doctorrich
08-16-2008, 12:10
Doczilla asked if I would post some information on canine analgesia in a tactical setting. We can divide veterinary pain management in the field into two catagories, chronic pain which can degrade the performance of the working dog but is not debilitating, and acute pain as a result of a sudden injury.
Chronic pain in the field can usually be managed by NSAIDs alone or in combination with mild narcotics (in more severe cases). Cases when I'd recommend these drugs are when the dog is limping occasionally in the field after strenuous exercise or after a jump or fall when the dog is not showing any acute swelling and is partially weightbearing on the limb.
First off, everything you've heard about human anti-inflammatory using in dogs is probably correct: avoid them, even as a stop-gap measure. Ibuprofen, naproxen, and acetaminophen are contraindicated in the canine patient. I have seen some dogs survive after multiple doses of ibuprofen and naproxen, but nearly all had a significant change in kidney function.
Acetaminophen is a different story. The most likely outcome of use of this drug is a severe toxic insult to the liver and the possibility of methemoglobinemia. Avoid Tylenol and don't even wave it in the direction of the dog.
Aspirin is a partial help at best, and could possibly result in gastric ulceration or clotting disorders in the field. If nothing else is available, a one-time dose of 325mg coated aspirin in a large breed dog shouldn't get you into trouble.
If you're operating in the field with a working dog, I'd recommend carrying a veterinary NSAID with instructions for use clearly printed on the label. Rimadyl (carprofen) can be administered to the dog once or twice daily depending on dosage. It's an older NSAID and long-term administration requires monitoring of hepatic enzymes (occasionally this drug causes acute hepatitis).
Metacam (meloxicam) is a once-daily NSAID in liquid form for oral administration. In my book, it has the most “bang for your buck”: great action with few side-effects. Although the drug company says that the med can be given on an empty stomach, I'd still advise to administer this drug with a meal or treat. Long-term administration is safer in my opinion than carprofen.
Deramaxx (deracoxib) is a selective COX-2 inhibitor with a mechanism of action similar to that of Celebrex or Vioxx in humans. It is, in my opinion, the strongest NSAID available in veterinary medicine today. It is a once daily pill that should always be administered with food. Overdosage will result in renal failure and possibly perforated gastric ulceration. If the dog's pain is not adequately managed with Metacam, I jump to Deramaxx. Only in rare cases do I continue this drug for long-term administration (hip dysplasia or post-surgical pain are two good indications).
It goes without saying, don't combine NSAIDs and administer them simultaneously. It would be hard to treat NSAID-induced side effects in the field, so err on the side of caution. If the dog doesn't eat, it doesn't get the med.
Tramadol 50mg tablets are safe to combine with NSAIDs in most cases. I use 50mg tabs twice daily to augment the analgesia provided by NSAIDs. In a large dog, one 50mg tab twice daily is sufficient for the management of most chronic pain. If the dog gets nauseous on NSAIDs, tramadol can be administered as a sole agent at the same dose. Avoid the formulation with acetaminophen.
Joint supplements like glucosamine +/- chondroitin +/- MSM are generally safe and can be administered with all of the previously mentioned agents. However, remember that they are supplements and not analgesics. Don't rely on glucosamine for pain relief, only for maintenance.
In severe trauma, you can utilize human narcotics so the K9 handler won't have to be tasked with carrying their dog's supply of schedule II drugs. I don't have any personal experience in administering narcotics orally... I depend on parenteral administration.
Morphine is my favorite canine narcotic, followed by hydromorphone. Morphine can be administered IM or SQ at 0.5mg/kg in combination with NSAIDs- avoid IV administration if possible. A second identical dose can be administered if 0.5mg/kg isn't sufficient to control the pain. However, dogs often get opioid dysphoria at higher doses. If you notice crying, biting, screaming, with or without mydriasis, reverse with naloxone. Titrate to effect.
Hydromorphone can be substituted for morphine at a dose of 0.1mg/kg. You can administer hydromorphone IM, SQ, and also IV.
Side effects from both drugs include transient hyperthermia and excessive panting, as well as vomiting immediately after administration. That's okay.
It's safe to induce general anesthesia with hydromorphone IV, followed by 0.2mg/kg diazepam or midazolam. If you can't intubate after a dose of both drugs IV, repeat diazepam and try again. Propofol (diprivan) is also a good choice as well as etomidate.
Remember that you can use buprenorphine 1mL/20 pounds or butorphanol 0.2mg/kg IV to reverse profound sedation from the heavy narcotics while preserving most of the analgesia. Do this only as a last resort. I'm not a fan of either of these drugs as primary analgesics. In dogs, they're just not as effective as morphine or hydro.
