IM or SC

RE: IM or SC

David Mills — Sun, 16 Sep 2018 22:22:40 GMT

There is quite a bit of evidence out there for opiods and onset of action sc vs im.

Methadone - no appreciable difference im vs iv. Sc takes about 10-15 mins longer.

Buprenorphine similar but only as 30-60% as effective when given sc (and it stings). It apparently gets trapped in the sq fat and absorption is very variable in terms of time frame.

Not sure about other components, haven't appraised the evidence.

RE: IM or SC

Liz Barton — Sun, 16 Sep 2018 22:13:37 GMT

[quote user="Michael Woodhouse"]

The only thing I give to small animals IM is depomedrone. I would include the sub cut route for frusemide with the cat.

I personally believe this is another bit of vet folklore not born out by practical experience. I find no practical difference.

[/quote]

Have you noticed it slower with fat animals? Surely if it went intra-adipose it would take aaaaaages.

RE: IM or SC

Liz Barton — Sun, 16 Sep 2018 22:11:50 GMT

[quote user="vs0u "]Been giving triple i/m, but will try it s/c from now on.[/quote]

Also split the dom/torb and give first, as the ketamine is the bit which really smarts - can be given comfortably IM once the dom/torb have taken effect (I would argue SC would then NOT be as effective due to the peripheral vasoconstriction).

RE: IM or SC

Anthony Todd — Sun, 16 Sep 2018 11:56:59 GMT

[quote user="vs0u "]Suspect the speed of onset maybe more of an issue in shocked animals? [/quote]

For sure, then you want to IV everything; I was referring to routine consults on your own, where the patient's distress [ I know the IM crowd will say it never happens....] really upsets the owner and the animal.

[One of my associates used to palm the syringe plunger for SC and was accused of "not giving the animal an injection"...

RE: IM or SC

vs0u — Sun, 16 Sep 2018 11:05:59 GMT

This is a useful thread. I've always given depomedrone s/c - it seems to work well and not had any problems. Also frusemide.

Been giving triple i/m, but will try it s/c from now on.

Suspect the speed of onset maybe more of an issue in shocked animals?

RE: IM or SC

Michael Woodhouse — Sat, 15 Sep 2018 20:28:35 GMT

[quote user="Robin Grimmer"]Reasons for i/m: speed of onset. Preferable route for all premeds and 'modvet' triple and quad anaesthetics[/quote]

When I qualified I gave all pre-meds/triple anaesthetics IM. The animals didn't like it and needed more restraint. Undoubtedly more stressful and painful. I moved to giving some subcut and found them just as effective. A couple of times we 'raced' a couple of cats to sleep or a couple of similar sized dogs to pre-med and found no appreciable difference.

My view is the cortisol response from the restraint and pain of injection adds greater variability in speed of onset. The data sheet for methadone suggests much slower onset if given sub cut but that is not born out by my experience and pain scoring in practice. The only thing I give to small animals IM is depomedrone. I would include the sub cut route for frusemide with the cat.

I personally believe this is another bit of vet folklore not born out by practical experience. I find no practical difference.

RE: IM or SC

Anthony Todd — Sat, 15 Sep 2018 13:38:00 GMT

BITD we all, AFAIK gave virtually everything via S/C [or I/V]; dogs and cats.

It was seemingly painless, no reactions and seemed to work. Mind you most of us didn't have the luxury of a nurse to hold the animal and owners were usually not reliable to restrain anything except their wallet.....

Only reaction I ever remember was one Depomedone given I/M in a dog.

That's what I actually said!

And they all did.... Even I, back then, realised they worked quicker and better IM or IV, but it worked well enough for us; may even have used a higher dose rate, I would today.

Under certain difficult circumstances and with limited help it may be worth remembering good old SC.

That's all I said and meant and provided some evidence that, with somed drugs it made no difference in blood levels.

Who's turboing now?

[sorry Arlo and Liz but fair's fair]

RE: IM or SC

Robin Grimmer — Sat, 15 Sep 2018 12:02:24 GMT

But that wasn't what you were saying. In your pm you said that SC was just as effective as im in all cases. Once again you have been shown to be in the wrong and hopelessly out of touch so have changed your tune and twisted things around. Much like the fna thread.

RE: IM or SC

Anthony Todd — Sat, 15 Sep 2018 11:54:51 GMT

[quote user="robloxley"]Beyond speed and reliability, sheer efficacy can differ[/quote]

I can't and wouldn't argue with that at all, all I can add is that all drugs we used, when given S/C seemed to be effective and this includes ACP and atropine and antibiotics, which was all that was available BITD.

[Acp, and even thiopentone came after I started; we only had ether or pentobarb for cats and dogs.... My first boss in the UK cut horses with chloroform....]

It may well be that other drugs work just as quickly SC as in the quote below which was all I was trying to get across to my charming colleague.

S.c. administration of 100 mg hydrocortisone shows excellent pharmacokinetics for emergency use with only a short delay in cortisol increase compared with i.m. injection. It has a good safety profile and is preferred by patients over i.m. injection. [in humans, source if needed available]

So giving a drug SC could save someone's skin and blood sometime, as well as being easier to give when singlehanded.

RE: IM or SC

Rob Loxley — Sat, 15 Sep 2018 08:50:51 GMT

Beyond speed and reliability, sheer efficacy can differ

E.g. for buprenorphine - and my experience bears this out too - see https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-2995.2010.00541.x "IV and IM administration of buprenorphine provided better postoperative analgesia than SC or OTM administration of the drug and these routes of administration should be preferred when buprenorphine is administered to cats"

But then I'm forgetting that BITD cats didn't experience pain!