TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER

Teknik Operasi Amputasi Dewclaw

Disusun Oleh :

No NIM Nama Mahasiswa

1. 1509005101 Leoni Arifah Agustina
2. 1509005112 Putri Nur Hasanah
3. 1509005114 I Gede Pratama Candra Wibawa
4. 1509005115 Dzikri Nurma’rifah Takariyanti
5. 1509005116 Kadek Satria Adi Marhendra
6. 1509005119 Dinda Nur Hidayah

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

TAHUN 2018

i
 RINGKASAN

Cakar adalah anggota tambahan badan yang terlindung dari ujung kaki. Cakar
sebenarnya adalah pembesaran dan pengerasan dari kuku. Pencabutan cakar atau
dewclaw adalah operasi yang bertujuan untuk mengangkat dan menghilangkan cakar
hewan (misalnya kucing dan anjing) dengan cara mengamputasikan seluruh atau
sebagian dari falang distal, atau memutuskan tulang, jari kaki hewan. Operasi amputasi
dewclaw disebut juga dengan onychectomy. Operasi ini dibagi tiga jenis berdasarkan
instrument bedahnya yaitu dengan menggunakan laser, dengan pisau bedah (scalpel)
serta metode gullotine. Daerah operasi dibalut selama 2-3 hari dan jahitan dibuka
setelah 7-14 hari. Anjing atau kucing dapat dipasangkan Elizabethan collar selama 7-10
hari untuk mencegah anjing/kucing menjilati balutan. Pengobatan dengan antibiotik dan
analgesik dapat diberikan di pagi hari keesokan hari setelah tindakan operasi.

Kata Kunci : Cakar, dewclaw, onychectomy

SUMMARY

Claws are additional members of the body that are protected from the toes. Actual claws
are enlargement and hardening of the nails. Claw or dewclaw extraction is an operation
that aims to remove and remove animal claws (such as cats and dogs) by amputating all
or part of the distal phalanx, or breaking the bones, toes of the animal. Dewclaw
amputation surgery is also called onychectomy. This operation is divided into three
types based on the surgical instrument using a laser, with a scalpel and gullotine
method. The operating area is bandaged for 2-3 days and the sutures are opened after 7-
14 days. Dogs or cats can be paired with Elizabethan collar for 7-10 days to prevent
dogs / cats from licking bandages. Treatment with antibiotics and analgesics can be
given in the morning the following day after surgery.

Keywords: Claws, dewclaw, onychectomy

ii
 KATA PENGANTAR

Puji syukur penulis panjatkan kehadirat Tuhan Yang Maha Esa yang telah memberikan
rahmat serta hidayah-Nya sehingga penyusunan paper ini dapat diselesaikan.

Paper ini disusun penulis sebagai tugas dari mata kuliah Ilmu Bedah Khusus Veteriner,
yang berjudul “Teknik Operasi Amputasi Dewclaw”. Melalui penulisan paper ini, diharapkan
mahasiswa mampu memahami lebih dalam tentang Teknik Operasi Amputasi Dewclaw.

Terima kasih penulis sampaikan kepada dosen mata kuliah Ilmu Bedah Khusus Veteriner
yang telah membimbing dan memberikan kuliah demi lancarnya penulisan tugas paper ini. Kritik
dan saran yang membangun sangat penulis harapkan untuk penulisan paper yang lebih baik lagi
kedepannya.

Demikianlah paper ini penulis susun, semoga bermanfaat dan dapat memenuhi tugas mata
kuliah Ilmu Bedah Khusus Veteriner.

Denpasar, 3 September 2018

Hormat Saya,

Penulis

iii
 DAFTAR ISI

COVER ....................................................................................................................i

RINGKASAN ..........................................................................................................ii

KATA PENGANTAR..............................................................................................iii

DAFTAR ISI ............................................................................................................iv

DAFTAR GAMBAR ...............................................................................................v

DAFTAR LAMPRAN .............................................................................................vi

BAB I. PENDAHULUAN .......................................................................................1

1.1 Latar Belakang ..........................................................................................1

1.2 Rmumusan Masalah ..................................................................................1

1.3 Tujuan Penulisan .......................................................................................1

1.4 Manfaat Penulisan .....................................................................................2

BAB II. TINJAUAN PUSTAKA .............................................................................3

2.1 Teknik Operasi ..........................................................................................3
2.1.1 Preoperasi ....................................................................................3
2.1.2 Operasi .........................................................................................4
2.1.3 Tindakan Pasca Operasi Pengangkatan Dewclaw .......................5

BAB III. PEMBAHASAN .......................................................................................7

BAB IV. SIMPULAN DAN SARAN ......................................................................8

4.1 Simpulan....................................................................................................8

4.2 Saran ..........................................................................................................8

DAFTAR PUSTAKA ..............................................................................................9

LAMPIRAN JURNAL.............................................................................................10

iv
 DAFTAR GAMBAR

Gambar 1. Metode Operasi Amputasi Dewclaw. ..................................................... 4

Gambar 2. Anjing Pasca Operasi Pengangkatan Dewclaw Di Kedua Kaki Belakang.

Daerah Operasi Dibalut Dan Lehernya Dipasangkan E-Collar ............. 6

v
 DAFTAR LAMPIRAN

Jurnal 1. A review of medically unnecessary surgeries in dogs and cats…………....10

Jurnal 2. Perioperative Pain Management in Veterinary Patients............................... 10

Jurnal 3. Postoperative Bleeding in Retired Racing Greyhounds ............................... 10

Jurnal 4. Dewclaws in wolves as evidence of admixed ancestry with dogs ............... 10

vi
 BAB I

PENDAHULUAN

1.1 Latar Belakang Masalah

Prosedur bedah kosmetika dalam dunia veteriner dilakukan dengan dua tujuan yaitu
estetika untuk menampilkan hewan kesayangan sesuai standar ras hewan dan memberikan
kebanggaan bagi pemilik hewan atas penampilan hewan kesayangannya berbeda dari yang
lain, serta tujuan terapeutik bagi hewan pasca kecelakaan atau cedera permanen. Salah satu
contoh operasi bedah kosmetika adalah pencabutan cakar atau dewclaw.

Cakar adalah anggota tambahan badan yang terlindung dari ujung kaki. Cakar
sebenarnya adalah pembesaran dan pengerasan dari kuku. Hewan berkuku disebut ungulata.
Ungulata terbagi dalam 2 kelompok besar: hewan berkuku genap (misalnya antelop, sapi,
rusa, babi, domba, kambing) dan hewan berkuku gasal (kuda, badak dan tapir). Hewan
berkuku genap yang berjari kaki lebih dari 3 dan 4 lebih kuat, sehingga hewan itu lebih bisa
membawa beban yang lebih berat, sementara hewan berkuku ganjil adalah dengan jari kaki 1
dan 2 kurang bisa.

Pencabutan cakar atau dewclaw adalah operasi yang bertujuan untuk mengangkat dan
menghilangkan cakar hewan (misalnya kucing dan anjing) dengan cara mengamputasikan
seluruh atau sebagian dari falang distal, atau memutuskan tulang, jari kaki hewan. Karena
cakar berkembang dari jaringan germinal dalam falang ketiga, maka amputasi tulang
diperlukan untuk sepenuhnya menghapus cakar. Meskipun hal ini umum di Amerika Utara,
pencabutan kuku dianggap sebagai tindakan kekejaman terhadap hewan dibanyak Negara
seperti Australia, Brazil, Eropa, Austria, Britania Raya, Israel, dan Amerika Serikat.

1.2 Rumusan Masalah

1.2.1 Bagaimana teknik pre-operasi dan anestesi operasi amputasi dewclaw?
1.3.1 Bagaimana teknik operasi amputasi dewclaw?
1.4.1 Bagaimana hasil dan pasca operasi amputasi dewclaw?
1.3 Tujuan
1.3.1 Untuk mengetahui teknik pre-operasi dan anestesi operasi amputasi dewclaw.
1.3.2 Untuk mengetahui teknik operasi amputasi dewclaw.
1.3.3 Untuk mengetahui hasil dan pasca operasi amputasi dewclaw.

1
1.4 Manfaat Tulisan
Manfaat dari penulisan paper ini yaitu agar mahasiswa dapat mengetahui bagaimana
definisi operasi amputasi dewclaw, teknik pre-operasi dan anestesi operasi amputasi
dewclaw, teknik operasi dewclaw, hingga hasil dan pasca operasi amputasi dewclaw, dan
juga pembuatan paper ini untuk melengkapi tugas Ilmu Bedah Khusus Veteriner tentang
teknik operasi amputasi dewclaw.

2
 BAB II.

TINJAUAN PUSTAKA

2.1 Teknik Operasi

2.1.1 Preoperasi

- Waktu
Operasi amputasi dew claw pada hewan yang baru lahir bisa dilakukan
bersamaan dengan tail docking pada umur 1-2 hari. Jika prosedur tidak dilakukan
saat itu, maka dianjutkan untuk menunggu hingga hewan berusia setidaknya
berusia 12 minggu.
- Persiapan Obat dan Alat
Sebelum melakukan operasi, obat yang harus disiapkan adalah obat
premedikasi seperti atropin sulfat, obat anestesi yang meliputi xylasin dan
ketamin, serta antibiotik cair. Alat yang digunakan adalah alat steril individu
seperti : hands glove, masker dan baju operasi, serta seperangkat alat bedah
(Curcio, 2006)
- Persiapan Tempat Operasi
Tempat operasi harus dalam keadaan bersih dan steril, letakkan alas plastik di
atas meja operasi dan suhu ruangan operasi harus stabil.
- Persiapan Operator
Sebelum melakukan operasi, operator maupun co-operator terlebih dahulu
melepas asesoris yang dapat mengganggu jalannya operasi. Tangan operator dan
co-operator hharus steril dalam melakukan operasi untuk menghindari timbulnya
infeksi bawaan dari luar tubuh hewan. Tangan dicuci menggunakan air bersih dan
sabun. Selanjutnya di steriliasi menggunakan alkohol 70%. Penghitungan dosis
obat yang diberikan untuk tujuan premedikasi dan anastesi harus tepat dan
pengunaan alat-alat sterilisasi individu dengan benar serta memperhatikan SOP
dalam melakukan operasi. (Quartarone et al, 2012)
- Anastesi
Sebelum melakukan anastesi, perlu dilakukan pendataan riwayat pasien
(Posner, 2010) meliputi :
o Hewan
o Berat
3
 o Umur
Sebelum operasi dilaksanakan, pasien diperiksa keadaan fisiknya dan
dipuasakan selama 8-12 jam dengan tujuan menghindari terjadinya hipersalivasi
dan vomit pada pemberian anestesi. Selanjutnya melakukan hitungan untuk
mengetahui dosis obat premedikasi dan anestesi yang diberikan terhadap pasien.
Sedasi dan anestesi lokal dianjurkan ketika melakukan prosedur ini pada anak
anjing dan anestesi umum dianjurkan untuk hewan yang lebih tua. (Niel et al,
2016)
Rumus : Berat Badan x Dosis Anjuran
Sediaan

Dosis Anjuran
a. Atropin sulfat : 0,02 – 0,04 mg/kg
b. Xylasin : 1-3 mg/kg
c. Ketamin : anjing 10-15 mg/kg & kucing 10-30 mg /kg

2.1.2 Operasi

Gambar 1. Metode operasi amputasi dewclaw.

4
Operasi amputasi dewclaw disebut juga dengan onychectomy. Operasi ini dibagi tiga
jenis berdasarkan instrument bedahnya yaitu dengan menggunakan laser, dengan
pisau bedah (scalpel) serta metode gullotine. Semua onychectomy dilakukan oleh
dokter hewan berpengalaman yang telah melakukan operasi ini setidaknya 1 tahun
dengan jumlah tindakan sebanyak 7 kali operasi.

a. Onychectomy yang menggunakan laser dilakukan dengan laser karbon dioksida

menggunakan metode disartikulasi (21) (Gambar 1B).
b. Onychectomy yang menggunakan scalpel dilakukan dengan menggunakan pisau
bedah (scalpel) dengan metode yang sama seperti onychectomy laser.
c. Onychectomy guillotine dilakukan dengan gunting kuku tipe guillotine yang steril
menggunakan metode disartikulasi atau amputasi tulang. Metode guillotine
disartikulasi didefinisikan sebagai penghilangan seluruh phalanx ketiga dengan
disartikulasi ruang sendi interphalangeal distal dengan gunting kuku atau
amputasi phalanx ketiga pada fleksor dengan pisau bedah. Metode guillotine
amputasi tulang adalah amputasi di bawah proses ungual meninggalkan prosesus
fleksor dari phalanx ketiga bagian dalam (Gambar 1A) (Clark et al., 2014)

2.1.3 Tindakan Pasca Operasi Pengangkatan Dewclaw

Daerah operasi dibalut selama 2-3 hari dan jahitan dibuka setelah 7-14 hari.
Anjing atau kucing dapat dipasangkan Elizabethan collar selama 7-10 hari untuk
mencegah anjing/kucing menjilati balutan. Jika balutan kotor atau basah maka harus
segera diganti untuk mencegah infeksi. Jika daerah operasi terlihat bengkak
menandakan balutan terpasang terlalu ketat sehingga harus segera dilepas.

5
 Gambar 2. Anjing pasca operasi pengangkatan dewclaw di kedua kaki belakang. Daerah
operasi dibalut dan lehernya dipasangkan E-collar. Sumber:
https://www.dogforums.com/dog-health-questions/262546-dew-claw-surgery-surgery.html

Pengobatan dengan antibiotik dan analgesik dapat diberikan di pagi hari keesokan
hari setelah tindakan operasi. Jenis antibiotik yang dapat diberikan secara topikal seperti
neosporin dua kali sehari, dan obat analgesik seperti carprofen dengan dosis 2 mg/kgBB
(Dyson, 2008). Dianjurkan agar anjin/kucing dibatasi pergerakannya selama beberapa hari.

6
 BAB III

PEMBAHASAN

Operasi amputasi dewclaw merupakan operasi yang masih dipertanyakan

kelegalannya dan masih menjadi pro kontra di kalangan masyarakat. Hal ini dihubungkan
dengan perlindungan animal welfare sehingga tidak semua negara mengizinkan tindakan ini
seperti Australia, New Zealand dan beberapa negara di Eropa.

Operasi pengangkatan dewclaw dikatakan diperlukan khususnya pada kaki belakang

karena secara umum hanya terhubung dengan kulit, berbeda dengan dewclaw di kaki depan
yang tersambung dengan tulang. Jika hanya terhubung kulit maka ada resiko robek saat
tersangkut. Namun hingga saat ini belum ada penelitian mengenai tingkat kejadian cidera
akibat dewclaw.

Pada anjing Toy breeds dewclaw dihilangkan untuk memudahkan menggunting dan
menyisir bulunya. Pada anjing yang dipakai untuk berburu, dewclaw pada kaki belakang
biasanya dipotong karena mudah tersangkut bila berada di lapangan. Beberapa bangsa anjing
ynag biasanya diamputasi dewclawnya adalah Alsatian, boxer, dalmatian, papillon dan silku
terrie.

Adanya claw juga dikhawatirkan akan merusak perabotan rumah terutama pada
hewan peliharaan seperti kucing dan anjing membuat pemilik hewan melakukan operasi ini
pada peliharaannya.

Tak jarang pula operasi ini dilakukan karena alasan medis seperti infeksi, adanya
tumor, atau adanya gangrene pada phalanx ketiga. Kejadian claw tumbuh kembali biasanya
akibat dari metode operasi yang tidak menghilangkan sel germinal pada prosesus ungual,
seperti pada jenis operasi dengan pisau bedah dan dengan gunting kuku guillotine.

Menghilangkan dew claws berpotensi menimbulkan stres, rasa sakit atau infeksi
setelah prosedur dilakukan dan/atau selama penyembuhan. Beberapa breeder di Amerika
memilih untuk menghilangkan dewclaw saat anak anjing masih berusia 3-5 hari pertama
untuk tujuan estetika/penampilan.

7
 BAB IV

SIMPULAN DAN SARAN

4.1 Simpulan

Pencabutan cakar atau dewclaw adalah operasi yang bertujuan untuk

mengangkat dan menghilangkan cakar hewan (misalnya kucing dan anjing) dengan
cara mengamputasikan seluruh atau sebagian dari falang distal, atau memutuskan
tulang, jari kaki hewan. Operasi amputasi dewclaw disebut juga dengan
onychectomy. Operasi ini dibagi tiga jenis berdasarkan instrument bedahnya yaitu
dengan menggunakan laser, dengan pisau bedah (scalpel) serta metode gullotine.
Daerah operasi dibalut selama 2-3 hari dan jahitan dibuka setelah 7-14 hari. Anjing
atau kucing dapat dipasangkan Elizabethan collar selama 7-10 hari untuk mencegah
anjing/kucing menjilati balutan. Pengobatan dengan antibiotik dan analgesik dapat
diberikan di pagi hari keesokan hari setelah tindakan operasi.

4.2 Saran

Saran yang dapat penulis berikan adalah operasi amputasi de claw ini
harus ditangani dengan cepat dan tepat dengan cara pembedahan. Pembedahan
merupakan tindakan yang paling efektif dalam penanganan amputasi de claw

8
 DAFTAR PUSTAKA

Niel L, Keyserlingk MAG, Mills KE. 2016. A review of medically unnecessary surgeries in

dogs and cats. Canada : JAVMA vol 248 (2)

Sudisma, IGN. 2016. Ilmu Bedah dan Teknik Operasi. Denpasar : Plawa Sari.

Clark et al. 2014. Comparison Of 3 Methods Of Onychectomy. Can Vet J 2014;55:255–262

Dogs Forum: Dew Claw Surgery.....From Surgery Thru Recovery. From

https://www.dogforums.com/dog-health-questions/262546-dew-claw-surgery-
surgery.html

Dyson, D.H., 2008. Perioperative Pain Management in Veterinary Patients. Vet Clin Small
Anim 38 (2008) 1309–1327

Katz&Dogs Wellness Clinic: Post-Operative Care Instructions. From

http://katzdogswellness.com/wp-content/uploads/2010/10/Post-Operative-Care-
Instructions.pdf

9
LAMPIRAN JURNAL

10
Reference Point

A review of medically unnecessary surgeries

in dogs and cats
Katelyn E. Mills BSC From the Animal Welfare Program, Faculty of Land and Food Systems, University of
British Columbia, Vancouver, BC V6T 1Z6, Canada (Mills, von Keyserlingk); and the
Marina A. G. von Keyserlingk PhD Department of Population Medicine, Ontario Veterinary College, University of Guelph,
Lee Niel PhD Guelph, ON N1G 2W1, Canada (Niel).
Address correspondence to Dr. Niel (lee.niel@uoguelph.ca).

