analgesia post c section

Re: analgesia post c section

a.bardell — Mon, 29 Jul 2013 20:34:00 GMT

ketofen! As long as owner can pill the cat that is

Re: analgesia post c section

Clive Ansell — Mon, 29 Jul 2013 15:19:21 GMT

[quote user="Michael Woodhouse"]

[quote user="Linda Filshie"]Well, unless your c-section is a cat, that is![/quote]

I don't think I have ever done a cat caeser or even delivered a kitten.

[/quote]

I don't do many, possible 2 a year. One of the OOH clinics I worked in used to get a few, mainly from 3 local breeders.

The last one I did I will never forget; I was doing a locum in sole charge practice, when a know bad debtor and serial pain in the arse presented a DSH that had been in labour >48 hours. I offered and advised PTS, but all 4 of the nursing staff refused to help and threatened to down tools and walk out -I had mutiny in the ranks and was left with no choice but to do the op. Bill was never paid, plus the cat got mastitis too that was treated foc. They should have it stopped from their wages! boss man not a happy chappy.

Re: analgesia post c section

Robert Jenkins — Mon, 29 Jul 2013 14:56:09 GMT

I work on the assumption that anything I have attacked with a scalpel, suture needle, 'surgeons hands' etc. will hurt!!

Data sheets have the caveat of 'safety not established' ie. drug company has not invested in necessary research

Opiates after kittens removed, and cautious use of Meloxicam (with owners informed consent) appear ok. So far...

Re: analgesia post c section

Robert Jenkins — Mon, 29 Jul 2013 14:56:09 GMT

I work on the assumption that anything I have attacked with a scalpel, suture needle, 'surgeons hands' etc. will hurt!!

Data sheets have the caveat of 'safety not established' ie. drug company has not invested in necessary research

Opiates after kittens removed, and cautious use of Meloxicam (with owners informed consent) appear ok. So far...

Re: analgesia post c section

Michael Woodhouse — Sun, 28 Jul 2013 23:07:43 GMT

[quote user="Linda Filshie"]Well, unless your c-section is a cat, that is![/quote]

I don't think I have ever done a cat caeser or even delivered a kitten.

Re: analgesia post c section

Neil Wheadon — Sun, 28 Jul 2013 22:54:45 GMT

Several previous discussions on this, but not cats. I use local anaesthetic line blocks. Caesarians attract a different type of client. Often they are breeding for profit and have read the data sheets, therefore if anything goes wrong post partum, the first place some go is the blame game, so I would be really careful using anything off licence or contraindicated. . Neil

Re: analgesia post c section

Clive Ansell — Sun, 28 Jul 2013 21:36:02 GMT

No products are specifically licenced for use in pregnancy or lactation in the cat. Next step down the cascade, we can use products licenced in the cat for the nearest and next best thing.

I would give an opiate once kittens are out (if I trying to save them), then Metacam or Onsior off label with clients consent.

I must have done hundreds of cat and dog C-sections, and have given nsaid's and opiates to almost all of them, Can't think of a single problem in 17 years.

The other option of course is to give it and keep stum, but I didn't say that. I know many vn's who would (another debate perhaps)

Re: analgesia post c section

Christina Smith — Sun, 28 Jul 2013 21:18:16 GMT

[quote user="Alexa Bardell"]

which brings us back to what do we use in cats or do they just not get any analgesics?

[/quote]My thoughts are that if that cat is comfortable and settles to suckle the kittens then no need. If she is obviously uncomfortable and fearful then hand rear and choose pain relief to alleviate distressed behaviour. Gabapentin may be a good choice if the cat is fearful/aggressive or feral

Re: analgesia post c section

a.bardell — Sun, 28 Jul 2013 19:56:20 GMT

which brings us back to what do we use in cats or do they just not get any analgesics?

Re: analgesia post c section

Nigel Davies — Sun, 28 Jul 2013 19:39:42 GMT

I presume that because the drug was used in direct contravention of the data sheet recommendations and (I presume) no informed consent was obtained, it would have been difficult to fight the case.

From NOAH compendium (Vetergesic but all buprenorphine brands have the same warning ):

"Use during pregnancy or lactation

No foetal malformations were noted in reproduction studies in rats when buprenorphine was administered by subcutaneous, intramuscular, or intravenous routes. Although post-implantation losses and early foetal deaths were observed, these may have resulted from a lower level of parental care owing to sedation of the mothers.

The product should not be used pre-operatively in cases of Caesarean section, due to the risk of respiratory depression in the offspring periparturiently, and should only be used post-operatively with care. Although the reproduction studies in animals do not indicate a teratogenic risk, buprenorphine should be used with caution in pregnant animals".

Re: analgesia post c section

Linda Filshie — Sun, 28 Jul 2013 19:09:59 GMT

[quote user="Michael Woodhouse"]

Pardale V

Use during pregnancy and lactation: There are no known contraindications for use during pregnancy.[/quote] Well, unless your c-section is a cat, that is!

Re: analgesia post c section

Clive Ansell — Sun, 28 Jul 2013 16:19:52 GMT

[quote user="Claire Fisher"]

The most recent VDS newsletter has a story about a claim that was settled - bitch received buprenorphine as a premed which is specifically contraindicated in the data sheet. I believe it can be used post op with care, we also use Rimadyl once pups removed as then is lactating rather than pregnant.

[/quote]

I wonder why the claim was settled rather than disputed?

