had used the DSS system, and they agreed a final score.
The results of this scoring system were similar to those
obtained with the VAS and DSS scales.
It has been shown that carprofen provides effective anal-
gesia for up to 18 to 20 hours after anaesthesia in dogs
(Lascelles and others 1994a, Slingsby and Waterman-Pearson
2001). It has also been reported that meloxicam can control
postoperative pain for up 20 hours in dogs undergoing
abdominal surgery (Mathews and others 2001). In both
groups in the present study, the postoperative pain scores were
clinically acceptable at 12 and 24 hours after surgery, and it
was not necessary to provide a supplementary dose of anal-
gesia to any of the dogs. Both meloxicam and carprofen could
therefore be considered effective in controlling orthopaedic
postoperative pain for up to 24 hours.
In dogs the mean half-life (t1/2) of meloxicam is 24 hours
(Busch and others 1998). In a study in dogs undergoing
surgery, the mean t1/2 of carprofen was also found to be close
to 24 hours (Lascelles and others 1998). There are limitations
to the direct application of pharmacokinetic data to estimate
the duration of the effects of NSAIDs because some of them
produce active metabolites, and for others, including carpro-
fen, the plasma concentration may not provide a good indi-
cation of the clinical response (Lees and others 1991, Lascelles
and others 1998). However, the long t1/2 values of both
meloxicam and carprofen in dogs may account for the long
analgesic effects observed in this study, which are in agree-
ment with previous reports (Mathews and others 2001,
Slingsby and Waterman-Pearson 2001).
There were no significant differences between the dogs
treated with carprofen and meloxicam in terms of their res-
piratory rate, heart rate and mean arterial pressure after the
operations. These findings may be explained by the similar
analgesic profiles of the two drugs. Orthopaedic pain in dogs
is often associated with an increase in arterial blood pressure
(Sammarco and others 1996). Nevertheless, previous studies
have failed to observe any significant differences in the arte-
rial pressures between groups despite significant differences
in pain scores (Pibarot and others 1997). Similarly, Holton
and others (1998a) observed no correlation between physio-
logical measurements such as heart and respiratory rates and
the severity of pain.
Carprofen has a high COX-1/COX-2 ratio and has been found
to provide reliable analgesia without side effects when admin-
istered preoperatively in a variety of orthopaedic procedures
in dogs (Nolan and Reid 1993, Lascelles and others 1994a,
Grisneaux and others 1999). Meloxicam has a significantly
greater effect on prostaglandin E2 (PGE2) inhibition in COX-2
models than in COX-1 models, and it has the highest COX-1/
COX-2 ratio, inducing 50 per cent inhibition of the synthesis
of PGE2 (Kay-Mugford and others 2000). This profile could
also make meloxicam suitable for preoperative administra-
tion. In this study there were no significant differences
between the plasma concentrations of urea and creatinine
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before and 24 hours after the operations, and no adverse
effects were reported during the postoperative period, sug-
gesting that no renal damage had occurred. Similar findings
have been reported after the administration of meloxicam to
dogs and cats before operations (Mathews and others 2001,
Slingsby and Waterman-Pearson 2002).
The preoperative administration of meloxicam was safe
and effective in relieving postoperative pain for up to 24 hours
after elective orthopaedic procedures in dogs, and no sup-
plementary doses of analgesics were required. However, it is
generally accepted that it is better to treat intraoperative and
postoperative pain with more than one drug. There are nor-
mal variations within a population of dogs with respect to the
intensity of the signs of pain displayed, and it is important
to design specific analgesic protocols for individual dogs
(Slingsby and Waterman-Pearson 2002). The authors there-
fore consider that the administration of NSAIDs such as
meloxicam or carprofen, together with parenteral, trans-
dermal and/or epidural opioids should be the treatment of
choice to reduce or even eliminate the pain and stress suffered
by dogs after orthopaedic procedures.
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 Downloaded from http://veterinaryrecord.bmj.com/ on October 20, 2015 - Published by group.bmj.com

Comparison of the analgesic effects of

meloxicam and carprofen administered
preoperatively to dogs undergoing
orthopaedic surgery
F. G. Laredo, E. Belda, J. Murciano, M. Escobar, A. Navarro, K. J.
Robinson and R. S. Jones

Veterinary Record 2004 155: 667-671

doi: 10.1136/vr.155.21.667

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