Successful Outpatient Pain Management in Dogs With Mild to Moderate Pancreatitis Using a Novel Wearable Device for Continuous Hydromorphone Delivery

Abstract

Background: Inpatient management for pancreatitis might be costly. Hypothesis/Objectives: Describe a standardized outpatient protocol for pancreatitis. Animals: Nineteen client-owned dogs. Methods: Single-arm prospective observational study. Inclusion criteria included ≥ 2 clinical signs of pancreatitis, an abnormal SNAP cPL, no evidence of mechanical obstruction, and no significant comorbidities. All dogs received: fuzapladib (0.4 mg/kg IV q24 h for 3 days), subcutaneous fluids (up to 20 mL/kg/d SQ), hydromorphone (0.01 mg/kg/h delivered by a wearable infusion device), anti-emetics (maropitant citrate &/or ondansetron), and nutrition. Dogs were assessed every 24 h for 3 days via physical examination and calculation of modified clinical activity index (MCAI; indicator of severity) and Glasgow composite measure pain scale (GCMPS) scores (indicator of analgesic adequacy). Results: Ten of 19 dogs had a Spec cPL ≥ 400 μg/L and were considered to have suspected pancreatitis. Nine dogs had an abnormal SNAP cPL but Spec cPL < 400 μg/L and were reported in the assessment of protocol complications only. In the suspected pancreatitis group, MCAI decreased from Day 0 to Day 2 (median: 6, IQR: 5, vs. median 3, IQR: 4.25). GCMPS decreased from Day 0 to Day 2 (median: 7.5, IQR: 7.75, vs. median 0, IQR: 2.75). 2/19 dogs were hospitalized, 1 dog due to relapsed clinical signs, and 1 dog at the owner's request. A cutaneous adverse reaction could not be ruled out in 1 dog. Conclusions and Clinical Importance: In this non-blinded study, most dogs were successfully treated on an outpatient basis. Mild to moderate cases of pancreatitis predominated.