I n ancient Rome, during the First Century CE, Lucius

Columella wrote that it was proper to remove the
tails of puppies to prevent their growth to an “abomi-
nable length” and to prevent madness, which is pre-
sumed to refer to rabies.1 Although the idea that this
procedure could protect dogs against rabies has long
since been abandoned, tail docking is still commonly
performed, both because of a belief that it reduces
the incidence of injuries and because of the result-
ing perceived improvements in aesthetics. However,
the effectiveness of this procedure in preventing inju-
ries has been questioned, and the idea of performing
this and other surgical procedures on animals solely
for cosmetic reasons has been heavily criticized in
many parts of the world.2 In fact, some countries have
passed legislation restricting these types of surgeries.
While anecdotal reports suggest that certain cosmet-
ic procedures such as ear cropping are in decline in
North America, to our knowledge there are no reliable
estimates on the numbers of these procedures per-
formed annually.
Most surgical procedures performed on dogs and
cats in North America are performed for therapeutic,
diagnostic, or preventive purposes; that is, they are
medically necessary. In contrast, procedures that are
not necessary for maintaining health or that are not
beneficial to the animal can be classified as MUSs.This
would include procedures performed mainly to alter
the appearance of animals (eg, ear cropping and tail
docking in dogs), procedures performed solely to pre-
vent behaviors that are destructive or annoying (eg,
devocalization and defanging in dogs and onychec-
tomy in cats), and procedures of dubious or minimal
benefit (eg, dewclaw removal in dogs). Note that elec-
tive neutering of healthy dogs and cats has historically
been performed to prevent or reduce the risk of fu-
ture health problems (eg, pyometra, mammary gland
neoplasia, and reproductive tract–related neoplasia)
and to prevent unplanned breeding, which benefits
the population as a whole by reducing the number
of unwanted animals.3 Thus, for the purposes of the
ABBREVIATIONS
CVMA Canadian Veterinary Medical Association
MUS Medically unnecessary surgery
present review, we did not classify elective neuter-
ing of dogs and cats as an MUS, even though there is
evidence that elective neutering, while decreasing the
risk of certain health issues in dogs, may increase the
risk of others.4
MUSs Commonly Performed
on Dogs and Cats
Tail docking
Tail docking (caudectomy) is the surgical removal
of the distal portion of the tail. In the Middle Ages, tail
docking was performed on hunting and fighting dogs
to lessen the risk of injury to the tail5 and is still com-
monly performed on dogs of various hunting, work-
ing, and terrier breeds.Tail docking is most often done
within the first week after birth. Typically, a scissors
or scalpel is used to remove the distal portion of the
tail, with 1 or more sutures used to close the result-
ing wound. Alternatively, an elasticized band is placed
around the tail, causing loss of tissue circulation and
eventual death and sloughing of the tail.6 According to
1 study,6 tail docking is often carried out by dog breed-
ers without the use of anesthetics or analgesics. Even
when tail docking is performed by veterinarians, an-
esthetics or analgesics may not be used, with 1 study6
finding that only 10% of veterinarians used anesthetics
or analgesics in conjunction with tail docking. Given
that the use of anesthetics and analgesics in veterinary
practice has increased in general since that study was
published,7 it is possible that the percentage of vet-
erinarians using pain management techniques in con-
junction with tail docking has also increased. Howev-
er, good estimates are not available.
Tail docking is sometimes performed in adult dogs
because of tail injury, neoplasia, or self-trauma and in
these instances would be considered a medically nec-
essary surgery. Note that treatments other than tail
docking have been described for dogs with self-trau-
ma of the tail, including behavioral modification and
pharmacologic treatment.8 However, the efficacy of
these alternative treatments has not been examined.
One argument in favor of tail docking is that these
breeds require docking to avoid future tail injury.2 To

162 JAVMA • Vol 248 • No. 2 • January 15, 2016

test this theory, Diesel et al9 completed a case-con-
trol study of tail injuries in working and nonworking
dogs with and without docked tails. Tail injuries that
were reported included fractures, dislocations, lac-
erations, contusions, self-trauma, and neoplasia. The
weighted risk of tail injuries in working dogs (0.29%)
was significantly higher than the risk in nonworking
dogs (0.19%), and the risk for dogs with docked tails
(0.03%) was significantly lower than the risk for dogs
without docked tails (0.23%). However, the overall tail
injury rate was quite low, and the authors estimated
that 500 dogs would need to have their tails docked
to prevent 1 tail injury.9 A separate study10 reported
similar results, with a tail injury risk of 0.90% for work-
ing breeds and 0.53% for nonworking breeds, and an
estimate that 232 dogs would need to have their tails
docked to prevent 1 tail injury severe enough to re-
quire treatment by a veterinarian. Recently, Lederer et
al11 examined owner reports of tail injuries in docked
and undocked hunting dogs during the shooting sea-
son in Scotland and found that rates of injuries were
higher in undocked spaniels and undocked dogs of
the hunt, point, and retrieve breeds. The authors also
found that the number of injuries reported for both
docked and undocked hunting dogs was higher than
previously reported for working and nonworking
dogs. For example, 54.7% of undocked spaniels and
20.8% of docked spaniels reportedly had at least 1 in-
jury during the shooting season. However, only 4.4% of
dogs with a tail injury required veterinary treatment,
suggesting that the risk of serious injury was much
lower than the overall injury estimate. These results
indicate that there may be some minor benefits to tail
docking but likely only in particular breeds of dogs
that are participating in hunting activities.
Notably, a number of dog breeds, including the
Pembroke Welsh Corgi and Australian Shepherd, have
a naturally occurring mutation in the T-box transcrip-
tion factor T gene (C189G) that results in a short-tail
phenotype.12 In addition, a few breeds with naturally
occurring short tails do not have this mutation, sug-
gesting that there are other yet-to-be-discovered genet-
ic factors affecting tail phenotype. Recently, selective
breeding by outcrossing to a Pembroke Welsh Corgi
with the natural bobtail gene resulted in the birth of
Boxers with naturally short tails.13 Thus, it may be pos-
sible for breeds that traditionally have undergone tail
docking to develop family lines with naturally short
tails. Note, however, that there have been anecdotal
reports that breeding for a bobtail appearance has re-
sulted in health concerns related to deformed tails and
spinal cord defects. Unfortunately, no scientific litera-
ture is available on this topic, and the extent of this
problem is currently unknown.
Individuals disagree as to whether there is pain
associated with tail docking. When asked about the
degree of pain associated with tail docking in pup-
pies, 82% of dog breeders sampled in Australia indi-
cated “none” or “mild.”6 In contrast, the majority of
veterinarians (76%) reported the associated pain to
JAVMA • Vol 248 • No. 2 • January 15, 2016
be “significant” or “severe.” In a study14 of 50 puppies
(Doberman Pinschers, Rottweilers, and Bouviers des
Flandres) that underwent tail docking at 3 to 5 days of
age, all puppies vocalized intensely at the time of tail
amputation, indicating that the procedure was indeed
painful. The authors also reported that the puppies
settled down relatively quickly after the procedure,
suggesting that the pain did not last long; however,
puppies were only monitored until they settled, which
took approximately 3 minutes, and further pain behav-
iors may have occurred at later time points. Despite
the seemingly short duration of pain, some opponents
of tail docking have argued that any pain is unjust if it
is unnecessary.15
Whether tail docking can result in chronic pain
in dogs has not been extensively studied. Gross and
Carr16 described 5 Cocker Spaniels and a Miniature
Poodle that had extensive self-trauma at the surgical
site for several months up to 1 year after tail amputa-
tion and reported that application of mild pressure to
the affected tail areas elicited a severe pain response.
The pain in these dogs was attributed to neuroma de-
velopment. Young female cattle that have undergone
tail docking show increased agitation following appli-
cation of hot or cold packs to the tail stub, suggesting
that hypersensitive nerve bundles may be present,17
and up to 80% of human amputees report experienc-
ing phantom pain following limb amputation.18 Thus,
there is a potential for neuropathic pain in dogs fol-
lowing tail docking, although whether or how fre-
quently this occurs is unknown.
Tail docking may also have detrimental effects on
social communication in dogs,19 as research suggests
that social communication in dogs is largely reliant on
body language, with the tail playing an important role.
For example, Leaver and Reimchen19 examined behav-
ioral responses to dogs with different tail lengths by
placing a remotely controlled life-sized dog replica in
a park.They assessed responses to tails that were short
or long and to tails that were wagging or still. Large
dogs showed more caution approaching the replica
dog when it had a short tail than when it had a long
tail, and the authors speculated that this was a con-
sequence of failure by the replica dog to signal. Also,
large dogs approached the replica dog with a long, still
tail less frequently than they approached the replica
dog with a long, wagging tail but approached repli-
ca dogs with short, wagging tails and short, still tails
with about equal frequency. In contrast, small dogs
showed greater caution than large dogs, regardless of
tail length or motion, likely because of the height dif-
ference and the small dogs’ inability to view the tail.
Results of this study indicated that social communica-
tion in dogs relies on proper observation of tail sig-
naling, suggesting that tail docking may impair social
communication in dogs.
Collectively, the available evidence suggests that
tail docking is unnecessary as a routine procedure to
prevent injury, particularly in nonworking companion
dogs; that it causes short-term pain and has the po-
163
tential to cause long-term neuropathic pain in some
animals; and that it impairs social communication,
which could lead to increased negative interactions
with other dogs.
Ear cropping
In dogs, ear cropping involves reshaping the ap-
pearance of the external ear, usually by removing up
to half of the caudal portion of the pinna (auricula).
Following removal of the pinna, the ears are taped and
splinted to facilitate healing in the desired shape. This
procedure is typically performed when puppies are
between 9 and 12 weeks old, after they have received
their initial vaccinations.20 Most often, dogs are anes-
thetized during the procedure and may or may not be
given analgesics afterward.
Historically, ear cropping was performed to pre-
vent ear damage during hunting or fighting, and some
proponents of ear cropping continue to suggest that
cropping is necessary to prevent accidental tearing
of pendulous ears, particularly in hunting dogs. How-
ever, there is no evidence to support these claims, and
many working breeds, such as spaniels and retrievers,
have naturally pendulous ears. It has also been sug-
gested that ear cropping reduces the risk of ear infec-
tion, as a result of less trapping of moisture and debris
in the ear canal.21 While there is some evidence to sug-
gest that dogs with pendulous ears have a higher risk
of otitis externa, compared with dogs with erect ears,
it appears that specific breeds tend to have a higher
predisposition than others regardless of ear conforma-
tion.22,23 For example, 1 study found that otitis externa
is more common in Cocker Spaniels, Poodles, and Ger-
man Shepherd Dogs,24 and another found a higher
prevalence in Golden Retrievers and West Highland
White Terriers.23 None of these breeds traditionally
have their ears cropped, and their natural ear position
varies between hanging and erect. At least 1 textbook
on veterinary surgery25 no longer includes detailed in-
formation on ear cropping in dogs because of ethical
concerns associated with the procedure, with the au-
thors indicating their support for the AVMA position
statement against this procedure.
To the best of our knowledge, there are no pub-
lished studies on whether ear cropping results in
acute or chronic pain in dogs, although given the
length of the resulting wound, it is clear that the pro-
cedure results in some level of acute pain. However,
information is lacking on common anesthetic and an-
algesic practices for dogs undergoing ear cropping. In
addition, we are not aware of any studies on whether
alterations in ear conformation influence communica-
tion with humans or other dogs.
Importantly, ear cropping is no longer taught at
colleges of veterinary medicine in the United States.
Thus, veterinarians performing this procedure in the
future will largely be self-taught,26 particularly as vet-
erinarians experienced with this procedure retire.
Some veterinarians have justified performing this
procedure because of concerns that serious compli-
164 JAVMA • Vol 248 • No. 2 • January 15, 2016
cations and animal welfare issues will arise if the pro-
cedure is done by unqualified individuals who are not
veterinarians and do not have access to appropriate
facilities, anesthetics, and analgesics.26
Dewclaw removal
In dogs, the dewclaws represent the vestigial first
digits of the forelimbs and, occasionally, hind limbs.27
Some breeds, such as the Great Pyrenees, Bauceron,
and Norwegian Lundehund, have double dewclaws on
each of the hind limbs.28 Dewclaw removal is typically
performed within the first few days after birth, usually
without anesthesia or analgesia,29 but it may also be
performed later in life (eg, when the dog is spayed or
neutered).30 Sedation and local anesthesia are recom-
mended when performing this procedure on young
puppies, and general anesthesia is recommended for
older animals.31
The main argument in support of dewclaw re-
moval is that it prevents injuries associated with ac-
cidental tearing of the dewclaws.29 While the forelimb
dewclaws are typically attached by bone, the hind
limb dewclaws are often attached only by skin, which,
some have suggested, makes them prone to catching
and tearing. Furthermore, because there is no wear of
the associated nail, regular trimming is required to re-
duce the chances of the nail being caught. However, to
date, no research is available to determine the actual
incidence of dewclaw tearing, so the true scope of this
problem is unknown.
To our knowledge, the impact of dewclaw remov-
al on the welfare of dogs has not been researched. As
with any surgery, there is the potential for acute and
chronic pain, but the severity of the pain is unknown.
Declawing
Declawing (onychectomy) is an elective surgi-
cal procedure that involves removal of the claws
through amputation of all or part of the distal pha-
lanx. Several variations of the procedure have been
described, including removal of the entire distal pha-
lanx with a scalpel or surgical laser and removal of
all or most of the distal phalanx with a nail clipper.32
Removal of the distal phalanx with a surgical laser
appears to be the quickest procedure and is associat-
ed with lower levels of postoperative stress and pain
than removal with a scalpel.33 However, it has also
been associated with a higher number of postopera-
tive complications in the days following the proce-
dure.33 Transection of the tendons of the deep flexor
muscle (ie, tendonectomy) is sometimes performed
as an alternative to onychectomy, as it prevents ex-
tension of the claws and results in fewer signs of
pain.34 Both onychectomy and tendonectomy should
be performed only by veterinarians with appropriate
anesthesia and postoperative analgesia.
Declawing is usually performed to prevent
scratching-related injuries to people and damage to
property. Recent surveys35,36 of veterinarians indi-
cate that aggression and property destruction due to
scratching are frequent behavior problems reported
by cat owners. Scratching of people and other animals
is undesirable because of the potential for injury and
infection, particularly in people who are immuno-
compromised. In some cases, this scratching may be
intentional and related to aggression, but in others it
is unintentional during play and handling. There ap-
pears to be a relatively high prevalence of aggression
in owned cats, with recent research suggesting 36%
of cats display aggression toward their owners37 and
almost 50% of cats display aggression toward either
familiar or unfamiliar people.38 However, although de-
clawing will prevent scratching-related injuries, it is
unlikely to resolve the problem of aggression in gener-
al owing to the potential for cats to bite as an alterna-
tive to scratching. More research is needed to identify
means to prevent aggression-related behaviors by cats
toward their owners.
Scratching items in the environment is a normal
behavior that serves a number of functions for cats,
including territorial marking and nail conditioning.39
Farm cats have been reported to scratch between 1
and 6 times a day. Scratching behavior is driven almost
entirely by the presence of conspecifics39 but is still
present in cats housed singly in homes.Although it is a
normal behavior, environmental scratching is general-
ly deemed to be undesirable by owners because it can
lead to property damage.While recent estimates of the
prevalence of environmental scratching are unavail-
able, 2 older studies40,41 suggest that 15% to 25% of
cats show inappropriate scratching of property, with
one of these studies40 indicating that scratching might
increase the risk of cat relinquishment. Although de-
clawing is 1 method of preventing scratching dam-
age, there are alternative methods that do not involve
surgery. For example, owners can provide appropriate
outlets for scratching and trim their cats’ nails regular-
ly. Therefore, when this procedure is requested, every
effort should be made to educate and assist owners of
cats to pursue possible alternatives that could allevi-
ate the need for surgery.
The National Council for Pet Population has esti-
mated that approximately 14.4 million of the 59 mil-
lion cats in the United States are declawed.42 Similarly,
a recent study43 reported that 20% of cats admitted
in the Raleigh, NC, area had undergone declawing
or, more specifically, onychectomy. Interestingly, the
percentage of cats that are declawed has apparently
not changed in the past decade despite the growing
controversy surrounding the procedure.43 In a survey
conducted by Yeon et al,34 cats reportedly continued
to make scratching movements following declawing,
but 91% of owners surveyed had an overall positive
attitude about the procedure, whether onychectomy
or tendonectomy.
Various studies44–47 have demonstrated that ony-
chectomy causes postoperative pain in cats. For exam-
ple, Carroll et al44 examined postoperative pain in cats
receiving either butorphanol or no analgesia following
onychectomy and found that in comparison to control
JAVMA • Vol 248 • No. 2 • January 15, 2016
cats, butorphanol-treated cats had higher analgesia
scores during the first 24 hours after surgery. Further-
more, according to owner reports, butorphanol-treat-
ed cats were more likely to eat and act normally and to
have lower lameness scores during the first day after
discharge. Cloutier et al45 found that even when cats
were treated with butorphanol before surgery, they
had evidence of postoperative pain, as determined by
comparison with control cats that underwent a sham
procedure. Both of these studies involved removal of
the distal phalanx with a scalpel or clipper, but recent
studies assessing the effect of laser removal suggest
that this procedure also results in postoperative pain,
although to a lesser degree than that associated with
other methods. Clark et al46 found that cats that under-
went laser onychectomy were less reluctant to jump
after surgery than were cats in which onychectomy
was performed with a scalpel or clipper. Similarly,
Holmberg and Brisson47 compared pain scores dur-
ing the 10 days following onychectomy with either
a scalpel or a laser and found that both groups had
elevated pain scores during the first 9 days but that
the mean score over the first 7 days was higher for the
scalpel group, compared with the laser group. Finally,
Robinson et al33 assessed limb function by measur-
ing ground reaction forces following laser or scalpel
onychectomy and found that forces were reduced in
both groups following surgery, but the reduction was
greater in the scalpel group.
Researchers have also studied the pain associat-
ed with tendonectomy versus onychectomy, but dif-
ferences between the procedures are unclear. While
1 study48 found that tendonectomy resulted in lower
pain scores, compared with onychectomy, during the
first 24 hours after surgery, another study45 found no
differences in pain scores when comparing the 2 pro-
cedures. Jankowski et al48 reported differences in post-
operative complications associated with the 2 proce-
dures. Of 18 cats that underwent onychectomy, 1 had
severe postoperative pain and another had long-term
lameness. Of 20 cats that underwent tendonectomy,
1 had long-term lameness, but owners of 6 cats ex-
pressed dissatisfaction with the procedure because of
continued scratching and issues with claw growth and
trimming.
Although both onychectomy and tendonectomy
have the potential to cause acute postoperative pain,
it is likely that a multimodal analgesic approach will
provide adequate pain control. Although a review of
all studies assessing efficacy of analgesic regimens for
control of postoperative pain following onychectomy
and tendonectomy is beyond the scope of the cur-
rent discussion, we encourage future research to de-
termine which analgesic regimes are commonly used
in current veterinary practice and whether they are
sufficient.
A number of studies have assessed short-term
and long-term postoperative complication rates fol-
lowing onychectomy. Short-term postoperative com-
plications following onychectomy include pain and
165
associated lameness, hemorrhage, swelling, infection,
and changes in behavior.48,49 Pollari and Bonnett50
examined the risk of postoperative complications
when onychectomy was performed alone or in com-
bination with other surgeries and reported that cats
that underwent onychectomy in combination with
ovariohysterectomy or castration were more likely
to have postoperative complications than were cats
that underwent either procedure alone.This was par-
ticularly concerning because 53% of cats underwent
both procedures.
One common long-term complication of ony-
chectomy is claw regrowth, with rates reportedly
ranging from 3.4% to 15.4%, depending on the study
and the method of claw removal.46,48,49 One study46
found that claw regrowth was more common with use
of a nail clipper than with use of a scalpel or laser
(15.4% vs 6.5% and 3.4%). Other long-term complica-
tions include persistent lameness and signs of chronic
pain.46,48,49 Clark et al46 reported the highest rates of
pain-related complications, with up to 23% of cats
having ongoing lameness and 42.3% of cats showing
signs of pain on paw palpation. Owners have also re-
ported long-term behavioral changes in cats following
onychectomy such as house soiling and an increased
resistance to allowing the paws to be handled or an in-
creased incidence or severity of biting, compared with
behavior before the procedure.51
Alternatives to declawing include regular nail
trimming and use of artificial nail caps to minimize
property damage and provision of appropriate
scratching surfaces such as scratching posts and sub-
strates.52 A study53 of 128 Italian cat owners found that
sexually intact male cats were more likely to scratch
other surfaces when a scratching post was absent
from the environment, and Cozzi et al39 reported that
a feline interdigital semiochemical, a cat pheromone
replacement made of fatty acids, can be used to con-
trol excess behavioral scratching through placement
of this substance on a desired scratching location.
Behavior modification methods may also decrease en-
vironmental scratching. Given clear evidence of pain
and postoperative complications with declawing, this
procedure should be considered as a last resort after
all other behavior modifying measures have been at-
tempted and when the only other alternative is relin-
quishment or euthanasia.
Devocalization
In dogs, devocalization (ventriculocordectomy)
involves complete or partial removal of the vocal folds
to prevent vocalization or reduce the intensity of vo-
calizations that are produced. The procedure can be
done through an oral approach or by means of a lar-
yngotomy. Anecdotally, the oral approach appears to
be more commonly used in clinical practice, although
laryngotomy is the recommended approach.54 Devo-
calization procedures vary in effectiveness, with great
variation among breeds.54 In particularly excitable
dogs, increased airflow through the larynx following
devocalization can result in the ability to bark to some
166 JAVMA • Vol 248 • No. 2 • January 15, 2016
degree.54 As a result, some owners administer tranquil-
izers after surgery.54
Excessive barking is seen as an undesirable behav-
ior by owners and others affected by the barking and
reportedly increases the risk of relinquishment.55,56
One study56 found that excessive barking accounts
for 11.3% of reported undesirable behaviors in dogs.
Alternatives to devocalization are typically aimed at
addressing the underlying cause of the undesirable
barking. Common causes of undersirable barking in-
clude general anxiety, separation anxiety, and compul-
sive disorders,57 and treatment by means of behavior
modification with or without adjunctive medication
should be attempted first. One study58 found that
positive reinforcement training was effective at reduc-
ing barking in response to someone knocking at the
door, and dogs that are exercised more frequently are
found to bark less than dogs that are not exercised.59
While there appears to be general agreement within
the veterinary behavior community that positive re-
inforcement is the most appropriate training method
for dogs, barking is often treated through the use of
methods that incorporate positive punishment. Both
electric shock and citronella spray collars have been
found to reduce the incidence of certain types of bark-
ing.60,61 However, the effectiveness of citronella spray
collars is decreased when the collar is worn continu-
ously, and a rebound effect (increased barking) is
frequently observed after the collar is removed.60 In
addition, there are concerns that electric shock and
citronella spray collars may cause fear and pain in
dogs. One study61 found no difference in serum cor-
tisol concentrations between dogs wearing electric
shock or citronella spray collars and control dogs.
However, another study62 found behavioral signs of
fear and stress in dogs in response to use of an electric
shock collar, including lowered posture, vocalizations,
oral behaviors, and aggression toward the handler.62
In addition, when used improperly, electric shock col-
lars can lead to burns and infections. Finally, in dogs
with excessive barking, devocalization only removes
the manifestation of the problem (ie, the dog is no
longer being able to bark) and does not address the
underlying behavioral problem, which may be nega-
tively affecting the dog’s quality of life. Thus, in dogs
with excessive barking, the underlying cause should
be identified and addressed before devocalization is
considered.
A potential long-term complication of devocaliza-
tion in dogs is formation of a laryngeal web that ob-
structs airflow63 and may require corrective surgery.31
Laryngeal web formation occurs more commonly af-
ter devocalization through an oral approach, with clin-
ical signs developing between 3 months and 3 years
after surgery in 1 report.63
Defanging
Defanging involves removal or reduction of the
canine teeth and can be performed in either puppies
or adult dogs. Although this procedure should only be
performed with appropriate dental techniques, it is,
in some cases, performed by cutting or breaking the
teeth near the gingival margin and may or may not
involve adequate anesthesia and analgesia.64
Defanging was originally developed to decrease
the danger captive wild animals posed to humans,
and similar justifications have been presented by ad-
vocates of this procedure in companion animals.65
Although aggression can be a serious concern in cer-
tain dogs, this procedure is not fully effective at reduc-
ing the risks of biting injuries. Appropriate treatment
of aggression should involve risk management and
treatment to reduce the behavior problem. Although
research has not been conducted on pain and behav-
ioral effects of defanging in companion animals, this
procedure is considered unnecessary when trying
to prevent human-animal conflicts with exotic carni-
vores and similar results can be predicted for compan-
ion animals.65
Legislation Related to MUSs
Some of the earliest legislation restricting MUSs
in dogs and cats was passed in the European Union
in 1987, when the European Convention for the Pro-
tection of Pet Animals was implemented. This treaty
prohibits any “surgical operation for the purpose of
modifying [the] appearance of a pet animal or for
other non-curative purposes,”66 which would include
tail docking, ear cropping, devocalization, declawing,
and defanging. Veterinarians can make exceptions
to these prohibitions if the procedure is considered
necessary for curative reasons or the benefit of a par-
ticular animal, or to prevent reproduction.66 However,
regardless of the reason, all surgical operations must
be carried out by a veterinarian and under anesthesia
if the animal is believed to be in, or have the possibil-
ity of being in, severe pain.66 Although this convention
was initially ratified by 4 member states in 1992, it is
noteworthy that as of 2014 some members of the EU
had yet to ratify it. In some of the countries that have
not yet ratified the convention, alternative legislation
restricts at least some of these procedures. For exam-
ple, in the United Kingdom and the Netherlands, ear
cropping, tail docking, and declawing are restricted. In
addition, some countries, such as France, have ratified
the convention but excluded tail docking from the list
of prohibited procedures.67
Many additional countries have incorporated
MUSs into their animal welfare legislation, but rec-
ommendations vary by country. For example, de-
clawing, ear cropping, and tail docking are restrict-
ed in Australia and Israel; declawing, devocalization,
and ear cropping are restricted in New Zealand; and
tail docking and ear cropping are restricted in Bra-
zil. We are not aware of legislation in any countries
that restricts surgical removal of the dewclaws in
dogs.
Current Status in North America
Both the CVMA and AVMA have a number of po-
sition statements regarding MUSs. For instance, the
JAVMA • Vol 248 • No. 2 • January 15, 2016
AVMA position statement on tail docking and ear
cropping states that it “opposes ear cropping and tail
docking of dogs when done solely for cosmetic pur-
poses.”68 The AVMA has also produced comprehensive
literature reviews and fact sheets to support these
position statements. The CVMA has taken a stronger
stance by indicating that the organization “opposes
the alteration of any animal by surgical or other inva-
sive methods for cosmetic or competitive purposes,”
which includes tail docking and ear cropping in dogs
as well as cosmetic dentistry, tattooing, and piercing.69
Although these position statements are decidedly
against MUSs, they are ultimately only suggestions be-
cause these organizations have no enforcement ca-
pabilities. Indeed, veterinarians practicing in Canada
and the United States are still able to perform these
procedures at their own discretion, with a few excep-
tions. In addition, anecdotal reports suggest that some
procedures, most notably tail docking, are performed
by breeders without the assistance of a veterinarian.
It has been suggested that some veterinarians elect to
continue tail docking puppies in fear that failure to do
so will result in less qualified people, such as breeders,
undertaking the procedure without access to proper
medical facilities and appropriate analgesics.2 This
concern is supported by a study6 that found 51% of
the breeders that were surveyed were performing the
procedure on their own.
The CVMA position statement on cosmetic al-
terations also states that the association “strongly
encourage breed associations to change the breed
standards” in the hopes that the number of dogs
that are ear cropped and tail docked will decrease.69
Breed standards in Canada and the United States
have changed to allow showing of dogs that have not
undergone ear cropping or tail docking. This is like-
ly to have reduced the number of dogs undergoing
these procedures, but relevant figures are not avail-
able. Although the Canadian Kennel Club and Ameri-
can Kennel Club do not encourage these procedures,
they also do not specifically discourage them. The
American Kennel Club, for instance, states that it
endorses “acceptable practices integral to defining
and preserving breed character and enhancing good
health.”70
The CVMA and AVMA also have position state-
ments against MUSs used primarily for behavioral
modification, including declawing, devocalization, and
removal or reduction of the teeth.52,69,71,72 For exam-
ple, the CVMA position statement on onychectomy
of domestic cats states that the association “strongly
discourages onychectomy of domestic cats for routine
purposes” as it “prevents cats from expressing nor-
mal behaviors and causes pain.”52 The AVMA position
statement echoes this message and encourages client
education and other preventive measures be taken be-
fore declawing is considered. Similar suggestions for
attempts at behavioral modification to prevent the
problem behavior are included in the devocalization
position statements of both the CVMA and AVMA.
However, for each of these position statements there is
167
little guidance as to what attempts at alternative strat-
egies are sufficient to justify the need for these pro-
cedures. Thus, owners with a lower tolerance for be-
havioral problems may elect to pursue them without
first attempting alternative strategies.42 Notably, pur-
suing alternative strategies to correct behavior prob-
lems related to scratching, aggression, and barking can
involve substantial time, expertise, and expense, and
owners may not be willing to invest their resources in
alternative strategies when a surgical option is avail-
able. Some have argued that if these procedures were
unavailable, such owners might opt for relinquish-
ment or euthanasia. However, many veterinary clinics
offer declawing of kittens in conjunction with spaying
or neutering as a preventive measure when scratching
behavior is not yet a concern.Thus, further discussion
among stakeholders to determine how best to balance
these ethical tradeoffs with an aim toward reducing
the number of these procedures being performed is
needed.
The role of national veterinary organizations such
as the CVMA and AVMA in reducing the number of
MUSs that are performed should not be underestimat-
ed. In some cases, their position statements have been
incorporated into regulations initiated by provincial
or state regulatory bodies to restrict veterinarians
from performing these surgeries. For instance, restric-
tions on veterinarians performing ear cropping and,
in some cases, tail docking have been incorporated
into the bylaws of veterinary organizations in 6 Cana-
dian provinces (British Columbia, Manitoba, Saskatch-
ewan, Newfoundland and Labrador, New Brunswick,
and Prince Edward Island).73 However, these restric-
tions do not apply to nonveterinarians who may be
performing tail docking and dewclaw removal outside
of a clinic environment. Newfoundland and Labrador
is the only Canadian province that has incorporated
MUSs into formal legislation. In this province, the An-
imal Health and Protection Act was passed in 2010,
banning ear cropping in dogs for the purposes of con-
forming to breed standards.74 Additionally, this prov-
ince has bylaws that prohibit docking of tails in all
animals except when medically necessary.
A number of similar bylaws have been created in
some states within the United States, many of which
are based in principle on the AVMA guidelines. Four-
teen states restrict tail docking in some species; how-
ever, only Maryland and Pennsylvania restrict tail
docking of dogs.75 In Pennsylvania, this restriction is
for unqualified persons performing the procedure af-
ter 5 days of age, but veterinarians can perform the
surgery regardless of age.75 Legislation restricting ear
cropping of dogs is the most common in the United
States, with 9 states having restrictions. In the case of
Washington State, ear cropping is permitted when in
line with good husbandry practices.75 After the CVMA
released a position statement in 2009 that “discour-
ages devocalization of dogs unless it is the only alter-
native to euthanasia,” and the AVMA released a similar
statement 4 years later, a law was passed in Massachu-
setts that banned this procedure.76 Devocalization is
168 JAVMA • Vol 248 • No. 2 • January 15, 2016
also prohibited in 4 other US states, unless medically
necessary. In addition to state-level restrictions, mu-
nicipalities have in some cases implemented bylaws
restricting MUSs in animals. For example, declawing
is banned in a number of municipalities throughout
California.
While veterinary organizations in North America
have been clear about discouraging various MUSs
through the publication of position statements, their
role to date has been relatively passive. In contrast, the
Australian Veterinary Association actively called for a
ban on tail docking in dogs starting in 2008,77 which
was in part responsible for passage of national legisla-
tion banning this procedure. This legislation ensures
that no persons in Australia, including nonveterinar-
ians, can perform this procedure. We would suggest
that there may be value in veterinarians in Canada and
the United States taking a similar stance in suggesting
formal legislation as a method of reducing the number
of MUSs in dogs and cats.
Public Attitudes Toward
MUSs in Dogs and Cats
Community consensus regarding right and wrong
governs the actions of society, which then forms
policies and laws.78 Challenges arise when there is
disagreement among stakeholders, preventing a con-
sensus from being reached. This is the case for many
MUSs, in that stakeholders differ in what they consid-
er to be acceptable. Given the distributed authority
governing companion animal welfare regulations and
legislation in Canada and the United States, it is not
surprising that leadership comes in large part from
the CVMA and AVMA, in combination with the Cana-
dian and American kennel clubs and specific breed
associations. Equally disconcerting is that despite the
American Kennel Club stating that unaltered dogs will
not be disqualified when entered into competitions,79
many owners believe that failure to comply with tradi-
tional breed standards will reduce their dogs’ chances
of winning. Some organizations have argued that ban-
ning these procedures is a violation of an individual’s
rights. For example, the United Kingdom–based Coun-
cil of Docked Breeds campaigns to protect the own-
er’s right to choose tail docking as an option, argu-
ing that legislating these practices removes a person’s
freedom of choice.80
Social distance is defined as the emotional, psycho-
logical, and physical distance between one individual
and another, typically 2 humans.81 In the past few de-
cades, the social distance between humans and com-
panion animals has decreased drastically. This likely
accounts for the change in attitudes regarding what is
acceptable versus unacceptable in relation to animal
treatment, with the effect that practices that were once
seen as being acceptable are now questioned.81 In
some cases, language choice can be used to influence
stakeholders and evoke emotion, a strategy commonly
used by animal rights advocates, who employ words
such as oppression, suffering, and cruelty to appeal
to human emotion.82 In other cases, euphemisms can
be used to increase social distance and decrease em-
pathy. Both the CVMA and AVMA have acknowledged
these potential concerns in their position statements
regarding declawing and devocalization by stating that
owners must be educated with regards to the poten-
tial alternatives, the details of the procedure to be per-
formed, and the potential risks. However, there are no
data available to determine how often these conversa-
tions between veterinarians and owners occur or what
effect they have on the owner’s willingness to proceed
with the procedure. Further research in this area is
critical to accurately gauge current societal views on
MUSs in dogs and cats.
Conclusions
We strongly believe that in a clinical setting, surgi-
cal procedures should be performed on animals only
if they have or can be expected to have clear benefits
for the animal or the population as a whole. At a mini-
mum, the procedures discussed in the present review
all cause some degree of acute pain and are associated
with some risk of infection or other adverse effects.
Society’s attitudes toward dogs and cats have changed
over time, likely because of decreased social distance,
with the result that attitudes toward certain proce-
dures that were once considered acceptable are now
being reconsidered. In many countries, discussions
among broad ranges of stakeholders have resulted in
legislation banning surgical procedures that are con-
sidered elective or unnecessary.
People are willing to acknowledge that animals
experience pain but do not always appear to be will-
ing to take appropriate action to treat or prevent
that pain.83 This appears to be true in the case of the
procedures discussed in the present review, which
are known to be painful but are still commonly per-
formed.84 We recommend the following strategies
for enacting change in Canada and the United States
with regards to MUSs in dogs and cats. First, further
research and education are needed on effective meth-
ods for preventing or treating the underlying behavior
problems that traditionally have resulted in declaw-
ing, devocalization, and defanging. Second, further
research on public attitudes toward MUSs is needed;
specifically, understanding the beliefs and values held
by the public must be a priority, as only then will it be
possible to encourage policy and legislation that ac-
curately reflect the views of current society.Third, vet-
erinarians should take a leadership role in educating
both owners and the broader public on the important
topic of MUSs in dogs and cats.
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Correction: Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention

