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Full Research Article

Comparative Analgesic Efficacy of Meloxicam, Carprofen and Tolfenamic Acid for Perioperative Pain Management in Canine Orthopaedic Cases

L
Likchavi Kurrey1
R
Rukmani Dewangan1,*
0000-0002-5826-2391
J
Jasmeet Singh2
R
Raju Sharda1
I
Ishant Kumar1
S
Sangram Singh1
M
Muskan Sengar1
1Department of Veterinary Surgery and Radiology, College of Veterinary Science and Animal Husbandry, Anjora, Durg (C.G.), Dau Shri Vasudev Chandrakar Kamdhenu Vishwavidyalya, Durg-491 001, Chhattisgarh, India.
2Teaching Veterinary Clinical Complex, College of Veterinary Science and Animal Husbandry, Anjora, Durg (C.G.), Dau Shri Vasudev Chandrakar Kamdhenu Vishwavidyalya, Durg-491 001, Chhattisgarh, India.

ABSTRACT

Background: Effective perioperative pain management is essential in canine orthopaedic surgery to promote early recovery, improve animal welfare and minimize postoperative complications. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely employed for perioperative analgesia; however, comparative analgesic evaluation of their efficacy in canine orthopaedic cases remains important.

Methods: The present study was conducted on canine cases (n=18) presented for surgical management of long bone fractures (femur/humerus). The animals were randomly divided into three groups (n=6 each) based on analgesic protocols: Meloxicam (0.2 mg/kg IM OD), carprofen (4 mg/kg SC OD) and tolfenamic acid (4 mg/kg IM OD). All animals were subjected to intramedullary pinning under a standardized anaesthetic regimen comprising atropine, dexmedetomidine, butorphanol and ketamine. Pre-emptive analgesics were administered and continued once daily for five days postoperatively. Pain was assessed using University of Melbourne Pain Scale (UMPS), comprising of both physiological and behavioural parameters on 0, 1, 3 and 5 post-operative days.

Result: All treatment groups exhibited significant (p<0.05) reduction in postoperative pain scores, indicating effective analgesia. Carprofen and Meoxicam treated animals consistently demonstrated lower physiological, behavioural and overall UMPS scores upto 3rd day postoperatively. However, Carprofen provided excellent pain control till complete recovery. In contrast, tolfenamic acid exhibited comparatively higher pain scores and less sustained analgesic efficacy till perfect healing. Behavioural parameters improved progressively in all groups with earlier normalization observed in the carprofen-treated animals. It was inferred that all three NSAIDs effectively reduced postoperative pain in canine orthopaedic cases; however, carprofen proved superior with sustained analgesic efficacy.

INTRODUCTION

Orthopaedic disorders, particularly long bone fractures involving femur and humerus, are among the most commonly encountered surgical conditions in canine cases. These injuries not only compromise locomotion but also induce significant pain and stress, adversely affecting the animal’s welfare and recovery (Fossum, 2019). Orthopaedic surgeries are prolonged and inherently painful procedures that induce significant nociceptive responses during and after surgical intervention (Mathews, 2000). The degree of pain and stress experienced by veterinary orthopaedic cases varies depending on the nature of trauma and extent of soft tissue injury. Effective perioperative pain management is a fundamental component of successful orthopaedic intervention in veterinary practice. Pain associated with fracture repair is typically acute and, if inadequately managed, may progress to chronic pain, compromising patient welfare, delaying functional recovery and increasing postoperative complications. Effective pain management requires consideration of both the intensity and duration of pain, with the primary objective of minimizing the overall pain burden throughout the perioperative period (Mathews and Dyson, 2005). Perioperative pain management, encompassing the preoperative, intraoperative and postoperative phases, aims to minimize pain, improve patient comfort and enhance recovery. Pre-emptive analgesia, involving the administration of analgesics before surgical injury, reduces peripheral and central sensitization, thereby decreasing postoperative pain and analgesic requirements. Consequently, non-steroidal anti-inflammatory drugs (NSAIDs) have become an integral component of perioperative pain management because of their analgesic, anti-inflammatory and opioid-sparing effects, contributing to improved postoperative recovery in both human and veterinary patients (Macrae, 2001; Moiniche et al., 2002; Dahl and Kehlet, 2011; Epstein et al., 2015; Doleman et al., 2021). Furthermore, the concept of multimodal or balanced analgesia, which targets multiple pathways involved in nociception, has gained widespread acceptance in veterinary practice (Flecknell and Waterman, 2000; Hansen, 2003).
       
In recent years, there has been increasing recognition of various therapeutic agents and techniques for effective pain management in veterinary cases (Padaliya et al., 2024). A variety of drugs, including non-steroidal anti-inflammatory drugs (NSAIDs), opioids, dissociative anaesthetics and alpha2-adrenoceptor agonists, have been employed for pre-emptive and post-operative analgesia in animals (Amarpal et al., 1999; Hoelzler et al., 2005; Hewson et al., 2006). Several studies have evaluated analgesic protocols in canine orthopaedic cases using various agents such as meloxicam, ketoprofen, ketamine and pethidine (Hansraj, 1999; Kazakos et al., 2005; Lafuente et al., 2005). Non-steroidal anti-inflammatory drugs such as meloxicam, carprofen and tolfenamic acid are widely used in veterinary medicine due to their analgesic, anti-inflammatory and antipyretic effects. These drugs primarily exert their action through inhibition of cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis and inflammation (Lees et al., 2004). Meloxicam and carprofen are relatively COX-2 selective and are commonly preferred for managing postoperative pain in dogs due to their improved safety profile (Lascelles et al., 2005). Meloxicam, an enolic acid derivative NSAID, possesses analgesic, anti-inflammatory and antipyretic properties (Plumb, 2002; Chaithra et al., 2021) and has been shown to be effective in managing postoperative pain in dogs undergoing soft tissue and orthopaedic surgeries (Andrade et al., 2001; Tatari et al., 2001; Hohner, 2004; Chaithra et al., 2021). Carprofen, a propionic acid derivative NSAID, is widely used for management of osteoarthritis and postoperative pain, providing analgesic effects lasting up to 18 hours with minimal adverse effects (Papich, 2021). It has also been reported to exhibit preferential COX-2 inhibition in canine tissues (Wilson et al., 2004) and has been successfully used in dogs undergoing ovariohysterectomy (Leece et al., 2005) and orthopaedic surgeries (Bufalari et al., 2012). Tolfenamic acid, another NSAID, has demonstrated efficacy in managing both acute and chronic locomotor pain in dogs and helps in reducing postoperative oedema (Chaffaux et al., 1991). Its effectiveness in controlling postoperative pain has also been reported in canine orthopaedic cases (Fonda and Perini, 2000).
       
