A comparison of owner management and complications in 67 cats with esophagostomy and percutaneous endoscopic gastrostomy feeding tubes

Esophagostomy feeding tubes were placed in 46 cats. Percutaneous endoscopic gastrostomy (PEG) feeding tubes were placed in 21 cats. Owner management and complications and facility of use were evaluated retrospectively by review of medical records and owner survey. Both tube types were equally effective for maintenance of body weight, ease of owner management, and complication rates. All of 12 owners surveyed were comfortable with PEG tube management. Ninety-six percent of 24 owners surveyed were comfortable with esophagostomy tube management. The esophagostomy tube can be placed less invasively, without specialized equipment, making it an excellent alternative to the PEG tube.     

Complications with non-endoscopic percutaneous gastrostomy in 31 cats and 10 does: a retrospective study

Percutaneous gastrostomy tubes were placed non-endoscopically in 31 cats and 10 dogs using either a rigid insertion tube (n=13) or an Eld gastrostomy tube applicator (n=28). Tubes were placed successfully in 38 of the 41 animals and the consequent feeding was of therapeutic benefit to 31 of the animals. Six of 41 died or were euthanased for reasons unrelated to gastrostomy. In four cases (10 per cent), gastrostomy failed with respect to correct tube placement or tube feeding. Overall complications occurred in 18 of 41 animals. Severe procedural complications occurred in two cats; a cardiorespiratory arrest during pharyngeal manipulation and erroneous tube placement through the distal oesophagus. Moderate late complications included peristomal food leakage (n=2), peristomal abscess (n=2) and pyloric outflow obstruction by a migrated tube (n=1). Complications associated with the feeding procedure, nausea and vomiting (n=3), led to aspiration pneumonia in one case.     

Evaluation of Percutaneous Gastrostomy as a Technique for Permanent Gastropexy

Objective- This study was designed to evaluate right-sided percutaneous endoscopic gastrostomy (PEG) as a method for creation of a permanent gastropexy.
Study Design- Percutaneous endoscopic gastrostomy adhesions were evaluated by gross examination and by mechanical testing and the results were compared with those obtained by conventional incisional gastropexy.
Animals or Sample Population- Fourteen mixed-breed dogs.
Methods- Incisional gastropexies were performed on the dogs of group one (N = 7) and PEG tubes were placed in the dogs of group 2 (N = 7). All skin sutures (group 1) and PEG tubes (group 2) were removed on day 14. The animals were maintained for an additional 44 days before euthanasia and immediate necropsy. Gastropexy adhesions were evaluated and collected for biomechanical evaluation using a materials testing machine.
Results- The duration of the procedure for group 2 was less (32.86 min ±7.65) than for group 1 (56.29 min ±8.28). The number of complications was not significantly different between group 1 and group 2 ( P =.103). Gastroperitoneal adhesions were present in 7 of 7 dogs in group 1 and 4 of 7 dogs in group 2. The adhesion lengths and widths were significantly larger in dogs in group 1 compared with those in group 2. The adhesions present in group 1 dogs sustained significantly greater tensile loads to failure (61.98 ±14.65 N), compared with the adhesions present in group 2 dogs (22.31 ±26.87 N).
Conclusions- Right-sided PEG inconsistently formed a weak gastropexy and the procedure was associated with a trend toward greater morbidity than incisional gastropexy.
Clinical Relevance- Right-sided PEG is not recommended as a means of prophylactic gastropexy.     

Gastric Myoelectric Activity after Experimental Gastric Dilatation-Volvulus and Tube Gastrostomy in Dogs

Gastric myoelectric activity was measured after experimental gastric dilatation-volvulus (GDV), GDV and tube gastrostomy, or tube gastrostomy in 12 dogs. Gastric myoelectric activity was recorded for 1 hour before (hour 0) and at hours 5, 24, 48, 72, and 96 after surgically induced GDV in six dogs. Three dogs with induced GDV and tube gastrostomy, and three dogs with tube gastrostomy only were also studied at hours 120, 144, and 168. The only significant change in the slow wave appearance or frequency from hours 0 to 48 was bradygastria at hour 5 in all three groups. A relative increase in the mean percentages of dysrhythmia from hours 72 to 168 in the dogs with a tube gastrostomy was caused by increases in tachygastria and arrhythmias. Dogs with GDV and tube gastrostomy had the greatest mean percentages of dysrhythmia, which were significantly more than those in dogs with GDV alone at hours 48, 72 and 96. The mean percentage of spike activity was less than or equal to 31 and varied widely. In general, there was less spike activity when the frequency of dysrhythmias was high. Thus, gastric myoelectric activity was disrupted from hours 48 to 168 after GDV with tube gastrostomy and after tube gastrostomy alone. Surgically induced GDV alone did not produce any significant or sustained dysrhythmias.     

