Take home analgesia for cat castrates.

RE: Take home analgesia for cat castrates.

Benjamin Alyoshkin — Sun, 05 Feb 2017 10:28:03 GMT

Thank you Clive for initiating this forum. I have not been sending cat castrations with oral metacam post op, while doing locum in three different practices recently, because this has been practice policy, and because, I guess, I am prepared to compromise to this extent with cat castrations. I had discharged castrated cats with 3-5 day oral metacam in the past, I think neutering included post op metacam in those other places. I sway towards giving some analgesia post op even though animals are active and equivocally exhibit normal behaviour on recovery. Out of interest, has anyone come across studies of pros and contras of post op analgesia post neutering? Please would you kindly give a link?

Had a memorable experience with discharging a rabbit (small ?fight wound stitch-up) in the past without pain relief. Although this was unintentional, the owner did not enquire if further pain relief would be a good idea, but wrote a complaint using florid (understatement) language.

So the rabbit actually reminds me of what I would like to add to this debate. I share all the views above, suggesting that we don't always assess pain accurately (pain assessment, I have seen, is more qualitative), we do extrapolate our personal experience, and anthropomorphise other species. I keep reminding myself that cats are solitary predators and it is a disadvantage for them to show weakness until it's no longer possible to hide it. I am also guided by the understanding that (a)it is beneficial to control inflammation and pain because we can, it's kind and to reduce deleterious effects of inflammation (agreed that some - how much - inflammation is protective); and (b) it is easier to pre-emp pain than to respond to it.

RE: Take home analgesia for cat castrates.

Imogene Ruygt — Sat, 04 Feb 2017 22:54:39 GMT

I am more likely to send home NSAIDs following castration if it's an older cat with larger testicles - these seem more prone to post-surgical inflammation and irritation, and are typically the ones who like to go home and lick. Younger cats and kittens seem to do well with a single injection of an NSAID. Everyone gets an intra-testicular block.

RE: Take home analgesia for cat castrates.

Bob Russell — Fri, 03 Feb 2017 11:34:49 GMT

Cat castrations get single dose meloxicam s/c. Spays get lower dose s/c and two follow up doses. No extra charge as we dispense individual doses. Manufacturer happily supplies extra oral syringes.

Dogs get enough to get them to the post op check. Usually no more than that.

We never hand out a bottle of Meloxidyl dog with two syringes. Just the one they are going to need. Saves the disaster scenario where the big syringe is used when the small one should have been.

RE: Take home analgesia for cat castrates.

celery — Thu, 02 Feb 2017 22:01:36 GMT

Have just asked my other half how many days analgesia he would require post op if he was castrated.... "for the rest of my life!"

RE: Take home analgesia for cat castrates.

bob lehner — Thu, 02 Feb 2017 21:46:37 GMT

[quote user="Carl Gorman"]Do you get clients to read the data sheets? Many of our clients do, and then have to be persuaded to use NSAIDs as they are alarmed by the many potential problems associated with these drugs[/quote]

Well any medicine you care to name, human or veterinary, will likely have a list of nasty side effects as long as your arm on the data sheet. I always tell clients 'It's a balance between the potential benefit, as against the possible and undesirable harm'.

Interesting point 'Do you get clients to read the data sheet?'. We are meant to give clients information about side effects or potential problems whenever we prescribe a medicine. Fine if it is in a whole pack, complete with the data sheet, but how many people religiously photocopy the datasheet to give to the client whenever a pack is split - e.g. handing out 10 preds in a pot, or whatever? Precious few in my experience.

RE: Take home analgesia for cat castrates.

James Laidlaw — Thu, 02 Feb 2017 20:09:05 GMT

[quote user="Carl Gorman"]and unreported levels much higher[/quote]

RE: Take home analgesia for cat castrates.

Carl Gorman — Thu, 02 Feb 2017 17:54:38 GMT

We don't give routine post op take home analgesia for cat neuters. As we do the CP work we have abundant opportunity to monitor post op behaviour in neutered cats and really don't see evidence of discomfort or the need for routine take home NSAIDs. I do worry that this has been a successful marketing campaign which many vets have blindly taken on board.

