Post op analgesia in very small dogs - what do you use?

Re: Post op analgesia in very small dogs - what do you use?

Virginia Campbell — Wed, 10 Jun 2015 00:48:46 GMT

Also, given the small-dog propensity to be both screamers and fussy eaters, we make extra sure to top up with a dose of Vetergesic before home time and extra sure to call the owner the next day just in case they are pouring NSAIDs down the gob of an unhappy, anorexic microdog. (Anybody else also find that Cocker bitches more prone than others to believing that the world has ended because they've been spayed?).

Re: Post op analgesia in very small dogs - what do you use?

Virginia Campbell — Wed, 10 Jun 2015 00:42:31 GMT

We use Pardale as our routine post- spay analgesic, but obviously impossible to dose accurately in the tinies so would use Loxicom as others on this thread do. We use Loxicom as our first-line NSAID for a lot of things - it comes with a big dog syringe and a little dog syringe in the box. I always throw away the big dog syringe before handing over a bottle to a <10kg dog owner to avoid[quote user="Joyce Whitehead"] told and demonstrated to use the 5kg dose of metacam. At recheck a week later they said they had run out of it in 3 days. Because they had given to the 50 dose. [/quote] this.

Re: Post op analgesia in very small dogs - what do you use?

Catriona MacIntyre — Tue, 09 Jun 2015 22:10:11 GMT

Thanks Gerry. Had been wondering for a while. Although...... now I'm worried the Sublingual Temgesic tablets I've dispensed in the past don't work either!

Actually, given my own experience of being given pethidine for renal colic, I have always had a little bit of scepticism where opioids are concerned.

[quote user="Gerry Henry"]

Absolutely won't work in Dogs Catriona, something to do with wrong Ph of saliva.

[/quote]

Re: Post op analgesia in very small dogs - what do you use?

Michael Woodhouse — Mon, 08 Jun 2015 22:10:41 GMT

Oral buprenorphine might work:

http://www.ncbi.nlm.nih.gov/pubmed/18597246

Re: Post op analgesia in very small dogs - what do you use?

Neil Wheadon — Mon, 08 Jun 2015 21:44:50 GMT

[quote user="Gerry Henry"]Absolutely won't work in Dogs Catriona, something to do with wrong Ph of saliva.[/quote]

Agreed, though I heard it was because it was to do with the squamous cells in the mouth being different to cats, but Gerry's answer seems more logical

Neil

Re: Post op analgesia in very small dogs - what do you use?

Gerry Henry — Mon, 08 Jun 2015 20:26:27 GMT

Absolutely won't work in Dogs Catriona, something to do with wrong Ph of saliva.

Re: Post op analgesia in very small dogs - what do you use?

Catriona MacIntyre — Mon, 08 Jun 2015 20:22:37 GMT

Think it's mentioned earlier in the thread, but Norbrook do Loxicom specially formulated for tiny dogs. I never use it though because I find the syringe supplied with the 10mm bottle is sufficient to measure properly.

In terms of opiates, buprenophine has been used orally (transmucosal, off licence) in cats so I wonder if that might work in these tiny dogs. I tend to use 5 mg Tramadol, available from Summit Pharmaceuticals

Re: Post op analgesia in very small dogs - what do you use?

Hannah Wynne Richards — Thu, 04 Jun 2015 10:59:38 GMT

I'll be good, and won't turbo-post.

Wynne

Re: Post op analgesia in very small dogs - what do you use?

Anthony Dennison — Thu, 04 Jun 2015 10:21:25 GMT

[quote user="Hannah Wynne Richards"]

Telephone call in the middle of the night "She's now screaming with pain, and there's a funny bend in her leg. It's your fault, because you refused to see her."

Wynne

[/quote]

Wynne. Read what I wrote again. Where at any point did the theoretical vet refuse to see her? I think you'll find the theoretical vet also said if there are any changes to ring straight back.

We cannot force people to come in OOH - the owner was the one that didn't want to come in in this situation.

Sorry for going off topic everyone else.

Re: Post op analgesia in very small dogs - what do you use?

Hannah Wynne Richards — Thu, 04 Jun 2015 10:10:43 GMT

Telephone call in the middle of the night "She's now screaming with pain, and there's a funny bend in her leg. It's your fault, because you refused to see her."

Wynne

Re: Post op analgesia in very small dogs - what do you use?

Anthony Dennison — Thu, 04 Jun 2015 09:39:56 GMT

[quote user="Hannah Wynne Richards"]

I tell them the exact opposite - that they're breaking the law if they use it other than exactly as they've been told.