in Veterinary Personnel

In the report “Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel”
(J Am Vet Med Assoc 2015;247:1252–1277), several paragraphs at the end of Appendix 4 (Model infection control plan for
veterinary practices, 2015) were mistakenly omitted.The final sections of the appendix should read as follows:
OCCUPATIONAL HEALTH
Infection control and employee health management:The following personnel are responsible for
development and maintenance of the practice’s infection control policies, record keeping, and
management of workplace exposure and injury incidents.
Staff responsible: ______________________________________
Record keeping: Current emergency contact information will be maintained for each employee. Records
will be maintained on vaccinations, rabies virus antibody titers, and exposure and injury incidents. Changes
in health status (eg, pregnancy) that may affect work duties should be reported to and recorded by the
office manager so that accommodations may be made.
Pre-exposure rabies vaccination: All staff with animal contact must be vaccinated against rabies, followed
by periodic titer checks and rabies vaccine boosters, in accordance with the recommendations of the
Advisory Committee on Immunization Practices.
Tetanus vaccination:Tetanus immunizations must be up-to-date. Report and record puncture wounds, animal
bites, and other animal-related trauma. Consult a health-care provider regarding the need for a tetanus booster.
Influenza vaccination:Veterinary personnel are encouraged to receive the current seasonal influenza vaccine.
The CDC website and healthcare consultation will be used for guidance (www.cdc.gov).
Documenting and reporting exposure incidents: Report incidents that result in injury or potential exposure
to an infectious agent to: __________________________ Information will be collected for each exposure
incident using OSHA forms 301, 300, and 300A. Incident reporting includes documenting the date, time,
location, person(s) injured or exposed, vaccination status of injured person(s), other persons present,
description of the incident, whether health-care providers and public health authorities were consulted, the
status of any animals involved (eg, vaccination history, clinical condition, and diagnostic information), first aid
provided, and plans for follow-up.
Staff training and education: Infection control and hazard awareness training and education will be
documented in the employee health record.
Pregnant and immunocompromised personnel: Pregnant and immunocompromised employees are at
increased risk from zoonotic diseases. If you are concerned that your work responsibilities may put you
at increased risk, inform: _____________________ so that preventive measures may be taken (such as
increased use of PPE) and other accommodations may be made. Consultation between the supervising
veterinarian and a health-care provider may be needed.
ADDITIONAL INFORMATION
The following information is attached to the infection control plan:
• Emergency services telephone numbers—fire, police, sheriff, animal control, poison control, etc
• Reportable or notifiable veterinary diseases and where to report
• State department of agriculture or board of animal health contact information and regulations
• State and local public health contacts for consultation on zoonotic diseases
• Public health laboratory services and contact information
• Environmental Protection Agency–registered disinfectants
• Occupational Safety and Health Administration regulations
• Animal waste disposal and biohazard regulations
• Rabies regulations
• Animal control and exotic animal regulations and contacts
• Other useful resources
Note that a modifiable electronic version of the model infection control plan is available on the National Association of
State Public Heath Veterinarians website (www.nasphv.org).

JAVMA • Vol 248 • No. 2 • January 15, 2016 171

Perioperative Pain
Ma nagement in
Veterinar y Patients
Doris H. Dyson, DVM, DVSc

KEYWORDS
 Analgesia  Surgical pain  Dog  Cat

As veterinarians in the twenty-first century, we have an ethical responsibility to our

patients and clients to avoid, or at least to reduce significantly, pain in animals under
our care. The American Animal Hospital Association and the American Association of
Feline Practitioners have joined to promote an emphasis in veterinary medicine on
pain management.1 Although this mandate can be stretched to cover a range from
‘‘less than appropriate’’ management to ‘‘unnecessary extremes’’ in analgesia admin-
istration, this article attempts to define a safe, practical, and yet suitable approach to
management of pain in the perioperative period. Treatment for pain that approaches
either extreme should be addressed by observation and refinement, because exact
recipes do not suit all individuals, even animals that have undergone a similar proce-
dure. Veterinarians must use their best judgment related to a starting point (often
beginning with guidelines), monitor the patient’s response to such treatment, and
adjust accordingly. Clearly, the veterinarian’s role in pain management is not
complete after establishment of an analgesic plan.

ADJUNCTS TO PAIN MANAGEMENT

Usually, we think of analgesic drugs when the topic of pain management is mentioned,
but it is important to keep in mind the other aspects that contribute to successful pain
control. Anxiety, stress, and uncomfortable surroundings have an impact on the indi-
vidual ’s ability to handle pain. We recognize the comfort of our own bed in a quiet
home with loving people, familiar objects nearby, and appetizing food as significant
determinants in our overall feeling of well-being. Research has also shown that psy-
chologic and physical aspects have an impact on the achievement of pain control.2
Veterinarians may be able to reduce anxiety and uncomfortable surroundings with
simple actions. Noise, temperature, and light can be maintained at a more optimal
level for our patients. Quiet rooms can be defined to isolate the patient to keep it
from disturbing others or to provide a calmer environment for the more sensitive

Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph,

Ontario, Canada N1G 2W1
E-mail address: ddyson@ovc.uoguelph.ca

Vet Clin Small Anim 38 (2008) 1309–1327

doi:10.1016/j.cvsm.2008.06.006 vetsmall.theclinics.com
0195-5616/08/$ – see front matter ª 2008 Published by Elsevier Inc.
1310 Dyson

animal. Nursing care that includes provision of clean bedding, comforting words, pet-
ting, cuddling, and playing with the pet should contribute significantly to the manage-
ment of mild pain and supplement the pharmacologic treatment of more severe pain,
as has been reported in human infants.3 Many practices encourage family visits during
hospital stays to help reduce patient stress and gain insight on other interventions to-
ward analgesia for the individual involved. Further information on good nursing care for
surgical patients can be found in the article by Shaffron, Fagella, and Taylor elsewhere
in this issue.
Nonanalgesic pharmacologic approaches can also provide calming effects that in-
tensify the pain relief from specific analgesic drugs. This is the principle behind neuro-
leptanalgesia, which is able to provide better results than analgesia alone when minor
surgical procedures are required. Therefore, the use of sedatives and tranquilizers is
considered along with the administration of analgesic drugs, when appropriate.

