Post-castration analgesics in dogs

RE: Post-castration analgesics in dogs

Luciano Nebiante PGCertSAS — Wed, 08 Feb 2017 16:42:34 GMT

[quote user="robloxley"]Found at http://onlinelibrary.wiley.com/doi/10.1111/jsap.12266/abstract;jsessionid=DE18E69395304EAB8572A8935783E4BC.f03t03

[/quote]

Nice one, sorry the paper is 2014 but for some reason I searched it again last year. I think when I was having a discussion with other colleagues regarding the same matter.

RE: Post-castration analgesics in dogs

Rob Loxley — Wed, 08 Feb 2017 13:43:29 GMT

[quote user="Luciano Nebiante PGCertSAS"]

[quote user="robloxley"]I'd be interested whether closed vs open technique affects complication/interference rates postop[/quote]

There is paper published on JSAP last year clearly stating that closed technique is superior in terms of post-op complications.

If you can't find it, I can have a look for you.

[/quote]

Found at http://onlinelibrary.wiley.com/doi/10.1111/jsap.12266/abstract;jsessionid=DE18E69395304EAB8572A8935783E4BC.f03t03

RE: Post-castration analgesics in dogs

Luciano Nebiante PGCertSAS — Wed, 08 Feb 2017 10:43:14 GMT

[quote user="robloxley"]I'd be interested whether closed vs open technique affects complication/interference rates postop[/quote]

There is paper published on JSAP last year clearly stating that closed technique is superior in terms of post-op complications.

If you can't find it, I can have a look for you.

RE: Post-castration analgesics in dogs

Beats — Tue, 07 Feb 2017 22:52:00 GMT

[quote user="janine redman"]That article advised scrotal rather than prescrotal incision. Is anyone here doing that?[/quote]

I do scrotal in young puppies - the ones that don't really have a "scrotum" that differs from the surrounding skin, usually if 5mths or less - I do suture, but seriously question whether this is advantageous or not especially when the testicle is the size of a cat one.

Haven't tried scrotal in adult dogs, though I understand is trendy in shelters state-side. I can't really get how this is faster/easier/less-complications than prescrotal I do as I see prepping the scrotum as either problematic or time-consuming etc.

I do intratesticular lidocaine in dog/cat castrates. The main disadvanntage I would note is it makes the testicles bigger which gives a bigger hole to push them out! I can see the logic in injecting into the cord intra-op instead prior to clamping (much like I do for bitch spays).

RE: Post-castration analgesics in dogs

janine redman — Tue, 07 Feb 2017 22:35:50 GMT

That article advised scrotal rather than prescrotal incision. Is anyone here doing that?

RE: Post-castration analgesics in dogs

Rob Loxley — Tue, 07 Feb 2017 16:10:48 GMT

[quote user="Neil Wheadon"] combination of sharp and blunt dissection of the spermatic fascia is recommended[/quote]

I was taught, in an open castrate, to break down the fascia with a swab, but having moved fully to sharp dissection with a pair of scissors, it seems much less traumatic.
I'd be interested whether closed vs open technique affects complication/interference rates postop

RE: Post-castration analgesics in dogs

Neil Wheadon — Tue, 07 Feb 2017 15:21:08 GMT

Interesting article in Clinicians Brief

http://www.cliniciansbrief.com/article/scrotal-approach-canine-orchiectomy

The author talks about reduced tissue handling, using less suture material and using low speed clippers and not clipping close to the scrotal skin.

From the article

Author Insight

When manually disrupting the layers of spermatic fascia and scrotal ligament, take care not to pinch the scrotal tissue to avoid unnecessary discomfort, bruising, and subsequent postoperative self-trauma. In large and/or older adult dogs, a combination of sharp and blunt dissection of the spermatic fascia is recommended.

