Validação clínica da escala Unesp-Botucatu para avaliar a dor em bovinos (UCAPS) e da escala de dor em vacas (CPS) em Bos taurus & Bos indicus
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Data
2022-07-01
Autores
Tomacheuski, Rubia Mitalli
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A avaliação da dor é crucial para orientar a tomada de decisão no manejo da dor e melhorar o bem-estar animal. Objetivou-se realizar uma validação clínica psicométrica da Escala Unesp-Botucatu para avaliar a dor em bovinos (UCAPS) e Escala de dor em vacas (CPS) para avaliação da dor pós-operatória em Bos taurus (Angus) e Bos indicus (Nelore) submetidos à castração sob anestesia geral. Dez touros da raça Nelore e nove da raça Angus foram submetidos a estresse térmico testicular e escrotal (34, 37 e 40°C) por 135 minutos seguido de orquiectomia. Realizou-se sedação com xilazina (0,05 mg/kg IV), indução anestésica com cetamina (2,5 mg/kg) e diazepam (0,05 mg/kg) IV, manutenção com isoflurano e analgesia preemptiva com flunixin meglumine (1,1 mg/kg IM) e xilazina peridural (0,05 mg/kg) antes da cirurgia. A gravação de vídeos foi realizada por 3 minutos 48h antes da cirurgia e em jejum (M0), antes da sedação em jejum (M1), após a cirurgia, 3h após decúbito esternal e antes da analgesia no pós-operatório (M2), 1h após a analgesia (morfina 0,1 mg/kg IM) (M3), e 24h após a cirurgia (M4), quando os animais receberam flunixin meglumine (1,1 mg/kg IM). Duas avaliadores encobertas, avaliaram 95 vídeos aleatorizados duas vezes (total de 4,75h de gravações), em duas fases, com intervalo de 30 dias entre elas. A dor foi avaliada com UCAPS, CPS, Escala Visual Numérica (NRS) e Escala Visual Analógica (VAS). A análise estatística foi realizada usando o software R e considerou-se as diferenças como significativas quando o p < 0,05. A análise de componentes principais indicou que UCAPS e CPS são unidimensionais. Não houve diferenças para os escores totais de qualquer escala entre as raças. A confiabilidade intra e inter-avaliador, utilizando o coeficiente de correlação intraclasse ou kappa ponderado, variou de bom (> 0,70) a muito bom (> 0,81) para todas as escalas. A validade de critério concorrente mostrou forte correlação (0,75–0,77) entre NRS e VAS versus UCAPS e CPS, e entre UCAPS e CPS (0,76). O modelo linear misto mostrou que UCAPS e CPS foram responsivas, pois todos os itens e o escore total aumentaram após a cirurgia, embora não tenham diminuído após a analgesia. Todos os itens na UCAPS e CPS mostraram correlação item-total de Spearman aceitável (0,3–0,7). A consistência interna pelo coeficiente α de Cronbach foi boa (0,72) para UCAPS e muito boa (0,79) para CPS. Ambas as escalas foram específicas (81–85%) e sensíveis (82–87%) para diagnosticar animais sem e com dor respectivamente. O ponto de corte para analgesia de resgate foi > 4 para UCAPS e > 3 para CPS. A área sob a curva apresentou excelente capacidade discriminatória (> 0,93) para UCAPS e CPS. Concluindo que a UCAPS e a CPS são instrumentos válidos e confiáveis para se utilizar clinicamente na avaliação da dor em bovinos Angus e Nelore. Não houve diferenças nos escores de dor entre as raças. O ponto de corte definido de ambas as escalas pode orientar a tomada de decisão para analgesia de resgate.
