subcut vs intramuscular vs intravenous for premed

RE: subcut vs intramuscular vs intravenous for premed

Rob Davis — Fri, 24 May 2019 10:03:02 GMT

This paper in JSAP 2009 suggested SC injections of ACP/buprenorphine was less painful and as effective as IM injections in dogs.

RE: subcut vs intramuscular vs intravenous for premed

Rob Loxley — Thu, 23 May 2019 17:43:38 GMT

I find im more reliable than sc; intrafat particularly unreliable.

Use the smallest needle - insulin syringes with 27-29g needles, orange needles for dogs and much less reaction from the dog

RE: subcut vs intramuscular vs intravenous for premed

Lindsey Edwards — Thu, 23 May 2019 14:21:58 GMT

IM - finest needle, plenty of distraction, very slow injection rate (so as not to create bolus within the muscle sheath) and avoid irritant substances (multidose buprenorphine?)

I have found sub cut for torb/dom to be as predictable as IM but was always taught buprenorphine is unpredictable in effect if not IM. I would IV a lot of patients and find them less reactive than IM for the most part for the anxious but not aggressive types.

Most take little notice of a single injection but if anxious/kennel guarding already they tend to bear a major grudge if you pull them out quick and impale them on a needle containing something that stings!

RE: subcut vs intramuscular vs intravenous for premed

Roland Bulkyn-Rackowe — Thu, 23 May 2019 13:38:51 GMT

For methadone this is published for "comfortan" in the SPC for IM vs SC injections and also SC is compared to IV in this paper: https://www.vaajournal.org/article/S1467-2987(16)30550-5/pdf

IM or IV are more reliable regarding plasma levels, onset of action and half-life than SC administration for methadone.

RE: subcut vs intramuscular vs intravenous for premed

Thomas Johnson — Thu, 23 May 2019 10:25:41 GMT

[quote user="Bob Russell"]Rather than get into a slanging match, I left a copy of the BSAVA Formulary open at buprenorphine with sticky arrow pointing to the bit that stated it could be given subcut[/quote]

However it also says (9th edition), "There is emerging evidence that analgesic efficacy of buprenorphine administered s.c. may be less than similar doses of buprenorphine administered i.m. or i.v to cats, therefore, this route is not recommended in cats or dogs."

RE: subcut vs intramuscular vs intravenous for premed

David Mills — Thu, 23 May 2019 09:59:22 GMT

Some studies have shown the buprenorphine sq has a less predictable onset and duration of action, and variable (sometimes as low as 30pc of im or IV) analgesia. It is to do with its interaction with sq fat apparently, and I'm not sure if this is affected by multi Vs single use vials. Its sedative effects may be what people are seeing, as the analgesia takes longer to kick in.

Methadone im shows little difference to iv in terms on onset of action and plasma levels, according to the manufacturers anyway, I've not looked into this.

I think it depends on the patient and clinic, I'm not sure there is one answer that fits all. I use im or IV, as I find it more reliable and quicker onset, but then we're often packed to the rafters each day, so efficiency and predictability are key considerations. We use methadone for most procedures now, excellent analgesia and much smoother anaesthetics with reduced inhalation requirements. Normally in a quad for cats.

RE: subcut vs intramuscular vs intravenous for premed

Bob Russell — Thu, 23 May 2019 09:46:26 GMT

I was told by a newly employed and newly qualified nurse that I was doing all my premeds wrong because we give them subcut.

Rather than get into a slanging match, I left a copy of the BSAVA Formulary open at buprenorphine with sticky arrow pointing to the bit that stated it could be given subcut. This nurse has subsequently moved to gain experience at a very large number of different practices but premeds still work well subcut.

I don't find there is much delay in the effects.

Using single dose buprenorphine makes it an almost painless process for the patient.

RE: subcut vs intramuscular vs intravenous for premed

Jo Murrell — Thu, 23 May 2019 08:05:00 GMT

There is evidence in cats undergoing ovariohysterectomy that SC buprenorphine is not as efficacious as IM or IV - we don't know if this is transferrable to dogs (thats a study that needs to be done) - but for this reason i prefer IM over SC premeds. However where i work most amenable dogs and cats have an IV catheter placed before premedication and we premedicate IV - this means that you get good sedation and you know that the drugs are going to reach high plasma concentrations and be effective.

RE: subcut vs intramuscular vs intravenous for premed

Joyce Whitehead — Wed, 22 May 2019 23:04:56 GMT

Subcut here for most dogs, either acp/bupe or sometimes acp/methadone, or Dom and torb. if just sedating not going to GA I will sometimes use Dom/torb IV for speed. I don’t like going IM as they object more and I’m usually not in a rush.

Cats I generally use IM for speed and they don’t seem too concerned.

RE: subcut vs intramuscular vs intravenous for premed

Michael Woodhouse — Wed, 22 May 2019 22:39:36 GMT

We pre-med nothing IM. More painful and no more effective in practice. Routine butorphanol/medetomidine s/c. Even methadone/medetomidine s/c. Triple cats s/c too. Massage site well afterwards.

If in a rush and a quiet dog might go IV to simply get on with things. IV sedate for radiographs etc.

[hate ACP so no comments there]