Timing of NSAIDs post Op

RE: Timing of NSAIDs post Op

Jo Murrell — Thu, 30 May 2019 17:35:57 GMT

I have just had a brief look at the literature on this and there are a lack of clinical studies looking at the effect of NSAIDs on wound healing - one study looked at the effect on wound healing following castration in calves and found no delay in wound healing (with flunixin). Other studies in lab animals have found an effect of some NSAIDs to delay wound healing but the evidence seems equivocal. There are a couple of review articles that conclude given the evidence that NSAIDs have no effect - i would have thought that there is more potential for pain causing interference with the wound would have more effect to delay healing than the administration of NSAIDs.

RE: Timing of NSAIDs post Op

Julian Earl — Thu, 30 May 2019 16:33:56 GMT

have asked this before but never seen a reply: Is there any evidence that NSAIDs delay wound healing post-operatively? I was told by a human rheumatologist that this is the case for people but it is never mentioned for our patients. Inflammation is of course the first stage of wound-healing so it would be a logical side-effect. Steroids can sop wounds healing at all so do NSAIDs do the same? It is not something that I have ever suspected but what about the experiences of the wise and wonderful on here?

Thanks in advance.

RE: Timing of NSAIDs post Op

Miriam Lodewyks — Fri, 24 May 2019 18:13:11 GMT

[quote user="vetbl.locum"]For c sections ? [/quote]

Haven't done one of those in a while to be fair (do mainly dentistry these days), I was referring to the O.P. which was a general question I think...

RE: Timing of NSAIDs post Op

vetbl.locum — Wed, 22 May 2019 22:25:05 GMT

[quote user="GrooveJet"]. I do use Buprenorphine premed and local/regional blocks where needed, so figure that will keep animals comfy until NSAID takes over.

[/quote] ki

For c sections ?

Rgds

RE: Timing of NSAIDs post Op

Miriam Lodewyks — Wed, 22 May 2019 18:35:07 GMT

Whoah! How did we get from the OP to discussing the use of pethidine during labour???

For what it's worth I also prefer to give NSAIDs once the patient is extubated as I have concerns about low BP causing renal issues (think it happened once). I do use Buprenorphine premed and local/regional blocks where needed, so figure that will keep animals comfy until NSAID takes over.

RE: Timing of NSAIDs post Op

Gillian Mostyn — Wed, 22 May 2019 14:53:42 GMT

From that website you linked to Michael:

Pethidine injections in labour

This is an injection of the drug pethidine into your thigh or buttock to relieve pain. It can also help you to relax. Sometimes, less commonly, a drug called diamorphine is used.

It takes about 20 minutes to work after the injection. The effects last between 2 and 4 hours, so wouldn't be recommended if you're getting close to the pushing (second) stage of labour.

Side effects

There are some side effects to be aware of:

it can make some women feel woozy, sick and forgetful
if pethidine or diamorphine are given too close to the time of delivery, they may affect the baby's breathing – if this happens, another drug to reverse the effect will be given
the drugs can interfere with the baby's first feed

[:D]

RE: Timing of NSAIDs post Op

Michael Woodhouse — Wed, 22 May 2019 14:29:55 GMT

[quote user="Nicola M"] Not close to actual delivery though[/quote]

https://www.nhs.uk/conditions/pregnancy-and-baby/pain-relief-labour/

Suggests pethidine used.

I know a human anaesthetist - I'll ask what they do.

RE: Timing of NSAIDs post Op

Nicola Cole — Wed, 22 May 2019 14:21:57 GMT

[quote user="Bob Russell"]

Human mums to be get opiates pretty much without thought.

[/quote] Not close to actual delivery though

RE: Timing of NSAIDs post Op

Gillian Mostyn — Wed, 22 May 2019 07:46:23 GMT

I also think it is more likely to be due to the 28 day disposal rule than anything else.

RE: Timing of NSAIDs post Op

Lucy Fleming — Tue, 21 May 2019 23:34:45 GMT

[quote user="Clive Ansell"]

[quote user="vetbl.locum"]but use Rimadyl[/quote]

More and more practices seem now to only stock Metacam, both injectable and oral, as their only nsaid. I don't know if that is a corporate business decision because they get a better deal?