Pain assessment is crucial to guide decision-making in pain management and improve animal welfare. We aimed to perform a clinical psychometrical validation of the UnespBotucatu Cattle Pain Scale (UCAPS) and Cow Pain Scale (CPS) for postoperative pain assessment in Bos taurus (Angus) and Bos indicus (Nelore) undergoing castration under general anaesthesia. Ten Nelore and nine Angus bulls underwent testicular and scrotal thermic stress (34, 37 and 40°C) for 135 minutes followed by orchiectomy. Sedation was performed with xylazine (0.05 mg/kg IV), induction of anaesthesia with ketamine (2.5 mg/kg) and diazepam (0.05 mg/kg) IV, maintenance with isoflurane, and preemptive analgesia with flunixin meglumine (1.1 mg/kg IM) and epidural xylazine (0.05 mg/kg) before surgery. Video recording was performed for 3 minutes 48h before surgery and fasting (M0), before sedation under fasting (M1), after surgery, 3h after sternal recumbency and before postoperative analgesia (M2), 1h after analgesia (morphine 0.1 mg/kg IM) administration (M3), and 24h after surgery (M4), when animals received flunixin meglumine (1.1 mg/kg IM). Two blinded evaluators assessed 95 randomised videos twice (total of 4.75h of recordings), in two phases, with a 30-day interval between phases. Pain was assessed with UCAPS, CPS, Numerical Rating Scale (NRS) and Visual Analogue Scale (VAS). Statistical analysis performed using R software and significant differences as considered p < 0.05. The principal component analysis indicated that UCAPS and CPS are unidimensional. There were no differences for the total scores of any scale between breeds. Intra and inter-rater reliability, using the intra-class correlation coefficient or weighted kappa, varied from good (> 0.70) to very good (> 0.81) for all scales. The concurrent criterion validity showed strong correlation (0.75–0.77) between NRS and VAS versus UCAPS and CPS, and between UCAPS and CPS (0.76). The mixed linear model showed that UCAPS and CPS were responsive because all items and total score increased after surgery, although they did not decrease after analgesia. All items of UCAPS and CPS showed acceptable Spearman item-total correlation (0.3–0.7). The internal consistency using Cronbach’s α coefficient was good (0.72) for UCAPS and very good (0.79) for CPS. Both scales were specific (81–85%) and sensitive (82–87%) to diagnose pain-free animals and animals suffering pain, respectively. The cut-off point for rescue analgesia was > 4 for UCAPS and > 3 for CPS. The area under the curve showed an excellent discriminatory ability (> 0.93) for UCAPS and CPS. The UCAPS and CPS are valid and reliable instruments to be used clinically to assess pain in Angus and Nelore cattle. There were no differences in pain scores between breeds after orchiectomy. The defined cut-off point of both scales can guide decision-making for rescue analgesia.
Pain assessment is crucial to guide decision-making in pain management and improve animal welfare. We aimed to perform a clinical psychometrical validation of the UnespBotucatu Cattle Pain Scale (UCAPS) and Cow Pain Scale (CPS) for postoperative pain assessment in Bos taurus (Angus) and Bos indicus (Nelore) undergoing castration under general anaesthesia. Ten Nelore and nine Angus bulls underwent testicular and scrotal thermic stress (34, 37 and 40°C) for 135 minutes followed by orchiectomy. Sedation was performed with xylazine (0.05 mg/kg IV), induction of anaesthesia with ketamine (2.5 mg/kg) and diazepam (0.05 mg/kg) IV, maintenance with isoflurane, and preemptive analgesia with flunixin meglumine (1.1 mg/kg IM) and epidural xylazine (0.05 mg/kg) before surgery. Video recording was performed for 3 minutes 48h before surgery and fasting (M0), before sedation under fasting (M1), after surgery, 3h after sternal recumbency and before postoperative analgesia (M2), 1h after analgesia (morphine 0.1 mg/kg IM) administration (M3), and 24h after surgery (M4), when animals received flunixin meglumine (1.1 mg/kg IM). Two blinded evaluators assessed 95 randomised videos twice (total of 4.75h of recordings), in two phases, with a 30-day interval between phases. Pain was assessed with UCAPS, CPS, Numerical Rating Scale (NRS) and Visual Analogue Scale (VAS). Statistical analysis performed using R software and significant differences as considered p < 0.05. The principal component analysis indicated that UCAPS and CPS are unidimensional. There were no differences for the total scores of any scale between breeds. Intra and inter-rater reliability, using the intra-class correlation coefficient or weighted kappa, varied from good (> 0.70) to very good (> 0.81) for all scales. The concurrent criterion validity showed strong correlation (0.75–0.77) between NRS and VAS versus UCAPS and CPS, and between UCAPS and CPS (0.76). The mixed linear model showed that UCAPS and CPS were responsive because all items and total score increased after surgery, although they did not decrease after analgesia. All items of UCAPS and CPS showed acceptable Spearman item-total correlation (0.3–0.7). The internal consistency using Cronbach’s α coefficient was good (0.72) for UCAPS and very good (0.79) for CPS. Both scales were specific (81–85%) and sensitive (82–87%) to diagnose pain-free animals and animals suffering pain, respectively. The cut-off point for rescue analgesia was > 4 for UCAPS and > 3 for CPS. The area under the curve showed an excellent discriminatory ability (> 0.93) for UCAPS and CPS. The UCAPS and CPS are valid and reliable instruments to be used clinically to assess pain in Angus and Nelore cattle. There were no differences in pain scores between breeds after orchiectomy. The defined cut-off point of both scales can guide decision-making for rescue analgesia.
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Palavras-chave
Analgesia, Animais de fazenda, Bem-estar animal, Comportamento animal, Manejo da dor, Bovinos