Pain medication after OVH?

[Dr. VETeLiB]

Some people were using Morphine, but it may be not effective in dogs. I have been using Carprofen. Any other thoughts/rationale?

[markos]

there is no clear answer, the degree of pain has to do with many things, like lenght of incision or the characher ( or the breed)of the dog( some withstand better pain than others). W can better tak about aesthesia-pain management. The opoioids are a hole chapter, also a chapter alone is what y find in every country, strong onew i believe are too strong for just a ove. Also y have to inject them. nsaid are ok as you can give them po for some days. you inject before the procedure andd you give the same ( very important to be the same) po for some days 1 or 2 usually are enough. care for renal health nsaids. carprofen is a good choice as it is one of the most studied and proven to be quite safe and efective. Y have to study very well every substance before y use it. my favorite book is a bsava anesthesia it has very good chapters for every substance.

[dabbad]

Here in Hungary, we are routinely useing meloxicam, (first day 0,2mg/kgs, from the second day 0,1mg/kgs, SID), sometimes Metamizole, or Tramadol is needed in a low dose.

[darko_ku_mkd]

In Macedonia we are also using meloxicam and tramadol, but rarely metamizole. So far we have good experience with meloxicam

[Hanan]

I use meloxicam

[megoldberg]

Get my textbook Pain Management for Veterinary Technicians and Nurses. 2015, you can get it here on this website. You will find everything you need
Mary Ellen

[Motoko]

Hi,
here you can review it, our dear Mary Ellen Goldberg's book.


Pain Management for Veterinary Technicians and Nurses,


Many thanks, we love your support,

[MarishkaGermany]

Good evening,

I am practicing in the US. You can give a single dose of meloxicam at 0.2mg/kg (always check renal values before giving any medication that can impact the kidneys). Continue pain management with buprenorphine which works very well in cats. While they are in the hospital you can use IV and then to go home use transmucosal through the mouth q 8 -12 hours for 3-4 days. Every animal is different however. I rarely use tramadol in cats, as buprenorphine seems to work better.

I use stronger opioids like methadone for other medical problems (eg fractures).

[Grajek]

I have a question,
why do you give analgesics for so long, bitches operated by me get meloxicam at once and often want to run after 24 hours,
so long administration of painkillers in my opinion is contraindicated

[HomeroFX]

I usualy use Meloxicam, Ketoprofeno, Metamizole or Carprofeno and in some cases I add tramadol in 2-4mg/kg BID for a few days.

[megoldberg]

When I lecture, in reference to acute surgical pain, it is important to remember to continue pain medication throughout the inflammatory process to prevent chronic pain from forming. How long do we treat? Depends on the duration of inflammation. You want to treat throughout the inflammatory process. It is positively NOT contraindicated to treat and OHE for at least several days.
Castration
Preoperative:
■ Neuroleptanalgesia to include opioid + acepromazine (0.01–0.05 mg/kg) OR alpha2 +/– ketamine (5–10 mg/kg IM: the higher doses are selected for cats that
are more dicult to handle)
■ Induction of anaesthesia: In some cats an opioid, an alpha2 adrenoceptor agonist and ketamine will provide sucient analgesia and anaesthesia for a castration
• Intravenous: Propofol to eect (3–10 mg/kg), ketamine (3–5 mg/kg) + diazepam or midazolam (0.25 mg/kg), or alfaxalone (3–5 mg/kg). Note: if an alpha2
adrenoceptor agonist has been used preoperatively these doses may be lower
• Intramuscular: An alpha2 adrenoceptor agonist + ketamine (5–10 mg/kg) or tiletamine/zolazepam (3–4 mg/kg).
Maintenance of anaesthesia: Inhalation anaesthesia or ketamine or propofol or alfaxalone IV to eect. Note: in many cases a castration can be completed without
the need for maintenance anaesthesia drugs; however, there should be a plan for extending the anaesthesia time in the event the cat becomes responsive or
complications arise. Equipment should also be available for endotracheal intubation.
Local anaesthetic techniques: Intra-testicular block and pre- and/or post-surgery skin inltration with lidocaine.
Postoperative analgesia: NSAID.

