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Post Op Pain Management Question
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11 October 2017 - 4:59 pm
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My dog Maddie is scheduled for amputation of her right front leg next Tuesday.  She was originally scheduled last week (it was delayed due to a questionable xray which turned out to be okay) and when we checked her in we discussed post op pain meds with the nurse.  She advised that Maddie would come home on Codeine.  Having been prescribed Tylenol with Codeine myself, I question whether this is strong enough for post operative pain.  I'm wondering what is typically prescribed?  Right now she is on 600 mg of Tramadol a day, 400 mg of Gabapentin a day and 100 mg of Deramaxx a day (she is 165 lbs).   I want to make sure that if codeine isn't typically prescribed, we leave with the right meds next week.  Her surgery will be Tuesday morning and the plan is for her to come home Wednesday.  Thank you in advance!

Bobbi & Maddie

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11 October 2017 - 5:50 pm
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Great question Bobbi, thanks for asking. I'm interested to hear what our Fairy Vet Mother has to say. I myself would wonder if Codeine is strong enough. I've had major surgeries and I know it wouldn't be for me.

In our experience Tripawds usually come home with a minimum of Tramadol, a Fentanyl patch, a non-steroidal anti-inflammatory like Metacam and Gabapentin for nerve pain. You can read more about the latest Veterinary Pain Management Guidelines then ask your vet about why they chose Codeine. 

Also this post may help you with more info:

Post-Surgery Pain in Tripawd Dogs and Cats

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12 October 2017 - 9:25 am
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Codeine is a much stronger and more effective pain reliever than tramadol so you will see more vets using it for post-op pain.  Our local neurologist uses this quite a bit for dogs with severe back or neck pain.  The only problem is the potential for human abuse so you will not see it used for chronic pain.

Pam

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12 October 2017 - 11:36 am
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Thank you both.   Should she get something in addition to the codeine though?  That's my concern.  Originally Maddie's oncologist put her on the three meds she is currently taking.  After seeing the surgeon, he increased the gabapentin and took her off the tramadol completely.  Within 24 hours her pain had noticeably increased.  When I called him and told him this, he increased the gabapentin to 600 mg a day which did not seem to do anything but knock her out.  When I called again, her surgeon was not in so the other surgeon put her back on tramadol and reduced the gabapentin back to 400 mg and she's much better.  I guess this is why I'm concerned about the choice of codeine because the last change in pain meds seemed to make her worse.  The surgeon did say that tramadol has been shown not to work well in dogs - but it does seem to work for Maddie. 

Virginia
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12 October 2017 - 11:53 am
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My non Vet, unprofessional input.  EVERY DOG IS DIFFERENT AND EVERY DOG REACTS TO PAIN MEDICINE DIFFERENTLY!

You are being guided by yiur Vet and if Madeline is much more comfortable with the latest combo of Tram and Gaba at the new doses he suggested, then stick with it!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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12 October 2017 - 12:03 pm
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Thanks - yes she is better on it for the pre-surgery leg pain.  I am worried about post amputation.  When I asked the nurse what meds she would come home with and she said "Codeine" I got worried that it wouldn't be enough.  I will talk to him again when she goes in for the procedure on Tuesday and make sure I tell him I'm worried about her post operative pain.  I really like this vet specialty center and they have always been great whenever any of my dogs have been treated there - I guess I'm probably just over reacting.  I hate seeing her in pain crying 

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13 October 2017 - 10:16 am
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I'm sure that they would have no problems substituting the tramadol for the codeine. Definitely keep up the Deramaxx for at least 2 weeks post op.

People also have different tolerances to the various narcotics and it is not unusual for some drugs to work better than others.  Unfortunately it is sometimes hard to predict in our pets because they can't tell us how they feel.

There is something called an Assisi Loop that I am probably going to order for my own dog Julian (he has arthritis in his hock joints).  It can be used for both chronic and acute pain and there is an indication for post op pain specifically for amputees.  It looks promising and I will let everyone know how it works.  I have also used CBD oil (I use Hemp RX) but so far that has not been that helpful.

Pam

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13 October 2017 - 9:45 pm
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Thanks Jerry!

Pam

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