ADVANCE APPLICATION OF ANALGESIA

Fentanyl patches require advance application to be effective for perioperative pain

management. Animals that are admitted the night before can have a patch placed if
this is an option for postoperative management. The advantage of this method is
achievement of a steady-state level of analgesia in 12 hours (cats) to 24 hours (dogs)
and lasting 72 hours. Fentanyl plasma concentrations vary significantly among individ-
uals, however, and it may not be possible to guarantee achievement of good analgesic
levels at the time of surgery. The impact of a fentanyl patch on inhalant requirements
during surgery has been estimated by minimum alveolar concentration (MAC) mea-
surement. A MAC reduction of 18% in cats4 and 37% in normothermic dogs is ex-
pected, with no significant MAC reduction in hypothermic (34.5 C) dogs.5 The
reduction in MAC in cats is not much different than after administration of butorphanol,6
and because hypothermia, which is commonly expected during longer and more pain-
ful surgical procedures, reduces the impact on MAC as well, further intramuscular opi-
oid administration in premedication should not cause concerns. If clinical signs of
opioid administration are apparent in advance of premedication (eg, panting, mild se-
dation), one may elect to give only half of the opioid dose planned. Further opioid can
be administered if needed during the operation. Many anesthetists believe that these
results and the safety associated with opioid use during surgery provide little reason
to reduce opioid doses significantly in the premedication period, however (Table 1).
Thus, the entire dose is usually used for premedication when fentanyl patches are used.
Some nonsteroidal anti-inflammatory analgesics (NSAIAs) may also be adminis-
tered in advance of premedication if there are no present or expected contraindica-
tions for use (see the article by Papich and the article by Mathews elsewhere in this
issue). This preoperative use may be a reasonable option to ensure analgesia at the
time of recovery if the operation is unlikely to be associated with excessive blood
loss or hypotension. A complete history from the owner and careful assessment of
the patient are critical to ensure that NSAIA use is actually safe, however, irrespective
of time of administration. For example, owners may administer aspirin to their pet and
yet not consider this when asked indirectly if the animal is on any medication. Related
to considering use before surgery, not all NSAIAs can be recommended. Carprofen,
meloxicam, and tepoxalin have been assessed and found to be safe in healthy dogs
when given in advance of anesthesia.7–10 Recommendations on timing of NSAIA
administration varies according to the route selected. If oral drugs are selected,
they are usually not given with premedication but at the last meal, although oral admin-
istration can result in a rapid effect similar to that achieved with intravenous dosing
 Perioperative Pain Management 1311

(30–60 minutes). Research indicates that the achievement of maximum plasma con-
centrations is longer, and that onset of analgesia for acute synovitis is slower, after
meloxicam administration when compared with other NSAIAs,11 although clinical
experience associated with treatment of surgical pain shows an onset that is typical
of other NSAIAs. Subcutaneous administration of any NSAIA may result in a longer
onset, however.
The analgesic efficacy of NSAIAs has been documented for several surgical proce-
dures in dogs12–15 and cats,16–19 but this should not eliminate consideration of
additional analgesic drugs. Because no significant MAC reduction results from the
preoperative administration of NSAIAs,20,21 the addition of opioid analgesics can
provide this and other benefits, such as prevention of wind-up.

PREMEDICATION

Most surgical procedures performed in general practice are elective; thus, the patient
is presented without pain. The ideal approach to managing pain in these patients is to
prevent it, and this usually starts with the premedication analgesics. Other patients
presented for surgery may have accompanying pain and have analgesia on board
as discussed previously or may be receiving continuous rate infusions (CRIs; as dis-
cussed elsewhere in this article) according to the level of pain on admission to the hos-
pital. The anesthetist or practitioner must consider any present opioid effects at time of
presentation for surgery in addition to the impact of other drugs on board when decid-
ing on premedication requirements. If the analgesic administered during the preoper-
ative period is effective, it should never be assumed that the intraoperative and
postoperative pain is going to be managed equally as well. For some surgical proce-
dures, the pain may be less after surgery (eg, cervical disk surgery), whereas for
others, the pain may be greater during and after surgery (eg, most fracture repairs,
peritonitis).
Opioid analgesics are the most commonly selected drugs for perioperative pain pre-
vention or treatment. The specific drug selection and dose should be based on the level
of expected pain. Butorphanol or buprenorphine is appropriate for mild (to moderate)
pain (likely that involved in an ovariohysterectomy or castration performed by an expe-
rienced veterinarian). Buprenorphine has the advantage of a 6-hour duration of effect
compared with as little as 2 hours with butorphanol. Morphine or hydromorphone could
be selected for a longer effect as well, but low doses (eg, 0.2–0.3 mg/kg, 0.02–0.03 mg/
kg, respectively) may be more appropriate for milder pain. Occasionally the ‘‘harder to
handle’’ patient requires use of these more profound opioids at higher doses for the ad-
ditional sedating effect that they achieve; however, dysphoria and panting may be a dis-
advantage. It is important to keep in mind that elective surgery is not always associated
with mild pain. Surgical skill (ie, inexperienced) and patient condition (eg, severe obe-
sity) can change the expected pain level of a procedure. Onychectomy in a cat is an
elective procedure associated with a greater level of pain. Good analgesia has been
shown after administration of buprenorphine (0.01 mg/kg),22 although hydromorphone
(0.05 mg/kg) could also be chosen for premedication for such procedures. When other
surgical procedures are required that involve more extensive tissue trauma or take lon-
ger to perform (thus increasing inflammation from tissue handling), the m-agonists are
usually selected, and typical doses in dogs are 0.3 to 0.5 mg/kg and 0.03 to 0.05
mg/kg for morphine and hydromorphone, respectively, or fentanyl at a dose of 3 to 5
mg/kg. Extremely painful operations or those in which significant wind-up may be
present may require up to 1.0 mg/kg and 0.1 mg/kg, respectively, especially when
performed in smaller patients (surface area impact on drug dosing). Cats are safely
 1312
Dyson
Table 1
Common analgesic drugs are listed with suggested doses and expected duration of effect based on various indications

Drug Indication Dose Duration

Buprenorphine Minor procedures (eg, castration, joint tap, laceration) 0.003–0.005 mg/kg 4–8 hours
Mild to moderate pain (eg, ovariohysterectomy) 0.005–0.1 mg/kg 4–8 hours
Butorphanol Minor procedures (eg, castration, joint tap, laceration) 0.1–0.2 mg/kg 3–6 hours
Mild to moderate pain (eg, ovariohysterectomy) 0.2–0.4 mg/kg 2–4 hours
Fentanyl Premedication or loading dose 2–10 mg/kg 15–20 minutes
Moderate pain associated with most orthopedic 2–5 mg/kg/h Infusion duration
procedures (eg, fracture repair, back surgery) 1 20 minutes
Moderate to severe pain associated with major surgery 3–10 mg/kg/h Infusion duration
(eg, thoracotomy, amputation) 1 20 minutes
Fentanyl patch Painful procedures that may benefit from extended Cats, dogs <10 kg: 25 mg/h 3–5 days
duration of effect (eg, declawing) or from steady 10–20 kg: 50 mg/h 3 days
level of underlying analgesia (eg, trauma surgery,
20–30 kg: 75 mg/h 3 days
orthopedic surgery) in association with other
analgesic techniques >30 kg: 100 mg/h 3 days
Hydromorphone Mild to moderate pain associated with straightforward 0.02–0.03 mg/kg 3–6 hours
abdominal surgery (eg, ovariohysterectomy) or
elective orthopedic surgeries (eg, dew claw removal)
Moderate pain associated with most orthopedic 0.03–0.05 mg/kg 3–4 hours
procedures (eg, cruciate surgery, declawing)
Moderate to severe pain associated with major surgery 0.05–0.1 mg/kg. (monitor for 3–4 hours
(eg, thoracotomy, amputation) hyperthermia in cats if high doses are given)
Ketamine Used as premedication (usually in combination) for Cat: 5–7 mg/kg 20–30 minutes
good restraint and somatic analgesia Dog: 3–5 mg/kg
Short-term analgesia 0.2–4 mg/kg 10–30 minutes
Analgesic infusion (usually with other drugs) 0.1–2 mg/kg/h Infusion duration
Ketamine with Used to supplement premedication effect 0.03–0.04 mL/kg 4–6 minutes
diazepam
(1:1 or 2:1)
 Lidocaine Used in association with any induction for analgesia 2 mg/kg 5> 50–200 mg/kg/min Infusion duration
and MAC reduction; often given before induction (reduce dose in 1 hour or stop 20 minutes
and then infusion used before recovery)
Used in association with any induction for antiarrhythmic 2 mg/kg (twice in 10 minutes) 1 Infusion duration
effect, analgesia and MAC reduction; bolus often given 120 mg/kg/min (reduce dose in 1 hour)
before and after induction and then infusion used
Medetomidine Used as premedication in healthy animals for more Dog: 10–20 mg/kg 1–2 hours
profound restraint and associated analgesia Cat: 20 mg/kg
Supplementation of analgesia (and sedation) 1–2 mg/kg/h Infusion duration
Used immediately after surgery (in close association 1–2 mg/kg 0.2–0.5 hour
with extubation)
Meperidine Short-term mild to moderate analgesia for 5–10 mg/kg 0.5–2 hours
intramuscular use only
Morphine Mild to moderate pain associated with straightforward Dog: 0.2–0.3 mg/kg 3–4 hours
abdominal surgery (eg, ovariohysterectomy) or Cat: 0.2 mg/kg
elective orthopedic operations (eg, dew claw removal)
Moderate pain associated with most orthopedic Dog: 0.3–0.5 mg/kg 3–4 hours
procedures (eg, cruciate surgery, declawing) (not in cats)
Moderate to severe pain associated with major surgery Dog: 0.5–1 mg/kg 3–4 hours
(eg, thoracotomy, amputation) (not in cats)

Perioperative Pain Management

Nonsteroidal Possibly alone in mild to moderately painful
anti-inflammatory procedures and as supplementation of other
analgesics analgesia in moderate to severe pain
Loading dose is rarely needed in elective procedures
(without wind-up and less painful)
Injectable formulations are noted as follows:
Carprofen Cat: 4 mg/kg once >24 hours
Dog: 4 mg/kg/d 5> 2 mg/kg/d 12–24 hours
Ketoprofen (postoperative use only) 2 mg/kg/d 5> 1 mg/kg/d 24 hours
Meloxicam 0.2 mg/kg/d 5> 0.1 mg/kg/d 24 hours

Range noted relates to surface area adjustment or degree of effect required. A separate cat dose is noted when needed. An extended list of drugs and more detail
are found in this article and in the other article by Dyson elsewhere in this issue.

1313
1314 Dyson

premedicated with hydromorphone for procedures associated with moderate to severe

pain, using a starting dose of 0.05 mg/kg and considering that the duration of effect may
be longer in cats than in dogs. Caution related to use of high doses or early repeat dos-
ing is warranted to avoid hyperthermia (see section on preparation for recovery for more
detail). Fentanyl can also be used in the cat at similar doses as used in the dog. Mor-
phine, however, is rarely used at a dose higher than 0.2 mg/kg in the cat.
Ketamine is a somatic analgesic that may be added to the premedication. Telazol
contains tiletamine, another N-methyl-D-aspartate (NMDA) antagonist with similar
analgesic properties. Hyperalgesia associated with surgery in people seems to be
less with ketamine, and the requirement for postoperative analgesia is reduced.23,24
Ketamine is a useful premedication in cats (5–7 mg/kg), although it is more often
selected in those that are hard to handle. Although ketamine is rarely used in dogs
for premedication, evidence for incorporation as an intraoperative infusion is pre-
sented elsewhere in this article.
At the time of premedication, this author often administers sedatives to reduce anx-
iety from the handling involved (Table 2). Acepromazine is quite effective in most cats
and dogs. Even low doses can be helpful (0.01–0.02 mg/kg) when selected in the quiet
or older dog. Cats typically require a minimum of 0.05 mg/kg if an effect is to be
achieved by its addition to the premedication, whereas more may be required after
surgery to produce an improvement in analgesia (discussed in the section on prepa-
ration for recovery). The older cat or dog may be managed without acepromazine as
part of the premedication in most situations, however, with the option of adding this for
recovery if necessary. Compromised patients are best managed without using ace-
promazine. Preliminary evidence indicates that treatment of hypotension may be
more difficult when acepromazine is on board.25 Benzodiazepines (diazepam or mid-
azolam at a dose of 0.2 mg/kg) can produce an anxiolytic effect and are occasionally

Table 2
Drugs (dosages listed reflect combination use) that are useful in combination with some
of the analgesics inTable 1

Acepromazine Preoperative use in Cat: 0.05–0.15 mg/kg 3–4 hours

young healthy Dog: 0.02–0.05 mg/kg
animals
Preoperative use in Cat: 0.02–0.05 mg/kg 3–4 hours
geriatric patients Dog: 0.01–0.02 mg/kg
Immediate Cat: 0.02–0.05 0.5–2 hours
postoperative use (in Dog: 0.01–0.02
close association with
extubation)
Diazepam or Used with 0.2–0.5 mg/kg 10–20 minutes
midazolam premedication
Used intravenously in 0.2 mg/kg 5 minutes
association with
induction, during
surgery, or with
recovery
Propofol Used to supplement 0.5–1 mg/kg 2–3 minutes
premedication effect

These are typically used with opioids and have no analgesic properties but enable the analgesic to
be more effective because of the calming effect achieved.
 Perioperative Pain Management 1315

selected in place of acepromazine in more critical patients when an additional sedative

effect beyond that of the opioid alone is desired. In most critical cases, however, it is
not necessary to include a benzodiazepine, because opioid use in these patients usu-
ally is associated with a good level of sedation.
a2-Agonists can also be used for analgesia and sedation in healthy dogs and cats.
Those animals showing any potential for cardiovascular compromise or organ dys-
function should not be given this class of drug because of its peripheral vasocon-
striction effects and depression of cardiac output. Medetomidine is the most
commonly used a2-agonist in small animals (5–20 mg/kg for dogs, 10–20 mg/kg for
cats). At these doses, one can expect significant MAC reduction and analgesia for
approximately 1 hour, although some animals show a more prolonged sedative ef-
fect. Low doses reduce the duration of cardiovascular depression rather than the
degree.26 During the postoperative period, microdoses (as discussed elsewhere in
this article) may be used, and such low doses (<2 mg/kg) have less effect on the car-
diovascular system.
NSAIAs can be administered at this time (if not given earlier) if no contraindications
exist, but it must be recognized that the full effect may not be present at the comple-
tion of short procedures. Patients need to be covered with other means of analgesia
for 30 to 60 minutes before an NSAIA is effective.

INDUCTION

Such drugs as opioids, ketamine, a2-agonists, or lidocaine may be components of the

induction protocol; as such, they result in analgesia at this time.
Only in critical cases do opioids facilitate induction (usually combined with diazepam
at a dose of 0.2 mg/kg). The opioid dose required is at the high end (hydromorphone at
0.05–0.1 mg/kg administered intravenously, fentanyl at a dose of 10–20 mg/kg
administered intravenously) and provides good analgesia, although respiratory de-
pression and bradycardia are to be expected. Fortunately, the associated negative
effects from opioids are managed easily with positive-pressure ventilation or anticho-
linergic administration. The higher doses suggested previously are more likely required
when minimal premedication or analgesia is on board in advance. Such patients are
often continued on opioid infusions (as described elsewhere in this article) to maximize
MAC reduction.
For the more common situations, ketamine is frequently used for induction, com-
bined with opioids, acepromazine, a2-agonists, or benzodiazepines. The dose used
for intravenous administration may have a short duration of analgesia, whereas typical
doses that are used intramuscularly, as often performed in cats, should provide some
analgesia for the duration of surgery. Nevertheless, it must be recognized that the an-
algesia associated with ketamine is more somatic than visceral, so further analgesia
may be required. Teletamine (in Telazol) would have similar effects.
a2-Agonists may be administered intramuscularly with ketamine to achieve induc-
tion. Postoperative analgesia was apparent after ovariohysterectomy in cats that
received ketamine and medetomidine intramuscularly for anesthesia.27 Comments
and concerns related to this combination are similar to those given for premedication.
It is important to recognize that although good analgesia is associated with these
drugs, the duration is limited to, and often less than, the sedative effect.28
Lidocaine is discussed in greater detail related to use in CRIs. A single dose (2 mg/kg)
should result in a short period of analgesia and MAC reduction. For this reason, it may
be used as part of the induction.
1316 Dyson

MAINTENANCE

Inhalants, propofol, and thiopental do not produce analgesia, although excessive

depth of anesthesia may allow painful procedures to be performed. These depths
are associated with significant respiratory and cardiovascular depression, however,
and wind-up is unlikely to be avoided. Thus, a more balanced method of anesthesia
is preferred.
Local anesthesia should be included in procedures in which a significant benefit is
possible. Digital (onychectomy), dental (extractions), intercostal (thoracotomy), epidu-
ral (hind limb fractures), and brachial plexus (forelimb fractures) blockade has been
used to improve intraoperative and postoperative analgesia in small animals. Readers
are referred to the articles by Lemke and Valverde elsewhere in this issue for details on
techniques.
Single-dose administration of any of the analgesics previously mentioned can be
performed as needed during maintenance of anesthesia. If the premedication dose
is waning or was poorly judged, another dose can be given to bring the level up to
what may be effective. For example, one may see that the hydromorphone effect is
not as good 2 hours into a procedure. At least half of the dose has been eliminated
by this time, and another half-dose could be given. Repeat dosing of long-duration
drugs (eg, hydromorphone) may be helpful during surgery but can create adverse
effects in recovery if the dose on board is greater than required when the animal is
recovering (ie, a full dose given at 2 hours may be beneficial for the surgery but results
in too high a dose at recovery). For this reason and others, CRI administration has
gained popularity. A CRI may be calculated as described under this topic elsewhere
in this article.
Epidural administration of morphine or hydromorphone may reduce further analge-
sia requirements for 12 to 24 hours. The analgesia effect has been measured as far
forward as the forelimbs and can be an excellent supplementation of analgesia for tho-
racotomy and peritonitis. More detail on this technique is found in the article by Valve-
rde elsewhere in this issue.
Morphine has also been placed intra-articularly to affect receptors directly in joints.
The evidence on its benefit is controversial,29,30 but the addition of local anesthetic is
effective and the technique is simple. Morphine (0.1 mg/kg) is added to bupivacaine
(approximately 0.1 mL/kg [0.5% solution]) and placed intra-articularly at time of joint
closure. With this technique and epidural administration, the dose of morphine is so
low that systemic side effects are not significant.
Patient monitoring is invaluable in assessing patient analgesia during surgery.
Increases in respiratory rate, heart rate, or blood pressure are typically noted when fur-
ther analgesia is necessary. It is necessary to ensure that ventilation is adequate, how-
ever, because an increase in pCO2 attributable to hypoventilation is a common
confounder associated with similar physiologic changes.