Nonendoscopic Antegrade Percutaneous Gastrostomy: The Effect of Preplacement Gastric Insufflation on Tube Position and Intra-Abdominal Anatomy

Nonendoscopic tube gastrostomy was performed on 41 anesthetized dogs using the technique of Fulton and Dennis with or without gastric insufflation prior to tube placement. Immediately after tube placement, dogs were euthanized and postmortem examinations performed. When gastric insufflation was not performed (group I), gastrostomy tubes penetrated the visceral surface of the stomach in 25% of dogs. The deep leaf of the omentum was interposed between stomach and body wall in the majority of these dogs, exposing other intra-abdominal organs to potential injury. Additionally, displacement and tethering of the spleen cranial to the gastrostomy site were observed in 33% of dogs in group I. Similar results were obtained when preplacement gastric insufflation was performed after the orogastric tube was inserted sufficiently far to displace the stomach laterally against the body wall (group II). In contrast, consistent positioning of gastrostomy tubes through the parietal surface of the stomach was achieved when the stomach was insufflated prior to lateralizing the left abdominal wall with the gastric end of the orogastric tube (group III). It was concluded that the blind percutaneous gastrostomy technique is made safer by insufflating the stomach immediately prior to pushing the gastric wall laterally into contact with the parietal peritoneum. J Vet Intern Med 1996;10:15–20. Copyright © 1996 by the American College of Veterinary Internal Medicine .     

Treatment of idiopathic hepatic lipidosis in cats: 11 cases (1986-1987)

Idiopathic hepatic lipidosis was diagnosed in 11 cats. Cats were treated by delivery of balanced nutrients supplemented with L-carnitine via a surgically placed gastrostomy tube. Feeding through the gastrostomy tube was initiated in the hospital and was continued at home in all cats. The mean duration of gastrostomy tube feeding was 48 days (range, 22 to 98 days). Vomiting associated with feeding (3 cats) and localized cellulitis at the gastrostomy site (2 cats) were the most frequent complications. Vomiting was controlled by reducing the volume of food administered at each feeding or by administration of metoclopramide. Cellulitis was treated successfully by parenteral administration of antibiotics and local wound cleansing. Seven of 11 cats (65%) survived and have remained clinically healthy for 15 to 29 months (mean, 20 months) since diagnosis. The other 4 cats died of peritonitis (n = 1), pneumonia (n = 1), hepatic encephalopathy (n = 1), or cardiopulmonary arrest (n = 1) between 0 and 10 days after surgery.     

Significance of the Heineke-Mikulicz Pyloroplasty in the Treatment of Gastric Dilatation-Volvulus A Prospective Clinical Study

Twenty-six dogs with gastric dilatation-volvulus (GDV) were stabilized medically, followed by tube gastrostomy and gastropexy. In 13 dogs, a Heineke-Mikulicz pyloroplasty was also performed. Complications and recurrences were monitored during the immediate postoperative period and for 5 to 31 months thereafter. Barium gastrograms and contrast radiographs of the stomach were evaluated at week 1 and months 5 to 31. Significantly fewer dogs without pyloroplasty had complications during the immediate postoperative period. There were no differences in the long-term complication rates. Radiographic evaluations of the width of the pylorus, the size of the stomach, and the rate of gastric emptying showed no differences between dogs with and without pyloroplasty at any evaluation period. The Heineke-Mikulicz pyloroplasty increased the immediate postoperative complication rate after surgical fixation of the stomach for the treatment of GDV. It did not appear to influence the long-term outcome of the surgical treatment of this disease. The Heineke-Mikulicz pyloroplasty is not recommended in the treatment of GDV unless pyloric outflow obstruction can be demonstrated.     

