Analgesia in Caesarian Sections

Re: Analgesia in Caesarian Sections

Mark Holmes — Wed, 13 Jun 2012 07:57:28 GMT

I rely on buprenorphine but I use it once the pups are out. I give a single dose of an NSAID. It's a difficult time to cover as I prefer to get them home ASAP then the pups are the owners responsibility.

Re: Analgesia in Caesarian Sections

katie mountford — Wed, 13 Jun 2012 01:23:06 GMT

Mark, what opioid do you use in the 24hrs before the fentanyl starts providing analgesia?

Re: Analgesia in Caesarian Sections

Laura Playforth — Mon, 11 Jun 2012 15:29:44 GMT

[quote user="Mark Holmes"][quote user="Laura McDermott"]

[quote user="Mark Holmes"]Any reason you are not using them for c sections? A particular contraindication? My reasoning was that the half life is so short that any small anount the pups recieve is going to be of limited effect. [/quote]

I would use it post-op but I would worry about respiratory depression as I know this can be more pronounced with fentanyl than other opioids

[/quote] In the bitch or pups? I think this may be a concern in elective caesars if you apply the patch pre op. In a routine caesar the plasma levels will take 24 hours to develop by which time both bitch and pups should be strong enough that they are resilient to any respiratory depression.

[/quote]

Good point, I meant I wouldn't use it IV pre- or during op. The patches I will definitely consider

Re: Analgesia in Caesarian Sections

Mark Holmes — Mon, 11 Jun 2012 14:59:24 GMT

[quote user="Laura McDermott"]

I would use it post-op but I would worry about respiratory depression as I know this can be more pronounced with fentanyl than other opioids

Re: Analgesia in Caesarian Sections

Laura Playforth — Mon, 11 Jun 2012 13:51:12 GMT

I would use it post-op but I would worry about respiratory depression as I know this can be more pronounced with fentanyl than other opioids

Re: Analgesia in Caesarian Sections

Mark Holmes — Mon, 11 Jun 2012 11:16:56 GMT

[quote user="Laura McDermott"]

Out of curiosity, where do you place them, and have you had any issues with bitches pulling them off and eating them? I agree they work very well and fentanyl is my opioid of choice in hospitalised patients in CRI (often in cobination with ketamine) NOT for C-sections I hasten to add! I have had occasion to see dogs OOH that have eaten the pacthes though, and OD can obviously be fatal if untreated. I know that it is unusual to place an E-collar on C-sections, so I wondered if this increased the chance of ingestion?

[/quote]

I usually place them on the back, mid lumbar where they are awkward to reach. We clip, scrub and spirit the area and dry it with a hair dryer. Once the area is grease and sprit free sick them on and cover with a primapore. They stick very tight and to be honest 3days later when they are due to be removed I struggle to get them off so would not expect them to be chewed off and eaten. Any reason you are not using them for c sections? A particular contraindication? My reasoning was that the half life is so short that any small anount the pups recieve is going to be of limited effect. That said its not licensed, if you feel that its a problem I'll go back to NSAIDS. I believe they need something as squashed or starved pups are just as dead as any other.

Re: Analgesia in Caesarian Sections

Rajat — Mon, 11 Jun 2012 11:10:55 GMT

Hi Laura

My theoretical preference for analgesia in bitches in epidural (morphine not local) and I do use line blocks in fat bitches or when the epidural doesnt go in. I say theoretical because unless one is doing a lot of epidurals it can take a fair amt of GA time. So I mostly end up using line blocks as you mentioned lido or itnraepicaine with bupivacaine, sometimes add opioid too (eg morphinr 0.1mg/kg or bupe 0.01mg/kg) as this can prolong the block upto 24 hours.

post op I use tramadol and buprenoprhine - and reverse any sedation seen in pups with naloxone. I think a grumpy bitch (sorry!) would be less willing to feed and care for her pups than a happier one.. I typically dont use nsaids in lactating bitches or queens. I do worry that tramadol is not strong enough on its own for analgesia so always try to use locals so that bitch can go home as soon as poss and not have to stay in for parenteral opioids.

Cats similar but mainly use line blocks again and post op bupe- advantage of bupe is that it can be given transmucosally in cats easily with excellent effects and absorption unlike dogs. the bupe seems to affect the kittens less than the pups somehow, dont know why!

Cheers

Raj

Re: Analgesia in Caesarian Sections

Laura Playforth — Mon, 11 Jun 2012 10:23:58 GMT

Re: Analgesia in Caesarian Sections

Mark Holmes — Mon, 11 Jun 2012 10:11:51 GMT

There is another option now, Fentanyl patches, they take 24 hours to work but offer 3 days of good analgesia. Personally induce with straight propofol, whip the pups out and fill her up with buprenorphine. I have used post op NSAIDS as I think the risk to the pups of having a sore bitch eithr not feeding or sitting on the pups is also to consider. I have had no problems doing so but recently moving to patches

Re: Analgesia in Caesarian Sections

Laura Playforth — Mon, 11 Jun 2012 09:25:46 GMT

Would you consider using a local anaesthetic line block?

Derek Flaherty uses the following (based on his own experience);

'Once the animal is anaesthetised, there is some benefit to performing a ‘line block’ at the incision site, using a lidocaine/bupivacaine combination (lidocaine giving fast onset but short duration, while the bupivacaine will have a slow onset but will last 4-6 hours, providing post-operative analgesia). This technique will allow a reduction in the requirement for anaesthetic maintenance agents, thus decreasing foetal exposure.'

Re: Analgesia in Caesarian Sections

bob lehner — Mon, 11 Jun 2012 09:20:18 GMT

There was a discussion on this in Aug 2011 - 'NSAIDS post caesarean'.

An interesting topic in that many licensed veterinary products carry contra-indications for pregnancy and /or lactation and the non-veterinary products in common use probably lack any data relating to our species.

This was my contribution at the time - I'm still waiting for an answer from 'an expert':

'This is actually quite an interesting and rather confusing topic.

Metacam data sheet has a specific contra-indication for use during pregnancy and lactation. Ditto Previcox and Onsior.

Rimadyl has a contra-indication during pregnancy and in very young animals - but the data sheet doesn't specifically say don't use in lactating animals. However if you look at the various other brands of carprofen on the market most of them do specifically say don't use in lactation - some say this is because there are no specific safety data in lactating dogs.

Buprenorphine data sheets say don't use for caesarean pre-op. One brand says don't use in lactation - another says use with care in lactation.

Butorphanol injection doesn't seem to mention problems in pregnancy or lactation - but butorphanol tabs say don't use in lactation.

Tramadol use in humans says don't use in pregnancy - and not recommended in lactation (tho' amount excreted in milk is small). I doubt if there is any data on Tramadol excretion in canine milk ?

The only veterinary licensed analgesic I can find which doesn't seem to have have any contra-indications for pregnancy or lactation is Pardale (codeine and paracetemol).

Overall I think the problem is down to lack of specific data - and obviously drug firms then cover their backs. The difficulty as usual for those at the coal face is that if you use a product off-label and there is a problem then you may face the consequences. Also I think it is a bit difficult to get the owner to sign an off-label consent form for a product where there is a specific contraindication for that particular use.

Clearly animals post-caesar should have analgesia - it would be nice to have some advice from an expert in the field !'