Analgesia for bitch spays

Re: Analgesia for bitch spays

Mark Hedberg — Mon, 24 Sep 2012 18:09:47 GMT

I suppose that's one question I always had concerning human c-sections - rather than hauling on tissue and yanking it around, why not make the incision 1cm wider and not have to have two people leaning on rectractors to make the hole big enough?

Re: Analgesia for bitch spays

Anthony Todd — Mon, 24 Sep 2012 17:28:07 GMT

[quote user="Gillian Mostyn"]However, do you know anyone who has had any abdominal surgery and neither took painkillers nor felt any pain? [/quote]

Yeah, my wife and a doctor friend, hysterectomy and caesar. No pain whatsoever, mind you, in both cases the surgeons know the patient very well and were considered to be very gentle and sympathetic to tissues....

So I still say pain relief if necessary ,but make sure the pain is not indicating a problem, which all posters have side-stepped.

I'd rather have my painful appendix indicating a problem rather than being masked with "routine" analgesia.

Re: Analgesia for bitch spays

Malcolm Ness — Mon, 24 Sep 2012 15:38:58 GMT

Would you expect a flank bitch spey to be more painful; less painful or just as painful as a mid-line spey??

Interesting differences between sentiments expressed in this thread and in the one about cat speys. Perhaps there is more to perioperative analgaesia than how much of which drug you tip into the patient.

Re: Analgesia for bitch spays

Hannah Wynne Richards — Thu, 20 Sep 2012 12:55:44 GMT

Hear hear Gillian

Wynne

Re: Analgesia for bitch spays

Gillian Mostyn — Thu, 20 Sep 2012 12:48:34 GMT

[quote user="Anthony Todd"]I also say the post-op pain may be related to surgical sympathy and some vets [and many human surgeons] don't realise that.[/quote]

OK, fair enough, I am being anthropomorphic, I admit it.

However, do you know anyone who has had any abdominal surgery and neither took painkillers nor felt any pain? (I am not talking about someone deciding to be 'brave' to avoid taking analgesia.) I don't.

Re: Analgesia for bitch spays

Anthony Todd — Tue, 18 Sep 2012 22:14:05 GMT

[quote user="Nixthevet"]I didn't say routine analgesia is always needed.[/quote] etc.

I was agreeing with you.....!!

What some are saying ,and some not, is that because the cervix, abdo. muscles etc. are cut there must always be delayed [inflammatory] pain and therefore we should always give post-op analgesia.

What I ,and some others are saying is "not necessarily".

Some have quoted examples of bitches ostensibly [but we can't be sure can we, goes the counter argument] showing no signs of post-op pain.

I also say the post-op pain may be related to surgical sympathy and some vets [and many human surgeons] don't realise that.

Re: Analgesia for bitch spays

Nixthevet — Tue, 18 Sep 2012 14:24:35 GMT

[quote user="Anthony Todd"]

[quote user="Nixthevet"] but the fact of the matter is that like us human every animal is different and some will experience discomfort/pain where the majority might not....[/quote]

That's why routine analgesia might not be needed. ..... We're back where we started.

I wonder if one could give enough "routine" analgesia to mask a serious post op problem??

Certainly Fentanyl masked my dislocated ankle a treat....

[/quote]

I didn't say routine analgesia is always needed...in fact what i am saying is that there can be no set routine because every patient has to assessed seperatley to devise an individual analgesic protocol that suits that patient.

What I am not doing is getting bogged down trying to dissect the minute details of exactly what pain is and what the types are as this was not what the original poster asked my opinion on and I have very little interest in creating an argument just for arguments sake.( No offence intended to anyone).

Re: Analgesia for bitch spays

patrick murphy — Tue, 18 Sep 2012 12:48:24 GMT

me too. although I have learnt something, there does come a point.if I haven't figured out my view on post op analgesia or how to fix ears after all of this time, then maybe I should hang up my boots

Re: Analgesia for bitch spays

Martin Atkinson — Tue, 18 Sep 2012 10:15:15 GMT

[quote user="Gillian Mostyn"]

[quote user="Anthony Todd"]I cut myself shaving and I was in agony for a week but I just carried on and pretended every thing was normal.[/quote]

When you flippantly compare this to abdominal surgery where the b****** cervix is incised, I give up.

