Analgesia in Orthopaedics

Re: Analgesia in Orthopaedics

BengalcatRVN — Wed, 13 Oct 2010 14:01:15 GMT

[quote user="Nick BATFINK Shackleton Dip AVN(surg)VN MBVNA"]

[quote user="Emily Smith RVN"]

Ideally the Fentanyl patch should be applied the day before the surgery.

[/quote]

Would like to give a word of warning if placing patches pre-surgery. If warming devices are used such as heat pads, warm air blankets etc... if the skin where the patch has been placed is warmed this will increase the blood supply to the area causing increased uptake of drugs and may lead to possible overdose.

[/quote]

This is going to sound really stupid, but I never thought about that. How silly of me is that! We don't use them at my clinic but if we do, then I'll definatly remember this.

Just never crossed my mind. Guess it's the same with all patches, animal or human. lol, smokers might lean against radiators to get a nice big hit from their patches now!

Re: Analgesia in Orthopaedics

Emma Townson VN Cert IV MBVNA — Wed, 13 Oct 2010 12:36:35 GMT

Thanks guys for all your tips :) Nick, I will look into giving methadone - the morph really does make them throw up! Only good thing is - can catch out oweners who say their dogs have had no food this morning and they V+ undigested biscuts that are still hard...!

Re: Analgesia in Orthopaedics

Phrin Vernon RVN — Sun, 10 Oct 2010 22:04:53 GMT

When I used to work in referral, I'm pretty sure we placed the fentanyl patch at the end of surgery, and used injectable analgesia for the first 24 hrs for that very reason Nick

Re: Analgesia in Orthopaedics

Nick Shackleton — Sat, 09 Oct 2010 19:21:16 GMT

[quote user="Emily Smith RVN"]

Ideally the Fentanyl patch should be applied the day before the surgery.

[/quote]

Re: Analgesia in Orthopaedics

Emily Smith RVN — Sat, 09 Oct 2010 10:36:47 GMT

We don't do many orthpaedics in practice but ops such as amputations and cruciates we normally use acp/morphine premed, local infiltration around joint and wound before closure and we apply a Fentanyl patch. NSAIDs are also given usually at the time of premed.

We then repeat the Morphine after 4 hrs and give Vetergesic before going home as the Fentanyl patch takes 12-24hrs to take effect. Ideally the Fentanyl patch should be applied the day before the surgery.

Hope this helps

Emily

Re: Analgesia in Orthopaedics

laurad — Fri, 08 Oct 2010 22:42:12 GMT

doing a hindlimb disarticulation or cclr we use a ketamine infusion peri op, acp/vet premed, local infiltration around wound on closure and then subsequent vetergesic. This seems to work really well for our patients. They have a nice recovery from the op

Re: Analgesia in Orthopaedics

Nick Shackleton — Fri, 08 Oct 2010 19:50:26 GMT

Sounds like good protocols.

Personally I prefer methadone to morphine, less likely to cause vomiting which can cause oesophagitis. And for those naughty patients we'd give papaveretum.

Also try implementing the use of pain scoring post op. we used to grade our patient every four hours and give them top ups as required, even if they have had a epidural. We used to use the Short Form of the Glasgow Pain Scale. It's available here http://www.gla.ac.uk/departments/painandwelfareresearchgroup/downloadacutepainquestionaire/

The score is made up of 4 section, giving a total score out of 24, if mobility is impaired one section is missed out giving a total score of 20. Analgesia is recommended on a score less than/equal to 6/24 or 5/20 depending on how many sections are used.

Also remember with epidurals that you need to palpate patient bladders as can cause urine retention..

Also used ketamine and fentanyl (both injectable and fentanyl trans-dermal patches). Have used ketamine and fentanyl both as boluses and as a infusion.

We also used to put local / opiates intra-articular pre-op.

For forelimb surgery could look at doing b. plexus blocks.