Wynne

[/quote]

But Wynne, if you tell them how to use it over the phone they are following your instructions.

Does this situation sound familiar to anyone?

5pm, Sunday. Phone call OOH:

Owner: My dog fluffly was running around in the field and is now limping a bit, I am worried about her

Vet: Ok, well I can have a look at her at the surgery if you want, but just to let you know we are OOH and the fee is £x, is that ok?

Owner: Oooh no I don't want to pay that, but I am worried about Fluffy

Vet: I notice Fluffy was spayed recently. Do you still have the loxicom/metacam/generic NSAID that she went home with, is there any left?

Owner: Ooooh yes I do have some of that, why do you ask?

Vet: Give her (correct dose amount, possibly underdose just to make sure) to help with the pain, and we can book an appointment for when we open first thing tomorrow morning. If that doesn't help or things get worse, ring back and we'll need to see her sooner than tomorrow.

Owner: Why, thanks very much! See you in the morning, hopefully not before.

Re: Post op analgesia in very small dogs - what do you use?

Hannah Wynne Richards — Thu, 04 Jun 2015 09:06:20 GMT

I tell them the exact opposite - that they're breaking the law if they use it other than exactly as they've been told.

Wynne

Re: Post op analgesia in very small dogs - what do you use?

Anthony Dennison — Thu, 04 Jun 2015 08:44:12 GMT

[quote user="Neil Wheadon"] My main issue though is not only the expense to both owner and practice (many practices include analgesia in the price) but also the fact that the owner will have a practically full bottle lurking about the house[/quote]

I agree with everyone else that havign some spare NSAID lying around can be a good thing sometimes - often with dogs (who get a 10ml bottle) there is some left over after 3 days, so we tell owners to keep it in a cupboard somewhere.

With cats, our PMS (Teleos) is set up so that a loxicom cat bottle is split up into ml, so we can add whatever is needed on to the record.

Re: Post op analgesia in very small dogs - what do you use?

Gerry Henry — Wed, 03 Jun 2015 19:20:28 GMT

We do dozens - literally - of l/doodle pups at 8wks about 2 - 2.5kgs each; had problems with intra-op analgesia so changed to comfortan 30 mins before then ket/dom (0.05 and 0.04mls/Kg BW) IM; intubate and maintain on 1% iso; NSAID as soon as knocked out; lovely smooth anaesthetic, lovely recovery, bouncing and shouting for food an hour later; wouldn't use ligatures in such small dogs neither would I 'pop' the suspensory ligament, use your bipolars at reduced power (Ellman 4); easier to find uterus visually than by feel, its a knack but you get the hang pretty quickly.

We give the comfortan at a slightly higher dose than normal, for a 2 - 2.5kg pup we'll give 0.2mls IM.

Re: Post op analgesia in very small dogs - what do you use?

Martin Atkinson — Wed, 03 Jun 2015 18:03:39 GMT

[quote user="Gillian Mostyn"]we are relying on clients to correctly know what is wrong with their pet. Not always easy [/quote]Yes when even my doctor client kept giving the dog NSAIDs when it developed HGE and killed it, what hope is there for the general public. You cannot trust the pet owning public to do anything right even when its written down in black and white in front of them.

Re: Post op analgesia in very small dogs - what do you use?

Joyce Whitehead — Wed, 03 Jun 2015 17:46:23 GMT

Thanks for the tip about the small Loxicom Michael, that's useful to know. I'm another one who sometimes has had a sigh of relief when the owner phones out of hours with something I know a dose of metacam will help, and they have some in the cupboard. I usually tell owners to hang onto it, but to get advice before using it. And I tend to advise small dog owners to give drops per kg rather than use the syringe. Although we had a 5kg poodle last year with back pain, told and demonstrated to use the 5kg dose of metacam. At recheck a week later they said they had run out of it in 3 days. Because they had given to the 50 dose. As the 5 was such a small amount that it couldn't be right, even though that is what they were told and shown. Surprisingly no ill effects!

Re: Post op analgesia in very small dogs - what do you use?

Gillian Mostyn — Wed, 03 Jun 2015 17:42:14 GMT

Oops....off on a tangent but....

I do know what you mean Michael, but it is different in animals. We know that we only have a headache or sprained ankle, but we are relying on clients to correctly know what is wrong with their pet. Not always easy..... I have some clients, with pets with recurrent problems, who I am happy to supply analgesia for. I wouldn't, however, suggest that everyone should stock painkillers for their pet.