[/quote] Actually this is not as silly as it sounds. This may not add much to the discussion which has now pretty well run its course but the most painful thing I have experienced is a stubbed toe, admittedly the pain is fleeting but when I've fractured my tibia and radius I didn't think I'd done anything so serious on either occasion because it didn't hurt much, however I cant relate this to major abdominal surgery because I haven't had that. Now if this is to do with relative numbers of pain receptors or if the body 'realises' when there is a serious injury the fight or flight mode kicks in and releases loads more intrinsic pain relief I don't know so it could well be that the same scenario occurs in animals.

Re: Analgesia for bitch spays

Gillian Mostyn — Tue, 18 Sep 2012 10:01:17 GMT

[quote user="Anthony Todd"]I cut myself shaving and I was in agony for a week but I just carried on and pretended every thing was normal.[/quote]

When you flippantly compare this to abdominal surgery where the b****** cervix is incised, I give up.

Re: Analgesia for bitch spays

Mark Holmes — Mon, 17 Sep 2012 22:52:05 GMT

Animals can however take some actions to mitigate their own pain as we do. They can be immobile as we would be. They can be depressed as we would be, they can move differently as we would and they can avoid doing things as we would. If an animal is not doing those things and us bright, eating, wabting to play etc then surely they are not in pain or they do not consider any pain they experience significant. I cycled 50 miles my back was sore, it wasn't however significant. It is possible to know if an animal is in pain, it is more difficult to know if they are in discomfort, and to what degree that discomfort is bothering them. One could argue that discomfort is pain which is not of sufficient intensity to be significant.

Re: Analgesia for bitch spays

Anthony Todd — Mon, 17 Sep 2012 22:33:11 GMT

[quote user="nikki"]back to normal playing with her toys and trying to do the wall of death round the garden on Sunday. Needless to say she hasn't had any additional analgesia.[/quote]

Yeah, she appeared normal, but she was, actually, in severe pain, animals do mask pain , you know, so how do you know she wasn't in acute pain, you're only the owner and a vet. how on earth could you be capable of assessing pain or discomfit?

I cut myself shaving and I was in agony for a week but I just carried on and pretended every thing was normal.

The bitch had had major abdominal surgery, so she must have been in absolute agony as she rushed around the garden.

Re: Analgesia for bitch spays

Bob Russell — Mon, 17 Sep 2012 17:45:55 GMT

It is becoming a circular argument now but humans can complain about the pain and pain relief can be titrated to effect but our patients cannot.

Re: Analgesia for bitch spays

Anthony Todd — Mon, 17 Sep 2012 16:29:20 GMT

[quote user="Nixthevet"] but the fact of the matter is that like us human every animal is different and some will experience discomfort/pain where the majority might not....[/quote]

That's why routine analgesia might not be needed. ..... We're back where we started.

I wonder if one could give enough "routine" analgesia to mask a serious post op problem??

Certainly Fentanyl masked my dislocated ankle a treat....

Re: Analgesia for bitch spays

Nixthevet — Mon, 17 Sep 2012 14:30:45 GMT

I would not be happy if my boss chanted down from on high and tried to dictate any black and white protocol on when analgesia can be administered.

Clearly everyone on here has their own way of doing things and many purport to never having to administer post-op analgesia thanks to excellent surgeical technique, but the fact of the matter is that like us human every animal is different and some will experience discomfort/pain where the majority might not.... so like every aspect of veterinary medicine treatment guidleines are great but there is no one size fits all rule and treatment should be tailored to the individual animal's response.