Effective orthopaedic pain management mainly relies on multimodal approach like use of NSAIDs to reduce inflammation, neuropathic modulators for nerve pain and holistic therapies like physical rehabilitation and controlled exercise. Pre and post operative use of NSAIDs play a significant role not only in minimizing pain but also providing comfortable and perfect recovery. In view of the critical role of pain management of NSAIDsin orthopaedic surgeries, the novelty of the present study lies in the head-to-head clinical comparison of meloxicam, carprofen and tolfenamic acid in canine orthopaedic cases undergoing standardized fracture repair procedures, with emphasis on both pre-emptive and postoperative analgesic efficacy under field clinical conditions using University of Melbourne Pain Scale (UMPS) as an objective tool for pain assessment.

MATERIALS AND METHODS

Place of work
 
The present work was carried out in Department of Veterinary Surgery and Radiology and Teaching Veterinary Clinical Complex in College of Veterinary Science and A.H., Anjora, Durg (C.G.) during January to December 2024. The study was conducted on 18 clinical cases of femoral and humeral long bone fractures presented for surgical management were included irrespective of age, breed and sex after obtaining owner consent. Fractures were diagnosed based on clinical and radiographic examination and cases with concurrent systemic illness, severe complications, or prior prolonged medication history were excluded from the study. Animals were randomly allocated into three treatment groups consisting of six dogs each for administration of meloxicam, carprofen, or tolfenamic acid.
 
Experimental design
 
Eighteen canine orthopaedic cases requiring surgical interventions for intramedullary pinning were selected for the study and randomly divided into three groups based on the analgesic protocol viz., group M(meloxicam @ 0.2 mg/kg OD IM), group C (carprofen @ 4 mg/kg, SC OD) and group T (tolfenamic acid @ 4 mg/kg OD IM), comprising of 6 animals in each. Each animal was fasted for 12 hours and water withheld for 6 hours prior to surgical intervention. To minimize procedural variation, all dogs were subjected to a standardized anaesthetic and surgical protocol and fracture stabilization was performed using intramedullary pinning under aseptic conditions. Atropine was administered@0.04 mg/kgIM followed 5 minutes later withdexmedetomidine (0.05 mg/kg body wt. IV) and butorphanol (0.02 mg/kg body wt. IV) using separate syringes. After 10 minutes of the preanaesthetic medication, induction and maintenance of anaesthesia was done by ketamine (5 mg/kg b.wt.) intravenously. Various analgesics viz., meloxicam, carprofen and tolfenamic acid were administered 30 minutes prior to pre-anaesthetic medication (pre-emptive analgesia) and continued once daily for 5 days post-operatively. Postoperative management included routine supportive therapy comprising fluid therapy, antibiotic coverage, wound care and restricted activity as per standard clinical practice.
 
Evaluation of analgesia
 
Analgesic efficacy was assessed using physiological, behavioural and pain-related parameters with the University of Melbourne Pain Scale (UMPS) at day zero, 1, 3 and 5 following administration of analgesia pre-emptively and post-operatively intervals. Parameters such as posture, vocalization, response to palpation, Mental status, behaviour and general activity were considered during assessment as shown in Table 1, which includes 6 categories and 12 variables with a total score range of 0-27 depending upon the extent of pain experienced by the animal. Overall score was added to give a total score (Firth and Haldane, 1999).

Table 1: The University of melbourne pain scale.



Statistical analysis
 
The subjective data generated from scoring of various parameters by University of Melbourne Pain Scale (UMPS) were analyzed applying appropriate statistical analysis using Kruskal-Wallis followed by post hoc multiple comparison tests wherever significant differences were detected for comparing the analgesic efficacy between and within groups. Statistical significance was considered at p<0.05.

RESULTS AND DISCUSSION

Effective pain management is a critical determinant of successful recovery following orthopaedic surgery in dogs. In the present study, the analgesic efficacy of meloxicam, carprofen and tolfenamic acid was evaluated in canine orthopaedic cases using University of Melbourne Pain Scale (UMPS), which integrates both physiological and behavioural parameters for comprehensive pain assessment.
 
Physiological parameters
 
The physiological parameters recorded in animals of all experimental groups differed non-significantly (p>0.05) upto third day post-operatively, indicating a comparable response to analgesic administration (Fig 1). However, on day 5 post-surgery, a significant increase (p<0.05) in physiological score was observed in animals of Group T as compared to Group M and C which might be indicative of inadequate analgesic control an persistence of post operative pain. The comparatively better physiological stability observed in animals of Groups M and C could be attributed to their superior analgesic and anti-inflammatory properties of meloxicam and carprofen, which preferentially inhibit COX-2 enzyme and reduce prostaglandin-mediated inflammation (Lees et al., 2004; Lascelles et al., 2005). The findings simulate with observations of Surbhi et al., (2010) and Ranpriya et al., (2013), where in improved physiological parameters in dogs treated with meloxicam and ketoprofen following orthopaedic surgeries.

Fig 1: Physiological data of UMPS at various days in different groups.


