Analgesia post dog C Section

RE: Analgesia post dog C Section

vetbl.locum — Thu, 28 Jan 2021 20:49:23 GMT

[quote userid="11308" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29570/analgesia-post-dog-c-section/228088#228088"]

bob lehner said:
Rimadyl just says don't use in pregnant animals

Yes, we use Rimadyl.

[/quote]

I use rimadyl also The Large animal version has zero milk withdrawal in cows so guess that very little gets into milk

Assume that is same for Bitches & Queens

On that note is the Casade dead since we have left EU?

Rgds

RE: Analgesia post dog C Section

Anthony Dennison — Mon, 25 Jan 2021 14:35:32 GMT

[quote userid="6897" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29570/analgesia-post-dog-c-section/227937#227937"] Rimadyl just says don't use in pregnant animals[/quote]

Yes, we use Rimadyl.

RE: Analgesia post dog C Section

bob lehner — Mon, 18 Jan 2021 11:07:48 GMT

[quote userid="11308" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29570/analgesia-post-dog-c-section/227927#227927"]meloxicam datasheer specifically states not to use in pregnant or lactating bitches, but carprofen doesn't so we use this loophole. [/quote]

Depends which Carprofen brand you look at. Rimadyl just says don't use in pregnant animals - most of the other brands also exclude lactation - e..g. ''Studies in laboratory species (rat and rabbit) have shown evidence of foetotoxic effects of carprofen at doses close to the therapeutic dose. The safety of the veterinary medicinal product has not been established during pregnancy and lactation. Do not use in pregnant or lactating bitches''.

RE: Analgesia post dog C Section

Anthony Dennison — Sun, 17 Jan 2021 22:53:00 GMT

I've posted about this before, and I think I learned it from this forum:

No premed, but will have methadone 0.2mg/kg once pups are out. Propofol induction, perfalgan and and carprofen at induction, go home with pardale and carprofen.

The meloxicam datasheer specifically states not to use in pregnant or lactating bitches, but carprofen doesn't so we use this loophole.

RE: Analgesia post dog C Section

vetbl.locum — Sat, 16 Jan 2021 17:46:47 GMT

[quote userid="4747" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29570/analgesia-post-dog-c-section/227897#227897"]We use propofol induction without premed[/quote]

Does the increased dose of propofol not mitigate against no opoid?

I dont know enough about the pharmacology Just I feeling I have

Rgds

RE: Analgesia post dog C Section

Charlotte Marshall — Sat, 16 Jan 2021 17:36:18 GMT

We use propofol induction without premed in most cases (although the last one had comfortan as she was a bit crazy and needed calming to get the i/v) buprenorphine or comfortan and meloxicam once pups out and meloxicam to go home with for a few days and the owner signs for off license use. I went to a BSAVA lecture in 2018 and it recommended several days of carprofen or meloxicam to go home with.

RE: Analgesia post dog C Section

Lindsey Edwards — Fri, 15 Jan 2021 18:34:04 GMT

www.dvm360.com/.../i-like-big-blocks-and-i-cannot-lie

RE: Analgesia post dog C Section

Rob Davis — Fri, 15 Jan 2021 17:59:07 GMT

[quote userid="11901" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29570/analgesia-post-dog-c-section/227861#227861"]Where do you all get IV paracetamol? Can’t find a stock item with Covetrus....[/quote]

Perfalgan. I think we get it from Dunlops, or Henry Schein or whatever they call themselves these days, but I can check with our nurses if you can't find it.

RE: Analgesia post dog C Section

Miriam Lodewyks — Fri, 15 Jan 2021 17:32:15 GMT

Where do you all get IV paracetamol? Can’t find a stock item with Covetrus....

RE: Analgesia post dog C Section

vetbl.locum — Tue, 05 Jan 2021 21:20:37 GMT

[quote userid="13683" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29570/analgesia-post-dog-c-section/227498#227498"]Always use a line block (lido/ket or lido/medetomidine, reported to extend to 18-24hrs, recovery improved since started this recipe)[/quote]

Do you have details or reference for these recipes?

RE: Analgesia post dog C Section

Carl Bradbrook — Fri, 01 Jan 2021 13:19:38 GMT

Great discussion and a scenario that can be challenging to manage.

I would definitely consider an opioid premed, methadone is likely to be best suited. I would avoid buprenorphine, based on the information provided on the data sheet. Pethidine would be an alternative, but remember it has a much shorter duration of action. I would have naloxone available so this can be given to the pups on delivery if needed- they are bradycardic or respiratory depression is a concern.

Paracetamol, given IV is a good option, which can then be followed up post anaesthesia PO and discharge.

A one off NSAID at the end of the procedure, provided the bitch is CV stable and you have no other concerns.

An infiltration block with lidocaine before final scrub will help to reduce nociception on skin incision. Bupivacaine can then be used to infiltrate into the muscle surrounding the linea alba prior to closure to extend the block. Lidocaine is useful as the initial choice due its rapid onset when speed is important during patient preparation, whereas bupivacaine will extend the block for uptown 8 hours.

Alfaxalone is likely to have benefit as the induction agent of choice.

As mentioned elsewhere informed owner consent is essential, explaining that licensed options are limited, but giving the benefits of using good analgesia on both the bitch and the pups.

RE: Analgesia post dog C Section

Joyce Whitehead — Wed, 30 Dec 2020 14:52:13 GMT

I presume you mean paracetomol brand? We use pardale, licensed, safe to use in pregnancy and no mention of issues with lactation either.

RE: Analgesia post dog C Section

Lindsey Edwards — Tue, 29 Dec 2020 23:27:15 GMT

I have started using paracetamol after discharge and seems to be as good or better than nsaids and first preference in humans, wsava pain Council recommends single dose only (all off license regardless as far as I am aware, would consider stocking brand if not contraindicated, anyone?).