Ovariohysterectomy/ovariectomy
Preoperative:
■ Analgesia: Opioid ± ketamine (5–10 mg/kg IM: the higher doses are selected for cats that are more dicult to handle)
■ Sedation: Acepromazine (0.01–0.05 mg/kg IM) or alpha2 adrenoceptor agonist
■ Induction of anaesthesia:
• Intravenous: Propofol to eect (3–10 mg/kg), ketamine (3–5 mg/kg) + diazepam or midazolam (0.25 mg/kg), or alfaxalone (3–5 mg/kg). Note: if an
alpha2 adrenoceptor agonist has been used preoperatively these doses may be lower
• Intramuscular: An alpha2 adrenoceptor agonist + ketamine (5–10 mg/kg) or tiletamine/zolazepam (3–4 mg/kg).
Maintenance of anaesthesia: Inhalation anaesthesia or ketamine or propofol or alfaxalone IV to eect (1/3 or 1/2 of initial dose).
Note: in many cases an ovariohysterectomy or ovariectomy can be completed without the need for maintenance anaesthesia drugs; however, there should be a plan
for extending the anaesthesia time in the event the cat becomes responsive or complications arise; venous access is recommended.
Local anaesthetic techniques: Incisional and intraperitoneal/ovarium ligament block with lidocaine.
Postoperative analgesia: NSAID.

These are directly from the WSAVA GPC Pain Treatise published in the Journal of Small Animal Practice and is available for open access at the GPC pages of www.wsava.org.

[aKp1]

Hello sir, I am Veterinary Surgeon from India. And have been doing OVH since last 5 years. I haven't been using any analgesic medications. During the anaesthesia, I have been using tramadol or flunixin meglumine for analgesia. Post operatively day 1, I would be giving only anti-histamines and antimicrobials if I find any breach in the asespis or if I know the patient will be kept in a not so clean environment.

[megoldberg]

Hello Doctor,
Tramadol is not effective in dogs because dogs do not make the M1 metabolite necessary to process the drug. If you must use it, the suggestion is to use 5-10 mg/kg every 6-8 hours which is much higher than formularies suggest. After day 1, only 33% of the drug reaches receptors. Additionally, you must use the NSAID with it. Why not be using a local anesthetic to add to your multimodal analgesia. I worked on a study where pigs were given flunixin meglumine after knee replacement and on necropsy these animals had massive gastric ulcers. It is a COX-1 NSAID. Is it not possible to use meloxicam or carprofen which are COX-2 NSAIDS? Just trying to help improve your protocols.
Best Wishes,

[Motoko]

It is a COX-1 NSAID

Is it not possible to use meloxicam or carprofen which are COX-2 NSAIDS?

Hello, to complete what our dear Dr. Megoldberg is explaining, her point, this COX-1 NSAID, it is responsable for producing a synthesis of gastric protector prostaglandins, which avoid erosions of the gastric mucosa.
So, inhibitors of COX-2 are more suitable.

Even though, I don't have the complete article, this one can introduce what we are talking about:
https://www.ncbi.nlm.nih.gov/pubmed/18923189


And this one, https://www.ncbi.nlm.nih.gov/pmc/art...00081-0147.pdf

https://www.sciencedirect.com/scienc...6192308090297X

Just for quick review, even they are quite old, and I just found them on the internet,

[megoldberg]

Thank you so very much Mokoto. I have quite a few articles that explain how COX-2 NSAIDS are less damaging than COX-1 NSAIDS.
All of the following are excellent articles:
• Innes et al. Review of the safety and efficacy of long-term NSAID use in the treatment of canine Osteoarthritis. Veterinary Record (2010) 166, 226-230.
• KuKanich et al. Clinical pharmacology of nonsteroidal anti-inflammatory drugs in dogs. Vet Anaesth Analg. 2012 Jan;39(1):69-90.
• Monteiro-Steagall et al. Systematic Review of NSAID-Induced Adverse Effects in Dogs. J Vet Intern Med 2013 Sep-Oct;27(5):1011-9.
• Hunt JR et al. An analysis of the relative frequencies of reported adverse events associated with NSAID administration in dogs and cats in the United Kingdom. Vet J. 2015 Nov;206(2):183-90.
• Lomas AL, Grauer GF. The renal effects of NSAIDs in dogs. J Am Anim Hosp Assoc. 2015 May-Jun;51(3):197-203.

