Pain relief post gastric or intestinal op

Re: Pain relief post gastric or intestinal op

Claire Fisher — Tue, 19 Nov 2013 20:20:32 GMT

We use iv paracetamol in hospitalised patients if opiods aren't enough - 10mg/kg dose.

Re: Pain relief post gastric or intestinal op

Hanna Bennett — Tue, 19 Nov 2013 19:10:26 GMT

from personal experience paracetomol gives decent visceral analgesia, and is the only nsaid permitted for humans with IBD, which makes me wary in dogs - i'm also in favour of the parenteral dose once the dog is normovolaemic but don't tend to give oral follow up. We would give these dogs methadone, and if they had extensive surgery would go for a cri - occasionally do get ileus which we assume is secondary to the opioids, especially as it tends to resolve when you reduce the dose - not sure if the ileus aids healing or not to be honest!

Re: Pain relief post gastric or intestinal op

Bob Russell — Tue, 19 Nov 2013 17:26:03 GMT

[quote user="David Mills"]

I do think generally you situation is poorly catered for in terms of oral medication post-operatively. I'm not sure what they do in humans?

[/quote]

Severe pain would be on morphine pumps, controlled by patient. The step-father of one of our nurses was in this situation last year.

Re: Pain relief post gastric or intestinal op

emerald — Tue, 19 Nov 2013 15:59:02 GMT

[quote user="David Mills"]

Paracetamol's main action is these days thought to be related to Cox-3 inhibition, which is mainly active as a modifier of spinal propagation of pain impulses, and it has very little effect on Cox1 or 2 and therefore a high safety profile for GI ulceration. It's therapeutic index is actually very wide in dogs - the suggested dose is 10mg/kg but the licensed dose is 33.3mg/kg (Pardale-V). According to VPIS you only really see toxicity above around 100mg/kg. However, its use in GI cases is not really supported by strong evidence so whilst it being recommended in an article is all very well it may not be effective.

Regarding NSAIDs, there is some evidence that they are pretty crap at controlling visceral pain. They would be indicated for post-surgical pain associated with muscle disruption. However, it may be that adverse effects of NSAIDs such as vomiting may be related to local irritation from oral medication so whilst I might cautiously use a parenteral injection as a one-off I would not use an oral preparation.

I do think generally you situation is poorly catered for in terms of oral medication post-operatively. I'm not sure what they do in humans?

[/quote]

Thanks for all the replies.

I am concerned about using nsaids as worried would cause interference with anastomosis repair, and also could cause GI irritation/ulceration.

But obviously don't want an animal in pain!

Re: Pain relief post gastric or intestinal op

David Mills — Tue, 19 Nov 2013 14:23:51 GMT

I do think generally you situation is poorly catered for in terms of oral medication post-operatively. I'm not sure what they do in humans?

Re: Pain relief post gastric or intestinal op

Michael Woodhouse — Tue, 19 Nov 2013 14:05:32 GMT

I've used codeine for symptomatic relief of diarrhoea.

We'd use NSAIDS merrily and additional opioids if required. They get buprenorphine and medetomidine in the pre-med. If you've ever given a colicing horse xylazine you won't discount it as an analgesic for visceral pain.

Re: Pain relief post gastric or intestinal op

Anthony Todd — Tue, 19 Nov 2013 12:42:26 GMT

[quote user="Linda Filshie"]Not sure if you're being sarcastic or not, but as I've never had a case of constipation/obstipation on opiate use, I'm happy to continue[/quote]

No I'm not at all; I thought opiates reduced gut mobility [I remember kaolin and morph] but perhaps I'm wrong, slowing the gut wouldn't be a bad idea?

Re: Pain relief post gastric or intestinal op

Linda Filshie — Tue, 19 Nov 2013 12:27:44 GMT

[quote user="Anthony Todd"]

[quote user="Linda Filshie"]Can't see why you wouldn't go down the opiod/nsaid route myself.[/quote]

Yes, wouldn't gut hypomotility be helpful for healing as well?

[/quote]

Not sure if you're being sarcastic or not, but as I've never had a case of constipation/obstipation on opiate use, I'm happy to continue

Re: Pain relief post gastric or intestinal op

Anthony Todd — Tue, 19 Nov 2013 12:21:16 GMT

[quote user="Linda Filshie"]Can't see why you wouldn't go down the opiod/nsaid route myself.[/quote]

Yes, wouldn't gut hypomotility be helpful for healing as well?

Re: Pain relief post gastric or intestinal op

Martin Atkinson — Tue, 19 Nov 2013 11:02:12 GMT

I've not had any issues with the buprenorphine or butorphanol that goes with the pre-med and post op NSAIDs - usually carprofen. The odd one may get a top up of buprenorphine if I feel it is necessary.

Re: Pain relief post gastric or intestinal op

Linda Filshie — Tue, 19 Nov 2013 10:56:44 GMT

Hasn't paracetamol got a rather thin therapeutic margin in dogs? Can't see why you wouldn't go down the opiod/nsaid route myself.

Re: Pain relief post gastric or intestinal op

Bob Russell — Tue, 19 Nov 2013 10:20:15 GMT

Why avoid nsaid's?

We would go with opiates (buprenorphine or methadone) together with onsior. We used to use meloxicam and have no issues with that choice. We are using a lot more paracetamol for old crocks but not for post-op use. I feel rather guilty that we had a pretty good painkiller available that was never used!