Hyperglycemia in dogs and cats with head trauma: 122 cases (1997-1999)

OBJECTIVE: To determine whether hyperglycemia is associated with head trauma in dogs and cats and whether the degree of hyperglycemia corresponds to severity of neurologic injury or outcome. DESIGN: Retrospective study. ANIMALS: 52 dogs and 70 cats with head trauma and 122 age- and species-matched control dogs and cats. PROCEDURE: Severity of head trauma was classified as mild, moderate, or severe. Blood glucose concentrations recorded within 1 hour after admission were compared between case and control animals and among groups when case animals were grouped on the basis of severity of head trauma or outcome. RESULTS: Blood glucose concentration was significantly associated with severity of head trauma in dogs and cats and was significantly higher in dogs and cats with head trauma than in the control animals. However, blood glucose concentration was not associated with outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that dogs and cats with head trauma may have hyperglycemia and that degree of hyperglycemia was associated with severity of head trauma. However, degree of hyperglycemia was not associated with outcome for dogs and cats with head trauma. Because hyperglycemia can potentiate neurologic injury, iatrogenic hyperglycemia should be avoided in patients with head trauma.     

Indications, outcomes and complications following lateral thoracotomy in dogs and cats

OBJECTIVES: Lateral thoracotomy is widely used for surgical management of thoracic diseases in small animals. The purpose of this paper is to describe the indications for lateral thoracotomy in dogs and cats and the associated outcomes and complications. METHODS: Medical records of animals undergoing lateral thoracotomy were reviewed and owners contacted regarding complications and survival. Relationships between signalment and treatment variables and outcome variables were investigated. RESULTS: Seventy dogs and 13 cats underwent lateral thoracotomy. Sixty-two per cent of cats and 91 per cent of dogs survived to discharge. Survival to discharge was significantly lower in cats than dogs, for neoplastic than non-neoplastic disease and in older animals. Survival to discharge was higher in animals undergoing patent ductus arteriosus ligation than in those undergoing lung lobectomy or oesophageal surgery. Survival to discharge was not related to surgeon experience. The incidence of complications was not related to species, age, disease, duration of surgery, surgeon experience or duration of thoracostomy tube placement. A low complication rate (5 per cent) was associated with thoracostomy tubes. CLINICAL SIGNIFICANCE: The approach of lateral thoracotomy has a minimal complication rate and animals with a disease requiring this approach have a high survival rate.     

Clinical use of low-profile cystostomy tubes in four dogs and a cat

Traditional cystostomy tubes (used for temporary or permanent diversion of urine in dogs and cats) are long (> or = 22 cm) and cumbersome to stabilize, requiring sutures or bandages to hold the tube against the body. Use of a low-profile gastrostomy port system as a low-profile cystostomy tube (LPCT) in 4 dogs and a cat was investigated; owner satisfaction with the device was assessed. Technical difficulty associated with placement and management of LPCTs was similar to that for traditional cystostomy tubes; with LPCTs, activity and mobility of pets was not compromised, and bandaging was not required. Complications included lower urinary tract infection, mild peristomal leakage of urine and leakage from components of the system, and subcutaneous peristomal infection. Four of 5 owners considered the tube to be easy to use; all owners said they would be comfortable repeating their decision to use the LPCT in their pet.     

Prevalence and characteristics of pain in dogs and cats examined as outpatients at a veterinary teaching hospital

OBJECTIVE: To determine prevalence of pain among dogs and cats examined as outpatients at a veterinary teaching hospital and characteristics of pain in dogs and cats with evidence of pain. DESIGN: Cross-sectional study. ANIMALS: 1,153 dogs and 652 cats examined as outpatients at The Ohio State University during 2002. PROCEDURE: A questionnaire was administered to owners of all dogs and cats. For dogs and cats with evidence of pain, the cause, signs, anatomic location, type (superficial somatic, deep somatic, or visceral), duration, and severity of the pain and the principle mechanism (inflammatory, neuropathic, both, or unknown) responsible for the pain were determined on the basis of questionnaire responses and results of physical examination. The presence of primary hyperalgesia, secondary hyperalgesia, allodynia, and hyposensitivity was recorded. RESULTS: 231 (20%) dogs and 92 (14%) cats had evidence of pain. Dogs with evidence of pain were significantly older and heavier than dogs without. Cats with evidence of pain were significantly older than cats without. In most dogs and cats with evidence of pain, the pain was determined to be of short duration (< 7 days), of mild or moderate severity, somatic, associated with primary hyperalgesia, and inflammatory. Analgesic drugs were frequently administered to dogs with chronic pain, but were not always considered effective. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that mild or moderate pain associated with inflammation may be seen in dogs and cats examined as outpatients. Older, heavier dogs and older cats were more likely to have evidence of pain.     