We may not agree on the exact drugs to use for each case, but if we follow the 3 basic principles of pain management we will be able to provide appropriate analgesia for any patient in our hospital. The three principles are: 1) analgesic drugs should be administered preemptively; 2) multimodal analgesia should be used (especially when pain is moderate to severe); 3) analgesia should continue as long as pain that decreases the quality of life is present or at least until pain can be reasonably tolerated. Using these three principles together is imperative for good analgesia – we call it ‘BALANCED ANALGESIA’ – and one without the other decreases our effectiveness at controlling pain.

If I am allowed to attach papers that will help you understand NSAIDS, I will gladly so this.
Mary Ellen

[Motoko]

Sure dear Dr, please, is a plasure and a priviledge to have you here.

Feel free to post the articles

This if it is in your hands, please,

Lomas AL, Grauer GF. The renal effects of NSAIDs in dogs. J Am Anim Hosp Assoc. 2015 May-Jun;51(3):197-203.

And those which you considered...

[francevet]

I as premedication use intramuscular methadone together with medetomidine, then I continue for 2- 3 days with oral robenacoxib. The bitches do not present complaints or vocalizations and start eating immediately or the day after.

[Tomassousa]

As anesthesiologist you should use a very good analgesia pre and intraoperatively. Pain should be prevented from happening during surgery since afterwards you will have a need for a pain ransom. Be sure to have in consideration a combination of AINES + Opioids and with that said be sure to have in mind the type of opioid you are using. If it's a total agonist or only partial or even a agonist/antagonist. For OVH i strongly recommend total agonist as morphine or methadone. I also recommend if you can and have the security to use it, fentanil for the short period of time in wich you retract the ovarian pedicle since it is the most painfull process in the surgery mentioned. I worked in UNESP- botucatu in Brazil and they have a lot of pain research. Analgesia and anesthesia should be tailored to every pacient, althought i like protocols i must say i never used one. I always tailor every anesthesia to every patient. Be sure to remember not moving is not equal to having no pain. If you use Buprenorphine you will have a ceiling effect! I recommend checking http://www.vasg.org/
Hope it helps

[Parviz-Jew]

I have been working with CBD in small animal and prognosis is perfect

[megoldberg]

There are tons of papers out there about cannabis. I highly encourage you to join the Facebook Group Veterinary Cannabis Academy. Many papers to download https://www.facebook.com/groups/VetC...epa=SEARCH_BOX
Additionally, visit this website: http://www.veterinarycannabis.org/ The experts handle this website! Papers and Resources here. http://www.veterinarycannabis.org/
A new textbook entitled Veterinary Cannabis Therapy will be published probably early 2020. Publisher Springer/Nature.

Much is being studies on this topic!!!

[ketsuii]

We use 1 mL vial Tramadol IM. the 1mL is distributed for 2-3 injections

[lazydayz80]

Mary Ellen is an incredibly knowledgeable teacher. She runs a analgesia course through VetMedTeam which I found invaluable for raising my level of analgesia provided for surgical patients.

[vetoALEX]

My protocole
Methadone 0,2 mg kg IM
Medetomidine 20 ugkg IM
Zoletil 5 mg kg IM
Meloxicam 0,2 mg kg SC
Duplocilline

Very efficient. Very Good
No need rescue

[shirlvet]

I am an oncologist rather than a surgeon, but I know our surgeons frequently use methadone as part of the premed for painful procedures (including OVH) and normally use meloxicam injectable post-op as a single dose then dispense oral meloxicam.
I am very conscious that pre-empting pain improves control thus analgesa in a premed is, in my opinion, essential

[Molexxaem]

The posts here are a bit helpful. Thank you,

[Huxley]

My protocole
Methadone 0,2 mg kg IM
Medetomidine 20 ugkg IM
Zoletil 5 mg kg IM
Meloxicam 0,2 mg kg SC
Duplocilline

Very efficient. Very Good
No need rescue

This one is working, recommend this protocol.

[giovet]

Meloxicam,Robenacoxib here in Hellas

[giovet]

In Macedonia we are also using meloxicam and tramadol, but rarely metamizole. So far we have good experience with meloxicam

I am sure that you mean in NORTH Macedonia.Macedonia is in another country dear.

[Molexxaem]

Meloxicam, too.