Gastrotomy - Post op analgesia

Re: Gastrotomy - Post op analgesia

Utlendigur — Sat, 12 Apr 2014 20:59:03 GMT

[quote user="Francisco Gomez"]My thoughts so far was to use NSAIDs if you are making a single incision to remove a foreign body in a 'well patient', because it's pain relief and anti inflammatory effects. If I'm cutting into a black stomach pot-GDV or there is a concern involving the gastric or intestinal mucosa in general, I would avoid these drugs. I'm happy to be corrected.[/quote]

Pretty much what I tend to do, although I hold off the nsaids for 24hrs to see what happens - if eating/drinking, bright, no vomiting etc then I'll give them on the basis that the mucosa usually turns over in about 24hrs. But if it's had a FB, especially something abrasive like bone or peach stone, grating along its guts for a few days, I tend to keep them in on fluids and opioids to monitor them (if the client hasn't brought it in despite it puking and not eating for days, they are not likely to be particularly reliable at bringing them back for checks).

Re: Gastrotomy - Post op analgesia

Francisco Gomez — Sat, 12 Apr 2014 20:50:57 GMT

My thoughts so far was to use NSAIDs if you are making a single incision to remove a foreign body in a 'well patient', because it's pain relief and anti inflammatory effects. If I'm cutting into a black stomach pot-GDV or there is a concern involving the gastric or intestinal mucosa in general, I would avoid these drugs. I'm happy to be corrected.

Re: Gastrotomy - Post op analgesia

Neil Wheadon — Sat, 12 Apr 2014 20:44:14 GMT

http://journals.lww.com/americantherapeutics/Abstract/2005/01000/Mechanism_of_Action_of_Paracetamol.8.aspx

Seems to suggest paracetamol inhibits COX2 and maybe COX3!! a variant of COX1 so maybe this is why it's considered safer.

Any thoughts anyone?

Neil

Re: Gastrotomy - Post op analgesia

Neil Wheadon — Sat, 12 Apr 2014 20:39:23 GMT

[quote user="Robin Grimmer"]Why are NSAIDS contraindicated? [/quote]

Good question

It's interesting that

1) In this case the Cocker Spanial was on twice maintanance overnight but it's PCV still rose from 49 to 55% in the morning, so I was underdoing the fluids.

2) When they go home, they will no longer be on fluids and so won't be getting that fluid support.

So in both cases there could be a degree of dehydration after surgery which could be exacerbated by the use of NSAID's.

This paper http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045681/ seems to suggest that NSAID's do adversely affect the stomach by a variety of mechanisms including possibility of damage to areas with decreased blood flow (so the protective mucous and bicarbonate production are decreased) which will occur where you have cut the stomach.

Interestingly though it goes onto say that COX1 and COX2 need to be inhibited.

I'm not pretending to be an expert but it's interesting isn't it?

Neil

Re: Gastrotomy - Post op analgesia

Robin Grimmer — Sat, 12 Apr 2014 20:15:17 GMT

Why are NSAIDS contraindicated? Data sheets say do not use if gi haemorrhage, ulceration etc but can't see any reference to gi surgery. I've been using nsaids for all my gastrotomies and enterotomies without any problems. They are all invariably on iv fluids.

Re: Gastrotomy - Post op analgesia

Bob Russell — Fri, 11 Apr 2014 14:43:48 GMT

[quote user="Malcolm Ness"]

[quote user="Neil Wheadon"]self abuse[/quote]

Is that really what you meant??!!

[/quote]

I would suggest (with a veterinary audience!) the term self-harming!

Re: Gastrotomy - Post op analgesia

Malcolm Ness — Fri, 11 Apr 2014 14:22:25 GMT

[quote user="Neil Wheadon"]self abuse[/quote]

Is that really what you meant??!!

Re: Gastrotomy - Post op analgesia

Mark Holmes — Fri, 11 Apr 2014 13:03:02 GMT

Don't knock the codeine in pardale - it's presence gives perfect justification for using generic paracetamol at a fraction of the price.

Re: Gastrotomy - Post op analgesia

Mark Holmes — Fri, 11 Apr 2014 12:59:59 GMT

I vote paracetamol don't knock the codeine in pardale - it's presence gives you freedom to use generic paracetamol at a fraction of the cost. With very little imagination you can find justification for avoiding the combined product.

Re: Gastrotomy - Post op analgesia

Mark Holmes — Fri, 11 Apr 2014 12:57:27 GMT

I vote paracetamol

Re: Gastrotomy - Post op analgesia

Neil Wheadon — Fri, 11 Apr 2014 11:24:35 GMT

[quote user="Bob Russell"]Oral buprenorphine [/quote]

Good in cats, the buccal mucosa in dogs isn't great for absorption

Tramadol, there are a fair few human suicides with this and we hand lots out. Also no clinical data (unlicenced) so we still use it rather than licenced drugs, researched with a very occasional side effect that we know about. Finally very debatable half life. I had a lady in yesterday giving 50mg every 3 hours which is closer to what the evidence seems to suggest, where most prescriptions are max QID

Neil

Re: Gastrotomy - Post op analgesia

Andrew Kent — Fri, 11 Apr 2014 11:14:18 GMT

[quote user="Neil Wheadon"]

Hi Andy

I presume Pardale is fine then?

Thankyou

Neil

[/quote]

Pardale is fine, though I tend to use it at 10mg/kg BID rather than the higher label dose. The codeine is at fairly homeopathic doses whichever dose rate you use.

Andy

Re: Gastrotomy - Post op analgesia

Bob Russell — Fri, 11 Apr 2014 10:57:14 GMT

Oral buprenorphine (preferably sublingual) can be helpful.

I have found paracetamol depressingly good (I have spent a working lifetime not using it!) and tramadol is brilliant in some patients. It interests me when people say negative things about it but I am pretty convinced it has a place in veterinary medicine.

Re: Gastrotomy - Post op analgesia

Neil Wheadon — Fri, 11 Apr 2014 10:53:36 GMT

Hi Andy

I presume Pardale is fine then?

Thankyou

Neil

Re: Gastrotomy - Post op analgesia

Andrew Kent — Fri, 11 Apr 2014 10:47:44 GMT

I would happily use paracetamol or tramadol in these post-op

Andy