 
Response to palpation
 
In the present study, the mean score values for response to palpation in animals of all groups showed a non-significant (p>0.05) decrease on day 1 post-surgery with gradual and significant (p<0.05) decline on days 3 and 5 (Fig 2) which indicates a decrease in postoperative pain and improved comfort to animals. Between group comparison revealed that animals of Group C exhibited significantly (p<0.05) lower palpation scores as compared to Groups M and T by day 3 postoperatively, suggesting superior intermediate analgesic efficacy. However, on day 5, animals in Group T showed significantly (p<0.05) higher palpation scores compared to Groups M and C, indicating relatively poor pain control with tolfenamic acid. Behavioural observations further supported these findings as majority of animals demonstrated guarding behaviour or reacted before or during palpation on day 0 and day 3, reflecting the presence of postoperative pain alongwith tenderness at the surgical site which gradually decreased by day 5 indicating effective pain alleviation and healing progression. The comparatively better performance of carprofen may be attributed to its sustained anti-inflammatory action and effective inhibition of prostaglandin synthesis, leading to reduced peripheral sensitization (Lascelles et al., 2005). The present findings are in accordance with the reports of Surbhi et al., (2010) and Ranpriya et al., (2013), who observed a significant reduction in response to palpation in dogs administered meloxicam and ketoprofen following orthopaedic surgeries.

Fig 2: Response to palpation of UMPS at various days in different groups.


 
Activity
 
Animals of Group M and T showed a non-significant (p>0.05) decrease in the activity scores on day 1, followed by a significant (p<0.05) reduction on days 3 and 5 post-surgery. To its contrary, animals of Group C exhibited a significant (p<0.05) decrease in activity scores throughout the observation period, indicating more effective and sustained analgesic action (Fig 3). Immediately post surgery, four dogs appeared restless alongwith frequent posture changes upto day 1 while animals of all the groups remained alert with comparatively decreased  restlessness and behavioural changes by day 3. From 5th day onwards, most of the animals were calm and showed minimal sign of discomfort suggesting progressive alleviation of pain. The significantly lower activity scores observed in animals of Group C confirmed superior efficacy of carprofen, which may be attributed to its potent anti-inflammatory action and prolonged inhibition of prostaglandin synthesis (Lascelles et al., 2005). Meloxicam also showed effective analgesic action, although slightly less pronounced than carprofen, whereas tolfenamic acid demonstrated comparatively lesser efficacy, particularly during the early postoperative period. The present findings are in accordance with Surbhi et al., (2010) and Ranpriya et al., (2013), who reported a significant reduction in activity-related pain behaviours following administration of NSAIDs (meloxicam, ketoprofen) in dogs.

Fig 3: Activity of UMPS at various days in different groups.


 
Posture
 
In the present study, the mean posture scores in animals of Group M and T showed a non-significant (p>0.05) decrease on day 1 post-surgery, followed by a significant (p<0.05) reduction on days 3 and 5. However, animals of Group C exhibited a significant (p<0.05) decrease in posture scores from day 1 onwards, which persisted throughout the postoperative period up to day 5 (Fig 4). Comparison among groups revealed that posture scores in animals of Group C were significantly (p < 0.05) lower than those of Groups M and T on days 3 and 5 post-surgery, indicating superior analgesic efficacy of carprofen in improving postural comfort and reducing pain-associated abnormalities. Clinical observations indicated that postural abnormalities such as guarding of the affected limb, sternal recumbency and standing with head lowered were present in few animals on the day of surgery and during the first postoperative day, reflecting acute postoperative pain and discomfort. However, milder postural deviations such as lateral recumbency and standing with head held up were observed only after 72 hours in few animals. The superior performance of carprofen in the present study may be attributed to its potent anti-inflammatory and analgesic properties, resulting in better control of postoperative pain and early return to normal posture (Lascelles et al., 2005). Meloxicam also showed satisfactory improvement, whereas tolfenamic acid demonstrated comparatively slower recovery in postural parameters. The findings of the present study are in agreement with those of Surbhi et al., (2010) and Ranpriya et al., (2013), who reported significant improvement in posture and reduction in pain-related postural abnormalities in dogs treated with NSAIDs (meloxicam, ketoprofen) following orthopaedic surgery.

Fig 4: Posture of UMPS at various days in different groups.


 
Vocalization
 
The mean scores for vocalization in Groups M and T showed a non-significant (p>0.05) decrease on day 1 post-surgery, followed by a gradual and significant (p<0.05) reduction on days 3 and 5 whereas, Group C exhibited a significant (p<0.05) decrease in vocalization scores from day 1 onwards, which persisted up to day 5 postoperatively, indicating better analgesic efficacy (Fig 5). Comparison between groups revealed that vocalization scores were lower in animals of Group C on day 3 as compared to Groups M and T. Furthermore, on day 5, animals of Groups M and C showed significantly (p<0.05) lower vocalization scores compared to Group T, suggesting comparatively reduced pain perception in these groups. Behavioural observations indicated that intermittent vocalization, either spontaneously or upon handling, was present in many animals during the preoperative period. However, only a few animals exhibited vocalization during the postoperative period, reflecting effective pain management and recovery. The comparatively lower vocalization scores observed in Group C may be attributed to the superior analgesic and anti-inflammatory effects of carprofen, which effectively reduced nociceptive stimulation and associated behavioural responses (Lascelles et al., 2005). Meloxicam also demonstrated effective reduction in vocalization, whereas tolfenamic acid showed relatively lesser efficacy in controlling pain-associated vocal responses. The findings of the present study are in agreement with those of Surbhi et al., (2010), who reported reduced vocalization scores in dogs administered meloxicam and ketoprofen following orthopaedic surgeries. Additionally, studies utilizing UMPS in canine pain assessment have consistently demonstrated that vocalization is a sensitive indicator of postoperative pain and analgesic response (Surbhi et al., 2010).

