Pain management strategies in the dental patient - DVM
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Pain management strategies in the dental patient


DVM InFocus


Butorphanol is widely used, but it has a ceiling effect and requires frequent dosing. It can be combined with ketamine in the CRI perioperative cocktail. The dosage is 12 mg butorphanol in 1 liter of LRS given at 1-2 ml/kg/hr.

Butorphanol will antagonize the sedative effect of high doses of a complete opiod agonist.

In cats, the analgesic effect of butorphanol and oxymorphone combined is greater than the additive effect. Another option is the low dose administration of butorphanol in Pet-tinic, clindamycin liquid or amoxicillin. Either the 2 mg /ml or 10 mg /ml preparation can be used to make a final concentration of 0.46 to 0.49 mg/ml of butorphanol. This is dosed at 0.5 ml-1.0 ml for a 1- 20 lb. cat twice daily.

•Fentanyl: The transdermal 25, 50 and 100 ug/hr patches have a lag time of approximately 12 hours. It's a novel "non-intrusive" method of administering the product. There is evidence that the uptake is unpredictable, and the plasma concentration is variable among cats.

Buprenorphine would appear to be the opoid of choice for pain attenuation in the cat. The onset of action is relatively slow (20-30 minutes); its duration of effect lasts from eight to 12 hours. The buccal or transmucosal route has proved to be ideal for cats.

Tramadol is an effective and well-tolerated agent to reduce pain resulting from trauma, and also for the management of chronic pain of malignant or nonmalignant origin.

The combination of tramadol and morphine is infra-additive and thus not recommended for post-operative analgesia.

The administration of tramadol and an NSAID provides more profound analgesia than either drug used alone.

•NSAIDS: NSAIDs are contraindicated in animals with pre-existing renal disease, hypovolemia or bleeding disorders. NSAIDs, by controlling inflammation, help prevent central hypersentization or wind-up. The available NSAIDs are: meloxicam, piroxicam, carprofen, ketoprofen and tepoxalin.

Pain control is an unimplemented and underutilized medical need for our veterinary dental patients. In order to institute adequate pain management strategies, a multidisciplinary, multimodal approach should be taken.

Dr. Surgeon owns the ANC Veterinary Center in New Rochelle, New York. He is a fellow of the Academy of Veterinary Dentistry and a diplomate of the American Veterinary Dental College.


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Source: DVM InFocus,
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