CONTINUOUS RATE INFUSIONS

The following discussion covers the use of CRI analgesia administration in the preop-
erative, intraoperative, and postoperative situations. There are several advantages to
this technique of administration in the management of pain. A steady level of analgesia
is more likely to be achieved, because the mountains and peaks associated with
intermittent analgesic use are avoided. A steady level is more likely to avoid significant
adverse effects and is more easily titrated to achieve continuous comfort. When cer-
tain procedures or periods of time require a greater level of analgesia, it can be
‘‘dialed’’ to effect. Although the benefit of steady-state pain relief is difficult to
 Perioperative Pain Management 1317

measure, preemptive analgesia achieved in various ways has been shown to reduce
postoperative analgesia demand in a multitude of studies (339 papers displayed in
a recent search) ranging from local anesthetic31 to nonsteroidal32 and even inhaled
opioid use.33 Therefore, it is likely that our patients also reap such benefits with con-
tinuous analgesia control. Considering that infusions can be used during surgery, the
anesthetist and the patient can gain from the impact on inhalant requirements (MAC
reduction). Based on drug selection for these infusions, there may be other benefits
that arise (discussed under the section on specific infusions).
Anyone can administer a CRI if he or she is capable of giving fluid therapy to
a patient. A syringe pump is not required, although it is the simple way to manage
infusions, especially when frequent adjustment of the dose is required. An ordinary
fluid pump is usually capable of delivering drugs from a syringe, however. Test the
consistency of fluid administration of the pump at hand with a saline infusion (watching
the drips falling from an extension set) in advance of using this technique. If the con-
sistency is limited to higher rates, the analgesic can be diluted in a part of, or the entire,
hourly surgical or maintenance fluid to enable accurate administration. Only diazepam
cannot be diluted because of concerns about precipitation. Midazolam can be used
interchangeably with diazepam (same dosing recommendations would apply), and it
can be diluted in fluids or mixed with other analgesics without such concerns. If neither
a fluid pump nor a syringe pump is available, the use of a burrette inserted within the
fluid line enables drug administration in a smaller volume of surgical or maintenance
fluid (add analgesic to the volume to be given in 15–60 minutes). Another alternative
is to reduce the volume in a bag of fluids to that appropriate for the duration of admin-
istration (eg, 250 or 500 mL rather than 1000 mL) and to spike this remaining volume
with the expected drug requirement at the fluid rate to be administered. This last rec-
ommendation is more suitable for surgical patients than for awake patients, which
would be less tolerant of fluid volume adjustment. The volume during surgery would
be given at 10 mL/kg/h. A surgical fluid rate adjustment from 5 to 20 mL/kg/h could
be safe in most animals, however, and would allow analgesia dose modification
from half to double the starting point if deemed necessary. A second bag of fluids
would have to be connected should fluid requirements dictate an increase in rate,
as needed for blood loss correction.
Almost any analgesic can be adjusted to be given as an hourly rate by using the fol-
lowing calculation:[Effective Dose (mg)/Typical Duration of Effect (h)]
The calculation can be performed using pharmacologic data. For example, a dose
of morphine at 0.5 mg/kg is likely to provide 4 hours of pain relief in a dog. This pro-
vides an estimate of the dose per hour (0.125 mg/kg/h), which can usually be adjusted
as the effect is observed in the individual. In some situations, one might observe that
a dose of 0.5 mg/kg given to a particular dog provides only 3 hours of analgesia. The
calculation can use this clinical information to define the individual patient ’s infusion
guideline (0.17 mg/kg/h). Because there is a possibility of a reduced drug requirement
with the CRI method of administration, either calculation may result in an overestima-
tion of the dosage and require adjustment according to the patient ’s response. Similar
analgesic effects were observed in dogs administered half the dose as a CRI com-
pared with intermittent intramuscular injection of morphine.34 CRIs are usually limited
to drugs with a duration of effect of 6 hours or less.
It must also be recognized that an hourly rate maintains analgesia that was achieved
by an initial loading dose. As long as the expected duration of the loading dose is sim-
ilar to that of the infusion drug, it does not have to be the same drug. Also, a short-
duration drug like fentanyl can be easily used after a longer duration drug like
morphine. Analgesia needs may increase over the first 4 hours (morphine ’s expected
1318 Dyson

duration) if the pain involved remains constant. Careful observation of the patient
should indicate if this is the case. Because surgical pain may actually lessen over
the first 4 to 24 hours after surgery, changes in fentanyl infusion may not be required,
may be increased for only a few hours, or may actually decrease over time.
Veterinarians have several analgesic drug options for CRIs. Typically, an opioid is
chosen first (eg, morphine, hydromorphone, fentanyl) in awake patients or during
surgery. When a long-lasting opioid is on board during surgery (usually part of the pre-
medication), however, lidocaine may be the first drug selected as a CRI to improve
analgesia during surgery. The reasons for this are discussed elsewhere in this article.
Other infusions (eg, ketamine, medetomidine) are usually added when these options
alone are ineffective. These drugs are rarely selected alone for analgesia by CRI.
One analgesic cocktail (morphine, lidocaine, and ketamine [MLK]) has gained popular-
ity for surgery and is also discussed elsewhere in this article.

Opioid Continuous Rate Infusion

There are several reports on morphine CRI in dogs.34–36 Although a rapid intravenous
bolus of morphine is contraindicated because of histamine release,37 a slow intrave-
nous infusion can be used without concern. The doses that have been assessed range
from 0.12 mg/kg/h34 to 0.34 mg/kg/h.36 The analgesia produced varied from mild to
moderate. The higher dose resulted in plasma concentrations that were greater
than the previously suggested analgesia range but were not associated with signifi-
cant cardiovascular or respiratory side effects in healthy awake dogs. Because seda-
tion is apparent at the higher CRI, it should be safe to assume that in the awake animal,
undesirable central nervous system (CNS) depression would accompany any respira-
tory depression and provide a clue to overdosage. Sedation and mild hypothermia are
expected consequences of using opioids for analgesia in the awake animal. In the
anesthetized dog, bradycardia and respiratory depression are obvious, but both are
easily treated in this setting, as mentioned previously. A conservative dose range
for a morphine CRI may fall within the range of 0.12 to 0.25 mg/kg/h (corresponding
roughly to the effect from 0.5–1.0 mg/kg as an intermittent dose) for dogs. Fentanyl
is preferred in cats.
There are no published studies using hydromorphone as a CRI in dogs or cats. Con-
sidering the fact that the duration of effect tends to be similar to morphine and that
hydromorphone is 10 times as potent as morphine, however, one should be able to
extrapolate safely from the studies using a CRI with morphine. Thus, a dose range
of 0.01 to 0.03 mg/kg/h should be effective. In either case, a loading dose of morphine
from 0.3 to 1.0 mg/kg or a loading dose of hydromorphone from 0.03 to 0.1 mg/kg
would be given to achieve appropriate analgesia in advance of starting the CRI. Hy-
dromorphone, in contrast to morphine, is safe given rapidly intravenously at these
doses.38 The selected dose would vary with the procedure performed and the
expected pain associated with it, in addition to the individual patient. Smaller patients
would need a higher dose per kilogram than large dogs.
Fentanyl is presently the most popular opioid for CRI. The effectiveness and cardio-
vascular safety of this infusion in dogs have been reported.39,40 Its short duration of ef-
fect makes it suitable for administration by this method. The dose-related MAC
reduction and ceiling effect (42 mg/kg/h) from fentanyl CRI were first reported in
1982.41 Doses of 3, 12, and 42 mg/kg/h showed a MAC reduction of 20%, 44%, and
65%, respectively. Practical intraoperative administration involves a loading dose of
3 to 5 mg/kg followed by a CRI of 10 mg/kg/h. This infusion can be halved or doubled
based on the desired effect on the inhalant requirements. In rare critical cases in which
isoflurane must be extremely low, fentanyl (50 mg/mL] and midazolam (5mg/mL)
 Perioperative Pain Management 1319

(10:1 as vol/vol) have been administered at 1 mL/kg/h (45 mg/kg/h 1 0.45 mg/kg/h,
respectively). High intraoperative infusions of fentanyl (>5 mg/kg/h) need to be lowered
in advance of recovery (approximately 20 minutes before the end of surgery). This
should reduce the chance of postoperative dysphoria. Infusions used in the awake
or recovering patient are usually 2 to 5 mg/kg/h, with doses as high as 10 mg/kg/h in
extremely painful conditions.
Butorphanol has also been used as a CRI at 0.1 to 0.4 mg/kg/h. This infusion would
be most appropriate for mild to moderate pain. A loading dose of 0.1 to 0.4 mg/kg
would be appropriate.
Practical evidence for use of opioid CRIs in cats is nonexistent. Analgesia has been
shown to be good after low-dose morphine administration (0.2 mg/kg),42 and MAC
reduction has been determined as significant at high (1.0 mg/kg) but not low (0.1
mg/kg) doses.6 Morphine as a CRI is not likely to be suitable in cats, however, because
of concerns for excitement with overdosing. If a m-agonist is required, fentanyl would
be the preferred drug because of its short duration of effect, thus reducing concerns
for overdosing and excitement. Low doses of hydromorphone as a CRI can be used in
the cat with assessment of effectiveness of the infusion, adjustment as needed, and
monitoring for hyperthermia, however. An infusion based on a 6-hour duration of
effect43 rather than 4 hours, unless proved otherwise by individual response, may
be a practical approach in cats (0.005–0.01 mg/kg/h). In general, butorphanol selec-
tion as a CRI would be a safe alternative for mild to moderate pain.

Lidocaine Continuous Rate Infusion

Lidocaine has been shown to reduce MAC in dogs, provide analgesia, and act as an
antiarrhythmic. It is an excellent choice in cases in which these benefits are of value
(eg, animals presented with gastric dilation/torsion, splenic tumors, chest trauma, car-
diac disease). Such critical patients can be induced with the addition of 2 mg/kg as
a bolus in advance of the induction agent, a second bolus of 2 mg/kg after intubation
and stabilization onto an inhalant, and a CRI started at 120 mg/kg/min (7 mg/kg/h). This
recommendation achieves immediate therapeutic levels for antiarrhythmic effects and
an expectation for a MAC reduction of approximately 43%. This approach is extrap-
olated from studies performed in normal and cardiovascular-compromised
patients.44,45 Plasma levels from this method are similar to those achieved in longer
than 30 minutes from a single 2-mg/kg dose followed by a 200-mg/kg/min (12 mg/
kg/h) CRI. This second method would be suitable for dogs with no evidence of cardio-
vascular compromise, arrhythmia concern (requiring an immediate antiarrhythmic
level), or possibly liver compromise (although lidocaine accumulation depends more
on flow than on liver function). It is a simple method for intraoperative MAC reduction
and analgesia in other cases (10 mg/kg/h simplifies calculations even more so with
likely little difference), however. Before recovery or after 1 hour in long surgical proce-
dures, the CRI should be reduced to 40 to 80 mg/kg/min (2–5 mg/kg/h) to reduce the
chance of mildly toxic plasma levels. The infusion can simply be stopped if not needed
for postoperative analgesia or arrhythmia management. At lower infusions, the MAC
may be reduced by approximately 20%. Analgesia can be achieved with as little as
1 to 3 mg/kg/h, however. The effective loading dose for analgesia in the awake patient
is similar to that during anesthesia (1–4 mg/kg).
Although MAC reduction has been measured in cats during lidocaine infusion, sig-
nificant cardiovascular depression has been shown.46 It has been suggested as an
analgesic in the awake cat at a loading dose of 0.25 to 1 mg/kg followed by a CRI
at 0.5 to 2 mg/kg/h.47 At the Ontario Veterinary College, however, the author and
her colleagues have no experience in this setting.
1320 Dyson

Ketamine Continuous Rate Infusion

Ketamine has been studied as a CRI in dogs and shown to provide an approximately
25% MAC reduction at 10 mg/kg/min (0.6 mg/kg/h).35 Intraoperative CRI administra-
tion is suggested at 2 to 10 mg/kg/min (0.1–0.6 mg/kg/h) after a loading dose provided
by ketamine in the induction or 2 mg/kg administered intravenously. At these doses,
MAC reduction and somatic analgesia are expected without evidence of significant
sympathetic drive. Doses between 0.1 and 2 mg/kg have been used for analgesia in
the postoperative setting when other analgesics alone are not effective. CNS depres-
sion, muscle rigidity, and sympathetic drive may occur with higher doses, depending
on coinciding drug use.

Morphine/Lidocaine/Ketamine Continuous Rate Infusion

A single report on the use of an MLK cocktail has been published.35 Analgesia and
MAC reduction are achieved with a mixture of morphine (12 mg), lidocaine
(150 mg), and ketamine (30 mg) in surgical fluid (500 mL) dripped at the standard
surgical fluid rate (10 mL/kg/h). This provides morphine at a rate of 4 mg/kg/min
(0.24 mg/kg/h), lidocaine at 50 mg/kg/min (3 mg/kg/h), and ketamine at 10 mg/kg/
min (0.6 mg/kg/h). The mixture produced the same MAC reduction (45%) and cardio-
vascular effects as morphine alone (same dose as in mixture). A multimodal approach
to analgesia was suggested as the benefit of this cocktail. This view may not be taken
by all anesthetists, however. If there is no measurable advantage, a simpler approach
may be more appropriate.48 The lack of benefit with the addition of ketamine along
with opioids during orthopedic surgery was similar35 to that shown in the study by
Muir and colleagues. This MLK cocktail is not simpler to use and shows no clear ad-
vantage when compared with using higher lidocaine infusions or opioid infusions.
Although no advantage has been shown at this point, it does not cause harm if mixed
properly and inhalant adjustments are made appropriately. For severe postoperative
pain, the concentrations of each drug in this mixture, and their combined potential
effect, are unlikely to confer adequate analgesia.

PREPARATION FOR RECOVERY

Appropriate analgesia should be achieved in advance of recovery. This may require

lowering or stopping infusions (as previously addressed), adding additional analgesics
(eg, NSAIAs delayed for concerns about hypotension or those only used for postop-
erative administration), or bringing single-dose opioid injections up to therapeutic
levels based on timing of last administration. There is no reason to avoid additional
opioids until after recovery if the patient is expected to require more than the level
on board. Delay in recovery associated with analgesia administration is more likely
attributable to poor drug or dose selection. Calculate the dose required to produce
the desired effect as described in the section on repeated intraoperative dosing during
maintenance, and administer just before turning off the inhalant. If the drugs on board
are likely to provide adequate analgesia, however, recovery can proceed with plans to
provide more analgesia only if the patient seems to need such.
Sedatives should be preemptively administered if thought to be useful in recovery.
The primary concern about acepromazine relates to intraoperative hypotension; how-
ever, a low dose in the premedication prevents this. Also, administration of low doses
(0.01–0.02 mg/kg) at recovery does not seem to affect blood pressure adversely at this
time. In hard-to-handle or stress-sensitive patients that were given acepromazine as
part of their premedication, additional dosing before recovery may be appropriate
to achieve significant sedation. The dose chosen depends on the residual
 Perioperative Pain Management 1321

premedication dose effect expected, but 0.01 to 0.02 mg/kg in dogs and 0.02 to
0.1 mg/kg in cats are suggested. In some cases, medetomidine may be preferred
(1–2 mg/kg given as the patient is extubated). This is more likely to be chosen for
the extremely aggressive animal.

POSTOPERATIVE ANALGESIA

Need for further analgesia is assessed after recovery. The patient must be carefully
assessed to determine if excitement, whining, or agitation is pain, dysphoria, or disori-
entation. When in doubt, pain should be assumed, and the response to treatment
defines if this judgment was correct. When pain is suspected or clearly displayed,
rapid administration of hydromorphone, fentanyl, or butorphanol, as appropriate,
should be performed. Morphine must be given intramuscularly or slowly intravenously.
If necessary, propofol (0.5–1-mg/kg increments) can be used to return the animal to an
anesthetized state until morphine is fully effective. Diazepam (0.2 mg/kg administered
intravenously) is also effective in the short term to deepen the plane of sedation in
a recovering animal that is showing signs of pain and provides time for the opioid to
take effect. It is important to recognize that some dogs can become quite excited after
benzodiazepine administration in the fully awake animal requiring analgesia. The opi-
oid should always be given first in this circumstance.
Low doses of acepromazine (0.01–0.02 mg/kg for dogs, 0.02–0.05 mg/kg for cats)
can be given if an animal is appearing only mildly uncomfortable or mildly dysphoric.
Response to treatments (acepromazine or more opioid) may be the best method of
diagnosis when uncertain. Occasionally, the treatment selected may be a reversal
agent. If the patient is clearly dysphoric or returns to a whining state shortly after
additional opioid administration, or if suspicion exists related to the use of high doses
of opioid during surgery, a slow titration of naloxone can be given to effect (4 mg/kg
diluted to 10 mL and given in 1-mL increments every minute).
For the animal that is thrashing and difficult to assess, medetomidine (1–2 mg/kg)
can be helpful. Some analgesia is achieved, and when recovery occurs in 15 to 20 min-
utes, it is usually smooth if the initial recovery behavior was disorientation. This is an
excellent approach in the ‘‘husky syndrome,’’ wherein disorientation in this breed is
associated with dramatic behavioral responses that are difficult to differentiate from
pain.
After stabilization of the patient in an analgesic state at recovery, regular
assessment is required to maintain this comfortable state. The patient may need no
more analgesia, occasional single-dose injections of opioid, or CRI administration of
one or more drugs to manage the pain.

ADVICE FOR SPECIFIC CASES

Not every case can be considered in this article, but a few special situations are
discussed.

PEDIATRICS

Much evidence exists that human babies experience pain.49,50 Responses to typical
analgesics are not always as expected. A study in puppies revealed that newborn
pups have a reduced requirement for analgesia and that, overall, puppies may be
more sensitive to opioid-associated respiratory depression.51 By 1 month of age,
puppies have a significantly increased analgesic requirement. Based on this evidence,
we must not ignore analgesia but must be cautious to monitor the effects of it.
1322 Dyson

Our primary analgesic choices for these cases include opioids and local anesthesia.
Ketamine may be a consideration as well and seems to be a reasonable choice for
short procedures in human infants,52 although neonates may be less responsive to
NMDA antagonists and ketamine is thus ineffective in providing analgesia.53
Opioids alone provide good restraint and sedation in addition to analgesia. In most
situations, sedatives are not required in pediatric patients. The dose of opioid selected
for premedication in healthy pediatric patients is often at the higher end of the range
related to patient size, but redosing may be less frequent, and if profound sedation is
associated with doses given, lower doses should be chosen. In sick patients or those
younger than 1 month of age, low doses should be administered. The patient can be
induced with propofol, diazepam/ketamine, or mask inhalant and then maintained on
inhalant.
Local anesthesia is an excellent choice when possible. Eutectic mixture of local
anesthetics (EMLA) cream is effective for local analgesia if given 30 minutes to
penetrate the skin. The weight of the animal must be used to calculate a safe volume
of injectable local anesthesia (2% lidocaine or 0.5% bupivicaine at approximately 0.4
mL/kg). Dilution to half strength with saline can be performed to allow more volume
without risking toxicity. If laryngeal desensitization is performed, the use of 2% lido-
caine drops rather than the 10% spray reduces the lidocaine dose by this route, allow-
ing for a larger volume to be used in other specific local blockade.
NSAIAs are not recommended in patients younger than 8 weeks of age because of
their effect on kidney development.