Re: Analgesia for bitch spays

Hannah Wynne Richards — Mon, 17 Sep 2012 13:57:55 GMT

PS to above Though the op would be FOC any requested estra analgesia above what you normally supply would be charged at human private hospitalrates-could turn out tobe a nice little money spinner

Wynne

Re: Analgesia for bitch spays

Hannah Wynne Richards — Mon, 17 Sep 2012 13:14:58 GMT

I'm so angry about this I'm prepared to do a hysterectomy(or prostatectomy if applicable ) FOC on any of you-using your standard pre-med /anaesthetic/post op analgesia regimes-and you can pain score yourselves afterwards If there's any doubt at all we should always assume it's painful

Wynne

Re: Analgesia for bitch spays

Rajat — Mon, 17 Sep 2012 12:57:38 GMT

[quote user="Sarah Keir"]

[quote user="Gillian Mostyn"]

Oh, sorry, I forgot - you can do a bitch spay without traumatizing any tissue. My mistake.

[/quote]

I've seen a couple of bitch spays after laproscopic ovario-ectomies. Fantastic recoveries!

[/quote]

I am in the interesting position of having done and still doing laparoscopic OE, routine midline OE and routine midline OHE (and in the past also did laparoscopic OHE). I prefer doing lap OEs to all others- simplest, and less pain for patient. There's definitely a quicker recovery in the lap dogs and they seem to be more active (we keep them 24 h for monitoring and analgesia) based on our inhouse ops for last 5 years or so - don't take my word for it, Evelyn, have a look at the literature:

http://onlinelibrary.wiley.com/doi/10.1111/j.1532-950X.2009.00572.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=fals
http://onlinelibrary.wiley.com/doi/10.1111/j.1532-950x.2005.00041.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false
http://onlinelibrary.wiley.com/doi/10.1111/j.1532-950X.2004.04003.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false
http://avmajournals.avma.org/doi/abs/10.2460/javma.2005.227.921?journalCode=javma

Not sure why they leave air in the abdomen (CO2?) - CO2 is meant to diffuse very quickly but I can still see why it would be irritant/painful I thought the recommendation was to empty the abdo of as much CO2 as poss before closure, like you would with a stomach full of air after an endoscopy..

Re: Analgesia for bitch spays

Rajat — Mon, 17 Sep 2012 12:43:40 GMT

[quote user="Mariette Asselbergs"]

...but that doesn't mean I need to move with the fashion....

.. I have seen too many bad reactions to metacam and its other NSAIDS friends that I deal them out as sweeties. If paracetamol is not licensed in the UK than maybe who didn't go with the times....?? That it is safer than metacam is definitely a good justification for VMD (who have never been bothered as far as I know about small animal prescriptions).

...As a vet I can only use my training to observe my post op patients for signs of pain.

[/quote]

Hi Mariette...well you call it fashion, I call it demonstrable proven safe analgesia. I wonder if you can point me towards any studies looking at efficacy of paracetamol post spay in bitches? or castrate in dogs? I know there is plenty of info and research on the NSAID classe pf drugs. Using our vet training (as you mentioned to decide on which drugs to use) I feel it is our responsibility to ensure our patients do not suffer after we cut them, and we use safe drugs. Despite all of us having seen NSAID reactions, as a percentage these are very low, and the safety index is quite high. So I don't believe this is due to 'fashion' but a proven track record of efficacy and safety which has made it ( I thought!!) a basic standard of care..

Another point- I wonder if some of the s/e we see with NSAIDS are due to a combination of cox inhibition, inhibition of autoregulation of blood flow and hypo-perfusion of the gut periop all in combo. For my older patients, I give NSAIDs post op - many a time I have been glad not to have had them on-board periop!

As for observing them before deciding which one gets analgesia and which one doesn't......it has been thrashed out already, so briefly, I don't believe (unless hospitalized for the whole post-op period- and serial pain scores performed 2-3x daily) that we can determine these pets are in mild-moderate pain or that it is fair to ask owners to assess them for such. If despite all that is published and known on pain relief and the difficulties involved in detecting pain in companion species, we as vets continue to believe interventions are only justified when obvious outward signs are present, I think many pets will suffer in silence.