Fig 5: Vocalization of UMPS at various days in different groups.


 
Mental status
 
The mean score values of mental status in animals of Group M showed a non-significant (p>0.05) decrease throughout the observation period. While animals of Group C exhibited a non-significant (p>0.05) decrease in mental status score on day 1, followed by a gradual and significant (p<0.05) reduction on days 3 and 5 post-surgery. However, animals of Group T also showed a non-significant (p>0.05) decrease in mental status scores on days 1 and 3, followed by a significant (p<0.05) reduction on day 5 (Fig 6). Comparison revealed that mental status scores were significantly (p<0.05) lower in animals of Group C on days 3 and 5 as compared to Groups M and T, indicating better analgesic efficacy of carprofen in improving behavioural responses associated with pain. Behavioral observations showed that animals in all groups exhibited signs of aggressiveness or wary action on day 0, likely due to acute pain and stress associated with trauma and surgical intervention. However, from day 3 onwards up to day 5 post-surgery, most animals displayed submissive and over-friendly behaviour, suggesting improved comfort and reduction in pain.The significantly improved mental status observed in Group B may be attributed to the superior analgesic and anti-inflammatory effects of carprofen, which reduce nociceptive input and associated stress responses (Lascelles et al., 2005). Meloxicam also showed moderate improvement, whereas tolfenamic acid demonstrated comparatively delayed recovery in behavioural parameters. The findings of the present study are consistent with those of Ranpriya et al., (2013), who reported significant improvement in behavioral parameters, including mental status, following administration of NSAIDs in canine orthopaedic cases. Similar observations have also been reported in studies utilizing UMPS for pain assessment in dogs (Surbhi et al., 2010).

Fig 6: Mental status of UMPS at various days in different groups.



Overall pain score using UMPS
 
The mean values of pain score in animals of Group M was 5.50±0.22, 3.33±0.21, 1.50±0.34 and 0.83±0.16,Group C was 6.16±0.16, 2.83±0.30, 1.16±0.16 and 0.66±0.21 and Group T was 5.83±0.30, 3.50±0.22, 1.83±0.30 and 1.66±0.21 on day 0, 1, 3 and 5 following operation respectively (Fig 7). In animals of Group M and C, the values of UMPS gradually decreased significantly (p<0.05) from day zero upto day 5. However, in animals of Group T, the values of UMPS were significantly (p<0.05) decreased from day of surgery till third postoperative day. There was non-significant (p>0.05) difference in the values of UMPS between 3rd and 5th day post surgery in animals of Group T. However, the pain scores were non-significantly (p>0.05) lower in group C in comparison to other groups after surgery throughout the observation period. Comparison among the groups revealed significantly (p<0.05) lower University of Melbourne Pain Scale (UMPS) scores in the meloxicam (Group M) and carprofen (Group C) groups than in the tolfenamic acid (Group T) group on 5th day postoperatively.  Overall UMPS scores declined significantly (p<0.05) from day 0 to day 5 in all groups, indicating effective postoperative analgesia. However, the reduction was more consistent and sustained in Groups M and C, whereas Group T showed a comparatively lesser decline, particularly between days 3 and 5. The significantly lower UMPS scores in Groups M and C on day 5 indicate superior prolonged analgesic efficacy. These findings are consistent with those of Kazakos et al., (2005), Bergmann et al., (2007) and Bufalari et al., (2012), who reported that combining non-steroidal anti-inflammatory drugs (NSAIDs) with opioids and a2-adrenergic agonists provides effective postoperative analgesia, improved behavioural comfort and enhanced recovery in dogs undergoing orthopaedic surgery. The superior analgesic efficacy of carprofen observed in the present study agrees with the findings of Bergmann et al., (2007) and Bufalari et al., (2012), who demonstrated improved mobility, reduced pain-related behaviour and greater postoperative comfort in carprofen-treated dogs. Similarly, the progressive improvement in posture, activity, vocalization and mental status supports previous reports that behavioural assessment is a sensitive indicator of postoperative pain relief (Firth and Haldane, 1999; Hansen, 2003). These findings confirm the effectiveness of NSAIDs analgesic protocols and support the clinical utility of UMPS for evaluating postoperative pain in canine orthopaedic cases.

Fig 7: Analgesic evaluation by UMPS in different groups at various time intervals.

CONCLUSION

In persuasion to present study, it can be concluded that all the three NSAIDs produced significant postoperative analgesia in canine orthopaedic cases, as evidenced by progressive reduction in UMPS scores throughout postoperative observation period. Among the drugs evaluated, Carprofen demonstrated comparatively superior and more sustained analgesic efficacy with lower behavioural and physiological pain scores than meloxicam and tolfenamic acid. Therefore, carprofen could be recommended as the preferred NASID for perioperative pain management in canine orthopaedic cases.

ACKNOWLEDGEMENT

The present study was supported by College of Veterinary Science and A.H., Anjora, Dau Shri Vasudev Chandrakar Kamdhenu Vishwavidyalya (DSVCKV), Chhattisgarh.
 
Disclaimers
 
The views and conclusions expressed in this article are solely those of the authors and do not necessarily represent the views of their affiliated institutions. The authors are responsible for the accuracy and completeness of the information provided, but do not accept any liability for any direct or indirect losses resulting from the use of this content.
 
Informed consent
 
The study was conducted after obtaining approval from the Institutional Animal Ethics Committee (IAEC) in accordance with CPCSEA guidelines for the use of animals in clinical research. Informed written consent was obtained from the owners prior to inclusion of dogs in the study and all clinical cases were managed following standard ethical and welfare practices during the perioperative period.

CONFLICT OF INTEREST

The authors declare that there are no conflicts of interest regarding the publication of this article. No funding or sponsorship influenced the design of the study, data collection, analysis, decision to publish,or preparation of the manuscript.

