Answering Your Questions: Practical analgesia in cats - Veterinary Medicine
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Answering Your Questions: Practical analgesia in cats
Cats will suffer in silence, so it's our job to either predict when they will face pain or recognize when they are feeling pain. Then we must choose suitable drugs from our armamentarium to prevent or relieve their discomfort.


VETERINARY MEDICINE


Regarding the opioids, a synergistic central nervous system sedative effect occurs in all species when opioids are combined with sedative or anxiolytic drugs. In general, when using opioids for pain management, reduce concurrent doses of acepromazine, alpha2 agonists, or benzodiazepines. Similarly, if the opioid is already on board, then reduce concurrent injectable and inhalant anesthetic doses. This can be viewed as a beneficial drug interaction because opioids allow dose reductions of drugs with cardiopulmonary depressant effects (e.g. isoflurane). No specific drug interactions with opioids preclude their use, but be mindful of additive physiologic effects when using opioids with other medications. For example, when used repeatedly or in high doses, opioids may cause urinary retention or gastrointestinal ileus. So in patients receiving atropine, which is known to cause ileus, and then an opioid, markedly decreased gastrointestinal motility may occur, necessitating closer monitoring of those patients' water and food intake.

NSAIDs have more potential drug interactions that could preclude their use. The relatively selective COX-2 agents (e.g. meloxicam, carprofen) can increase the toxicity of warfarin, methotrexate sodium, valproic acid, furosemide, spironolactone, and sulfonylureas.25 NSAIDs may decrease the efficacy of furosemide, thiazides, ACE inhibitors, and beta-blocking agents.24 Finally, relatively selective COX-2 agents are more likely to be toxic when administered with aminoglycosides, furosemide, cyclosporine, and glucocorticoids.25

Lesley J. Smith, DVM, DACVA
Department of Surgical Sciences
School of Veterinary Medicine
University of Wisconsin
Madison, WI 53706

REFERENCES

1. Dobbins S, Brown NO, Shofer FS. Comparison of the effects of buprenorphine, oxymorphone hydrochloride, and ketoprofen for postoperative analgesia after onychectomy or onychectomy and sterilization in cats. J Am Anim Hosp Assoc 2002:38:507-514.

2. Slingsby LS, Waterman-Pearson A. Comparison of pethidine, buprenorphine, and ketoprofen for postoperative analgesia after ovariohysterectomy in the cat. Vet Rec 1998;143:185-189.

3. Stanway G, Taylor P, Brodbelt D. A preliminary investigation comparing pre-operative morphine and buprenorphine for postoperative analgesia and sedation in cats. Vet Anaesth Analg 2002;29:29-35.

4. Lascelles BD, Robertson SA, Taylor P, et al. Comparison of the pharmacokinetics and thermal antinociceptive pharmacodynamics of 20 g/kg buprenorphine administered sublingually or intravenously in cats. Vet Anaesth Analg 2003;30:109.

5. Lascelles BD, Roberson SA. Antinociceptive effects of hydromorphone, butorphanol, or the combination in cats. J Vet Intern Med 2004;18:190-195.

6. Lascelles BD, Robertson SA. Use of thermal threshold response to evaluate the antinociceptive effects of butorphanol in cats. Am J Vet Res 2004;65:1085-1089.

7. Brock KA, Webb AI. Intravenous lidocaine kinetics in cats and dogs, in Proceedings. 3rd Int Cong Vet Anesth 1988;A61.

8. Heavner JE. Local anesthetics. In: Thurmon JC, Tranquilli WJ, Benson GJ, eds. Lumb and Jones veterinary anesthesia. 3rd ed. Baltimore, Md.: Williams & Wilkins, 1996;330-336.

9. Giasi RM, D'Agostino E, Covino BG. Absorption of lidocaine following subarachnoid and epidural administration. Anesth Analg 1979;58:360-363.

10. Lamont LA. Feline perioperative pain management. Vet Clin North Am Small Anim Pract 2002;32:747-763.

11. Duke T, Cox AM, Remedios AM, et al. The analgesic effects of administering fentanyl or medetomidine in the lumbosacral epidural space of cats. Vet Surg 1994;23:143-148.

12. Duke T, Cox AM, Remedios AM, et al. The cardiopulmonary effects of placing fentanyl or medetomidine in the lumbosacral epidural space of isoflurane-anesthetized cats. Vet Surg 1994;23:149-155.


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