As for cat spays- I believe they are painful. Based on using vs not using metacam in cat spays for last few years (post op). Also based on wound palpation for 2-3 d post op in a few cases.Classic trap of looks alright acting normal eating fine so must be non painful IMHO.

[quote user="Mark Holmes"]

[quote user="Clive Ansell"]

[quote user="Mark Holmes"]Re pain, anybody not giving invasive surgeries incl. bitch spays 0.1 ml/10kg ketamine really should since we started spays have been more settled and recovered far more smoothly and calmly, no comparison.

[/quote]

What other anaesthetic and analgesic drugs do you use with it?

[/quote]

Medetomidine/buprenorphine/meloxicam premed, ketamine with propofol at induction and meloxicam to go home.

No side effects of NSAID.

[/quote]

Nice! I really like medetomidine for neuters! and ketamine is fab too esp as a CRI!!

Re: Analgesia for bitch spays

Mark Holmes — Mon, 17 Sep 2012 11:58:44 GMT

[quote user="Clive Ansell"]

[/quote]

What other anaesthetic and analgesic drugs do you use with it?

[/quote]

Medetomidine/buprenorphine/meloxicam premed, ketamine with propofol at induction and meloxicam to go home.

No side effects of NSAID.

Re: Analgesia for bitch spays

Malcolm Ness — Mon, 17 Sep 2012 09:49:09 GMT

How many vets will prefer the familiarity and simplicity of a flank cat spey despite the likelihood that it is more painful than a midline spey?

Re: Analgesia for bitch spays

Bob Russell — Mon, 17 Sep 2012 09:22:52 GMT

[quote user="mariette asselbergs"]

[quote user="Mark Hedberg"]

What do you give cats, mariette?

[/quote][quote user="Mark Hedberg"]

What do you give cats, mariette?

[/quote]

Obviously no paracetamol Mark! But cats are rarely painful after a spay. If money is an issue for the owner (and I thought that was what we are talking about here) and if I needed to give a painkiller to a cat I may consider tramadol. Or sublingual buprenorphine.

Mariette

[/quote]

Who says cats are rarely painful after a spay? I would tend to agree cats rarely demonstrate signs of pain after a spay but how often do they demonstrate pain clearly ever?

Re: Analgesia for bitch spays

Rob Loxley — Sun, 16 Sep 2012 23:57:30 GMT

[quote user="Sarah Keir"] argued to try and get Comfortan or any other full u agoist to be beaten down. The bosses arguement was it costs too much so the clients won't pay for it and it would make the practice more at risk of being broken into[/quote]

Or maybe they can't be bothered to sort out their paperwork and processes to manage/use sch 2 CDs?
As I said before the list price (per kg dose) for methadone (even with the newer licensed product) is no more than for buprenorphine (even for one of the cheaper me-too competitors).

Re: Analgesia for bitch spays

Anthony Todd — Sun, 16 Sep 2012 21:39:14 GMT

[quote user="mariette asselbergs"]As a vet I can only use my training to observe my post op patients for signs of pain. I agree that this then depends on "believing" in what I see and my interpretation of that. But it helps having been operated myself several times in my life, and having been pleasantly surprised that good surgeons can cut you up quite severely with very little post op pain, even without painkillers, let alone nonsteroidals (which we didn't have for humans or animals in Mozambique until a little while ago....).[/quote]

Why on earth did this sensible, rational, reply get a red star? It counterbalances the "I had an op. and I needed analgesia therefore dogs do to" posts.

Arlo, why can't you make red starrers give a reason [as I get more than most....]

Surely if a red star is given there should be a good reason which can be justified?

Re: Analgesia for bitch spays

james herriot lied — Sun, 16 Sep 2012 17:18:36 GMT

[quote user="Evelyn Barbour-Hill"]

But: can you now define "suffering"?

[/quote]

Participating in this thread.