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    Full Research Article

    Comparative Analgesic Efficacy of Meloxicam, Carprofen and Tolfenamic Acid for Perioperative Pain Management in Canine Orthopaedic Cases

    L
    Likchavi Kurrey1
    R
    Rukmani Dewangan1,*
    0000-0002-5826-2391
    J
    Jasmeet Singh2
    R
    Raju Sharda1
    I
    Ishant Kumar1
    S
    Sangram Singh1
    M
    Muskan Sengar1
    1Department of Veterinary Surgery and Radiology, College of Veterinary Science and Animal Husbandry, Anjora, Durg (C.G.), Dau Shri Vasudev Chandrakar Kamdhenu Vishwavidyalya, Durg-491 001, Chhattisgarh, India.
    2Teaching Veterinary Clinical Complex, College of Veterinary Science and Animal Husbandry, Anjora, Durg (C.G.), Dau Shri Vasudev Chandrakar Kamdhenu Vishwavidyalya, Durg-491 001, Chhattisgarh, India.

    ABSTRACT

    Background: Effective perioperative pain management is essential in canine orthopaedic surgery to promote early recovery, improve animal welfare and minimize postoperative complications. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely employed for perioperative analgesia; however, comparative analgesic evaluation of their efficacy in canine orthopaedic cases remains important.

    Methods: The present study was conducted on canine cases (n=18) presented for surgical management of long bone fractures (femur/humerus). The animals were randomly divided into three groups (n=6 each) based on analgesic protocols: Meloxicam (0.2 mg/kg IM OD), carprofen (4 mg/kg SC OD) and tolfenamic acid (4 mg/kg IM OD). All animals were subjected to intramedullary pinning under a standardized anaesthetic regimen comprising atropine, dexmedetomidine, butorphanol and ketamine. Pre-emptive analgesics were administered and continued once daily for five days postoperatively. Pain was assessed using University of Melbourne Pain Scale (UMPS), comprising of both physiological and behavioural parameters on 0, 1, 3 and 5 post-operative days.

    Result: All treatment groups exhibited significant (p<0.05) reduction in postoperative pain scores, indicating effective analgesia. Carprofen and Meoxicam treated animals consistently demonstrated lower physiological, behavioural and overall UMPS scores upto 3rd day postoperatively. However, Carprofen provided excellent pain control till complete recovery. In contrast, tolfenamic acid exhibited comparatively higher pain scores and less sustained analgesic efficacy till perfect healing. Behavioural parameters improved progressively in all groups with earlier normalization observed in the carprofen-treated animals. It was inferred that all three NSAIDs effectively reduced postoperative pain in canine orthopaedic cases; however, carprofen proved superior with sustained analgesic efficacy.

    INTRODUCTION

    Orthopaedic disorders, particularly long bone fractures involving femur and humerus, are among the most commonly encountered surgical conditions in canine cases. These injuries not only compromise locomotion but also induce significant pain and stress, adversely affecting the animal’s welfare and recovery (Fossum, 2019). Orthopaedic surgeries are prolonged and inherently painful procedures that induce significant nociceptive responses during and after surgical intervention (Mathews, 2000). The degree of pain and stress experienced by veterinary orthopaedic cases varies depending on the nature of trauma and extent of soft tissue injury. Effective perioperative pain management is a fundamental component of successful orthopaedic intervention in veterinary practice. Pain associated with fracture repair is typically acute and, if inadequately managed, may progress to chronic pain, compromising patient welfare, delaying functional recovery and increasing postoperative complications. Effective pain management requires consideration of both the intensity and duration of pain, with the primary objective of minimizing the overall pain burden throughout the perioperative period (Mathews and Dyson, 2005). Perioperative pain management, encompassing the preoperative, intraoperative and postoperative phases, aims to minimize pain, improve patient comfort and enhance recovery. Pre-emptive analgesia, involving the administration of analgesics before surgical injury, reduces peripheral and central sensitization, thereby decreasing postoperative pain and analgesic requirements. Consequently, non-steroidal anti-inflammatory drugs (NSAIDs) have become an integral component of perioperative pain management because of their analgesic, anti-inflammatory and opioid-sparing effects, contributing to improved postoperative recovery in both human and veterinary patients (Macrae, 2001; Moiniche et al., 2002; Dahl and Kehlet, 2011; Epstein et al., 2015; Doleman et al., 2021). Furthermore, the concept of multimodal or balanced analgesia, which targets multiple pathways involved in nociception, has gained widespread acceptance in veterinary practice (Flecknell and Waterman, 2000; Hansen, 2003).
           
    In recent years, there has been increasing recognition of various therapeutic agents and techniques for effective pain management in veterinary cases (Padaliya et al., 2024). A variety of drugs, including non-steroidal anti-inflammatory drugs (NSAIDs), opioids, dissociative anaesthetics and alpha2-adrenoceptor agonists, have been employed for pre-emptive and post-operative analgesia in animals (Amarpal et al., 1999; Hoelzler et al., 2005; Hewson et al., 2006). Several studies have evaluated analgesic protocols in canine orthopaedic cases using various agents such as meloxicam, ketoprofen, ketamine and pethidine (Hansraj, 1999; Kazakos et al., 2005; Lafuente et al., 2005). Non-steroidal anti-inflammatory drugs such as meloxicam, carprofen and tolfenamic acid are widely used in veterinary medicine due to their analgesic, anti-inflammatory and antipyretic effects. These drugs primarily exert their action through inhibition of cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis and inflammation (Lees et al., 2004). Meloxicam and carprofen are relatively COX-2 selective and are commonly preferred for managing postoperative pain in dogs due to their improved safety profile (Lascelles et al., 2005). Meloxicam, an enolic acid derivative NSAID, possesses analgesic, anti-inflammatory and antipyretic properties (Plumb, 2002; Chaithra et al., 2021) and has been shown to be effective in managing postoperative pain in dogs undergoing soft tissue and orthopaedic surgeries (Andrade et al., 2001; Tatari et al., 2001; Hohner, 2004; Chaithra et al., 2021). Carprofen, a propionic acid derivative NSAID, is widely used for management of osteoarthritis and postoperative pain, providing analgesic effects lasting up to 18 hours with minimal adverse effects (Papich, 2021). It has also been reported to exhibit preferential COX-2 inhibition in canine tissues (Wilson et al., 2004) and has been successfully used in dogs undergoing ovariohysterectomy (Leece et al., 2005) and orthopaedic surgeries (Bufalari et al., 2012). Tolfenamic acid, another NSAID, has demonstrated efficacy in managing both acute and chronic locomotor pain in dogs and helps in reducing postoperative oedema (Chaffaux et al., 1991). Its effectiveness in controlling postoperative pain has also been reported in canine orthopaedic cases (Fonda and Perini, 2000).
           
