informed consent information for non arthritis analgesia

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informed consent information for non arthritis analgesia

Postby malernee » Tue Sep 07, 2004 3:09 pm

Use of NSAIDS for non arthritis analgesia

A primary advantage of NSAIDS for immediate postop analgesia is the lack of
CNS & respiratory depression. An effective analgesic which does not
contribute to respiratory depression is desirable in dogs which have
obstructive airway conditions (eg bulldogs) or in cases where you want the
animal to breath deeply rather than shallowly post opertive (e.g.,
thoracotomy). Also, in humans & other animals, there is less individual
variability in analgesic dose-response to NSAIDs than to opioids. Also,
NSAIDs are not anti-tussives, so they don't impair cough reflex, whereas
opioids tend to increase potential for aspiration (in dogs).

An advantage of carprofen over currently available injectable NSAIDs
(flunixin meglumine, ketoprofen, ketorolac) is that carprofen has less COX
activity & does not appear to decrease platelet function in vitro or in
vivo. This can be advantageous for some surgical procedures & in some

However, in general, that the safety margin of opioid analgesics is
wider than that of NSAIDs. Whereas I think that NSAIDs are relatively safe
for young, relatively healthy animals, I prefer to use opioids for
immediate post operative analgesia in older animals or in cases where
hypotension/hypoperfusion was a problem or is problem post operative. I prefer to
avoid NSAIDs in animals which have preexisting renal insufficiency,
pre-renal or renal azotemia, dehydration, hypovolemia, hemorrhage,
coagulopathy, GI ulcers, etc. & in animals which are on corticosteroid

A balanced analgesic (NSAID + opioid) can be used in some patients to
improve the quality of pain management w/o using as much of each drug as
would be needed if only an opioid or NSAID was used.

It is common practice to administer an opioid for immediate post operative analgesia
(effective during emergence from anesthesia) & then administrate an injectable
NSAID after the animal is awake & stable. Some folks prefer to wait a few
hrs postop b/f admin an NSAID due to concerns about hemostasis (eg
craniotomy, thoracotomy), whereas others don't wait.

Of the currently available NSAIDs, carprofen theoretically may have the
widest safety margin as an injectable. The injectable form has been used
in Europe for several years, where some folks administer it to dogs during
anesthesia for uncomplicated routine surgical procedures, so it provides
immediate postop analgesia. I probably will continue to use opioids for immediate postop analgesia in dogs & cats.
for more information about which drugs would be best see ... ?p=375#375
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