COMMON ELECTIVE SURGICAL PROCEDURES

Premade mixtures containing meperidine or butorphanol for premedication provide

a low level of analgesia conferred by the opioid and are capable of producing
a short-term mild to moderate analgesic effect. These mixtures are also dosed at
the lowest end of the analgesic range, again making them most suitable for mild
pain. With this in mind, further analgesia is required in many situations. NSAIAs are
useful in these cases. In any elective procedure, the NSAIA loading dose (initial
dose as double the maintenance dose) is usually not needed. The approved dosing
of meloxicam at 0.3 mg/kg in cats (United States) is not recommended, because
a dose of 0.1 or 0.2 mg/kg (orthopedic procedures) is adequate. Effective analgesia
is common with use of the maintenance dose (0.1 mg/kg) for elective procedures, be-
cause wind-up is not established with any associated increased analgesic demands.
If, however, the animal seems to be slightly uncomfortable later in the evening, a sec-
ond dose can be given because this does not exceed label dosing.
Cat castrations are associated with mild pain and may not require more analgesia
than that in the premedication period, provided that the procedure is performed within
15 to 30 minutes of administration. The administration of an NSAIA is a responsible
approach to avoid any painful experience, however. Dog castrations should be man-
aged adequately with an NSAIA, even if administered postoperatively, given the same
conditions as for the cat. Ovariohysterectomies in dogs and cats may require an
additional opioid dose for recovery if the NSAIA is withheld until the operation is
over, however. The opioid dose should be calculated in the premedication period,
and additional opioid should be added during or after surgery to achieve a total
dose of butorphanol at 0.2 to 0.4 mg/kg or meperidine at 5 to 10 mg/kg. A more
profound opioid dosed at the lower end of the range may be selected as part of the
premedication (usually given with acepromazine), however. The use of NSAIAs for 1
to 3 days is a reasonable option for postoperative analgesia in these cases. If the
 Perioperative Pain Management 1323

NSAIA is given 30 minutes or more before recovery, additional or more profound opi-
oid administration is less likely to be required. Onychectomy in cats is best managed
with buprenorphine or hydromorphone as part of the premedication and the addition
of local blocks using bupivacaine or a lidocaine-bupivacaine mixture in advance of
surgery (see the article by Lemke elsewhere in this issue). Postoperative NSAIA anal-
gesia is indicated for 2 to 3 days. This technique seems to be effective, although fen-
tanyl patches have also been applied for pain associated with the declawing
procedure. In this case, because the fentanyl patch usually is removed on discharge
and the effect quickly dissipates, analgesia can be continued with an NSAIA for 1 to 2
more days.

EMERGENCY CASES

The reader is referred to the article by Dyson elsewhere in this issue.

CESAREAN SECTION

There is little concern related to the use of opioids for premedication in patients re-
quiring a cesarean section. If puppies or kittens are sedated or have respiratory
depression from the expected placental transfer of the opioid, 1 drop of naloxone
(0.4 mg/mL from a 1-mL syringe) can be administered under the tongue, and repeat
doses can be sent home with the owner if longer acting opioids are involved. Doxap-
ram may be helpful during resuscitation of the newborn if the response to naloxone is
poor or if no opioids were used. Because of the analgesic effect of progesterone,
which is at high levels at this time in the bitch or queen, butorphanol may be adequate
as a premedication. Its short duration of effect can result in mild and short-duration
respiratory depression on neonates but provides short-term analgesia in the bitch at
recovery. A single dose of an NSAIA is often administered after surgery. Concerns
for milk transfer and the impact on the neonate ’s kidney development dictate the
use of one dose only, however. If low-dose butorphanol is given for the premedication,
the bitch could be provided a dose of hydromorphone for discharge, which can then
provide several hours of analgesia. The antagonistic effect of the butorphanol is likely
to be minimal when a m-agonist is given approximately 1 hour after butorphanol.
Although hydromorphone or morphine is suitable as a premedication in these cases,
low-end doses should be given initially, with more given after removal of the puppies if
deemed necessary (based on other analgesia present). There is a greater need to
reverse the neonate when profound m-agonists are selected, even when low doses
are used. Local analgesia is also a reasonable choice, especially in cases in which
inhalant use must be minimized because of cardiovascular instability. A local line block
is quick and easy; epidural local analgesia can provide a longer duration of effect but
involves more time and expertise.

GERIATRICS

In general, typical doses of analgesia are selected for the geriatric patient. Because of
the slower elimination, however, redosing may be required less frequently. As in the
pediatric patient, if excessive sedation is associated with the dose selected, lower
doses would be administered thereafter. Partial reversal by careful titration with nalox-
one and saline, as previously described, can also be considered if an excessive effect
of the opioid is noted.
1324 Dyson

SUMMARY

Pain exists; however, we can prevent it, and we can treat it. The fallacy that pain is pro-
tective and must be allowed to avoid risk for damage after surgery needs to be erad-
icated. Preoperative and postoperative analgesia is directed at aching pain, whereas
sharp pain associated with inappropriate movements persists. Analgesia provides
much more benefit than concern. Preoperative and intraoperative analgesia reduces
wind-up and postoperative demands for analgesia, and during general anesthesia,
it creates a more balanced plane associated with less cardiovascular depression.
The advice given in this article provides guidelines for the veterinarian that can be
adjusted according to the patient ’s needs and responses. Suggestions are provided
from the point of admission to discharge to give a starting point for individual tailoring
of an analgesic plan.

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J Vet Intern Med 2008;22:525–533

P o s t ope r at iv e Ble e ding i n Re t i r e d R a c i n g G r e y h o u n d s

A. Lara-Garcı́a, C.G. Couto, M.C. Iazbik, and M.B. Brooks

Background: Some retired racing Greyhounds (RRG) that undergo surgery bleed excessively.
Hypothesis: Greyhounds that bleed excessively will have one or more preoperative hemostatic abnormalities that can be
used to predict the risk and severity of postoperative bleeding.
Animals: Eighty-eight RRG undergoing ovariohysterectomy or castration.
Methods: All dogs were evaluated preoperatively with a physical exam, CBC, platelet count, OSPT, APTT, platelet func-
tion with PFA-100a; fibrinogen, D-dimer, plasminogen (Plmg), antiplasmin (AP), antithrombin (AT), and vWF concentration
(vWF:Ag); vWF collagen binding assay (vWF:CBA), and Factor XIII assay. Assays were repeated in the dogs that bled, and in
an age- and sex-matched control group of RRG.
Results: Twenty-six percent of the dogs had bleeding 36–48 hours after surgery. AP (P o.0001) and AT concentration
(P 5 .007) were significantly lower, and vWF:CBA (P 5 .0284) was higher preoperatively in the dogs with excessive hemorrhage. A
lower platelet count (P 5 .001) and hematocrit (P 5 .002), shorter OSPT (P 5 .0002) and higher plasma fibrinogen (P o.0001), and
AP (P 5 .001) concentration were detected at the time of bleeding compared with preoperative values in the dogs that bleed exces-
sively. The same findings were observed postoperatively for the control group, except for the decrease in hematocrit.
Conclusions and Clinical Importance: The results indicate that this excessive postoperative bleeding is not attributable to a
primary or secondary hemostatic defect, but could result from altered fibrinolysis.
Key words: Antiplasmin; Fibrinolysis; Hemostasis; Surgery; von Willebrand factor.

reyhounds have physiologic and hematologic
G peculiarities specific for the breed.1–5 The mean
packed cell volume (PCV), hemoglobin concentration,
red blood cell (RBC) count, and whole blood viscosity
are higher, whereas the white blood cell count, neutrophil
count, and platelet count1–3 are lower than in other
breeds of dogs. The serum total protein, globulin, a-glob-
ulin, and b-globulin concentrations are also lower than in
non-Greyhound dogs.1,3–5 In addition, platelet aggrega-
tion under high shear as determined with PFA-100a is
significantly shorter in retired racing Greyhounds (RRG)
than in non-Greyhound dogs.5
We have observed a tendency for RRG to develop
bleeding after minor trauma or a simple surgical proce-
dure, including ovariohysterectomy, orchiectomy,
dewclaw removal, or laparotomy. In the majority of the
dogs, one-stage prothrombin time (OSPT), activated
partial thromboplastin time (APTT), and platelet counts
(PLT) were within the reference ranges. Although anec-
dotal references to excessive bleeding can be found
in some Greyhound websites or Greyhound health man-
uals, there are no published controlled studies
From the Department of Veterinary Clinical Sciences and Veteri-
nary Teaching Hospital (Lara-Garcı´a, Couto, Iazbik), the OSU
Comprehensive Cancer Center (Couto), The Ohio State University,
Columbus, OH; and the Comparative Coagulation Section the Animal
Health Diagnostic Laboratory, Cornell University, Ithaca, NY
(Brooks). This work was performed at The Ohio State University
Veterinary Teaching Hospital, Columbus, OH. Preliminary data were
presented in abstract form at the 25th ACVIM Forum, Seattle, June
2007.
Corresponding author: Ana Lara Garcia, DVM, MS, PhD,
Department of Veterinary Clinical Sciences, College of Veterinary
Medicine, The Ohio State University, 601 Vernon L Tharp, 43210
Columbus, OH; e-mail: lara-garcia.3@osu.edu.
Submitted July 10, 2007; Revised October 15, 2007; Accepted
January 30, 2008.
Copyright r 2008 by the American College of Veterinary Internal
Medicine
10.1111/j.1939-1676.2008.0088.x
documenting or investigating this phenomenon in the
breed.
Recently, a website-based survey documented the
prevalence of diseases and major causes of death in 747
RRG in the United States in 2006.6 The mortality rate
during a 2-year period was 15%; and bleeding disorders
were one of the 4 most prevalent causes of death
reported, accounting for 8% of all deaths. Hematologic
diseases had a prevalence of 3.3%, with thromboembolic
disease and spontaneous and postoperative bleeding
accounting for 46% of these.6
Intra-operative and immediate postoperative bleeding
can be attributed to surgical technique (surgical bleeding)
or systemic abnormalities (nonsurgical bleeding).7 The lat-
ter includes primary hemostatic defects such as thrombo-
cytopenia, platelet dysfunction, or von Willebrand disease
(vWD), and secondary hemostatic defects such as hypo-
fibrinogenemia, hypoprothrombinemia, hemophilia A or
B, factor VII deficiency, or combined clotting factor defi-
ciencies.7 Delayed postoperative bleeding is more likely
caused by abnormal fibrin stabilization, factor XI defi-
ciency, or enhanced fibrinolysis.8 Finally, systemic
endothelial damage or dysfunction after postoperative
septic complications or hypertensive crises can result in
thrombocytopenia and generalized bleeding, as described
in women with HELLP (elevated liver enzymes, low plate-
let count) syndrome associated with preeclampsia and in
children with hemolytic-uremic syndrome.9–10
In our experience, limb amputation for osteosarcoma
(OSA) also frequently results in severe postoperative
bleeding in Greyhounds. In the past 3 years, 36% (10/
38) of the RRG that underwent limb amputation for
OSA at The Ohio State University Veterinary Teaching
Hospital (OSU-VTH) had severe delayed postoperative
bleeding that required intensive care management.b In six
of these dogs, the severity of the bleeding required trans-
fusion of packed RBCs and fresh frozen plasma, leading
to a transient poor quality of life postamputation,
lengthy hospitalization, and high medical bills.
526 Lara-Garcı́a et al
Our hypothesis was that Greyhound ‘‘bleeders’’ would
have one or more preoperative abnormalities in primary
or secondary hemostasis or in the fibrinolytic pathway
that could be used to predict the risk and severity of
postoperative bleeding. To test this hypothesis, primary
and secondary hemostasis were prospectively evaluated
preoperatively in RRG who underwent routine ovario-
hysterectomy or castration at OSU-VTH. The hemosta-
sis assays were repeated in those RRG who developed
bleeding complications at the time of the event, and in an
age- and sex-matched control group of RRG that under-
went ovariohysterectomy or castration at the same time
and did not bleed.
Material and Methods
Animals and Blood Samples
This study was approved by the Hospital Executive Committee
of The Ohio State University Veterinary Teaching Hospital. Eighty-
eight RRG from Greyhound Adoption of Ohio (Chagrin Falls,
OH—www.greyhoundadoptionofoh.org) were spayed or neutered
at the OSU-VTH between November 2004 and February 2006 as
part of a 3rd-year veterinary student teaching laboratory. A phys-
ical examination was performed on each dog, and blood was drawn
preoperatively for a CBC and hemostasis assessment. The following
tests were used to evaluate primary hemostasis: PLT, platelet func-
tion with PFA-100a closure time (CT), von Willebrand factor
antigen concentration (vWF:Ag), and von Willebrand factor activity
with collagen binding assay (vWF:CBA). Secondary hemostasis was
evaluated with APTT, OSPT, fibrinogen concentration, anti-
thrombin (AT) activity, and Factor XIII (FXIII). The fibrinolytic
pathway was evaluated by measuring plasminogen activity (Plmg),
antiplasmin activity (AP), and D-dimer concentration.
Before surgery, all RRG were premedicated with buprenorphinec
(0.05 mg/kg) and acepromazined (0.05 mg/kg) intramuscularly, and a
prophylactic dose of intravenous cefazolin sodiume (22 mg/kg IV) was
administered. Anesthesia was induced with ketaminef (5 mg/kg) and
diazepamg (0.25 mg/kg) IV, and maintained using isofluraneh in oxy-
gen. Respiration was supported with intermittent positive-pressure
ventilation, and intra-operative fluid therapy consisted of lactated Ring-
er’s solution (10 mL/kg/hours IV). The dogs were monitored during
surgery with electrocardiography, pulse oximetry, respirometry, capno-
graphy, measurement of peripheral arterial pressure, and body
temperature. After surgery, analgesia was continued with one single in-
tramuscular injection of carprofeni (4 mg/kg). The dogs were monitored
postoperatively until recovery and then transferred to a boarding area.
After the surgical procedure (spay or neuter), dogs were kept at
the OSU-VTH for a minimum of 4 days. All dogs underwent daily
physical examination, their bleeding score was recorded once a day,
and the areas of hemorrhage were photographed digitally. Although
there is no standardized scale to evaluate the severity of bleeding in
dogs, a system with scores ranging from 0 to 4 was adapted from the
one proposed by Buchanan and Adix for children with idiopathic
thrombocytopenic purpura (Table 1).11 The final bleeding score as-
signed to each RRG corresponded with the highest score recorded
during the postoperative period.
In dogs with clinical evidence of bleeding (ie, bleeding score 1–4),
the assays of hemostatic function performed at baseline were repeated
when the bleeding was detected. These assays were also performed in a
group of age- and gender-matched Greyhounds who underwent sur-
gery at the same time and did not have postoperative bleeding (ie,
bleeding score 0). The results of the hemostasis assays in this ‘‘control’’
group were used to assess which hemostatic changes developed post-
operatively as a result of the surgical procedure performed and for
comparison with the postoperative results of the ‘‘bleeder’’ group.
Table 1. Scale for severity of bleeding.
Score 0 Definitely no new bleeding
Score 1 Questionable new petechiae or bruising
Score 2 Definite new cutaneous hemorrhagic lesions
Score 3 Moderate to severe cutaneous bleeding without
measurable decline in hemoglobin concentration
Score 4 Severe external bleeding of sufficient magnitude
to decrease hematocrit by 46%
Adapted from the system for children with idiopathic thrombo-
cytopenic purpura.11
Sampling
Twenty milliliters of blood were collected from the jugular vein
by atraumatic direct venipuncture, and placed in a 3 mL siliconized
tube containing sodium ethylenediaminetetraacetate and in 4.5 mL
tubes containing 3.8% sodium citrate.j
One tube of blood collected in sodium citrate was placed in a rack
at room temperature for at least 10 minutes (and for no longer than
3 hours); this sample was used to evaluate platelet function with the
PFA-100.a The other tubes of citrated blood were immediately cen-
trifuged at 1,380  g for 10 minutes, and the plasma was transferred
to several polypropylene transfer tubes. One tube with plasma was
used for immediate determination of OSPT, APTT, and fibrinogen
concentration, and the rest of the tubes were stored in a freezer at
31C for 1–2 weeks. Frozen plasma was shipped for the additional
assays to the Comparative Coagulation Section laboratory (Animal
Health Diagnostic Laboratory, Cornell University, Ithaca, NY).
Platelet Count and Platelet Function Assays
Platelet counts were performed using automated counters (Cell-
Dyn 3500k or LaserCytel) or a manual hand count for those samples
below the reference ranges. Whole blood (800 mL) platelet function
assays were done by means of the PFA-100.a The PFA-100a simu-
lates primary hemostasis after injury to a small vessel under high
shear stress. Disposable cartridges with collagen and either epineph-
rine (10 mg) (COL/EPI) or adenosindiphosphate (ADP—50 mg)
(COL/ADP) were used as platelet activating reagents. The test was
performed twice with each type of reagent as described previously,
and the closure times (CT) were recorded.12,13 Greyhound-specific
reference intervals were used for hematocrit, PLT, and CT with
PFA-100.a5
Routine Hemostasis Assays
OSPT, APTT, and plasma fibrinogen concentration were deter-
mined by means of the automated analyzer ACL-200m and
commercially available reagents,n as described previously.14
Antithrombin
Plasma AT activity was measured with a synthetic chromogenic
substrate kito following the manufacturer’s recommendations for
assay conditions and instrumentation.p The assay detects AT activ-
ity based on inhibition of a thrombin reagent (anti-IIa activity) and
was modified by the substitution of pooled normal canine plasma,
rather than human plasma, as the calibration standard. The AT ac-
tivities of test plasma were reported as the percentage of the
standard, which had an assigned value of 100%.15
Von Willebrand Factor Assays
Plasma vWF concentration [vWF antigen (vWF:Ag)] was mea-
sured by enzyme-linked immunosorbent assay (ELISA) configured
 Bleeding in Greyhounds
with monoclonal anticanine vWF antibodies.16 The biologic activity
of vWF was evaluated in a collagen-binding assay (vWF:CBA).17
Deficiency of the high molecular-weight vWF multimers impairs the
ability of vWF to effectively bind collagen. Determination of the
ratio of vWF:Ag to vWF:CBA differentiates type 1 from type 2
vWD, based on the disproportionate lack of vWF:CBA in the latter.
A ratio of vWF:Ag to vWF:CBA greater than 2:1 is considered to be
diagnostic of type 2 vWD.17–18
Fibrinolysis Assays
The activities of Plmg and AP were measured using synthetic
chromogenic substrate kits and the manufacturer’s recommended
instrument.q,r,s The Plmg assay was modified by substitution of
urokinase, rather than streptokinase, to activate Plmg.19 Standard
curves for the Plmg and AP assays were derived from dilutions of a
canine plasma standard, and the results were reported as a percent-
age of the standard. Plasma D-dimer concentration was measured
using a semiquantitative latex agglutination assay,t as described
previously.20 The results of this assay were expressed semiquanti-
tatively within 4 ranges: o250, 250–500, 500–1,000, and 1,000–
2,000 ng/dL.
Factor XIII Deficiency Screen
A screening test to detect the presence of cross-linked fibrin was
performed by comparing the urea solubility of fibrin from control
dogs and test plasma.21 Briefly, 2 volumes of citrated plasma were
combined in a glass tube with 1 volume of an imidazole buffer and
1/10th volume of 0.25 M CaCl2. After incubation for 1 hour at
37 1C, the resultant fibrin clot was transferred to a 5 M urea solu-
tion, and the presence or absence of residual clot was recorded at
5-minute intervals. In the absence of Factor XIII, complete clot lysis
should occur within 5 minutes. Cross-linked fibrin, formed by
the action of Factor XIII, is insoluble in urea and remains intact.
Results are reported as normal or abnormal.22
Statistical Analysis
Graph Pad Prism softwareu was used for statistical analysis. De-
scriptive statistics were performed for all the variables. The
Kolmogorov-Smirnoff test was used to assess normal distribution
Fig 1. (A) Image of the surgical incision in one of the Greyhounds of the control group 36 hours post-surgery (bleeding score 0). (B) Image of
the surgical incision in one of the Greyhounds of the ‘‘bleeder’’ group 36 hours postsurgery (bleeding score 3).
527
of the variables before using parametric methods. The Student’s
t-test for independent variables was used to compare hemostatic
variables between groups (‘‘non-bleeders,’’ ‘‘bleeders,’’ or control
group). Comparisons within groups (‘‘bleeders’’ and control group)
were done using the Student’s t-test for paired samples. Contingen-
cy tables were used to compare categorical variables between
groups. Differences were considered statistically significant
when P o.05.
Results
Signalment and Prevalence of Postoperative
Bleeding in RRG
Eighty-eight Greyhounds were evaluated. There were
36 intact males and 52 intact females, with ages that
ranged from 1 to 11 years (mean 4 years). Although none
of the dogs experienced intra-operative or immediate
postoperative bleeding, 26% of the dogs (23/88) had de-
layed postoperative bleeding 36 to 48 hours after surgery.
The bleeding was scored as grade 1 in 2 dogs, grade 2 in
14 dogs, grade 3 in 5 dogs, and grade 4 in 2 dogs. The
observed signs of bleeding consisted of cutaneous bruis-
ing that extended from the area of the surgical incision
toward the periphery (Fig 1). There was no bleeding from
mucosal surfaces or in areas distant from the surgical
site. None of the dogs required transfusion of blood
components and the bleeding was self-limiting; bruising
was still present at the time the dogs were discharged, 4
days after the surgery.
There was no significant difference for sex between
‘‘bleeders’’ and ‘‘non-bleeders.’’ The age of the ‘‘bleed-
ers’’ (range 1–11 years, mean 3 years) was significantly
lower than in the ‘‘non-bleeders’’ (range 2–11 years,
mean 4 years) (P 5 .02). On physical examination, we
found that the prevalence of a left basilar systolic mur-
mur in the ‘‘non-bleeder group’’ was 69%, and it was
significantly higher than in the ‘‘bleeder’’ group, where it
was 52% (P 5 .013). The murmurs were graded as I
or II/VI in all dogs, except for 1 RRG from the ‘‘non-
bleeder group’’ that had a III/VI murmur.
528 Lara-Garcı́a et al