    Effective orthopaedic pain management mainly relies on multimodal approach like use of NSAIDs to reduce inflammation, neuropathic modulators for nerve pain and holistic therapies like physical rehabilitation and controlled exercise. Pre and post operative use of NSAIDs play a significant role not only in minimizing pain but also providing comfortable and perfect recovery. In view of the critical role of pain management of NSAIDsin orthopaedic surgeries, the novelty of the present study lies in the head-to-head clinical comparison of meloxicam, carprofen and tolfenamic acid in canine orthopaedic cases undergoing standardized fracture repair procedures, with emphasis on both pre-emptive and postoperative analgesic efficacy under field clinical conditions using University of Melbourne Pain Scale (UMPS) as an objective tool for pain assessment.

    MATERIALS AND METHODS

    Place of work
     
    The present work was carried out in Department of Veterinary Surgery and Radiology and Teaching Veterinary Clinical Complex in College of Veterinary Science and A.H., Anjora, Durg (C.G.) during January to December 2024. The study was conducted on 18 clinical cases of femoral and humeral long bone fractures presented for surgical management were included irrespective of age, breed and sex after obtaining owner consent. Fractures were diagnosed based on clinical and radiographic examination and cases with concurrent systemic illness, severe complications, or prior prolonged medication history were excluded from the study. Animals were randomly allocated into three treatment groups consisting of six dogs each for administration of meloxicam, carprofen, or tolfenamic acid.
     
    Experimental design
     
    Eighteen canine orthopaedic cases requiring surgical interventions for intramedullary pinning were selected for the study and randomly divided into three groups based on the analgesic protocol viz., group M(meloxicam @ 0.2 mg/kg OD IM), group C (carprofen @ 4 mg/kg, SC OD) and group T (tolfenamic acid @ 4 mg/kg OD IM), comprising of 6 animals in each. Each animal was fasted for 12 hours and water withheld for 6 hours prior to surgical intervention. To minimize procedural variation, all dogs were subjected to a standardized anaesthetic and surgical protocol and fracture stabilization was performed using intramedullary pinning under aseptic conditions. Atropine was administered@0.04 mg/kgIM followed 5 minutes later withdexmedetomidine (0.05 mg/kg body wt. IV) and butorphanol (0.02 mg/kg body wt. IV) using separate syringes. After 10 minutes of the preanaesthetic medication, induction and maintenance of anaesthesia was done by ketamine (5 mg/kg b.wt.) intravenously. Various analgesics viz., meloxicam, carprofen and tolfenamic acid were administered 30 minutes prior to pre-anaesthetic medication (pre-emptive analgesia) and continued once daily for 5 days post-operatively. Postoperative management included routine supportive therapy comprising fluid therapy, antibiotic coverage, wound care and restricted activity as per standard clinical practice.
     
    Evaluation of analgesia
     
    Analgesic efficacy was assessed using physiological, behavioural and pain-related parameters with the University of Melbourne Pain Scale (UMPS) at day zero, 1, 3 and 5 following administration of analgesia pre-emptively and post-operatively intervals. Parameters such as posture, vocalization, response to palpation, Mental status, behaviour and general activity were considered during assessment as shown in Table 1, which includes 6 categories and 12 variables with a total score range of 0-27 depending upon the extent of pain experienced by the animal. Overall score was added to give a total score (Firth and Haldane, 1999).

    Table 1: The University of melbourne pain scale.



    Statistical analysis
     
    The subjective data generated from scoring of various parameters by University of Melbourne Pain Scale (UMPS) were analyzed applying appropriate statistical analysis using Kruskal-Wallis followed by post hoc multiple comparison tests wherever significant differences were detected for comparing the analgesic efficacy between and within groups. Statistical significance was considered at p<0.05.

    RESULTS AND DISCUSSION

    Effective pain management is a critical determinant of successful recovery following orthopaedic surgery in dogs. In the present study, the analgesic efficacy of meloxicam, carprofen and tolfenamic acid was evaluated in canine orthopaedic cases using University of Melbourne Pain Scale (UMPS), which integrates both physiological and behavioural parameters for comprehensive pain assessment.
     
    Physiological parameters
     
    The physiological parameters recorded in animals of all experimental groups differed non-significantly (p>0.05) upto third day post-operatively, indicating a comparable response to analgesic administration (Fig 1). However, on day 5 post-surgery, a significant increase (p<0.05) in physiological score was observed in animals of Group T as compared to Group M and C which might be indicative of inadequate analgesic control an persistence of post operative pain. The comparatively better physiological stability observed in animals of Groups M and C could be attributed to their superior analgesic and anti-inflammatory properties of meloxicam and carprofen, which preferentially inhibit COX-2 enzyme and reduce prostaglandin-mediated inflammation (Lees et al., 2004; Lascelles et al., 2005). The findings simulate with observations of Surbhi et al., (2010) and Ranpriya et al., (2013), where in improved physiological parameters in dogs treated with meloxicam and ketoprofen following orthopaedic surgeries.

    Fig 1: Physiological data of UMPS at various days in different groups.