Peritoneal dialysis in dogs and cats: 27 cases (1976-1987)

The records of 25 dogs and 2 cats treated with peritoneal dialysis during an 11-year period were evaluated. The indications for peritoneal dialysis were acute renal failure in 21 animals, chronic renal failure in 5 animals, and azotemia of undetermined cause in 1 animal. Peritoneal dialysis resulted in a significant (P less than 0.05) decrease in serum urea nitrogen concentration in 19 of the dogs and a significant (P less than 0.05) decrease in serum creatinine in 20 dogs. The most common complication of peritoneal dialysis was hypoalbuminemia (11 animals affected). Other common complications were dialysate retention/catheter obstruction (8 animals), peritonitis (6 animals), hypochloremia (6 animals), and subcutaneous leakage of dialysate (6 animals). Twelve dogs and 2 cats died during treatment, 6 dogs were euthanatized, and 1 dog was lost to follow-up evaluation. The remaining 6 dogs survived and were discharged from the hospital after successful peritoneal dialysis. On the basis of the results of this study, the authors concluded that peritoneal dialysis, although associated with a high complication rate, was a successful technique for reducing azotemia in dogs with acute and chronic renal failure. Survival rates were poor because of the severity of the underlying renal diseases.     

Open peritoneal drainage versus primary closure for the treatment of septic peritonitis in dogs and cats: 42 cases (1993-1999)

OBJECTIVE: To determine survival rates in dogs and cats with septic peritonitis treated with open peritoneal drainage (OPD) versus primary closure (PC) after laparotomy. STUDY DESIGN: Retrospective analysis of medical records from Colorado State University Veterinary Teaching Hospital from 1993 to 1999. SAMPLE POPULATION: Thirty-six dogs and 6 cats with septic peritonitis documented by cytological examination or microbiological culture of abdominal fluid. METHODS: Medical records of dogs and cats with septic peritonitis treated by OPD or PC were reviewed. Age, weight, species, white blood cell (WBC) count, band neutrophil count, platelet count, serum glucose concentration, heart rate, body temperature, duration of hospitalization, and clinical outcome were recorded for each animal. Differences in treatments administered between the OPD and PC groups as well as the underlying cause of septic peritonitis were determined. RESULTS: There was no significant difference in survival between animals in the OPD versus PC groups (P =.26) with an overall survival rate of 71%. White blood cell count, band neutrophil count, platelet count, serum glucose and total bilirubin concentrations, heart rate, age, and weight were not significantly different between groups (P >.05). A significantly greater number of animals in the OPD group received plasma (P =.009), blood (P =.037), and a jejunostomy tube (P =.02) than animals in the PC group. There was a significant difference in the number of days spent in critical care unit with a mean of 6.0 +/- 4.1 days for the OPD group and 3.5 +/- 2.3 days for the PC group (P =.02). CONCLUSIONS: Open peritoneal drainage for the management of septic peritonitis in dogs and cats is an acceptable alternative to PC.     

Tolerance of cutaneous or mucosal flaps placed into a radiation therapy field in dogs

OBJECTIVE: To determine the clinical outcome and factors affecting cutaneous or mucosal flaps in dogs treated with radiation therapy (RT). STUDY DESIGN: Longitudinal clinical study. ANIMALS: Twenty-six client-owned dogs. METHODS: Dogs entered in the study had a flapping procedure and RT as part of their treatment. The sequence of flapping and RT included: (1) planned preoperative RT, (2) postoperative RT, and (3) flapping as a salvage procedure for management of complications or local tumor recurrence after RT. Flap complications were defined as necrosis, local infection, dehiscence, and ulceration. The risk and severity of flap complication were analyzed independently. RESULTS: Twenty (77%) dogs had a complication; 6 dogs required an additional flapping procedure; and 4 dogs had an unresolved complication. Flapping procedures performed to correct a complication, or failure of RT, had a significantly greater risk for complication; however, postoperative RT decreased the severity of complication. A dose per fraction of 4 Gy compared with 3 Gy was prognostic for increased severity of complications, whereas the head and neck location was prognostic for decreased severity of complication. CONCLUSIONS: Although morbidity was substantial, cutaneous or mucosal flaps were used successfully in an RT field in 85% of the dogs. Flaps that were part of the planned therapy as opposed to those used to correct a complication or failure of RT had a better clinical outcome. CLINICAL RELEVANCE: Cutaneous or mucosal flaps can be part of the treatment of dogs with tumor when adjuvant or neoadjuvant RT is to be used.     

