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Clinical Anesthesia > Pain Control and Analgesics in Animals > Flashcards

Pain Control and Analgesics in Animals Flashcards

1
Q

List the 3 classical drug groups that provide analgesia

List the ‘other’ drugs that provide analgesia

A
  • Opioids
  • NSAIDs
  • Local anesthetics
  • Aniline: paracetamol (acetaminophen)
  • NMDA antagonists: ketamine, amantadine, memantine, Gabapentin, Methadone, Tramadol
  • Alpha 2 agonists: (dex)medetomidine
  • Anti-depressants: amitriptyline
  • Cannabinoids
  • Magnesium
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2
Q

What are the non-pharmaceutical techniques to reducing pain/ providing analgesia? (9)

A
  • Compassionate, species appropriate nursing
  • Hot or cold compress
  • Passive movement
  • Massage
  • Acupuncture
  • TENS: transcutaneous nerve stimulation
  • Hydrotherapy
  • Laser
  • Neutroceuticals
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3
Q

What is a standard approach to providing analgesia in small animals?

A

1) An opioid
2) NSAID
3) +/- local anesthetic
4) +/- CRI
5) Ancilliary: cold compress on surgical site

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4
Q

What are the local anesthetic techniques? (5)

A

1) Topical adminstration
2) Field block
3) IVRA (IntraVenous Regional Anesthesia): usually used for cattle digit amputation
4) Specific Nerve Blocks
5) Epidural and Spinal Anesthesia

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5
Q

What are the top 5 local anesthetic techniques used in small animals?

A
  • Splash block
  • Infiltration
  • Intra-testicular lidocaine
  • Dental blocks
  • Epidural
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6
Q

Describe what a Splash Block is and what surgeries indicate its use

A

Local anesthetic is splashed into a surgical wound

  • Total ear canal ablation
  • Limb amputation
  • Thoracotomy through a chest drain

note: avoid suction/ swabbing site for 10 mins

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7
Q

What drug(s) are commonly used as a splash block in small animals?

A
  • Bupivicaine (lidocaine, ropivicaine)
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8
Q

What surgeries indicate the use of a local infiltration anesthetic, in small animals?

What drug is commonly used as a local infiltration anesthetic?

A
  • Wounds that need debridement + suture
  • Cutaneous lumpectomy

Drug: Lidocaine

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9
Q

What drugs are mixed together for the use of dental blocks in small animals?

A
  • Bupivicaine 0.5% + Lidocaine (2%)
    Both at a dose of 1mg/kg

Mix the drugs together in 4:1 volume ratio

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10
Q

What are the 4 main dental blocks used in small animals?

A

Maxilla:

1) Rostral Maxillary Block (infraorbital nerve): blocks incisors, canine, premolars 1, 2 + 3, soft tissue (muzzle) and rostral maxilla
2) Caudal Maxillary Block (maxillary nerve): blocks all maxillary teeth, nose, cheek and lip, palate (soft and hard), nasal mucosa. THIS IS NOT REQUIRED IN CATS

Mandible:

1) Rostral Mandibular Block (mental nerve): blocks incisor teeth, canine tooth, premolars 1, 2 + 3, rostral lip and rostral bone
2) Caudal Mandibular Block (inferior alveolar nerve): blocks all mandibular teeth, the entire mandible and the lip

Cautions:
Caudal Maxillary Block is NOT needed in cats
Bilateral Caudal Mandibular Block will paralyze the tongue, increasing risk of biting the tongue. Patient must remain in sternal recumbency and monitored

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11
Q

What surgies indicate the use of an epidural?

A
  • Surgery caudal to the umbilicus: perineal area, pelvis, pelvic limb and caudal abdominal laparotomy
  • Surgery of the thoracic limb (Morphine)
  • Thoracic surgery (Morphine)
  • Severe abdominal pain
  • Feline Urinary Tract Obstruction
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12
Q

What drugs can be used for an epidural in dogs and cats?

