CAL: Pain and Analgesia

Question 1

What type of drug is buprenorphine?

Answer 1

partial ag (m?)

Question 2

What type of drug is naloxone

Answer 2

fll antagonist

Question 3

What type of drug is butorphanol

Answer 3

mixed ag/ant

Question 4

Which analgesic cannot be given IV? Why?

Answer 4

Pethidine causes massive histamine release and anaphylaxis

Question 5

Give egs. of good, acceptable and unacceptable pain management for pre-op care of a 30kg lab cruciate repair surgery.

Answer 5

+ NSAIDs (carprofen, meloxicam) v inflam d/t surgery
+ morphine (good orthpeadic painkiller)
~ pethidine short doa and large volume wouldb e needed for this dog
~ buprenorphine long doa so will cover postop, but only partial ag so not strong pain relef
- not butorphanol, poor analgesia for surgery (m-R)

Question 6

Give egs. of good, acceptable and unacceptable pain management for intra-op care of a 30kg lab cruciate repair surgery.

Answer 6

+ top up opioids eg. morphine IM
+ CRI fentanyl
+ NO good analgesic but wears off quick
+ epidural morphine +- LA (though side effects may be too much, eg. motor paralysis, urinary dysfunction, delayed hair growth at site of clipping)
~ intraarticular morphine +- LA (check answer)
- not top ups of NSAIDs, should be dosed q12-24hrs

Question 7

Give egs. of good, acceptable and unacceptable pain management for post-op care of a 30kg lab cruciate repair surgery.

Answer 7

+ Oral NSAIDs

+ injectable opioids (if morphine given epidurally will provide 24hrs analgesia)

Question 8

2yo RTA cat, stable, femur fx going to sx tomorrow- pre-op analgesia?

Answer 8

> methadone
- pure m ag
- good in cats
- low risk of V+
buprenorphine
- partial m ag
- clinically better analgesia than morphine and pethidine
- rarely V+ and dysphoria
- can be given orally (transmucosal) with 100% bioavailability
NSAIDs
- carprofen and meloxicam effective, LIC once off dose for peri-operative analgesia
epidural analgesia of LA
- v GA drugs needed
- if morphine used can also give post-op analgesia
- cats meninges end further caudally so risk of hitting CSF
cage rest and nursing
- emotional component of pain

Question 9

Should you immobilise a fx in a rta cat before surgery?

Answer 9

No

- don’t tolerate bandages well and not advocated

Question 10

Cut on horses leg - best analgesia to inspect and tx?

Answer 10

• sedation + mepivicaine local (LIC horses)