Comparison of Hemostatic Parameters between Comparison of Preoperative and Postoperative Values

‘‘Bleeders’’ and ‘‘Non-Bleeders’’ Preoperatively
Preoperatively, there were no significant differences
between ‘‘bleeders’’ and ‘‘non-bleeders’’ for any of the
following factors: PLT, hematocrit, OSPT, APTT,
fibrinogen, vWF:Ag, platelet function using the PFA-
100a with COL/EPI and COL/ADP, Plmg, D-dimer, and
F-XIII (Table 2). The D-dimer concentration was
o250 ng/dL in all but two of the ‘‘non-bleeders,’’ which
had values of 250–500 and 500–1,000 ng/dL, respectively;
all ‘‘bleeders’’ had values of o250 ng/dL, except 1 dog
that had 250–500 ng/dL before surgery. Factor XIII ac-
tivity was normal for all the dogs in both groups.
In the ‘‘non-bleeder’’ group, AP and AT activities were
above the reference range in 20% and 23% of the dogs,
respectively. The AP and AT activities, although within
the normal range, were significantly lower in the ‘‘bleed-
er’’ group than in the ‘‘non-bleeders’’ (P o.001 and P 5
.007, respectively). The vWF:Ag was below the reference
interval in 21% of the ‘‘bleeders’’ and in 50% of the
‘‘non-bleeders’’ without significant differences between
groups (P 5 .9614), and the vWF:CBA was below the
reference range in 8% of the ‘‘bleeders’’ and in 30% of
the ‘‘non-bleeders’’ and was significantly higher in the
‘‘bleeders’’ (P 5 .0284). The ratio between the vWF:Ag
concentration and the vWF:CBA was significantly lower
in the ‘‘bleeder’’ group (P o.0001) (Table 2, Fig 2).
Control Group
within ‘‘Bleeders’’ and within Control Group
When the hemostatic variables were compared before
surgery and after surgery within the ‘‘bleeders,’’ and
before and after surgery within the control group, the
PLT was significantly lower in both groups (P 5 .001,
P 5 .03), the OSPT was significantly shorter (P 5 .0002,
P 5 .048), and the fibrinogen (P o.0001, P 5 .002) con-
centration and AP (P 5 .01, P 5 .04) activity were
significantly higher postoperatively in both groups
(Table 2; Figs 3 and 4). Concentration of the D-dimer
was significantly increased after surgery in both groups.
In 2 dogs within the control group (25%), the D-dimer
concentration increased to between 250 and 2,000 ng/dL
(P o.001), whereas in 3 dogs within the ‘‘bleeder’’ group
(13%), it increased to between 250 and 1,000 ng/dL
(P 5 .0238). The hematocrit was the only variable that
was significantly lower at the time of bleeding in the
‘‘bleeder’’ group (P 5 .002), but not in the control group
(P 5 .4533); the hematocrit decreased more than 6%
(ie, grade 4 bleeding) in 2/23 ‘‘bleeders’’ (10%) (Table 2,
Figs 3 and 4).
Comparison of Postoperative Values between
‘‘Bleeders’’ and Control Group
There were no significant postoperative differences be-
tween ‘‘bleeders’’ and the control group for any of the
hemostatic parameters evaluated, except for the ratio
vWF:Ag/vWF:CBA, which was lower in the ‘‘bleeder’’
group (P 5 .0389).

The control group consisted of 8 Greyhounds who Discussion

underwent spaying or neutering and had no signs
of bleeding (ie, Score 0). Before surgery, there were no
significant differences for any of the parameters evaluat-
ed between the control dogs and the rest of the
Greyhounds of the ‘‘non-bleeder’’ group.
In this prospective study, we documented the develop-
ment of delayed postoperative bleeding after spaying or
neutering in RRG, with a prevalence of 26%. In 10%
of the bleeders, there was a decrease in the hematocrit of

Table 2. Results of hemostatic parameters in ‘‘non-bleeder,’’ ‘‘bleeder,’’ and control group.

Laboratory Non-bleeder Pre-Sx Bleeder Pre-Sx Bleeder Post-Sx Control Post-Sx
Reference Ranges Mean (SD) n565 Mean (SD) n523 Mean (SD) n523 Mean (SD) n58
Hematocrit (%) 46–64 52.3 (4.3) 53.7 (3.7) 50.6 (4.4)a 53.7 (7.8)
PLT (109/L) 125–397 218 (51) 198 (46) 169 (49)a 181 (43)b
COL–ADP (seconds) 63–92 88.7 (22) 82 (13.6) 80 (11.4) 84.5 (21.9)
COL–EPI (seconds) 87–238 207 (71.3) 180 (59.1) 206.5 (82.5) 174 (64.8)
APTT (seconds) 9–21 14.4 (2.6) 13.7 (1.6) 13.7 (2.3) 15.6 (4.2)
OSPT (seconds) 6–7.5 6.8 (0.4) 6.8 (0.47) 6.3 (0.23)a 6.37 (0.48)b
Fibrinogen (g/L) 100–384 118 (29.7) 130 (40.8) 215 (37.5)a 200 (54.7)b
vWF:Ag (%) 70–180 73.7 (23) 74 (14) 81.4 (22.7) 71 (27.8)
vWF:CBA (%) 450 62 (20) 72.7 (16.5)c 80 (26.8) 62.2 (24.1)
Ratio vWF:Ag/vWF:CBA o2 1.2 (0.14) 1.03 (0.12)c 1.03 (0.13) 1.15 (0.11)
Antiplasmin (%) 65–120 107 (35.8) 82 (20)c 94 (26.4)a 108 (36.5)b
Antithrombin (%) 65–145 100.8 (36.4) 78.3 (17.2)c 74.8 (24.3) 95.6 (32.4)
Plasminogen (%) 60–170 71.6 (16.9) 65 (19.4) 62.3 (15.2) 71.1 (20.8)

PLT, platelet count; COL-ADP, closure time with collagen-adenosindiphosphate; COL-EPI, closure time with collagen-epinephrine;
APTT, activated partial thromboplastin time; OSPT, one stage phrothrombine time; vWF:Ag, von Willebrand Factor antigen concentration;
vWF:CBA, von Willebrand Factor collagen binding assay activity; Pre-Sx, preoperative; Post-Sx, postoperative.
a
Hemostatic parameters significantly differ within the ‘‘bleeder’’ group.
b
Hemostatic parameters significantly differ within the ‘‘control’’ group.
c
Hemostatic parameters significantly differ preoperatively between ‘‘bleeders’’ and ‘‘non-bleeders.’’
 Bleeding in Greyhounds
Fig 2. Scatter dot plots of the hemostatic parameters that differ significantly between the ‘‘bleeder’’ group (n 5 23) and ‘‘non-bleeder’’ group
(n 5 65) preoperatively (P o.05). The dotted lines represent the reference range limits for a given parameter, and the solid line represents the
mean of the values obtained for that parameter in each group of RRG.
more than 6% (ie, grade 4 bleeding) but blood compo-
nent therapy was not required by these dogs. In both
groups, platelet counts and platelet function were within
the reference ranges for the breed5 and were not signifi-
cantly different between ‘‘bleeders’’ and ‘‘non-bleeders.’’
Selective or combined clotting factor deficiencies were
ruled out on the basis of normal fibrinogen concentra-
tion, OSPT, and APTT in the ‘‘bleeders.’’ Factor XIII
deficiency was also ruled out on the basis of normal
Factor XIII assay.
All the RRG received the same analgesic and anesthet-
ic protocol pre- and postoperatively; therefore, it is
unlikely that differences between the groups are caused
by the drugs administered perioperatively. The delayed
bleeding makes drug-associated thrombocytopenia or
platelet dysfunction unlikely as a cause of bleeding. Fur-
thermore, in a previous study, acepromazine caused
thrombocytopenia and platelet dysfunction that lasted
o200 minutes.23 Although all the Greyhounds in this
study received carprofen perioperatively, the platelet
function with PFA-100a was within normal limits in both
groups at the time of bleeding. Previous studies reported
decreased platelet aggregation by aggregometry in dogs
that underwent surgery and received multiple doses of
carprofen, but there was no clinical evidence of bleeding
attributable to this drug in the postoperative period.24
Another study by Gaal et al25 demonstrated no changes
529
in platelet aggregation at high shear using PFA-100a
after treatment with carprofen for 5 days.
vWF is a large molecule composed of low-, intermedi-
ate-, and high-molecular weight (MW) multimers. The
high-MW multimers are vital for platelet adhesion to the
subendothelium in areas of high shear.26 In this study,
the vWF:Ag concentration was below the reference rang-
es in 21% of the ‘‘bleeders’’ (range 43–63%; mean
54.8%) and 50% of the dogs from the ‘‘non-bleeder’’
group (range 36–68%, mean 56%), without significant
differences between the groups. Paradoxically, the ‘‘non-
bleeder’’ group had significantly lower levels of high-
MW vWF than the ‘‘bleeder’’ group measured by
vWF:CBA (P 5 .0284); this unexplained phenomenon
should have made the ‘‘non-bleeders’’ more predisposed
to develop perioperative bleeding.
Greyhounds are not one of the breeds with a reported
high prevalence of vWD.26 In a recent 2-year period
(July 2002 to July 2004), approximately 10% (22 of 216)
of the Greyhounds screened at the Comparative Coagu-
lation Section had plasma vWF concentration of
30%.v In a previous study of platelet function with
PFA-100a in Greyhounds, we also found that 13% (3/23)
of the dogs had vWF:Ag concentrations below reference
range, but normal CT with the PFA-100.a5
Greyhounds commonly have a high velocity aortic
murmur because of relative aortic stenosis.27 Type 2 von
530 Lara-Garcı́a et al

Fig 3. Scatter dot plots for the preoperative and postoperative values of the hemostatic parameters that differ significantly within the
‘‘bleeder’’ group (n 5 23; P o.05). The dotted lines represent the reference range limits for a given parameter, and the solid line represents the
mean of the group of values obtained for that parameter in the ‘‘bleeder’’ group before or after surgery.

Willebrand’s syndrome (vWS), a depletion of high-MW
vWF multimers secondary to high shear, has been
described in humans with aortic valve mineralization,
and recently in dogs with aortic and subaortic stenosis.28
Interestingly, the prevalence of a left basilar systolic mur-
mur in the ‘‘non-bleeder’’ group was significantly higher
than in the ‘‘bleeder’’ group (P 5 .013). Type 2 vWS was
ruled out because the vWF:Ag/vWF:CBA ratio was be-
low 2. Because the decreases in vWF:Ag were moderate
and the platelet function assays were normal in the ‘‘non-
bleeder’’ group, it is possible that the ‘‘non-bleeder’’
group had lower vWF:CBA activity than the ‘‘bleeder’’
group owing to depletion of high-MW vWF multimers
associated with the higher prevalence of a high-velocity
aortic murmur.
Although vWF has always been seen as a platelet
adhesion molecule that is involved in only the primary
hemostatic process, recent evidence in humans has doc-
umented that plasma vWF:Ag is higher in hypertensive
than in normotensive human patients.29 Greyhounds
have high arterial blood pressure compared with mixed
breed dogs30,31; therefore, the vWF:Ag in this breed may
be artificially increased because of endothelial cell dam-
age secondary to hypertension. It is possible that the
‘‘bleeders’’ had higher vWF:Ag concentrations than the
‘‘non-bleeders’’ because they were hypertensive, and that
the high blood pressure contributed to the delayed bleed-
ing (ie, increased hydrostatic pressure dislodging the
hemostatic plug). Although this study did not examine
arterial blood pressure as a potential contributing factor
 Bleeding in Greyhounds 531

Fig 4. Scatter dot plots for the preoperative and postoperative values of the hemostatic parameters that differ significantly within the control
group (n 5 8; P o.05). The dotted lines represent the reference range limits for a given parameter, and the solid line represents the mean of the
group of values obtained for that parameter in the ‘‘control’’ group before or after surgery.

to the bleeding, a prospective study evaluating this pos-
sibility is under way.
It is possible that the delayed onset of bleeding (ie,
36–48 hours) in the affected Greyhounds would be
caused by enhanced fibrinolysis, because ‘‘bleeders’’ had
lower AP than ‘‘non-bleeders’’ before surgery, suggesting
activated fibrinolysis and, hence, a hypocoagulable state.
D-dimer concentrations in the ‘‘bleeder’’ group were
increased in only 3 dogs postoperatively, although theo-
retically D-dimer concentrations are expected to be high
in patients with hyperfibrinolysis. Several studies in hu-
mans have shown that bleeding patients with increased
fibrinolysis diagnosed by low plasminogen activator in-
hibitor type 1 (PAI-1) or short euglobulin lysis time
(ELT) can have normal D-dimer concentrations, and that
there was no correlation between D-dimer concentration
and PAI-1 or ELT.32,33 In this study, we did not measure
tissue-plasminogen activator (tPA) or PAI-1, which are
more specific fibrinolysis parameters whose results
could have supported or ruled out this possible explana-
tion for the postoperative bleeding in RRG. To our
knowledge, assays for tPA in canine plasma have not
been validated; we are currently evaluating an ELISA for
PAI-1 in dogs (Marjory B Brooks, unpublished observa-
tions, Animal Health Diagnostic Laboratory, Cornell
University, Ithaca, NY). At this moment, we are evalu-
ating this assay in RRG plasma at our institution as a
next step of the present study.
Aminocaproic acid is a prohemostatic agent that is
beneficial not only in patients with hyperfibrinolysis but
also in those with a variety of primary and secondary
hemostatic defects.34 Although the data in this study do
532 Lara-Garcı́a et al
not confirm hyperfibrinolysis as the primary cause of
postoperative bleeding in RRG, further clinical investi-
gation of the role of perioperative administration of
aminocaproic acid to decrease the prevalence or severity
of this complication is warranted.
We propose that values for hemostatic assays in Grey-
hounds may differ from those of the general dog
population, as it occurs with other clinicopathologic
analytes in the breed,1–5 and reference ranges for
vWF:Ag, vWF:CBA, AT, AP in RRG should be gener-
ated.
In a previous study in dogs undergoing elective ova-
riohysterectomy, there were no differences in the
hemostatic profiles before and after the procedure.35 In
our study, the hemostatic changes observed in both
‘‘bleeder’’ and control groups after surgery were identi-
cal, with the exception of the expected decrease in the
hematocrit for the ‘‘bleeders.’’ The shortening in OSPT
and the increase in fibrinogen and D-dimer concentra-
tions observed postoperatively within the ‘‘bleeder’’
group and within the control group support the hyper-
coagulable state that has been widely described in
humans after surgery attributable to release of TF intra-
operatively.36,37 The postoperative hypercoagulable state
is most likely responsible for the increase in AP in the
‘‘bleeders’’ compared with their baseline values, support-
ing the fact that these dogs, regardless of the initial
hemostatic profile, are capable of generating a compen-
satory response after surgical tissue trauma. This was
clinically evident by the fact that the bleeding was self-
limiting and the blood components were not required in
any of the ‘‘bleeders.’’ This will also most likely explain
the lack of differences in AP after surgery between the
‘‘bleeders’’ and the control group.
The low vWF:Ag, high AT, and high AP in RRG
could be an adaptational mechanism to racing or an evo-
lutionary trait designed to prevent clotting of blood with
high viscosity (ie, Greyhounds have high hematocrit and
whole blood viscosity) that circulates through large mus-
cle masses, as it has been reported in human athletes.38 A
recent study in transgenic polycythemic mice with HCT
of 85% reported thrombocytopenia, with platelet
counts that did not differ from those in wild type mice
when corrected for plasma volume, increased nitric oxide
concentration, and hypocoagulability based on comput-
erized thromboelastography and plasmatic coagulation
activity.39 It is very tempting to think that a similar
phenomenon may occur in sight hounds and that
they have evolved to be ‘‘hypocoagulable’’ in order
to prevent intravascular thrombosis during strenuous
exercise.
We did not evaluate the pedigrees of the ‘‘bleeders’’
and the ‘‘non-bleeders’’; it is possible that because racing
Greyhounds are derived from a relatively small genetic
pool, genetic disorders of clotting or fibrinolysis could be
partially responsible for this disorder.
In conclusion, approximately 25% of RRG develop
delayed postoperative bleeding 36–48 hours after a sim-
ple surgical procedure; this bleeding does not seem to be
attributable to a primary or secondary hemostatic disor-
der. Our data suggest that enhanced fibrinolysis could
play a role in the development of this complication. Fur-
ther investigation is needed in order to determine its
cause.
Footnotes
a
PFA-100, Dade Behring, West Sacramento, CA
b
Marin L, Couto CG, Iazbik MC, et al. Hemostatic complications
after limb amputation in retired racing Greyhounds. J Vet Intern
Med 2007;21:573 (abstract)
c
Buprenorphine HCL, Bedford Laboratories, Bedford, OH
d
Aceproject, Butler Animal Health Supply, Dublin, OH
e
f
Cephazolin sodium, Sandoz Inc, Princetown, NJ
Ketaset, Fort Dodge Animal Health, Fort Dodge, IA
g
Diazepam, Hospira Inc, Lake Forest, IL
h
Isosol, Vedco Inc, St Joseph, MO
i
Rymadil, Pfizer Inc, New York City, NY
j
Blue stopper tubes, Monoject, Sherwood, St Louis, MO
k
Cell-Dyn 3500 R, Abbott Laboratories, Abbott Park, IL
l
LaserCyte, IDEXX Laboratories, Westbrook, MD
m
ACL-200, Instrumentation Laboratory, Lexington, MA
n
IL Test APTT-C Activated Partial Thromboplastin Time and IL
Test PT-Fibrinogen, Instrumentation Laboratory
o
p
Stachrom AT III, Diagnostica Stago, Parsippany, NJ
StaCompact, Diagnostica Stago
q
StaCompact, Diagnostica Stago
r
Stachrom Plasminogen, Diagnostica Stago
s
Stachrom Antiplasmin, Diagnostica Stago
t
Minutex D-dimer latex, Biopool, Wicklow, Ireland
u
Prism version 4.0, GraphPad Software Inc, San Diego, CA
v
Spectrolyse/pL PAI-1, DiaPharma, West Chester, OH
Acknowledgment
Supported in part by the ACVIM Foundation and the
Savannah and Barry French Poodle Memorial Fund.
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2. Sullivan PS, Evans HL, McDonald TP. Platelet concentration
and hemoglobin function in Greyhounds. J Am Vet Med Assoc
1994;205:838–841.
3. Steiss JE, Brewer WG, Welles E, Wright JC. Hematologic and
serum biochemical reference values in retired Greyhounds. Com-
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See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/237973494

Dewclaws in wolves as evidence of admixed ancestry with dogs

Article  in  Canadian Journal of Zoology · February 2011

DOI: 10.1139/z03-183

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Dewclaws in wolves as evidence of admixed

ancestry with dogs
Paolo Ciucci, Vittorio Lucchini, Luigi Boitani, and Ettore Randi

Abstract: Vestigial first toes (dewclaws) on the hind legs are common in large dog (Canis lupus familiaris) breeds but
are absent in wild canids, including wolves (Canis lupus). Based on observational criteria, dewclaws in wolves have
been generally regarded as a clue of hybridization with dogs, although this was not substantiated by molecular evi-
dence. By means of population assignment and genetic admixture analysis, we investigated individual genotypes of
three dewclawed wolves from Tuscany (central Italy, 1993–2001). Based on 18 microsatellite markers, dewclawed
wolves were not uniquely assigned to the Italian wolf population but appeared to be second or later generation back-
crosses of wolf–dog hybrids. Alleles uniquely shared with dogs, and mitochondrial DNA and Y haplotypes identical to
those of Italian wolves, further supported their admixed ancestry. Although patterns of dewclaw inheritance in wolf–
dog hybrids and backcrosses have not been ascertained, we conclude that dewclaws in wolves, when present, are a
clue of admixed ancestry, probably originating in areas where large dog breeds are involved in cross-matings. Other
“atypical” morphological traits (e.g., white nails, atypical color patterns or body proportions, dental anomalies) as well
might be reliable clues of admixed ancestry, and they deserve careful monitoring and molecular investigation.