[/quote]

Metacam is the only injectable nsaid we stock. We keep a small stock of previcox tablets, in addition to the oral metacam. We're an independent practice. Though I don't make the purchasing decisions, I don't generally see the need to keep multiple nsaids in stock, when they are much of a muchness. As far as injectable is concerned, we would possibly struggle to get through vials of two different products in 28 days, especially if one was used less frequently than the other. I imagine it's a similar choice for most other places.

RE: Timing of NSAIDs post Op

Clive Ansell — Tue, 21 May 2019 18:48:15 GMT

[quote user="vetbl.locum"]but use Rimadyl[/quote]

More and more practices seem now to only stock Metacam, both injectable and oral, as their only nsaid. I don't know if that is a corporate business decision because they get a better deal?

RE: Timing of NSAIDs post Op

vetbl.locum — Tue, 21 May 2019 08:37:46 GMT

IMHO

Premed does brings sufficient benefits to dam and hence pups and out weighs risk to pups.

Rgds

PS Not sure what the risk to pups from NSAIDS is ; but use Rimadyl as no milk withdrawal just in case!

RE: Timing of NSAIDs post Op

Gillian Mostyn — Mon, 20 May 2019 12:54:29 GMT

[quote user="David Mills"]Pregnant women get pethidine all the time.[/quote]

Not close to expected delivery time though, only during early labour, as it causes too many problems for the baby if given soon before birth. And more recently, research seems to show that it is pretty ineffective for labour pain anyway - the benefits are due to sedation.

[quote user="David Mills"]Methadone and alpha 2s are both reversible in pups, so easily managed. [/quote]

I guess the argument hinges on whether a pre-med brings enough benefit to the bitch to make the increased risk to the pups valid. There is no answer, just opinion, but I find that straight propofol then iso is pretty stress free and recovery is smooth because the sedative/analgesic drugs are given peri-op.

RE: Timing of NSAIDs post Op

Michael Woodhouse — Mon, 20 May 2019 12:46:31 GMT

That doesn't mean you can't use it. It's very different in my eyes. We use heaps in pregnant cows

RE: Timing of NSAIDs post Op

David Mills — Mon, 20 May 2019 12:41:27 GMT

[quote user="Gillian Mostyn"]

[quote user="Anthony Dennison"]. Meloxicam specifically is contraindicated for use in pregnant or lactating bitches, whereas Carprofen isn't. [/quote]

Still contraindicated in pregnancy though...hence waiting till pups are out.

In the absence of any specific studies in pregnant bitches, such use is not indicated.

[/quote]

Not indicated is not the same as contraindicated.

Pregnant women get pethidine all the time.

Methadone and alpha 2s are both reversible in pups, so easily managed.

RE: Timing of NSAIDs post Op

Gillian Mostyn — Mon, 20 May 2019 12:37:16 GMT

[quote user="Anthony Dennison"]. Meloxicam specifically is contraindicated for use in pregnant or lactating bitches, whereas Carprofen isn't. [/quote]

Still contraindicated in pregnancy though...hence waiting till pups are out.

In the absence of any specific studies in pregnant bitches, such use is not indicated.

RE: Timing of NSAIDs post Op

Anthony Dennison — Mon, 20 May 2019 10:40:09 GMT

[quote user="Gillian Mostyn"] I hold off the NSAIDS until pups are out as a compromise between not using them at all (which, in theory, we 'should') and minimising risk to the pups.[/quote]

There was a discussion about this a while back. Meloxicam specifically is contraindicated for use in pregnant or lactating bitches, whereas Carprofen isn't. Because of that discussion we switched all our C-sections on to Rimadyl for post-op pain relief.

RE: Timing of NSAIDs post Op

Bob Russell — Mon, 20 May 2019 09:58:07 GMT

Human mums to be get opiates pretty much without thought. Risks are fairly quantifiable and predictable.

My discussions with owners tend to be limited to most medication is not licenced for pregnancy/parturition/lactation. This is generally a lack of testing rather than a measure of risk.