     
    Response to palpation
     
    In the present study, the mean score values for response to palpation in animals of all groups showed a non-significant (p>0.05) decrease on day 1 post-surgery with gradual and significant (p<0.05) decline on days 3 and 5 (Fig 2) which indicates a decrease in postoperative pain and improved comfort to animals. Between group comparison revealed that animals of Group C exhibited significantly (p<0.05) lower palpation scores as compared to Groups M and T by day 3 postoperatively, suggesting superior intermediate analgesic efficacy. However, on day 5, animals in Group T showed significantly (p<0.05) higher palpation scores compared to Groups M and C, indicating relatively poor pain control with tolfenamic acid. Behavioural observations further supported these findings as majority of animals demonstrated guarding behaviour or reacted before or during palpation on day 0 and day 3, reflecting the presence of postoperative pain alongwith tenderness at the surgical site which gradually decreased by day 5 indicating effective pain alleviation and healing progression. The comparatively better performance of carprofen may be attributed to its sustained anti-inflammatory action and effective inhibition of prostaglandin synthesis, leading to reduced peripheral sensitization (Lascelles et al., 2005). The present findings are in accordance with the reports of Surbhi et al., (2010) and Ranpriya et al., (2013), who observed a significant reduction in response to palpation in dogs administered meloxicam and ketoprofen following orthopaedic surgeries.

    Fig 2: Response to palpation of UMPS at various days in different groups.


     
    Activity
     
    Animals of Group M and T showed a non-significant (p>0.05) decrease in the activity scores on day 1, followed by a significant (p<0.05) reduction on days 3 and 5 post-surgery. To its contrary, animals of Group C exhibited a significant (p<0.05) decrease in activity scores throughout the observation period, indicating more effective and sustained analgesic action (Fig 3). Immediately post surgery, four dogs appeared restless alongwith frequent posture changes upto day 1 while animals of all the groups remained alert with comparatively decreased  restlessness and behavioural changes by day 3. From 5th day onwards, most of the animals were calm and showed minimal sign of discomfort suggesting progressive alleviation of pain. The significantly lower activity scores observed in animals of Group C confirmed superior efficacy of carprofen, which may be attributed to its potent anti-inflammatory action and prolonged inhibition of prostaglandin synthesis (Lascelles et al., 2005). Meloxicam also showed effective analgesic action, although slightly less pronounced than carprofen, whereas tolfenamic acid demonstrated comparatively lesser efficacy, particularly during the early postoperative period. The present findings are in accordance with Surbhi et al., (2010) and Ranpriya et al., (2013), who reported a significant reduction in activity-related pain behaviours following administration of NSAIDs (meloxicam, ketoprofen) in dogs.

    Fig 3: Activity of UMPS at various days in different groups.


     
    Posture
     
    In the present study, the mean posture scores in animals of Group M and T showed a non-significant (p>0.05) decrease on day 1 post-surgery, followed by a significant (p<0.05) reduction on days 3 and 5. However, animals of Group C exhibited a significant (p<0.05) decrease in posture scores from day 1 onwards, which persisted throughout the postoperative period up to day 5 (Fig 4). Comparison among groups revealed that posture scores in animals of Group C were significantly (p < 0.05) lower than those of Groups M and T on days 3 and 5 post-surgery, indicating superior analgesic efficacy of carprofen in improving postural comfort and reducing pain-associated abnormalities. Clinical observations indicated that postural abnormalities such as guarding of the affected limb, sternal recumbency and standing with head lowered were present in few animals on the day of surgery and during the first postoperative day, reflecting acute postoperative pain and discomfort. However, milder postural deviations such as lateral recumbency and standing with head held up were observed only after 72 hours in few animals. The superior performance of carprofen in the present study may be attributed to its potent anti-inflammatory and analgesic properties, resulting in better control of postoperative pain and early return to normal posture (Lascelles et al., 2005). Meloxicam also showed satisfactory improvement, whereas tolfenamic acid demonstrated comparatively slower recovery in postural parameters. The findings of the present study are in agreement with those of Surbhi et al., (2010) and Ranpriya et al., (2013), who reported significant improvement in posture and reduction in pain-related postural abnormalities in dogs treated with NSAIDs (meloxicam, ketoprofen) following orthopaedic surgery.

    Fig 4: Posture of UMPS at various days in different groups.


     
    Vocalization
     
    The mean scores for vocalization in Groups M and T showed a non-significant (p>0.05) decrease on day 1 post-surgery, followed by a gradual and significant (p<0.05) reduction on days 3 and 5 whereas, Group C exhibited a significant (p<0.05) decrease in vocalization scores from day 1 onwards, which persisted up to day 5 postoperatively, indicating better analgesic efficacy (Fig 5). Comparison between groups revealed that vocalization scores were lower in animals of Group C on day 3 as compared to Groups M and T. Furthermore, on day 5, animals of Groups M and C showed significantly (p<0.05) lower vocalization scores compared to Group T, suggesting comparatively reduced pain perception in these groups. Behavioural observations indicated that intermittent vocalization, either spontaneously or upon handling, was present in many animals during the preoperative period. However, only a few animals exhibited vocalization during the postoperative period, reflecting effective pain management and recovery. The comparatively lower vocalization scores observed in Group C may be attributed to the superior analgesic and anti-inflammatory effects of carprofen, which effectively reduced nociceptive stimulation and associated behavioural responses (Lascelles et al., 2005). Meloxicam also demonstrated effective reduction in vocalization, whereas tolfenamic acid showed relatively lesser efficacy in controlling pain-associated vocal responses. The findings of the present study are in agreement with those of Surbhi et al., (2010), who reported reduced vocalization scores in dogs administered meloxicam and ketoprofen following orthopaedic surgeries. Additionally, studies utilizing UMPS in canine pain assessment have consistently demonstrated that vocalization is a sensitive indicator of postoperative pain and analgesic response (Surbhi et al., 2010).