Author Insight

Do not attempt to fully close the dartos fascia, intradermal, and/or cutaneous layers of the incision with sutures, as this can lead to discomfort, seroma formation, self- trauma, and postoperative complications. (This is referenced to a paper I can't see)

Neil

RE: Post-castration analgesics in dogs

Roland Bulkyn-Rackowe — Mon, 06 Feb 2017 14:09:41 GMT

I did a few audits on neutering 10 years ago. We used the spreadsheet from here:

http://www.vetaudit.co.uk/POC.htm

We had a much higher complication rate in dog castration compared to bitch spays - 25%(!!) vs 4%. The most common complication noted was discomfort reported by the owner (not requiring intervention). There were also occasional need for medication (NSAID or antibiotic), buster collars (which we classified as medical intervention) and one or two surgical complications due to self trauma.

After the initial audit we changed our protocols to include less clipping and no handling of the scrotum; this definitely helped (complications down to <10% IIRC).

The next year we started to give local into the cord before clamping and post op meloxicam. Our complication rate dropped down lower again after this (less than 4%). All vets were experienced and using the same protocol.

RE: Post-castration analgesics in dogs

bob lehner — Wed, 01 Feb 2017 21:35:36 GMT

[quote user="mariette asselbergs"]If leaving the wound open is still standard practice in cats, calves, colts,[/quote]

Well - historically I guess castration wounds in farm animals and colts were left open to drain because the surgery was in no sense aseptic - you had to let the subsequent bad stuff drain out - If it couldn't escape then death from peritonitis would surely follow.

I can never understand why 'modern' castration of horses under GA still sometimes have wounds left open. I always sutured the scrotum with a running dissolvable suture. No problems, no risk of evisceration, no infection and no swelling.

RE: Post-castration analgesics in dogs

mariette asselbergs — Wed, 01 Feb 2017 21:07:41 GMT

And also: i have learned through long years of practice in different places and with many different vets that there are many ways of doing things. What was the standard practice 30 years ago is obsolete" now. To call something "bad practice" you need to present evidence. If leaving the wound open is still standard practice in cats, calves, colts, then what is the terrible "bad practice" in dogs?

Mariette

RE: Post-castration analgesics in dogs

mariette asselbergs — Wed, 01 Feb 2017 21:00:31 GMT

[quote user="Tomas Hansen"]

Guess that I'll better leave a remark in order not to leave Danes with a bad name here. I've never heard of "the Danish method" of leaving the skin open. That's not how we are taught in Vet School in Copenhagen anyhow. I would consider that approach a bad habit and taking an unnecessary risk.

It was the method used in 1990......

Anyway, it worked really well.

Mariette

[/quote]

RE: Post-castration analgesics in dogs

mariette asselbergs — Wed, 01 Feb 2017 20:58:56 GMT

No, the point is that since you increase the pressure in the testes it nicely is squeezed up along the spermatic cord so the clamping and the ligature don't hurt for a few hours. Need to give it a few minutes before stsrting.

Mariette

RE: Post-castration analgesics in dogs

Eilidh Corr — Wed, 01 Feb 2017 17:45:38 GMT

We were discussing this today in the practice with regard to calves - epidural might be a better approach? No more costly and probably safer to administer. Plus it at least numbs the site of the incision.

I've never seen the point of infiltrating the testes, then removing them - the bit that hurts afterwards is what remains!

RE: Post-castration analgesics in dogs

Lucy Fleming — Wed, 01 Feb 2017 17:41:30 GMT

[quote user="Clive Ansell"]

[quote user="mariette asselbergs"]I use intratesticular local anaesthetic and find it works wonders when they wake up.[/quote]

Why? the testicle is being removed. Don't see the need.

[/quote]

I've always wondered this as well - perhaps some diffuses up the cord to the clamp site?

RE: Post-castration analgesics in dogs

Tomas Hansen — Tue, 31 Jan 2017 20:19:15 GMT

RE: Post-castration analgesics in dogs

Seadna — Tue, 31 Jan 2017 18:36:42 GMT

[quote user="Anthony Todd"]I think that's how they castrate horses standing??[/quote]

If the farm dog gets his choppers on the testicles after they've been infiltrated with lidocaine it usually makes for hilarious face-pulling and drooling.

RE: Post-castration analgesics in dogs

Anthony Todd — Tue, 31 Jan 2017 12:21:28 GMT

[quote user="mariette asselbergs"]I use intratesticular local anaesthetic and find it works wonders when they wake up.[/quote]

I think that's how they castrate horses standing??