Comparison of pulse administration versus once daily administration of itraconazole for the treatment of Malassezia pachydermatis dermatitis and otitis in dogs

OBJECTIVE To compare clinical efficacy of pulse administration with itraconazole versus once daily administration for the treatment of cutaneous and otic M pachydermatis infection in dogs. DESIGN: Randomized controlled trial. ANIMALS: 20 dogs. PROCEDURE: Dogs were treated with itraconazole orally (n = 10/group), using a pulse administration regimen (5 mg/kg [2.3 mg/lb], PO, q 24 h for 2 consecutive days per week for 3 weeks) or once daily administration (5 mg/kg, PO, q 24 h for 21 days). No other treatment was permitted. On days 0 and 21, clinical severity of cutaneous and otic disease was assessed, and samples were collected for cytologic examination and yeast culture. Cytology (sum of the mean number of yeast organisms per oil immersion field for affected sites) and culture (mean of the score for extent of yeast growth for samples from affected sites) scores were calculated. RESULTS: For dogs in both treatment groups, clinical severity of cutaneous and otic disease was significantly decreased by day 21, but decrease in severity was not significantly different between groups. Similarly, skin cytology, skin culture, and ear culture scores were significantly decreased on day 21, compared with day 0, for both groups, but decreases were not significantly different between groups except that dogs in the pulse administration group had a significantly greater decrease in ear culture scores than did dogs in the daily administration group. However, when cytology scores only for ear samples were analyzed, day 21 score was not significantly decreased, compared with day 0 score, for either group. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that both pulse administration and once daily administration of itraconazole were efficacious in the treatment of M pachydermatis cutaneous infection in dogs. However, adjunctive treatment may be needed in dogs with M pachydermatis otitis.     

Efficacy of selamectin in the treatment and control of clinical signs of flea allergy dermatitis in dogs and cats experimentally infested with fleas

OBJECTIVE: To determine whether treatment with selamectin would reduce clinical signs of flea allergy dermatitis (FAD) in dogs and cats housed in flea-infested environments. DESIGN: Randomized controlled trial. ANIMALS: 22 dogs and 17 cats confirmed to have FAD. PROCEDURE: Animals were housed in carpeted pens capable of supporting the flea life cycle and infested with 100 fleas (Ctenocephalides felis) on days -13 and -2 and on alternate weeks with 10 to 20 fleas. On day 0, 11 dogs and 8 cats were treated with selamectin (6 mg/kg [2.7 mg/lb]). Dogs were retreated on day 30; cats were retreated on days 30 and 60. All animals were examined periodically for clinical signs of FAD. Flea counts were conducted at weekly intervals. RESULTS: Throughout the study, geometric mean flea counts exceeded 100 for control animals and were < or = 11 for selamectin-treated animals. Selamectin-treated cats had significant improvements in the severity of miliary lesions and scaling or crusting on days 42 and 84, compared with conditions on day -8, and in severity of excoriation on day 42. In contrast, control cats did not have any significant improvements in any of the clinical signs of FAD. Selamectin-treated dogs had significant improvements in all clinical signs on days 28 and 61, but in control dogs, severity of clinical signs of FAD was not significantly different from baseline severity at any time. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that topical administration of selamectin, even without the use of supplementary environmental control measures and with minimal therapeutic intervention, can reduce the severity of clinical signs of FAD in dogs and cats.     