A
  • Bupivicaine: sensory + motor block
  • Lidocaine: sensory + motor block
  • Morphine: sensory block only
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13
Q

Where is the injection site for an epidural in a dog?

A

Between vertebrae L7 + S1

  • Palpate caudal border of both wings of ileum
  • Use thumb and middle finger
  • Drop index finger into the space between L7 + S1
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14
Q

Where is the injection site for an epidural in a cat?

A

Between L7 + S1
Caution: much more shallow than in dogs and more likely to get CSF tap

Alternatively, a coccygeal approach may be warranted: helpful in blocked cats
Between Sacrum and Co1

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15
Q

What are some common-ish problems associated with an Epidural injection, and their Tx’s? (4)

A

1) Hypotension: local anesthetic can block sympathetic nerves, leading to vasodilation of the splanchnic circulation
Tx: IV fluids + vasopressor (e.g. Noradrenaline or Phenylephrine)

2) Urinary Retention: morphine prevents the relaxation of the detrusor muscle
Tx: empty bladder at end of surgery and monitor for q12 hours

3) Unintentional subarachnoid injection leading to Bradycardia: recognized by CSF appearing at the hub of the needle
If this occurs, only administer 1/2 volume of local anesthetic, but all of the morphine can be given
Tx: Treat bradycardia with atropine

4) Blood in the hub of the needle: remove immediately, flush hub, reposition and try again

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16
Q

What are the 3 rarer problems associated with an epidural injection, and their Tx’s?

A

1) Cranial spread of local anesthetic leading to respiratory depression
- Avoid large volumes of local anesthetic
- Reduce volumes in obese animals
- Keep head elevated relative to pelvis
- Administer drugs slowly

2) Prurits: Morphine has been known to cause a severe itching as a side effect in people
Tx: diphenhydramine, acepromazine, butorphanol

17
Q

What are the relative and absolute contraindications for an epidural injection?

A

Relative: these can be overcome with an experienced operator OR adequate management/ stabilization prior

  • Pelvic fractures or anatomic abnormalities
  • Obesity
  • Uncorrected hypovolemia/ hypotension
  • LV outflow obstruction (e.g. aortic stenosis)

Absolute: never give an epidural in these situations

  • Inflammation or skin infection at the site of epidural injection
  • Bacteremia or Sepsis
  • Coagulopathies: might hit a vessel and cause excessive bleeding
  • Peripheral neuronal disease: can be worsened from an epidural
18
Q

How is a wound analgesic (soaker) catheter placed?

A
  • Fenestrated, pliable catheter tubing is used
  • Placed in the deepest part of the wound
  • The catheter will exit by a small hole away from the wound and secured with a ‘Chinese finger trap’ suture
19
Q

What surgies indicate the use of a wound analgesic (soaker) catheter?

A
  • Major reconstructive surgery/ tumour surgery
  • Amputation
  • Radical mastectomy
  • Total ear canal ablation
  • When NSAIDs and other analgesics are not appropriate due to the medical condition of the patient
  • When sedation post-operatively is undesirable
20
Q

What drug is usually used for a wound analgesic (soaker) catheter, and how often?

A
  • Bupivicaine 1 - 1.5 mg/kg q 5-6hrs

and can be used for 48 hours

21
Q

What concentrations of fentanyl patches are appropriate for small animals?

A

2 - 4 ug/kg/hr

22
Q

How long can Fentanyl Patches provide analgesia for?

A

approx 72 hours

23
Q

How long do Fentanyl Patches take to work in cats and dogs? (onset of action)

A

Cats: up to 12hours
Dogs: up to 24 hours

24
Q

What drugs should not be used with a Fentanyl Patch and why?

A

Butorphanol: can antagonist the effects of Fentanyl
Buprenorphine: blocks the receptors for Fentanyl binding

Clinical Anesthesia (17 decks)

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