I shouldn't have to put a disclaimer on a post in this forum, so let's just say that I can't see your dog and prescribe drugs over the Internet. Proceed with due caution and seek competent care as soon as feasible.
Hope this helps, guys! Any questions?
Chronic pain in the field can usually be managed by NSAIDs alone or in combination with mild narcotics (in more severe cases). Cases when I'd recommend these drugs are when the dog is limping occasionally in the field after strenuous exercise or after a jump or fall when the dog is not showing any acute swelling and is partially weightbearing on the limb.
First off, everything you've heard about human anti-inflammatory using in dogs is probably correct: avoid them, even as a stop-gap measure. Ibuprofen, naproxen, and acetaminophen are contraindicated in the canine patient. I have seen some dogs survive after multiple doses of ibuprofen and naproxen, but nearly all had a significant change in kidney function.
Acetaminophen is a different story. The most likely outcome of use of this drug is a severe toxic insult to the liver and the possibility of methemoglobinemia. Avoid Tylenol and don't even wave it in the direction of the dog.
Aspirin is a partial help at best, and could possibly result in gastric ulceration or clotting disorders in the field. If nothing else is available, a one-time dose of 325mg coated aspirin in a large breed dog shouldn't get you into trouble.
If you're operating in the field with a working dog, I'd recommend carrying a veterinary NSAID with instructions for use clearly printed on the label. Rimadyl (carprofen) can be administered to the dog once or twice daily depending on dosage. It's an older NSAID and long-term administration requires monitoring of hepatic enzymes (occasionally this drug causes acute hepatitis).
Metacam (meloxicam) is a once-daily NSAID in liquid form for oral administration. In my book, it has the most “bang for your buck”: great action with few side-effects. Although the drug company says that the med can be given on an empty stomach, I'd still advise to administer this drug with a meal or treat. Long-term administration is safer in my opinion than carprofen.
Deramaxx (deracoxib) is a selective COX-2 inhibitor with a mechanism of action similar to that of Celebrex or Vioxx in humans. It is, in my opinion, the strongest NSAID available in veterinary medicine today. It is a once daily pill that should always be administered with food. Overdosage will result in renal failure and possibly perforated gastric ulceration. If the dog's pain is not adequately managed with Metacam, I jump to Deramaxx. Only in rare cases do I continue this drug for long-term administration (hip dysplasia or post-surgical pain are two good indications).
It goes without saying, don't combine NSAIDs and administer them simultaneously. It would be hard to treat NSAID-induced side effects in the field, so err on the side of caution. If the dog doesn't eat, it doesn't get the med.
Tramadol 50mg tablets are safe to combine with NSAIDs in most cases. I use 50mg tabs twice daily to augment the analgesia provided by NSAIDs. In a large dog, one 50mg tab twice daily is sufficient for the management of most chronic pain. If the dog gets nauseous on NSAIDs, tramadol can be administered as a sole agent at the same dose. Avoid the formulation with acetaminophen.
Joint supplements like glucosamine +/- chondroitin +/- MSM are generally safe and can be administered with all of the previously mentioned agents. However, remember that they are supplements and not analgesics. Don't rely on glucosamine for pain relief, only for maintenance.
In severe trauma, you can utilize human narcotics so the K9 handler won't have to be tasked with carrying their dog's supply of schedule II drugs. I don't have any personal experience in administering narcotics orally... I depend on parenteral administration.
Morphine is my favorite canine narcotic, followed by hydromorphone. Morphine can be administered IM or SQ at 0.5mg/kg in combination with NSAIDs- avoid IV administration if possible. A second identical dose can be administered if 0.5mg/kg isn't sufficient to control the pain. However, dogs often get opioid dysphoria at higher doses. If you notice crying, biting, screaming, with or without mydriasis, reverse with naloxone. Titrate to effect.
Hydromorphone can be substituted for morphine at a dose of 0.1mg/kg. You can administer hydromorphone IM, SQ, and also IV.
Side effects from both drugs include transient hyperthermia and excessive panting, as well as vomiting immediately after administration. That's okay.
It's safe to induce general anesthesia with hydromorphone IV, followed by 0.2mg/kg diazepam or midazolam. If you can't intubate after a dose of both drugs IV, repeat diazepam and try again. Propofol (diprivan) is also a good choice as well as etomidate.
Remember that you can use buprenorphine 1mL/20 pounds or butorphanol 0.2mg/kg IV to reverse profound sedation from the heavy narcotics while preserving most of the analgesia. Do this only as a last resort. I'm not a fan of either of these drugs as primary analgesics. In dogs, they're just not as effective as morphine or hydro.
I shouldn't have to put a disclaimer on a post in this forum, so let's just say that I can't see your dog and prescribe drugs over the Internet. Proceed with due caution and seek competent care as soon as feasible.
Hope this helps, guys! Any questions?