RE: Post-castration analgesics in dogs

Clive Ansell — Tue, 31 Jan 2017 12:11:42 GMT

[quote user="mariette asselbergs"]Years ago when I worked with a Danish colleague in Mozambique we compared stitching up as I was used to, and the Danish method (then? Still?) of leaving the wound open as in cats[/quote]

My only experience of that in dogs was once when I was working with a Polish locum. On his first day he castrated 2 dogs without closing the scrotal incisions, and speyed one bitch. All 3 ended up at the OOH provider with post op haemorrhage, leaving the practice to pick a tab in excess of £1000. On day 2 of his locum , he was advised he would no longer be required!

RE: Post-castration analgesics in dogs

Clive Ansell — Tue, 31 Jan 2017 12:08:31 GMT

[quote user="mariette asselbergs"]I use intratesticular local anaesthetic and find it works wonders when they wake up.[/quote]

Why? the testicle is being removed. Don't see the need.

RE: Post-castration analgesics in dogs

Clive Ansell — Tue, 31 Jan 2017 12:04:43 GMT

I don't send routine dog castrates home with any additional analgesia, to an opiate within the pre-med and a pre op injectable NSAID, usually Metacam. I don't think they need it, and think possible risks out way any benefits. Although, it does seem increasingly common to send home with 3 - 5 day post op nsaid.

Will be interesting to see JGW's clinical audit outcome.

I think if you need post op analgesia beyond or in addition to nsaid's, for routine uncomplicated cases, you need to be looking at surgical technique.

RE: Post-castration analgesics in dogs

mariette asselbergs — Tue, 31 Jan 2017 10:48:14 GMT

I use intratesticular local anaesthetic and find it works wonders when they wake up.

And for whjat it is worth: why stitch at all?

Years ago when I worked with a Danish colleague in Mozambique we compared stitching up as I was used to, and the Danish method (then? Still?) of leaving the wound open as in cats. After a weak both looked just the same, and this was in village dogs, operated on the back of a pick up and released in a dusty rural environment!

(To reassure readers, in Britain I stitch them up.....)

Mariette

RE: Post-castration analgesics in dogs

Anthony Todd — Mon, 30 Jan 2017 21:49:11 GMT

[quote user="Tomas Hansen"]quite tight in order to look good[/quote]

They look even better and never get touched if the sutures [single interrupted, always] make the wound edges just touch, without puckering or bulging. Mattress; never, IMHO.

Like a kissing your geriatric maiden aunt, as someone once said....

RE: Post-castration analgesics in dogs

Kate Richardson — Mon, 30 Jan 2017 21:48:44 GMT

Intradermal (or intra cuticular- assume same thing?) shouldnt be tight, they are just opposing the skin edges as should external skin sutures. So if that's one of the reason you are having post op pain problems then maybe technique/suture material needs to be reviewed. We use intradermal sutures a lot here and don't have any significant issues with post op pain. If management are insisting on specifics like this and there is an issue then training should be provided so everyone is comfortable and proficient at it.

RE: Post-castration analgesics in dogs

Tomas Hansen — Mon, 30 Jan 2017 21:28:57 GMT

I completely agree that to much handling contributes to post-OP pain, that could well have ben avoided (if Practice policies were different). We must e.g. do intracut sutures here in the skin, which often need to be quite tight in order to look good. I personally much prefer cruciate in the skin done sufficiently loose in order to allow for the little swelling that always occur. I'll defy try to ask the nurse to go easier on the bits when prepping and try to clipp less.

RE: Post-castration analgesics in dogs

Neil Wheadon — Mon, 30 Jan 2017 10:41:24 GMT

[quote user="Seadna "] I always used them without a second thought until one day when I accidentally clipped myself. Excruciating pain.[/quote]

Precisely and it goes on for a few days as I caught myself many years ago.

Cloth drapes/4 drapes, just secure without the skin as you would do. You'll be surprised how still the drape stays

Cut a hole and lay it on. By the time you have a couple of forceps adding weight it stays pretty still.

Yes it needs attention as it might move a bit but I feel it's worth it to avoid the post op pain

Neil

PS I fully endorse the 'soft hands' approach. I use tissue forceps instead of Rat Tooths when I can