Methadone

Re: Methadone

louiseRVN — Sun, 20 Sep 2009 19:00:31 GMT

Thanks stuart,

the procedure went well, I opted for meth pre med then incrementals i/v during the procedure, worked well, and was round enough to go home the same day, with NSAID and tramadol.

I would love to try the CRI and epidurals but dont think it is practical in our practice, but its something am very interested in.

Thanks for the heads up xx

Re: Methadone

Stuart Ford-Fennah — Sun, 20 Sep 2009 17:58:26 GMT

Hi Louise,

The use of full mew agonistsis great if you can give every 4-6hrs (in my experince more 4hrs) however as nick has already pointed out there are more options avalible to you, using the epidural may help to break the pain cycle - wind up and allow buprenorphine to be utilised otherwise you could go for a CRI - bit dodgy if you aske me overnight without proper hospitalisation faciclities but using morphine/methodone +/- ketamine iv with a syringe driver would also be benifitial depends how your vets feel about using those combinations you can also add meditomidine and lidocaine in if you want really good multimodal analgesia (dont forget an NSAID).

Hope all goes/has gone well

Stu

Re: Methadone

Nick Shackleton — Sat, 05 Sep 2009 14:09:51 GMT

Hope it is realatively pain free procedure. Also if he fails to settle during the disarticulation part of the procedure 1mg/kg of ketamine is quite handy to give. Best given IM as IV can cause apeona

Re: Methadone

louiseRVN — Sat, 05 Sep 2009 13:56:11 GMT

Oh great I forgot about that too DOH! We used that for all our xciates we did and worked well.

Thanks Nick and SS you have been a great help, am sure my GSD will thank you all for it!!

Re: Methadone

Nick Shackleton — Sat, 05 Sep 2009 13:43:33 GMT

[quote user="sisterscope1"]

What about a 'splash' block of bupivicaine? Would give you some decent analgesia for a few hours and relatively cheap. Just a thought.

[/quote]

Oh yeah forgot that!!!! Thnx SS

Re: Methadone

sisterscope1 — Sat, 05 Sep 2009 13:42:43 GMT

What about a 'splash' block of bupivicaine? Would give you some decent analgesia for a few hours and relatively cheap. Just a thought.

Re: Methadone

Nick Shackleton — Sat, 05 Sep 2009 13:42:13 GMT

[quote user="Nick Shackleton"]

We would given ACP/meth premed, NSAID + ABs IV pre-op, Repeat meth 4hrs, maybe fentanyl patch, and vetergesic to cover overnight. We would also use Tramadol too

[/quote]

Fentanyl patches can take up to 12hrs to take affect, they are CDs so may not be good to send home attached to patient.

Think IF I had to send home same day:

ACP/Meth premed

NSAID after induction

Repeat Meth every 4hrs

Vetergesic at discharge (or as close to depend when last meth runs out)

send home with oral NSAIDs and Tramadol

Re: Methadone

Nick Shackleton — Sat, 05 Sep 2009 13:38:23 GMT

We would given ACP/meth premed, NSAID + ABs IV pre-op, Repeat meth 4hrs, maybe fentanyl patch, and vetergesic to cover overnight. We would also use Tramadol too

Re: Methadone

louiseRVN — Sat, 05 Sep 2009 13:35:30 GMT

I did think of the epidural, but never seen it been used before and dont know how feesable that would be in our little small practice. I thought Methadone might be best option if thedog come round enough for it to be able to go home the same evening. (I know this is not the best option, but would rather it be home with someone to monitor, than being left at work alone- miss having those facilities soooo not used to it!!). I was thinking of sending it home with tramadol +/- oral vetergesic. All depends on my boss of course! was hoping Methadone would be enough of an analgesic to get it though the op.

What doses do you use out of courisity- same as morphine? Do you ive through the op also?

Re: Methadone

Nick Shackleton — Sat, 05 Sep 2009 13:28:05 GMT

Epidural maybe advisable in this kinda case, althou would have to be hospitalised overnight.....

Methadone only lasts 4hrs.

We usually repeat methadone until last thing and give vetergesic for overnight, althou we have an intern on site overnight so if they require top ups thru the night they can.....

Re: Methadone

louiseRVN — Sat, 05 Sep 2009 13:24:49 GMT

My main concern is we dont have Hospital facities- there is no one around over night. Do you think it would be feesable to use something like methadone AND be able to go home the same day? We have a FHEA in next week and the dog is crippled with pain and all we have is Vetergesic, and defo needs something stronger.

Re: Methadone

Nick Shackleton — Sat, 05 Sep 2009 13:20:19 GMT

We use methadone routinely at work what sort of info you after lousie