Howeaver ... I firmly believe that the skill of the surgeon is a major factor. If you are clumsy, slow, rough, make large incisions, abuse tissue, allow your patient to become hypothermic etc. then post op discomfort becomes a reality. Hence in the cats we follow, those neutered by recent graduates are definitely more likely to show discomfort, and I encourage younger vets to be honest, and if they feel the spay has been anything more than easy/quick then they should consider dispensing pain relief.

In other words, we are carrying out risk benefit assessments, and I think that is good practice. I appreciate that protocols make life easier for those in practice, and practice managers and accountants prefer to describe anything extra as 'good practice' but there are cases where you should not be blindly led by marketing.

Do you get clients to read the data sheets? Many of our clients do, and then have to be persuaded to use NSAIDs as they are alarmed by the many potential problems associated with these drugs. They are wonderful in many ways, and those of us who remember having nothing at all to safely give to orthopaedic ops (Pethidine?) never mind neutering, fully appreciate their benefits, but reported levels of side effects are high, and unreported levels much higher.

Local anaesthetic is wonderful - used prophylactically it prevents 'wind up' and so even short acting local anaesthetic use will have great post op benefits. If I use if for castrations, I use it in the cords, as I do for rabbits and GPs.

Carl

RE: Take home analgesia for cat castrates.

Evelyn Barbour-Hill — Thu, 12 Jan 2017 22:03:01 GMT

[quote user="Aine Seavers"]Re dosing it out in syringes to owner-here using non child proof containers for something that comes child proof leaves you open legally if something goes wrong. I am surprised it is not the same in UK,[/quote]

I bet it is.

RE: Take home analgesia for cat castrates.

Aine Seavers — Thu, 12 Jan 2017 21:41:00 GMT

Totally agree. I prefer it to Rimadyl in cats.

Richard Malik and Richard Gowan's study on the protective effects of meloxicam in some renal situations is
Retrospective case–control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease
Richard A. Gowan, Amy E. Lingard, Laura Johnston, Wibke Stansen, Scott A. Brown, Richard Malikctive

When querying with BI about times to reinject Meloxicam compared to 3 day claim for rimadly, this was the answer re Rimadyl

-"Cats have a variably defective gene which codes for a glucuronidation enzyme UGT1A6. This leads to cats’ sometimes poor but definitely variable ability to metabolise those drugs that require glucuronidation using this particular enzyme (for instance acetaminophen and carprofen). So in some cats the half-life of carprofen is indeed in the order of a couple of days, however because of the variable nature of the genetic defect, some cats are quite efficient at metabolising carprofen, meaning that pain relief would only last a few hours.Because of the variability in processing carprofen, following up with further carprofen is not an option"

As noted earlier, many of us in the earlier years of meloxicam, followed up the 3mg/kg dose well inside what BI then recommended be done(ie 8-12hrs later) so if one needed to pain rescue a 3mg/kg cat the next day or day after then it was done. Would be good for BI to release the data that makes them want this exclusion period as opposed to just the chart outlining How they want it done, not why they want it done.

Re dosing it out in syringes to owner-here using non child proof containers for something that comes child proof leaves you open legally if something goes wrong. I am surprised it is not the same in UK, would be worth checking to see where one stands on that aspect.

RE: Take home analgesia for cat castrates.

Anthony Todd — Thu, 12 Jan 2017 12:05:18 GMT

[quote user="Beats"]if is in pain then needs more pain relief - simples.[/quote]

Sure, but the key is "if it is".

I would find it hard to distinguish between recovering from whatever cocktail it has been anaesthetised with for 24 hours post GA and post-op pain.

I wonder how you differentiate the two?

Can one, or has anyone, pain-scored an animal after a GA only [for say a hip score etc.] and after some painful procedure, say a bone plating?

In other words are some people pain-scoring anaesthetic recovery and not actual pain?

RE: Take home analgesia for cat castrates.

Beats — Thu, 12 Jan 2017 11:32:19 GMT

Is anyone interested in a tangent on pain-scoring? I fail to get the point beyond a training exercise for nurses/students or in terms of actual research - in my view post-op pain is clinically a binary thing, i.e. pain yes/no - if is in pain then needs more pain relief - simples.

