Pain Relief

Re: Pain Relief

Susan Jackson — Sat, 16 Apr 2011 16:22:48 GMT

[quote user="Nick Shackleton"]

[quote user="Sal the 1st"]

I personally wouldnt be happy with any animal being discharged wearing a fentanyl patch - If an animal is in so much pain or it is perceived it will be in so much pain it needs fentanyl then it needs hospitalizing

[/quote]

I would tend to agree. Fentanyl is pretty potent stuff and if a patient is that painful, as mention previously they need to be hospitalised.

personally not keen the use of vetergesic or pethadine as main part of a premed. buprenorphine is only a partial agonist and personally should be using full agonist, such as morphine, methadone. (I know if I was having major surgery I know what I would prefer). Yes it has it's use. Also its length of duration. Means you can't safely top up with anything else until close to wear off time ie 4-6hrs.

Pethadine is too short acting and not really good for surgical candidates.

A combination of a good opiate and NSAIDs plus local anaesthesia (as appropriate) and maybe the use of ketamine and maybe an alpha2.

I think a lot of vets shy away from the use of the more potent opiates due to the H&S and register requirements for the storage and usage of these drugs.

[/quote]

They've done some good studies to show buprenorphine to work really well. Sorry can't access any to show you. I agree with the statement earlier about treating each animal individually.

Re: Pain Relief

bongo — Sat, 16 Apr 2011 14:21:36 GMT

[quote user="Sal the 1st"]

[quote user="sazzle RVN"]

in my opinion pain meds are massively underused in 1st opinion practice because of reasons like lack of knowledge and vets being 'scared' to use it (see above). Each animal should be treated as an individual and just because one animal died after using a drug doesn't mean that others should suffer.

When I was in 1st opinion we used buprenorphine/acp premed for most ops ie, bitch spays, ex laps etc. Bitch spays occaisionally would get the double dose of bup in premed or a top up later on if they were painful. They would also get s/c meloxicam either once induced or when they were given premed. They were never sent home with anything

Ortho ops were given pethidine/acp premed, morphine once pethidine run out (2hrs?) then morphine was given q6 hrs (or as close as u could get with no one there overnight!) til the next day when they would have bup.

the amount of times i would express my concern over an animal being in pain and the vet examining the animal and saying they were 'fine' would frustrate me. I can understand that they can become dysphoric on opioids etc but you taylor to the animals needs.

[/quote]

would just like to say not all 1st opinion practices are like this.

[/quote]

absolutely not, i know that, was just giving an example for the sake of the post

Re: Pain Relief

Nick Shackleton — Fri, 08 Apr 2011 18:58:57 GMT

[quote user="Sal the 1st"]

[/quote]

I would tend to agree. Fentanyl is pretty potent stuff and if a patient is that painful, as mention previously they need to be hospitalised.

Pethadine is too short acting and not really good for surgical candidates.

A combination of a good opiate and NSAIDs plus local anaesthesia (as appropriate) and maybe the use of ketamine and maybe an alpha2.

I think a lot of vets shy away from the use of the more potent opiates due to the H&S and register requirements for the storage and usage of these drugs.

Re: Pain Relief

Emily Smith RVN — Fri, 08 Apr 2011 18:49:29 GMT

Yeah its not ideal and I think thats why we are using Tramadol more now. The problem is we don't keep animals hospitalised overnight they have to go to vets now and most of our clients can't afford it. The practice is in a very poor area. If they do go home with the Fentanyl patch then owners are given clear instructions not to remove it or allow it to become hot (eg giving patient heat pads or lying next to a radiator) and we cover the patch with a primapore. The patient also will have a buster collar. The vet will then remove the Fentanyl patch after 3 days.

Re: Pain Relief

Sal the 1st — Fri, 08 Apr 2011 18:44:22 GMT

sorry wasnt saying you were was in reply to Emily's post - dont know about anywhere else but fentanyl is a drug of misuse as well around here

Re: Pain Relief

Gemma Harrison — Fri, 08 Apr 2011 18:39:34 GMT

The couple that we used fentanyl for, remained hospitalised while they were on.

Re: Pain Relief

Sal the 1st — Fri, 08 Apr 2011 18:34:11 GMT

Re: Pain Relief

Emily Smith RVN — Fri, 08 Apr 2011 18:29:12 GMT

Hello. This is one of the areas of nursing that I feel very strongly about and get very frustrated with our older vet & owner of the practice who is of the opinion that animals don't feel the same amount of pain that humans do! I think this is rubbish and we need to assume that if its going to hurt us then it will hurt the animal. For example last week he did a hind leg amputation on a cat. The cat recieved vetergesic, Metacam inj + another shot of vetergesic before going home the same day. He never sent the cat home on any oral meds or Fentanyl patch etc that our other vets would do. I was very cross and shocked with him about this and made this very clear to him & when questioned he said the cat appeared fine the day after the op and didn't need additional pain meds!!!

Generally through if the other vets operate then spays & dog castrates get vetergesic/ACP premed & Metacam s/c given at the same time. Cat castrates & most dentals get Pethidine/Acp & Metacam inj. Ortho ops normally get ACP/Morphine & Metacam. Then sent home with either Tramadol & Metacam or Fentanyl patch & Metacam. Local anaesthetic is also applied around joint/wound before closing up.

The older vet will give everything ACP/Pethidine/Metacam premed and ortho's will possibly get vetergesic if they are lucky!

We give the bitch spay owners the option of purchasing a 10ml bottle of metacam to go home with.

Hope this helps. Sorry I seem to have written an essay.

Emily

Re: Pain Relief

Sal the 1st — Fri, 08 Apr 2011 18:29:00 GMT

[quote user="sazzle RVN"]

[/quote]

would just like to say not all 1st opinion practices are like this.

Re: Pain Relief

Gemma Harrison — Fri, 08 Apr 2011 18:26:42 GMT

We use Vetergesic/ ACP pre meds for dogs, domitor/torbugesic/Ketamine for most cats, and cat dental pre med is torbugesic/diazepam/atropine. All have Metacam before/with pre med.

Most routine ops go home with oral metacam. RTA's etc usually have vetergesic every 6hrs while hosp, then home on Metacam.

We have just started to introduce more including tramadol/ pethidine/morphine etc. this is mostly down to a new grad vet though. We have also in the past gone to fentanyl (? spelling) patches, but only once or twice, the vets didn't seem happy with them.

Re: Pain Relief

bongo — Fri, 08 Apr 2011 16:59:08 GMT

Re: Pain Relief

Kim Hampson — Fri, 08 Apr 2011 15:40:20 GMT

Our vets use torb as a premed. Personally, i'd prefer to use vetergesic or something that lasts a little longer. They had one animal die when given it, so are now scared to use it again. We usually give Rimadyl/loxicom to most routine procedures.

If it was up to me, id give something string like morphine, to everything thats having an operation... assuming that any surgery is going to be painful to some degree and whats the point in debating if something is painful or only slightly painful. Pain is pain at the end of the day.

Some of the vets here refrain from giving pain relief in some circumstances to keep them quite, but that remains a controversial issue within our practice.

Hope this helps.