Preliminary investigations into the analgesic effects of topical ocular 1% morphine solution in dogs and cats

ObjectiveTo perform preliminary evaluations into the ocular analgesic effect of topical 1% morphine in a clinical setting and to determine onset, duration and complications.Study designProspective, randomised, blinded clinical study.AnimalsTwenty six dogs and seventeen cats, all client‐owned.MethodsDogs and cats with corneal ulceration requiring medical treatment or corneal conditions requiring surgery were included and randomly assigned to receive one drop of topical morphine (group M) or base solution (group B). Recordings were made prior to application and at 5, 10, 20, 30, 40, 50 and 60 minutes, then 2, 3, 4, 5 and 6 hours. Corneal aesthesiometry, blink rates and scores for blepharospasm (BLEPH), conjunctival hyperaemia (CH) and lacrimation (LAC) were recorded. Statistical analyses used anova,t‐tests and Mann–Whitney U tests as relevant.ResultsNo significant effect of treatment group on any recordings was found at any time point in either dogs or cats. Adverse effects of increased BLEPH, CH or blink rate were observed in six animals (three cats from group M and three dogs from group B), occurring within 5 minutes of drop application and lasting for between 10 minutes and 6 hours.Conclusions and clinical relevanceTopical ocular morphine showed no measurable analgesic effect against corneal pain in dogs and cats.     

Complications and outcomes associated with use of gastrostomy tubes for nutritional management of dogs with renal failure: 56 cases (1994-1999)

OBJECTIVE: To evaluate complications and outcomes associated with use of gastrostomy tubes in dogs with renal failure. DESIGN: Retrospective study. ANIMALS:56 dogs. PROCEDURE: Medical records were reviewed for dogs with renal failure that were treated by use of gastrostomy tubes. RESULTS: Mean +/- SD BUN concentration was 134 +/- 79 mg/dl and mean serum creatinine concentration was 9.0 +/- 3.8 mg/dl. Low-profile gastrostomy tubes were used for initial placement in 10 dogs, and traditional gastrostomy tubes were used in 46 dogs. Mild stoma-site complications included discharge, swelling, erythema, and signs of pain in 26 (46%) of dogs. Twenty-six gastrostomy tubes were replaced in 15 dogs; 11 were replaced because of patient removal, 6 were replaced because of tube wear, and 3 were replaced for other reasons. Six tubes were replaced by low-profile gastrostomy tubes. Gastrostomy tubes were used for 65 +/- 91 days (range, 1 to 438 days). Eight dogs gained weight, 11 did not change weight, and 17 lost weight; information was not available for 20 dogs. Three dogs were euthanatized because they removed their gastrostomy tubes, 2 were euthanatized because of evidence of tube migration, and 1 died of peritonitis. CONCLUSIONS AND CLINICAL RELEVANCE: Gastrostomy tubes appear to be safe and effective for improving nutritional status of dogs with renal failure.     

Results of preemptive epidural administration of morphine with or without bupivacaine in dogs and cats undergoing surgery: 265 cases (1997-1999)

OBJECTIVE: To determine prevalence of adverse effects associated with epidural administration of morphine with or without bupivacaine in dogs and cats undergoing surgery and evaluate effects of epidural administration of morphine on postoperative pain severity. DESIGN: Retrospective study. ANIMALS: 242 dogs and 23 cats. PROCEDURE: Morphine with or without bupivacaine was administered prior to surgery with a Tuohy needle, spinal needle, or epidural catheter. In 18 dogs that underwent surgery twice, results of preemptive epidural administration of morphine with or without bupivacaine were compared with results of systemic administration of oxymorphone and ketoprofen. RESULTS: The delivered fraction of isoflurane was significantly lower in animals given morphine and bupivacaine than in animals given morphine alone. Analgesia was of significantly longer duration in dogs given morphine and bupivacaine than in dogs given morphine alone. During anesthesia, mild respiratory and cardiovascular depression was reported. Seven dogs and 2 cats had urine retention, and 2 dogs developed pruritus. Six dogs vomited when a second dose of morphine was given epidurally the day after surgery. Eight of 72 dogs had delayed hair growth. In 18 dogs that underwent surgery twice, the delivered fraction of isoflurane was significantly lower and the duration of analgesia was significantly longer when morphine with or without bupivacaine was given epidurally than when oxymorphone and ketoprofen were given. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that preemptive epidural administration of morphine with or without bupivacaine is a safe and effective method of inducing long-lasting analgesia in dogs and cats and is superior to standard management of postoperative pain with repeated injection of oxymorphone and ketoprofen.