I was just reading an article in Dr. Doug Casey’s specialty folder regarding pain management after ACL surgery.>
I was just reading an article in Dr. Doug Casey’s specialty folder regarding pain management after ACL surgery.>
After Dr. Bob Stein lists his typical pain management ACL protocol, he notes that he has “drifted further and further away from routine Fentanyl patch use.” I personally LOVE Fentanyl patches for strong, lasting pain relief in conjunction with an NSAID and Tramadol in a normal, healthy dog. It provides great pain relief after an ACL, the owners can also see it’s value and like how it works and how it is so unobtrusive. We also use it in our end-stage cancer patients which works wonders when the patient may be nauseous, difficult for the owner to pill, or when all other oral medications do not provide good pain management. We do use spiked CRI’s (MLK usually; Morphine, Lidocaine, Ketamine) on our painful post-op surgeries as well, back pain patient’s, etc. We do steer clear of cats with Fentanyl and only use it as a last resort as they are more drug sensitive. A great site for CRI infusions can be found here at http://www.vasg.org/constant_rate_infusions.htm A La Dr. Stein as well. 🙂
I know there are many practices that do not use Fentanyl patches and I was curious to know what you do use and also what your experience has been with Gabapentin for pain control? We have dispensed Gabapentin for pain, but it is not our routine “go to drug” at the moment. As a technician pain control is a big issue; we want our patient’s as comfortable as is possible without sending them to the Betty Ford Clinic.
Comments
I also love Fentanyl for just
I also love Fentanyl for just about all canine orthopedic patients, keep in mind that there are a few patients who do not handle it well. I like to apply the patch and observe the patient for the first 24 hours if possible. I have seen a patient who after having the patch on for about 18 hours became very agitated, pacing, whining, panting. She also became constipated and had a very difficult time urinating. These are side effects not often seen but had happened to this patient twice, needless to say no more Fentanyl for her. As far as Gabapentin, I LOVE IT!!! Sorry to say my first experinece with it was my own dog, a F/S, 7 years old, Greeat Dane. She was seen at AREA by the neurologist and the Gabapentin gave her relief when other drugs did not. I also used it more recently with my 5 years old, MN, Great Dane with a partial ruptured C6-C7. After using it on my own kids our hospital started using it more often and have great success, a few patients do get sleeepy, but sleep is good when your in pain. For those of you not using Fentanyl or Gabapentin as of yet, what are you waiting for?
I also love Fentanyl for just
I also love Fentanyl for just about all canine orthopedic patients, keep in mind that there are a few patients who do not handle it well. I like to apply the patch and observe the patient for the first 24 hours if possible. I have seen a patient who after having the patch on for about 18 hours became very agitated, pacing, whining, panting. She also became constipated and had a very difficult time urinating. These are side effects not often seen but had happened to this patient twice, needless to say no more Fentanyl for her. As far as Gabapentin, I LOVE IT!!! Sorry to say my first experinece with it was my own dog, a F/S, 7 years old, Greeat Dane. She was seen at AREA by the neurologist and the Gabapentin gave her relief when other drugs did not. I also used it more recently with my 5 years old, MN, Great Dane with a partial ruptured C6-C7. After using it on my own kids our hospital started using it more often and have great success, a few patients do get sleeepy, but sleep is good when your in pain. For those of you not using Fentanyl or Gabapentin as of yet, what are you waiting for?
Hi Dogmom, the trend these
Hi Dogmom, the trend these days is getting away from fentanyl patches and using either injectable fentanyl or buprenorphine. The problem clinicians were having was with the continuous absorption of the patch due to poor adherence of the patch itself and not the drug. The patches were designed for human skin and not our canine/feline patients. I also love gabapentin and have my 17yr old poodle on it now for a acute cervical disc. Great group to join if you like pain management is IVAPM.org. Hope this helps
Doug Casey
Hi Dogmom, the trend these
Hi Dogmom, the trend these days is getting away from fentanyl patches and using either injectable fentanyl or buprenorphine. The problem clinicians were having was with the continuous absorption of the patch due to poor adherence of the patch itself and not the drug. The patches were designed for human skin and not our canine/feline patients. I also love gabapentin and have my 17yr old poodle on it now for a acute cervical disc. Great group to join if you like pain management is IVAPM.org. Hope this helps
Doug Casey
Thank you for the response
Thank you for the response Dr. Casey. I will see if I can get my clinic to use Gabapentin more, it seems like a great drug for pain.
Thank you for the response
Thank you for the response Dr. Casey. I will see if I can get my clinic to use Gabapentin more, it seems like a great drug for pain.
http://www.ivapm.org/
http://www.ivapm.org/
http://www.ivapm.org/
http://www.ivapm.org/
I recently attended a pain
I recently attended a pain seminar given by Dr. Mark Epstein (a strong proponent of IVAPM). I asked his recommendation for treatment of hyperesthesia in cats, since he stressed that all signs point to this being quite a painful condition in cats. He suggested Gabapentin as the drug of choice. My own cat has this, and at least 2-3 times a week would go through an episode – racing around uncontrollably, turning around toward his back and hissing, meowing in a way cats do when they are painful or very stressed. I put him on Gabapentin, and amazingly and to my relief he has had maybe only 2 very mild episodes in the past 3 months. No other changes or side effects apparent to me. Definitely something to consider.
I recently attended a pain
I recently attended a pain seminar given by Dr. Mark Epstein (a strong proponent of IVAPM). I asked his recommendation for treatment of hyperesthesia in cats, since he stressed that all signs point to this being quite a painful condition in cats. He suggested Gabapentin as the drug of choice. My own cat has this, and at least 2-3 times a week would go through an episode – racing around uncontrollably, turning around toward his back and hissing, meowing in a way cats do when they are painful or very stressed. I put him on Gabapentin, and amazingly and to my relief he has had maybe only 2 very mild episodes in the past 3 months. No other changes or side effects apparent to me. Definitely something to consider.
Well I am certainly glad it
Well I am certainly glad it is helping your cat. Does it have any sedative properties?
Well I am certainly glad it
Well I am certainly glad it is helping your cat. Does it have any sedative properties?
One of its side effects is
One of its side effects is mild sedation. I haven’t noticed any difference in my cat, using a very low dose (and he spends a lot of time sleeping anyway!). I had used it in a previous cat for idiopathic seizures, at the standard dose, and it seemed there was some mild sedation in his case.
One of its side effects is
One of its side effects is mild sedation. I haven’t noticed any difference in my cat, using a very low dose (and he spends a lot of time sleeping anyway!). I had used it in a previous cat for idiopathic seizures, at the standard dose, and it seemed there was some mild sedation in his case.
Great catlady thank you for
Great catlady thank you for the info. 🙂
Great catlady thank you for
Great catlady thank you for the info. 🙂