TRAMADOL Tramadol is a commonly dispensed opioid for at-home pain management. This drug is a weak agonistic property at all receptors. It is very commonly used to treat chronic pain like osteoarthritis in dogs. At clinical dosages, tramadol is unlikely to show the undesirable effects associated with the use of many other opioids. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) NSAIDs relieve mild to moderate pain by inhibition of prostaglandin synthesis. These drugs have a synergistic effect when used in combination with opioids or can have an opioid- sparing effect and allow a lower dosage of opioids to be used. The duration of NSAIDs varies between 12 to 24 hours, depending on which NSAID is used. The duration and effects of NSAIDs make them ideal for treating acute and chronic pain. Summary In this chapter, we discussed the many different pain options that can be used in small animal medicine. You should have
Contraindications for the Use of NSAIDs ● Renal Insufficiency. ● Hepatic Insufficiency.
● Dehydration. ● Hypotension. ● Concurrent use of other NSAIDs or Corticosteroids. ● Evidence of gastric ulceration. ● Pregnancy and lactation. Gabapentin has been found to be effective in treating neuropathic pain. Lower starting doses are recommended to avoid excessive sedation. Reduced dosages are needed in patients with renal insufficiency. This medication is only available as an oral route. ● Neonates. GABAPENTIN
a good understanding of these drugs and should be able to identify any signs of pain in small animals.
LOCAL AND REGIONAL NERVE BLOCKS
Learning objectives Discuss many of the commonly used drugs for local and regional never blocks. Explain when you would need a nerve block. Predict any side effects that you may see when using a nerve block. Identify the pros and cons of using nerve blocks and when they should not be used. Local and regional nerve blocks are commonly used in orthopedic surgery and dental procedures. Local anesthetics Why use local anesthetics? ● Minimal systemic effects when delivered peripherally. ● Decrease sympathetic response to surgical stimulation if given prior to surgery. ● Easy to use but knowledge of anatomy is essential. Local anesthetic toxicity Local anesthetics are safe, useful, and effective. It is important to be aware that they have the potential to cause toxicity. General anesthesia may mask some of the signs of toxicity and arrhythmias, hypotension, and respiratory arrest are the first signs that you may see. To minimize the risk of local anesthetic toxicity, you should: ● Dose according to the lean body weight. ● Be very careful with the dosage in very small patients. Summary In this chapter, we have discussed the uses of local and regional nerve blocks and when you would use them in small animal medicine. These are very useful to help decrease the need for References Acepromazine. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www. vasg.org/a_drugs.htm#ACE Alfaxalone. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg. org/alfaxalone.htm Alpha 2 Agonist – Xylazine. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg.org/alpha_2_agonists.htm Atropine. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg. org/a_drugs.htm#ATROP Dexmedetomidine. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www. vasg.org/d_drugs.htm#DEXMED Etomidate. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg. org/e_drugs.htm#ETOM Gabapentin. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg. org/g_drugs.htm#GABAP Isoflurane. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg. org/i_drugs.htm#ISO Ketamine. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg. org/k_drugs.htm#KET
outperform all other agents for the treatment of acute pain, especially surgical. The most common agents used are bupivacaine and Lidocaine. These two drugs act by blocking the transient increase in permeability of the neuronal membranes to sodium ions, which follows neuronal depolarization, thus producing complete analgesia through blockage of sensory transmission when applied to the tissues. ● Effective and reliable analgesia; the nerve transmission is completely blocked. ● Improved postoperative analgesia by providing highly effective pre-emptic and multi- modal analgesia. ● Dilute the local anesthetic to have a safer working volume. ● Aspirate before injecting to make sure that the local anesthetic is not going IV. Toxic dosage: ● Lidocaine : 6mg/kgs in dogs and 4 mg/kgs in cats. ● Bupivacaine : 2mg/kgs in dogs and 1.5mg/kgs in cats.
other pain medication that may have unwanted side effects. By providing your patient with a multi-modal analgesia, you can give your patient a painless procedure and a quicker recovery.
Local and Regional Nerve Blocks. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg.org/local_anesthetic_use.htm Maintenance Protocols. (2011). Veterinary Anesthesia & Analgesia Support Group. http:// www.vasg.org/maintenance_protocols.htm NSAIDS. (2011) Veterinary Anesthesia & Analgesia Support Group http://www.vasg.org/ nsaids.htm Pain Meds Veterinary. (2011). Anesthesia & Analgesia Support Group. http://www.vasg. org/the_pain_process.htm Propofol. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg. org/p_drugs.htm#PROP Sevoflurane. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg. org/s_drugs.htm#SEVO Tiletamine. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg. org/t_drugs.htm#TIL Tramadol. (2011). Veterinary Anesthesia & Analgesia Support Group. http://www.vasg. org/t_drugs.htm#TRAM
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