Re: Post op analgesia in very small dogs - what do you use?

Michael Woodhouse — Wed, 03 Jun 2015 17:35:01 GMT

[quote user="Neil Wheadon"]My main issue though is not only the expense to both owner and practice (many practices include analgesia in the price) but also the fact that the owner will have a practically full bottle lurking about the house. [/quote]

I'm not sure this is such a bad thing. I'm happy to let horse owners have some 'bute in stock. I have ibuprofen that I take if I have a sore leg for a day or two. Most farmers will have bottles of NSAID on hand. I've prescribed them specifically for 'just in case' need to a few of the shooting guys who run a lot of dogs. So long as people know the dose and what they are doing.

A small supply of doggy painkiller could almost be an essential aspect of a dog first aid kit. How many households don't have some aspirin/ibuprofen/paracetamol in one (or multiple) forms?

Re: Post op analgesia in very small dogs - what do you use?

Gillian Mostyn — Wed, 03 Jun 2015 17:34:50 GMT

In dogs we use metacam tablets for 3-4 days post op...the 1mg quarter very well so we can dose down to 2.5 kg. Will use metacam liquid for smaller dogs if needed. We dispense out small amounts quite frequently for exotics so will do the same...with a dose given in ml.

Re: Post op analgesia in very small dogs - what do you use?

Robin Grimmer — Wed, 03 Jun 2015 17:21:53 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]So I was a bit confused[/quote]OK sorry about that, I obviously meant giving oral NSAIDs after the initial post op injection. That said I've had at least two healthy cats go into acute renal failure following just one injection of Carprofen so I am very wary and if I suspect they are dehydrated they get nothing without fluids.

[/quote]

I'm cautious with nsaids in cats too. Having said that, I haven't had any problems with Metacam even once when I did a locum and accidentally gave some dog metacam injection to a cat. I didn't realise that you could get the dog metacam in the small bottles so assumed it was the cat one! Cat was fine luckily.

Re: Post op analgesia in very small dogs - what do you use?

Neil Wheadon — Wed, 03 Jun 2015 17:18:39 GMT

[quote user="Hannah Wynne Richards"]I use cat metacam - I record it as off-licence use - because of accuracy of dosing.[/quote]

I quite like this idea, and do do this.

I called Boehringer and yes it's 4 drops per kilo from the bottle and the bottle has been specially made so that it's accurate. The cat one is off licence and so I guess they wouldn't support it. My main issue though is not only the expense to both owner and practice (many practices include analgesia in the price) but also the fact that the owner will have a practically full bottle lurking about the house. How many cases have you seen where the owner has said 'Oh yes I've already given a dose of metacam before seeing you today?'

Neil

Re: Post op analgesia in very small dogs - what do you use?

Martin Atkinson — Wed, 03 Jun 2015 17:06:26 GMT

Re: Post op analgesia in very small dogs - what do you use?

Sammy82 — Wed, 03 Jun 2015 16:52:08 GMT

I have used cat metacam for tiny dogs (obvoiusly better if you can dose a dog version accurately). I am a bit wary of prescribing a very small number of drops like 2 or 3, so easy to overdose accidently or some owners giving an extra drop to be sure, thereby overdosing by 33%! If you use the cat syringe with it you have to double the dose, eg give the 1.5kg dog the 3kg cat dose as cats only get 0.05mg/kg, dogs 0.1mg/kg

Re: Post op analgesia in very small dogs - what do you use?

Hannah Wynne Richards — Wed, 03 Jun 2015 16:32:31 GMT

I use cat metacam - I record it as off-licence use - because of accuracy of dosing. I'm in the practice standards scheme, and the Inspector approved.

Wynne

Re: Post op analgesia in very small dogs - what do you use?

Robin Grimmer — Wed, 03 Jun 2015 15:46:25 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]

[quote user="Martin Atkinson"]

...."I rarely find any of my routine ops require anything other than a post op dose of carprofen".

[/quote]

Do you not give your cats any postoperative analgesia at all Martin?

[/quote]Read before you write Robin!

Yes they all get a post op dose of carprofen along with pre-op Torbugesic or Butorphanol. It is rare I feel they need anything other than that.

[/quote]

Yes but you then said

"And as for cats, I would far rather they were in a little bit of discomfort for 24 hours than risk renal failure from NSAIDs or feeling nauseous from opiates"

So I was a bit confused