RE: Take home analgesia for cat castrates.

Aine Seavers — Thu, 12 Jan 2017 10:37:55 GMT

There is a pdf and table BI sent out explaining it all-how do I attach that to this thread?

RE: Take home analgesia for cat castrates.

Anthony Todd — Thu, 12 Jan 2017 10:36:27 GMT

[quote user="Robin Grimmer"]

Also although we value nurse's input on pain scoring etc the decision on post op pain relief should be a veterinary one.

[/quote]

No it depends on the pain score, provided it is done accurately and, TBH, nurses are probably better than vets, they certainly would be better than me! Crikey, now they're nearly as qualified.... all the muscle attachments in the dog, anyone??

PS Any pain scores on castrations, whoever scores it!

RE: Take home analgesia for cat castrates.

Robin Grimmer — Thu, 12 Jan 2017 10:33:48 GMT

I have used metacam in old cats with arthritis and kidney disease. The quality of life is so much better that the owners don't want to stop treatment. In fact I have even seen an improvement in renal parameters presumably due to the cat feeling better and eating more/keeping better hydrated.

RE: Take home analgesia for cat castrates.

Aine Seavers — Thu, 12 Jan 2017 10:28:29 GMT

I collated a number of spectacular overdosing of dogs on Metacam ie a 5kg 16yr old dog given a 50kg dose (owner didnt have her glasses on) and did so for 3 days in a row-dog was apparently never happier in its life-another a husky ate the whole bottle of 180ml metacam in one hit-and so on-all the dogs were fine-no issues short or long term so I am more relaxed in dogs when owners panic with a mild overdose.Cats are not shrunken little dogs and so one can no more extrapolate the dog experience to cats than one can the experience of humans in ics on tiny doses of some meds to be bioequivalent in cats- what I can say is I know my own family 17yr old Siamese has been doubled dose on more than one occasion by over diligent and poorly communicating teenage daughters with no issue. The point-we should aim for accuracy each dose but the safety margin does appear to be high, much to the surprise of many of us given the mentality at the time of the product launch. Rimadly doesnt seem to be so tolerant of overdose.

RE: Take home analgesia for cat castrates.

Anthony Dennison — Thu, 12 Jan 2017 09:40:15 GMT

All our cats spays get 3 days pot-op pain relief. We decant a 3 day supply of Loxicom into a small bottle from a 15ml bottle and supple a 1ml syringe to draw it up.

RE: Take home analgesia for cat castrates.

Robin Grimmer — Thu, 12 Jan 2017 07:58:15 GMT

[quote user="Gillian Mostyn"]

Thanks for the info - interesting - but I think I'll stick with the lower dose and dosing interval. I also prefer using the 2 mg/ml version for cats- reduces the chances of accidental overdose.

[/quote]

I did a locum where they only had 5mg/ml Metacam injection, but had a small bottle as well as the larger one. I didn't realise it came in the smaller size and assumed it was the cat 2mg/ml one. So I gave a cat an overdose of 2.5x the recommended amount. It was for a CBA, not having a GA or anything. Not only that, but cat had had 2 days of oral Metacam after this before I realised my mistake! Cat was fine!

RE: Take home analgesia for cat castrates.

Kate Richardson — Thu, 12 Jan 2017 07:26:11 GMT

Just quickly, my understanding is the higher injectable cat metacam dose has no benefit over the lower dose. It doesn't last longer or give better pain relief. Again I will speak to boehringer and clarify

and much better accuracy of dosing with the cat specific metacam injection

RE: Take home analgesia for cat castrates.

Gillian Mostyn — Thu, 12 Jan 2017 06:44:49 GMT

Thanks for the info - interesting - but I think I'll stick with the lower dose and dosing interval. I also prefer using the 2 mg/ml version for cats- reduces the chances of accidental overdose.

RE: Take home analgesia for cat castrates.

