Microsoft word - analgesic guidelines for large animal.doc

If MARKED post-surgical/post-procedural pain anticipated,
such as:.

Canine Thoracotomy

-Place fentanyl patch 24 hours prior to surgery. Replace at 72 hours.

-Rimadyl at 2.2 mg/kg SQ pre-op (just prior to induction) then once again in 12
hours then PRN at 2.2 mg/kg PO at Q12hrs.
-Fentanyl IV at 10 mcg/kg/hour when thoracic cavity is entered; continuing until
closure is about to begin.
-Bupivicaine to infiltrate body wall, skin and intercostal nerves while closing.
-Diazepam at 0.5mg/kg IV can be used as an anxiolytic during recovery.
-Oxymorphone IM 0.1mg/kg for signs of pain not controlled by the fentanyl,
rimadyl, bupivicaine, regimen.
-Sucralfate 1 gm Q12hrs PO concurrent with any Rimadyl dosing if any Rimadyl
is determined to be necessary beyond the first 24hours.
Swine thoracotomy

-Place fentanyl patch 24 hours prior to surgery. Replace at 72 hours.
-Rimadyl at 2.2 mg/kg SQ pre-op (just prior to induction) then once again in 12 hours then PRN at 2.2 mg/kg PO at Q12hrs. -Fentanyl IV at 10 mcg/kg/hour when thoracic cavity is entered; continuing until closure is about to begin. -Bupivicaine to infiltrate body wall, skin and intercostal nerves while closing. -Diazepam at 0.5mg/kg IV can be used as an anxiolytic during recovery. -Oxymorphone IM 0.15mg/kg for signs of pain not controlled by the fentanyl, rimadyl, bupivicaine, regimen. -Sucralfate 1 gm Q12hrs PO concurrent with any Rimadyl dosing if any Rimadyl is determined to be necessary beyond the first 24hours.
Feline or rabbit thoracotomy

-Place a fentanyl patch 24 hours prior to surgery. Replace at 72 hours.
Cat>10kg 50mcg/hr 5.0mg Rabbit<2kg “HalfPatch”*note
Note* DO NOT cut patches in half for ‘Half patch’ dosing. Half of the membrane should
be covered with tape to prevent contact with skin.
-Rimadyl at 2.0 mg/kg SQ pre-op (just prior to induction) then once again in 12
hours. Long term dosing of cats and rabbits is not advised. Please consult with
DLAR veterinary staff for suggestions for NSAID use in multi-modal pain
management if necessary beyond 24 hours post-operative.
-Fentanyl IV at 10 mcg/kg/hour when thoracic cavity is entered; continuing until
closure is about to begin. For rabbits with procedures lasting less than 1 hour,
the IV fentanyl drip may be omitted.
-Bupivicaine to infiltrate body wall, skin and intercostal nerves while closing.
-Diazepam at 0.1-0.5mg/kg IV (cats) or 1.0-4.0mg/kg IM or IV (rabbits) can be
used as an anxiolytic during recovery.
-Oxymorphone 0.05-0.1mg/kg IM, SQ, or IV (cats) or 0.2mg/kg IM (rabbits) for
signs of pain not controlled by the fentanyl, rimadyl, bupivicaine.
Primate thoracotomy

-Please consult with DLAR veterinary staff on a case-by-case basis.
IF MODERATE post-surgical/post-procedural pain is anticipated (i.e.
abdominal surgery, large surgical incision with moderate to significant
muscle involvement, periosteal irritation, lengthy surgical procedure,
etc.), pick BOTH one opiate AND one nsaid from table 1. and table 2.
to be used in combination to provide ‘multi-modal’ therapeutic
analgesia. Please consult with DLAR veterinary staff for specific
questions.

IF MINOR post-surgical/post-procedureal pain is anticipated (i.e small
skin incision with minor muscle involvement), pick just ONE opiate
OR one nsaid depending on procedure. Please consult with DLAR
veterinary staff for specific questions.

Table 1.
SQ. 2 dose max. recommended then 0.1 mg/kg

Source: http://vetmed.duhs.duke.edu/PDF/Guidelines%20&%20Suggestions/large_animal_analgesic_guideline.pdf