TECA operation

RE: TECA operation

Sal the 1st — Tue, 21 Jul 2015 09:07:12 GMT

[quote user="Nick Shackleton"]

Definitely go for methadone over vetergesic. Im sure I dnot need to remind you of the reasons why methadone is preferable over vetergesic. Also use NSAIDs To treat post op inflammation. Also consider local anaesthetic nerve block. Also nitrous during anaesthesia.

[/quote]

and all the time remembering that the choice of medication would be the choice of the vet and not the nurse

RE: TECA operation

Nick Shackleton — Mon, 20 Jul 2015 20:21:26 GMT

Quite a lengthy surgery. We used to have another nurse or intern to scrub. but this was routine in most surgeries where I used to work. But can be handy for passing instruments and holding the ear canal as it's taken away. We used to hospitalise for at least a few days to ensure pain is under control on oral meds

RE: TECA operation

Mark Hedberg — Mon, 20 Jul 2015 09:14:20 GMT

[quote user="Selena (Hypnorm) Carnell VN"]

What are you pain management protocols for this op? do you have two nurses (scrub+anaesthetic) how long do you hospitalise for? One of our vets wants to book one in, and personally i think its out of his skill set having seen these done at referral level, also not sure if he is doing a bullae osteotomy the same time. Our current pain management id vetergesic, we now have methadone in stock but our vet doesn't use it as it only lasts 4 hours...! we are trying to update his pain management protocols.

[/quote]

TECA isn't an impossible op to do quite effectively at first opinion level; I cheerfully concede that it's an op that you don't just waltz into. The big issue is that the bulla osteotomy is absolutely mandatory; you've got to get into the middle ear to have any chance at success. (Oh, and mind the facial nerve while you're in there!)

Interestingly, in terms of pain management it's not as bad as all that; when properly done, you've removed a painful focus of infection and nastiness, so you may even find that the area hurts less after the op, even considering you've gone in and chopped a fair bit out of it. So not using methadone isn't a crime as long as some type of quality pain relief (eg bupe and some nice nsaids) is administered.

I can't help you with how good you think your vet is - this is something that (with all due respect) might be best discussed somewhere other than a semi-private forum. Definitely sit down for a chat; if it's something he's done before and is comfortable with, there's no reason it can't be done in a first opinion practice.

Good luck,
Mark

RE: TECA operation

Sal the 1st — Sun, 19 Jul 2015 23:33:25 GMT

haven't done any where I work now but this used to be quite a common op at a previous place I worked. Premed was usually ACP/Papaveretum, splash block during/towards the end of surgery (and I know some people will say that is crap but dogs that did get splash block were a lot more comfortable than those that didnt so we used them) and post op analgesia once the pap had waned was usually buprenorphine or a second dose of pap or v v occasionally fentanyl. Most times we did an LBO.

We usually kept in for the first night to make sure pain was well managed - unless we used a drain and then may have kept in for a second night.

Re surgical skills - I am guessing your vet wouldn't take on something he didn't think he could do? theatre staff was usually no more than 2 ie 1 vet and 1 nurse and everything that could possibly be needed was out and ready for use but I suppose if you have more staff available for theatre then an extra bod in there wouldn't go amiss but I wouldn't say it was essential

we weren't a referral practice (unless by 'referral' you mean people referred because they couldn't afford vet care - it was a charity hospital), we didn't employ specialists and we didnt have the option of sending patients elsewhere. People just got on and did what needed to be done and we got results. I think a lot of skills are being lost (in spite of all the money being spent on CPD and training) because people are being frightened off doing something new or unfamiliar or being told that they should be referring cases