Aine Seavers — Wed, 11 Jan 2017 23:39:34 GMT

[quote user="Charlotte Marshall"]However I know in the past certainly that my colleagues have happily given the 0.3 mg/kg dose then followed on with oral. And I have never seen problems associated with it.[/quote]

correct- lots of us did it to many many cats without any ensuing ADRs. However if we don't need to give it (even if didn't cause an issue )then we gave up doing it. We too use metacam for dog injection as the cat one came out many years later and dosing is easy on a one ml syringe as you say.

RE: Take home analgesia for cat castrates.

Charlotte Marshall — Wed, 11 Jan 2017 23:33:00 GMT

[quote user="Robin Grimmer"]

Metacam 5mg/ml injection 0.3mg per kg one off injection.

Metacam 2mg/ml injection 0.2mg per kg plus follow up with oral Metacam.

[/quote]This is true. We don't stock the cat metacam injection but if I am continuing with oral dosing I do use the lower dose. ( I have not had an issue with drawing up the correct amount I just use a 1 ml syringe, I always felt it was just a marketing strategy to create the lower strength for cats).

However I know in the past certainly that my colleagues have happily given the 0.3 mg/kg dose then followed on with oral. And I have never seen a problems associated with it.

RE: Take home analgesia for cat castrates.

Aine Seavers — Wed, 11 Jan 2017 23:32:29 GMT

[[quote user="Gillian Mostyn"]

Post-operative pain and inflammation following surgical procedures:

After initial treatment with Metacam 2 mg/ml solution for injection for cats, continue treatment 24 hours later with Metacam 0.5 mg/ml oral suspension for cats at a dosage of 0.05 mg meloxicam/kg body weight. The oral follow-up dose may be administered once daily (at 24-hour intervals) for up to four days.

[quote user="Aine Seavers"]THE 0.3MG/KG stand alone dose for cats[/quote]

I don't use that dose and haven't personally seen it recommended anywhere? (As far as I am aware, elimination of a drug is generally unaffected by dose so not sure why a bigger dose would last longer...???

[/quote]

It is not a personal recommendation but from BI technical vets and their recommendation that the 0.3mg dose -is which fairly commonly used here- is Not to be followed up with oral medication-goes back about 7 or 8yrs now due to some issues. BI have the pharmacokinetics done on it-I contacted them as another vet liked rimadylin cats simply because it lasted 3 days-allegedly-but when I looked into that the pharmacokinetics of rimadyl in cats is a lot more variable in the individual's response so we went with metacam. We have 3 doses of metacam here advised- so am surprised its not on the UK data sheet as has been around a long while.

Re bitches-yes metacam tabs an option.

Re renal issues- paper by Richard Malik et al out of the Pahran Melbourne cat study took a lot of the heat off renal issues and metacam use.

RE: Take home analgesia for cat castrates.

Robin Grimmer — Wed, 11 Jan 2017 22:41:11 GMT

Metacam 5mg/ml injection 0.3mg per kg one off injection.

Metacam 2mg/ml injection 0.2mg per kg plus follow up with oral Metacam.

RE: Take home analgesia for cat castrates.

Braden Collins — Wed, 11 Jan 2017 22:40:13 GMT

We just draw up 3 doses in syringes and send the owner home with these, so by using a large bottle and splitting it it's quite cheap.

I don't see my cat castrated as being painful, but I would rather assume they are and give some analgesia.

We've done thousands of cat stays and castrates and never had any renal issues, so to my mind the risk is sufficiently small.

Although we pride ourselves as vets being able to pick pain in animals, how often are people treating cats for arthritis? I think if the answer to that is "not very often", we need to reassess our thoughts on cats displaying pain. I know I missed it a lot in my younger years.

I also think the client perception of pain is important. We find people respond well to our "marketing" that everything gets pain relief, as the other Clinics in town make it an optional extra (which I think is unethical).

RE: Take home analgesia for cat castrates.

Gillian Mostyn — Wed, 11 Jan 2017 22:18:30 GMT

[quote user="Aine Seavers"]What dose of metacam are you using? [/quote]

The one recommended in the data sheets :

Post-operative pain and inflammation following surgical procedures:

[quote user="Aine Seavers"]THE 0.3MG/KG stand alone dose for cats[/quote]

[quote user="Beats"]I give loose syringes to bitch spays[/quote]

I just use metacam tablets.