    Fig 5: Vocalization of UMPS at various days in different groups.


     
    Mental status
     
    The mean score values of mental status in animals of Group M showed a non-significant (p>0.05) decrease throughout the observation period. While animals of Group C exhibited a non-significant (p>0.05) decrease in mental status score on day 1, followed by a gradual and significant (p<0.05) reduction on days 3 and 5 post-surgery. However, animals of Group T also showed a non-significant (p>0.05) decrease in mental status scores on days 1 and 3, followed by a significant (p<0.05) reduction on day 5 (Fig 6). Comparison revealed that mental status scores were significantly (p<0.05) lower in animals of Group C on days 3 and 5 as compared to Groups M and T, indicating better analgesic efficacy of carprofen in improving behavioural responses associated with pain. Behavioral observations showed that animals in all groups exhibited signs of aggressiveness or wary action on day 0, likely due to acute pain and stress associated with trauma and surgical intervention. However, from day 3 onwards up to day 5 post-surgery, most animals displayed submissive and over-friendly behaviour, suggesting improved comfort and reduction in pain.The significantly improved mental status observed in Group B may be attributed to the superior analgesic and anti-inflammatory effects of carprofen, which reduce nociceptive input and associated stress responses (Lascelles et al., 2005). Meloxicam also showed moderate improvement, whereas tolfenamic acid demonstrated comparatively delayed recovery in behavioural parameters. The findings of the present study are consistent with those of Ranpriya et al., (2013), who reported significant improvement in behavioral parameters, including mental status, following administration of NSAIDs in canine orthopaedic cases. Similar observations have also been reported in studies utilizing UMPS for pain assessment in dogs (Surbhi et al., 2010).

    Fig 6: Mental status of UMPS at various days in different groups.



    Overall pain score using UMPS
     
    The mean values of pain score in animals of Group M was 5.50±0.22, 3.33±0.21, 1.50±0.34 and 0.83±0.16,Group C was 6.16±0.16, 2.83±0.30, 1.16±0.16 and 0.66±0.21 and Group T was 5.83±0.30, 3.50±0.22, 1.83±0.30 and 1.66±0.21 on day 0, 1, 3 and 5 following operation respectively (Fig 7). In animals of Group M and C, the values of UMPS gradually decreased significantly (p<0.05) from day zero upto day 5. However, in animals of Group T, the values of UMPS were significantly (p<0.05) decreased from day of surgery till third postoperative day. There was non-significant (p>0.05) difference in the values of UMPS between 3rd and 5th day post surgery in animals of Group T. However, the pain scores were non-significantly (p>0.05) lower in group C in comparison to other groups after surgery throughout the observation period. Comparison among the groups revealed significantly (p<0.05) lower University of Melbourne Pain Scale (UMPS) scores in the meloxicam (Group M) and carprofen (Group C) groups than in the tolfenamic acid (Group T) group on 5th day postoperatively.  Overall UMPS scores declined significantly (p<0.05) from day 0 to day 5 in all groups, indicating effective postoperative analgesia. However, the reduction was more consistent and sustained in Groups M and C, whereas Group T showed a comparatively lesser decline, particularly between days 3 and 5. The significantly lower UMPS scores in Groups M and C on day 5 indicate superior prolonged analgesic efficacy. These findings are consistent with those of Kazakos et al., (2005), Bergmann et al., (2007) and Bufalari et al., (2012), who reported that combining non-steroidal anti-inflammatory drugs (NSAIDs) with opioids and a2-adrenergic agonists provides effective postoperative analgesia, improved behavioural comfort and enhanced recovery in dogs undergoing orthopaedic surgery. The superior analgesic efficacy of carprofen observed in the present study agrees with the findings of Bergmann et al., (2007) and Bufalari et al., (2012), who demonstrated improved mobility, reduced pain-related behaviour and greater postoperative comfort in carprofen-treated dogs. Similarly, the progressive improvement in posture, activity, vocalization and mental status supports previous reports that behavioural assessment is a sensitive indicator of postoperative pain relief (Firth and Haldane, 1999; Hansen, 2003). These findings confirm the effectiveness of NSAIDs analgesic protocols and support the clinical utility of UMPS for evaluating postoperative pain in canine orthopaedic cases.

    Fig 7: Analgesic evaluation by UMPS in different groups at various time intervals.

    CONCLUSION

    In persuasion to present study, it can be concluded that all the three NSAIDs produced significant postoperative analgesia in canine orthopaedic cases, as evidenced by progressive reduction in UMPS scores throughout postoperative observation period. Among the drugs evaluated, Carprofen demonstrated comparatively superior and more sustained analgesic efficacy with lower behavioural and physiological pain scores than meloxicam and tolfenamic acid. Therefore, carprofen could be recommended as the preferred NASID for perioperative pain management in canine orthopaedic cases.

    ACKNOWLEDGEMENT

    The present study was supported by College of Veterinary Science and A.H., Anjora, Dau Shri Vasudev Chandrakar Kamdhenu Vishwavidyalya (DSVCKV), Chhattisgarh.
     
    Disclaimers
     
    The views and conclusions expressed in this article are solely those of the authors and do not necessarily represent the views of their affiliated institutions. The authors are responsible for the accuracy and completeness of the information provided, but do not accept any liability for any direct or indirect losses resulting from the use of this content.
     
    Informed consent
     
    The study was conducted after obtaining approval from the Institutional Animal Ethics Committee (IAEC) in accordance with CPCSEA guidelines for the use of animals in clinical research. Informed written consent was obtained from the owners prior to inclusion of dogs in the study and all clinical cases were managed following standard ethical and welfare practices during the perioperative period.

    CONFLICT OF INTEREST

    The authors declare that there are no conflicts of interest regarding the publication of this article. No funding or sponsorship influenced the design of the study, data collection, analysis, decision to publish,or preparation of the manuscript.

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