RE: Timing of NSAIDs post Op

Gillian Mostyn — Sun, 19 May 2019 21:17:42 GMT

[quote user="Michael Woodhouse"]I remember as a student seeing some awful attempts at caesers as a student - wrestling with whelping bitches to gas down, fight on her back to clip with no pre-med etc.[/quote]

Not surprised you were scarred by that experience. I can assure you it isn't the norm, even without a pre med.

RE: Timing of NSAIDs post Op

Michael Woodhouse — Sun, 19 May 2019 20:57:47 GMT

[quote user="Kate Richardson"]Out of interest, does anyone use medetomidine for these as a premed? [/quote]

yes, every single time.

Also use butorphanol and NSAID at pre-med.

Explain the licencing issue, get a form signed.

I remember as a student seeing some awful attempts at caesers as a student - wrestling with whelping bitches to gas down, fight on her back to clip with no pre-med etc. Swore that would never be how I did things. Smooth anaesthetic, simple surgery, fast recovery.

RE: Timing of NSAIDs post Op

Kate Richardson — Sun, 19 May 2019 14:35:19 GMT

I was always worried that if the bitch wasn't comfortable post op she wouldn't mother the pups well, and caesarian already increases this risk anyway (or so I was/am led to believe) so maintaining the bitch's health is paramount to pup survival beyond the point of actual delivery. I would have thought minimising the inhalation component should be a priority and that's difficult to do without a good premedication. Is this a case of no perfect solution, but speed of the procedure is probably the most important element? I used to get the bitch clipped and prepped as best possible conscious, then get in quick as soon as anaesthetised and get the pups (or kittens for that matter) out asap.

Out of interest, does anyone use medetomidine for these as a premed?

RE: Timing of NSAIDs post Op

Gillian Mostyn — Sun, 19 May 2019 14:11:51 GMT

[quote user="vetbl.locum"]In that case, what is your GA plan for c section?[/quote]

Difficult to say a simple answer, as depends on health of bitch and puppies, her temperament, and what drugs are available to me. (I'm a locum).

I don't use opioids as a pre-med as they do have an impact on the foetuses. I hold off the NSAIDS until pups are out as a compromise between not using them at all (which, in theory, we 'should') and minimising risk to the pups.

Generally I just give propofol but then as soon as pups are out I give opioids and NSAIDS, and will send mum home with NSAIDS and sometimes pardale. I explain to the owner all the (theoretical) risks and get them to sign a form if necessary, but, like you, I don't feel allowing an animal to be in pain simply because of a lack of licensed products is acceptable.

However, I can understand why others are even more cautious. It is very easy to be on the wrong side of a judgement decision as there are always 'veterinary experts' ready to disagree with you. It is one thing to use a drug which isn't licensed for a specific use, but another to ignore a specific 'do not use' contraindication.

I'm of an age and situation where I'm confident in justifying my decisions, and would walk away from the profession if I was reprimanded for my use of analgesia!!! But younger vets may be less confident.

On a related note, most off license drug forms I see getting signed are unlikely to hold any weight. For it to be legally valid, you have to prove informed consent and therefore fully explain all the potential complications .... up to and including death for most drugs!! How many vets truly do that? How many could prove they did?

RE: Timing of NSAIDs post Op

Clive Ansell — Sun, 19 May 2019 09:37:05 GMT

None of the pre med or anaesthetic drugs I have looked at, are licenced for use in pregnancy or lactation, or specifically for C-sections. There also seems limited safety data relating to foetuses and neonates beyond standard laboratory animals.

Maybe we need a specific disclaimer document for the off label use of drugs for C-sections?

RE: Timing of NSAIDs post Op

vetbl.locum — Sat, 18 May 2019 23:33:02 GMT

[quote user="Gillian Mostyn"]How can we disagree when I have simply explained the reason for the status quo? I haven't said what I think or do.[/quote]

Ok sorry for that.

In that case, what is your GA plan for c section?

Rgds

RE: Timing of NSAIDs post Op

Gillian Mostyn — Sat, 18 May 2019 23:26:23 GMT

[quote user="vetbl.locum"]Sorry, we are going to have to disagree[/quote]

How can we disagree when I have simply explained the reason for the status quo? I haven't said what I think or do.

[quote user="vetbl.locum"]Still think our responsibly lies with the bitch not breeders' ill informed wrath.[/quote]

I agree.