Always use a line block (lido/ket or lido/medetomidine, reported to extend to 18-24hrs, recovery improved since started this recipe).

RE: Analgesia post dog C Section

Joyce Whitehead — Tue, 29 Dec 2020 21:45:10 GMT

We tend to not premed, but give iv paracetomol after propofol induction. Oxytocin once pups out, and buprenorphine immediately after that too. Usually a jab of metacam with off licence consent being on our ga form. I then tend to send home on pardale. I used to send home with Rimadyl but find no issue with pardale instead. I’ve had 2 sections myself and on both occasions had pethidine immediately post op (via epidural with number 1 as they had run out of drip pumps, IV with number 2) then onto paracetomol only.

RE: Analgesia post dog C Section

Nicola Cole — Tue, 29 Dec 2020 21:31:16 GMT

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29570/analgesia-post-dog-c-section/227448#227448"]I'm just curious why is this a thing as I heard it from other vets as well. Why are breeders allowed to pressure? It is our responsibility and our clinical judgement and if they don't like it they should be free to seek help some place else. [/quote]

It a ‘thing’ because loss of puppies can result in accusations against the vet from the breeder, regardless of how logical the actions. There was a VDS story a few years back about the use of buprenorphine-I believe they couldn’t defend it so had to pay out.

As an aside-personal preference for alfaxan, paracetamol. Methadone/bup I/v once puppies removed, carprofen.
I would choose carprofen over meloxicom as I find similar pain relief with them both, but metacam (haven’t checked the other manufacturers) notes pregnancy and lactation as contra-indications, rimadyl only mentions pregnancy. (and personally I see no benefit in metacam over rimadyl).

Always get signed for use of unlicensed drugs.
I’m never quite sure why as a profession we’re so concerned about the use of unlicensed drugs-surely we should be trusted to use the drugs we think are most appropriate based on a risk assessment of the condition? I was in hospital a couple of years ago-major haemorrhage risk, yet I was given anti-coagulants based on the assessment that bleeding was ‘better’ than throwing a pulmonary embolism and dying. I didn’t argue as I could see there was no real alternative. (Insert shrug shoulder emoji here).

RE: Analgesia post dog C Section

vetbl.locum — Tue, 29 Dec 2020 21:09:51 GMT

Premed : Pethidine or low dose Methadone I/M

Oxygen before Propofol induction (because it is the agent I am more familiar with)

Rimadyl S/C at start as no(??) milk excretion

Maintenance: Iso (& if available nitrous)

Line Block: I Just never remember to get this worked out prior. What do people use drug & dose wise?

Oxytocin once uterus stitched

Post op: Repeat Methadone if pain score high especially if used pethidine

Home: on Rimadyl tablets

Usually on iv fluids and give single dose Co amoxy pre op.

Use paracetamol in GI ops but for some vague reason not post C section. Is it better than NSAIDs or do we need to give both?

Rgds

PS Used to do flank approaches but now stopped as everyone else does midline.... Wonder if less painful ?

RE: Analgesia post dog C Section

Andreas Ege — Tue, 29 Dec 2020 08:56:15 GMT

Induction: propofol or alfaxan (depending on what the practice got), meloxicam sc or iv

Bup or meth iv once pups out

Home with meloxicam.

All bit dependent on practice protocol and stock. Would consider using paracetamol as well if worried how well pain seems controled.

RE: Analgesia post dog C Section

Julian Earl — Mon, 28 Dec 2020 23:09:09 GMT

[quote userid="9515" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29570/analgesia-post-dog-c-section"]

Anything else? local blocks, paracetamol, any other drugs?

What about going home?

[/quote]

Personally always favoured carprofen for cases when safety might have been an issue. No problems arose. When car[profen was first released , as" Zenecarp" in those days, there was a short paper in the Record stating that it was as potent an analgesic as Pethidine. That seems like a good recommendation generally for using it as an analgesic?

As for going home? Yes, always! As soon as we had cleaned up the operating theatre I always tried to go home before he telephone rang again! Doesn't everybody??

RE: Analgesia post dog C Section

Dinu Catilina — Mon, 28 Dec 2020 15:02:53 GMT

Paracetamol IV at induction, Loxicom inj, Methadone IV after puppies removed. Home on Pardale at our licence dose. This is our average but we will tailor the analgesia to our patient, my last night caesarian required rescue analgesia so I added IV ketamine.

We induce with propofol. We tried Alfaxan but we found bitches don't recover as smoothly with our protocol.

[quote userid="9515" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29570/analgesia-post-dog-c-section"]I'm concerned that we aren't giving enough pain relief post caesarean section, probably due to concerns over licensing and pressure from breeders[/quote]

I'm just curious why is this a thing as I heard it from other vets as well. Why are breeders allowed to pressure? It is our responsibility and our clinical judgement and if they don't like it they should be free to seek help some place else.

RE: Analgesia post dog C Section

Emily Rainbow — Mon, 28 Dec 2020 04:15:19 GMT

Paracetamol IV, Alfaxan induction (better APGAR scores for pups vs propofol), lidocaine line block.

Methadone/metacam once pups out. Home on metacam/paracetamol.

RE: Analgesia post dog C Section

Michael Woodhouse — Sun, 27 Dec 2020 21:53:05 GMT

Premed - medetomidine/butorphanol IV. Carprofen at same time. Induce propofol (PropoFlo), maintain iso. IV paracetamol. Reverse pups with atipamazole but never bitch.

Home on Pardale V at licenced dose rate for 5d.

Very happy with the protocol.

O sign off-licence consent.