It would be almost impossible to prove categorically that buprenorphine was the direct cause of death I would have thought, given there are many other factors and variables and the procedure comes with an element of risk attached; hypoxia during the GA, too long before surgery, the list is almost endless.

Re: analgesia post c section

Michael Woodhouse — Sun, 28 Jul 2013 15:27:47 GMT

Pardale V

Use during pregnancy and lactation: There are no known contraindications for use during pregnancy.

I'm still a bad man and give butorphanol in the pre-med and usually carprofen.

Re: analgesia post c section

Christina Smith — Sun, 28 Jul 2013 14:46:53 GMT

[quote user="Glenn Hodgson"]

FOR INTERESTS SAKE FORTH VALLEY ROYAL USE DIAMORPHINE DUREING LABOUR QUITE READILY. THEY ALSO DISPENSE OFF LIC. ANTIEMETICS DURING PREGNANCY WITH WERBAL OFF LIC. CONSENT, NOT WRITTEN.

PHONE BROKEN >CAPITALS..

[/quote]

I would strongly recommend that if you are in labour and somebody offers you diamorphine decline the offer and do without. You may suffer extreme after effects. Having been through labour twice my brush with diamorphine was overwhelming the most unpleasant experience. Second time around I gritted my teeth and and coped with the pain[which I cannot now recall other than vaguely, my husband probably has a more accurate memory of it!] Anecdotal interest point for mothers to be - not really adding to the debate. Pain relief during parturition will always be controversial in humans never mind animals. They generally seem to cope very well without and opiates may well confuse their maternal instincts. Not sure about c-section pain. What do humans take if they are breast-feeding - probably paracetemol.

Re: analgesia post c section

Glenn Hodgson — Sun, 28 Jul 2013 11:28:03 GMT

FOR INTERESTS SAKE FORTH VALLEY ROYAL USE DIAMORPHINE DUREING LABOUR QUITE READILY. THEY ALSO DISPENSE OFF LIC. ANTIEMETICS DURING PREGNANCY WITH WERBAL OFF LIC. CONSENT, NOT WRITTEN.

PHONE BROKEN >CAPITALS..

Re: analgesia post c section

Francisco Gomez — Sun, 28 Jul 2013 08:29:08 GMT

Vetergesic datasheet says 'use with care' post-op, so I guess you're safe once kittens/puppies are out. I agree with Clive, if you want to use a NSAID your only option (in cats) is probably get an off-license form signed...

Re: analgesia post c section

Clive Ansell — Sun, 28 Jul 2013 08:19:23 GMT

[quote user="Alexa Bardell"]

what about cats though?

[/quote]

Rimadyl tablets are not licensed, and Metacam and Onsior are advised against during pregnancy and lactation. All you can do is prescribe off label and get the client to sign a disclaimer. I've used Metacam and Onsior post C section in cats and have never had any problems at all.

I'll give opiates once kittens are out.

What do most folk use for ga in cat c sections? I remember reading some work somewhere where the best kitten survival rates were with xylazine/ketamine. I've used Dom/torb/ket in a rescue centre many times with no problems at all.

Re: analgesia post c section

Francisco Gomez — Sun, 28 Jul 2013 08:11:52 GMT

[quote user="Claire Fisher"]

[/quote]

I knew I read this somewhere, I was actually discussing this in another thread the other week. I should think things twice before I open my mouth! I'm already regretting my previous two posts... Let's learn from mistakes instead...

I knew you couldn't give an opioid for premed. However I thought that it was accepted in c-sections, at least in bitches, that once you had the puppies out, you could give an opioid IV intra-op. Apparently they do not advice to do that, coz some studies in rats saying that you can get higher conc. buprenorphine in milk than that in mum's plasma... Can you use off-label morphine? Or not that either? I guess that would be worse...

Now metacam can't be given. The datasheet specifically says this: 'Do not give in lactating or pregnant animals'. But apparently you can give Rimadyl if they are 'lactating'. What do you guys do? Do you give Rimadyl injection intra-op?

Re: analgesia post c section

a.bardell — Sun, 28 Jul 2013 08:06:24 GMT

what about cats though?

Re: analgesia post c section

Claire Fisher — Sat, 27 Jul 2013 23:09:00 GMT

[quote user="Francisco Gomez"]I was (probably wrongly) assuming the puppies died before feeding from mum... still they could have died for a completely different reason I guess... I've got to admit I don't give NSAIDs to c-section if I know puppies are going to feed.. But still poor mum!

[/quote]

Re: analgesia post c section

Francisco Gomez — Sat, 27 Jul 2013 22:42:19 GMT

I was (probably wrongly) assuming the puppies died before feeding from mum... still they could have died for a completely different reason I guess... I've got to admit I don't give NSAIDs to c-section if I know puppies are going to feed.. But still poor mum!

Re: analgesia post c section

Francisco Gomez — Sat, 27 Jul 2013 21:35:20 GMT

[quote user="Glenn Hodgson"]

Worth a muse though, I think a client sued and won claiming off lic drugs used prior to the pups dieing.

[/quote] I hope that client rots in hell... Sueing just because the vet wanted to give some pain relief to the bitch, what was in it for the vet if anything? £7 at most even if he/she owns the practice? I can't believe we live in a world that permits these sort of actions...

Re: analgesia post c section

Glenn Hodgson — Sat, 27 Jul 2013 21:04:06 GMT

3 days meloxicam and 8-24 hours buprenorphine. I have them given intra-op once the pups/kittens are out.

Worth a muse though, I think a client sued and won claiming off lic drugs used prior to the pups dieing.