Résumé : Des premiers orteils vestigiaux (ergots) existent fréquemment sur les pattes postérieures des races de chiens
(Canis lupus familiaris) de grande taille, mais sont absents chez les canidés sauvages, y compris les loups (Canis lu-
pus). En se basant sur des critères visuels, on a généralement considéré la présence d’ergots chez les loups comme un
indice d’une hybridation avec les chiens, bien que les données moléculaires n’aient pas appuyé cette conclusion. Nous
avons étudié les génotypes individuels de trois loups de Toscane (Italie centrale, 1993–2001) qui possèdent des ergots
au moyen d’une méthode d’assignation de population et d’une analyse de mélange génétique. D’après 18 marqueurs
microsatellites, les loups à ergots ne se regroupent pas exclusivement avec la population italienne de loups, mais ils
semblent être des hybrides loups–chiens issus de rétrocroisements de seconde génération ou de génération précédente.
Des allèles communs avec seulement les chiens, d’une part, et des haplotypes ADN mitochondrial et Y identiques à
ceux des loups italiens, d’autre part, viennent confirmer leur ascendance mixte. Bien que les patterns de transmission
des ergots chez les hybrides loups–chiens et chez les animaux issus de rétrocroisements n’aient pas été déterminés,
nous croyons que la présence d’ergots chez les loups est un indice d’une ascendance mixte, provenant de régions où
des chiens de races de grande taille sont impliqués dans les accouplements mixtes. D’autres caractères morphologiques
« particuliers » (e.g., tels que les ongles blancs, les patterns de couleur ou les proportions corporelles inusités et les
anomalies dentaires) peuvent aussi s’avérer être des indices fiables d’ascendance mixte; ils méritent un suivi attentif et
devraient donner lieu à une analyse moléculaire.
[Traduit par la Rédaction] Ciucci et al. 2081

Introduction (Boitani 1983, 1984; Bibikov 1985; Blanco et al. 1992;

Hybridization between wolves (Canis lupus) and domestic
dogs (Canis lupus familiaris) has often been feared in Eur-
asia in areas where human-induced low wolf densities, habi-
tat fragmentation, and large number of free-ranging dogs
increase the chances of nonpredatory wolf–dog encounters
Andersone et al. 2002). However, until recently wolf–dog
hybrids have been diagnosed solely on the basis of atypical
or anomalous morphological characters (i.e., size, propor-
tions, color patterns, etc.; Kronit 1971 cited in Andersone et
al. 2002; Boitani 1983; Bibikov 1985), a method whose reli-
ability is limited because it is essentially observational and

Received 3 October 2002. Accepted 7 October 2003. Published on the NRC Research Press Web site at http://cjz.nrc.ca on
23 January 2004.
P. Ciucci1 and L. Boitani. Università di Roma “La Sapienza”, Dipartimento di Biologia Animale e dell’Uomo, Viale
dell’Università, 32-00185 Roma, Italy.
V. Lucchini and E. Randi. Istituto Nazionale per la Fauna Selvatica, Via Cà Fornacetta, 9-40064 Ozzano Emilia, Italy.
1
Corresponding author (e-mail: paolo.ciucci@uniroma1.it).

Can. J. Zool. 81: 2077–2081 (2003) doi: 10.1139/Z03-183 © 2003 NRC Canada

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2078
subjective. In addition, not all morphological variation has a
genetic basis, and hybrids are not always morphologically
distinguishable from the parental taxon (Allendorf et al.
2001).
Although recent DNA population-level studies failed to
reveal large-scale introgression of dog genes in European
wolf populations (Vilà and Wayne 1999; Randi et al. 2000;
Randi and Lucchini 2002), molecular genetic markers did al-
low detection of some wolf–dog hybrids in Europe (Vilà et
al. 1997, 2003; Randi et al. 2000; Andersone at al. 2002;
Randi and Lucchini 2002; Lucchini et al. 2004). In addition,
rare backcrosses of wolf–dog hybrids into the parental wolf
population were already reported in Italy by Randi and
Lucchini (2002) who called for the development of a suite of
morphological, behavioral, and molecular traits to aid in the
distinction of pure wolf populations and areas of potential
introgression. However, limited molecular evidence is cur-
rently available on the admixed nature of anomalous
morphological characters, which are generally considered
“atypical” in wolves.
The dewclaw, a vestigial first toe on the hind leg, is never
found in wolves but can be common in large dog breeds.
Dewclaws in wolves were never observed by several North
American and Eurasian wolf biologists, and were not found
in the large wolf-pelt collections from Spain, Portugal, and
Italy (J.C. Blanco, L.D. Mech, F. Petrucci–Fonseca, S. Reig,
C. Vilà, personal communications). A case was reported from
Extremadura (Spain), in an area where wolves, large mastiff
dogs, and putative wolf–dog hybrids were known to occur
(Teruelo and Valverde 1992: 261). Similarly, from a large
collection of dingo (Canis lupus dingo) skins in the Natural
History Museum of London, only one specimen displayed
dewclaws; however, its skin did not conform to the standard
of purebred dingoes (J. Clutton-Brock, personal communica-
tion). In coyotes (Canis latrans), dewclaws are commonly
believed by some researchers to be a sign of hybridization
with dogs (L.D. Mech, personal communication), and the
same anecdotal evidence appears to hold for wolves. A com-
pilation of observational material reviewed by wolf special-
ists from the Great Lakes area in North America suggested
that dewclaws in wolves indicated hybridization with dogs
(Duman 2001), although no molecular investigation sup-
ported this conclusion. More recently, Andersone et al.
(2002) found dewcalws in a litter of seven mongrel pups
from northern Latvia whose individual genotypes (16 micro-
satellites) showed that most of the alleles were common with
dogs, whereas their mitochondrial DNA (mtDNA) haplotype
was typical of other Latvian wolves.
In contrast to wolves, dewclaws can be quite common in
large domestic dogs. Although in some breeds the character
is maintained through artificial selection (e.g., Great Pyre-
nees, St. Bernard), in others (Bernese, Newfoundland) it keeps
reappearing in the population despite being consistently se-
lected against (Alberch 1985). Both developmental (Alberch
1985) and genetic (Galis et al. 2001) arguments have been
used to explain the occurrence of dewclaws in dogs (see Dis-
cussion). Based on these theoretical grounds, we hypothe-
sized that dewclaws in wolves represent a trait inherited
through cross-mating with dogs rather than an expression of
phenotypic variation in wolves. To test this hypothesis we
analyzed 18 canine microsatellite loci, supported by addi-
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Can. J. Zool. Vol. 81, 2003
tional maternal and paternal genetic markers, to assess the
individual genotypes of dewclawed wolves and compared
them with Italian wolves and dogs.
Methods
In 1993–2001 we closely examined six wolves from the
Tuscany region (central Italy), four of which were illegally
or accidentally killed and two were livetrapped as part of a
radiotelemetry study. Three of these wolves displayed the
dewclaw on both hind legs, representing the first and only
wolves observed in Italy with this character out of 206 car-
casses examined from 1986 to 2001 (V. Guberti, personal
communication), and 19 wolves livetrapped since the 1970s
(Ciucci and Boitani 1998). Age of dead or livetrapped
wolves was estimated from patterns of dentition consump-
tion (Gipson et al. 2000). All dewclawed wolves (W520,
W535, W587) were from an area in south-central Tuscany,
which composes a secondary branch of the main wolf distri-
bution in Italy. The area consists of semiagricultural land-
scapes at about 300 m a.s.l. with extensive sheep production
and large numbers of maremma-type guard dogs, most of
which display dewclaws.
Wolf W535 was a 32-kg 6-month-old male livetrapped
and radio-collared in November 1993 in an area of the Prov-
ince of Siena where a wolf pack was being monitored by ra-
diotelemetry. W535 showed a high degree of association
with W390, the radio-collared alpha male of the pack and
potential father of W535, and displayed ecological and be-
havioral attitudes typical of wolves (P. Ciucci, L. Boitani,
E. Tedesco, and L. Artoni, unpublished data). Although
W390 did not display dewclaws and matched the phenotypic
standard of wolves, we never closely observed W535’s
mother or siblings. W535 died, apparently in good health,
from a vehicle collision in February 1994 at 9 months,
whereas W390 was illegally shot 1 month later. W520 was a
28-kg 9-month-old male poisoned in February 1999 also in
the Province of Siena, and W587 was an unaged female ille-
gally shot in November 2001 in the Province of Grosseto (N.
Cini, personal communication). Distances between the local-
ities where the three wolves were found ranged 20–60 km.
Phenotypically, the three dewclawed wolves were judged by
experienced observers to fall within the standard variability
of Italian wolves, with the exception of W520’s skull, which
at later inspection was, on average, smaller and displayed a
pronounced prognathism. W587 was found decapitated.
All dewclawed wolves were tissue-sampled for genetic
analyses, and DNA extraction and microsatellite genotyping
followed protocols by Randi and Lucchini (2002). We also
included in the analysis a set of 100 Italian wolves and 95
domestic and feral dogs as reference populations. Individual
genotypes of the dewclawed wolves were determined at 18
loci assigned to 16 different chromosomes (Neff et al. 1999)
as described in Randi and Lucchini (2002). Wolves and dogs
have distinct multilocus microsatellite genotypes, and hy-
brids can be identified by assignment procedures (Randi and
Lucchini 2002; Vilà et al. 2003). Multilocus genotypes of
dewclawed wolves were assigned to the Italian wolf or dog
populations using two procedures: a factorial correspondence
analysis (FCA; Benzécri 1973) of individual multilocus
scores computed using GENETIX version 4.02 (Belkhir et
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Ciucci et al. 2079

Fig. 1. Scores of individual wolf (Canis lupus) and dog (Canis lupus familiaris) microsatellite genotypes plotted on the first two axes
of a factorial correspondence analysis (FCA) performed using GENETIX.

Table 1. Alleles (size given as base pairs, including primers) of six microsatellite loci that were observed in
the dewclawed wolves (Canis lupus), which are shared with dogs (Canis lupus familiaris) but are absent in
the Italian wolf population (cf. Randi and Lucchini 2002).
CPH2 CPH6 CPH7 CPH12 C20.253 FH2132
W520 — — — — — —
W535 94 (0.34) — — — — —
W587 — 122 (0.15) 170 (0.32) 196 (0.09) 106 (0.76) 327 (0.05)
Note: Values in parentheses are the frequency of the allele in the dog population.

al. 1996–2001) and a Bayesian admixture analyses imple-
mented in STRUCTURE version 1.0 (Pritchard et al. 2000).
We used STRUCTURE with 100 000 iterations following a
burn-in period of 10 000 iterations to identify the number of
genetically distinct clusters that maximize the likelihood of
the data and to assign the individuals to the clusters using
only genetic information (Randi and Lucchini 2002; Luc-
chini et al. 2004). The amount of dog ancestry of the three
dewclawed wolves up to the second generation in the past
was estimated using STRUCTURE (options Usepopinfo = 1
and Genesback = 2), whereas their relatedness (r) was calcu-
lated using the program KINSHIP version 1.3.1 (Goodnight
and Queller 1999). To check for male wolf ancestry in
W535 and W520, we also investigated Y markers using four
microsatellites that map on Y chromosomes (Sundqvist et al.
2001). Further methodological details are provided in Randi
and Lucchini (2002) and Lucchini et al. (2004).
Results
The FCA split the dog and Italian wolf populations into
two clearly separated clusters, and the three dewclawed
wolves were marginal to the Italian wolf genotype distribu-
tion (Fig. 1). In addition, the Bayesian procedure assigned
each wolf and dog to the correct populations with high q
values (>0.99) and small 90% confidence intervals (dog:
0.97–1; wolf: 0.99–1), where the q value represents the pro-
portion of the genome that originate from that particular
population. In contrast, dewclawed wolves were assigned to
the Italian wolf population with lower q values (W535: q =
0.95; W520: q = 0.90; W587: q = 0.76) and larger 90% con-
fidence intervals (W520: 0.58–1; W535: 0.75–1; W587:
0.60–0.92), providing further evidence of their admixed an-
cestry with dogs. Males W535 and W520 shared a unique Y
haplotype that is very common in the Italian wolf population
but absent in the dogs that we analyzed (V. Lucchini and E.
Randi, unpublished data). W520’s microsatellite alleles were
also found in Italian wolves, but W535 and W587 shared
with dogs alleles that were absent from the Italian wolf pop-
ulation (Table 1). All three dewclawed wolves shared the
unique mtDNA haplotype of the Italian wolf population
(Randi et al. 2000).
Estimates of the amount of dog ancestry up to the second
generation in the past revealed that W587 had a high compo-
nent of dog ancestry (q = 0.99) at the second generation,
whereas W535 and W520 had lower values (q = 0.014 and
q = 0.122, respectively), suggesting that their hybridization
origin could only be older than two generations. Kinship
analysis suggested that W535 and W520 could be first-
degree relatives (r = 0.31; cf. Lucchini et al. 2002), which is
further supported (p = 0.95) by a simulation using 1000 rep-
licates (Goodnight and Queller 1999). W390 was assigned to
Italian wolves by Bayesian admixture analyses.
Individual heterozygosities (H; Nei 1987) of W535,
W520, and W587 ranged from 0.32 to 0.52, and only W535
(H = 0.32) was lower than the average heterozygosity for all
Italian wolves (H = 0.44; Randi and Lucchini 2002;
Lucchini et al. 2004).
Discussion
It has long been recognized that the occurrence of
dewclaws in dogs is correlated with body size and is more
frequent in large breeds (Darwin 1868: 35; Alberch 1985).

© 2003 NRC Canada

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2080
From a developmental point of view, the phenotypic varia-
tion necessary for the development of extra toes appears to
be linked with the size (number of cells) of the embryonic
limb bud, which is larger in large dog breeds (Alberch
1985). By exceeding a minimum threshold value in the num-
ber of limb-bud cells necessary to specify for extra toes
during morphogenesis, dog breeders cannot eliminate the ap-
pearance of the trait by continuously selecting for large size
(Alberch 1985). On the other hand, although mutations for
polydactyly are quite common in amniotes, they are not
evolutionarily stable owing to the strong negative pleiotropic
effects present during the phylotypic stage (Lande 1978;
Galis et al. 2001). In line with this theory, there are no pub-
lished reports of dewclaws in wild canids except for a red
fox (Vulpes vulpes) shot in 1913 on the island of Biskops-
Arnö in Sweden (Lönnberg 1916). Being evolutionarily con-
strained in amniotes, polydactyly in large dog breeds could
have been fostered by intense artificial selection, whereas
the expected negative pleiotropic effects might be responsi-
ble for the shorter life, higher incidence of locomotory dis-
eases, and higher mortality rates reported for polydactylous
dogs (Galis et al. 2001: 639).
Although possible in principle, it is therefore quite un-
likely that polydactyly could stochastically appear and be
maintained in wolves, even at the level of the local, inbred
populations. Accordingly, the heterozygosity observed in the
three dewclawed wolves we collected did not reveal high
levels of inbreeding compared with the Italian wolf popula-
tion. Alternatively, the extreme rarity of dewclawed wolves
and their exclusive occurrence in an area with high densities
of large dog breeds suggest that the trait represents a charac-
ter possibly displayed by wolf–dog hybrids and backcrosses.
Although we did not investigate patterns of genetic inheri-
tance of the dewclaws either in dogs or in wolf–dog hybrids,
our results confirmed that the dewclawed wolves we col-
lected in Tuscany were wolves of admixed ancestry, which
supported our original hypothesis. Since they shared the
mtDNA and Y haplotypes of the Italian wolf population, but
their Bayesian assignment probabilities were not intermedi-
ate between dogs and wolves as expected for F1 hybrids
(Randi and Lucchini 2002), they were most likely back-
crosses of wolf–dog hybrids into the Italian wolf population.
The amount of dog ancestry estimated up to the second gen-
eration in the past revealed that the dewclawed wolves we
sampled might represent second (W587) or later (W520,
W535) generation backcrosses, with the number of alleles
uniquely shared with the dog population increasingly diluted
by the number of generations since the origin of the hybrid-
ization.
It is noteworthy that according to observational criteria
alone, and with the notable exception of dewclaws, experi-
enced observers would not have distinguished the three
wolves from pure wolves. Unfortunately, in all three cases
we could not examine parents or siblings for the presence of
dewclaws. The case reported by Andersone et al. (2002)
supported our findings that dewclaws in wolves originated
from cross-mating with dogs, even though the dewclawed
pups they analyzed were obviously different from the
phenotypic standard of Latvian wolves. As successively con-
firmed by molecular markers, both presumptive parents of
these pups shared some dog-like traits (color patterns, skull
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Can. J. Zool. Vol. 81, 2003
traits), which indicated hybridization, but there was no men-
tion of dewclaws (Andersone et al. 2002).
Relatedness values among the three dewclawed wolves
suggest that at least two different hybridization events oc-
curred in this restricted area of Tuscany, reflecting local-
ly predisposing conditions (i.e., widespread, large-livestock
guard dogs; low density and social disruption of local wolf
packs; highly fragmented landscape). In addition, they share
the unique mtDNA haplotype of Italian wolves (Randi et al.
2000), confirming the previously described directionality of
wolf–dog (and wolf–coyote) hybridization (i.e., female wolves
mating with male dogs or coyotes; Boitani 1983; Lehman et
al. 1991; Gottelli et al. 1994; Roy et al. 1994; Vilà and
Wayne 1999; Randi et al. 2000; Randi and Lucchini 2002;
Vilà et al. 2003).
Although introgression of dog genes into the Italian wolf
population is apparently very limited and wolves and dogs
are genetically differentiated (Randi and Lucchini 2002), our
results provide additional evidence that wolves and dogs do
hybridize in the wild and that, at least occasionally, hybrids
can be successfully reintegrated into the wolf population
(Andersone et al. 2002; Randi and Lucchini 2002; Vilà et al.
2003; Lucchini et al. 2004). Following Allendorf et al.’s
(2001) categorization, these findings suggest that the Italian
wolf population might represent an intermediate case be-
tween type 4 and type 5 anthropogenic hybridization, with a
widespread pure wolf parental population interspersed with
few, localized areas of very limited introgression. In this re-
spect, as quantitative assessment of anthropogenic hybridiza-
tion is crucial to evaluate conservation scenarios (Allendorf
et al. 2001), intensive genetic sampling and monitoring are
urgently needed in areas of suspected hybridization. Map-
ping these areas on a regional scale would benefit from
screening diagnostic morphological traits that are reliable
clues of admixed ancestry (Randi and Lucchini 2002).
Among these, dewclaws on wolves are expected to be lim-
ited to cross-matings involving some large dog breeds. Other
presumptive morphological traits might be reliable as well
(e.g., white nails, atypical color patterns or body propor-
tions, dental anomalies; cf. Duman 2001), provided that their
molecular correlates are further investigated.
Acknowledgments
This study was funded by the Region of Tuscany and by
the Italian National Institute of Wildlife. We thank L. Artoni
and E. Tedesco for field assistance, and an anonymous ref-
eree for comments on an earlier draft of the manuscript.
C.D. Soulsbury kindly reviewed the English style of the text.
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