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General Drug Protocols

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Drug Protocols for Veterinary Surgery

Information to help general practices prepare for surgical procedures.

Both soft tissue and orthopedic surgery can result in moderate to severe post-operative pain. It is important to address this pain pre-operatively, intra-operatively and post-operatively. Although there are many possible drug protocols to tackle peri-operative pain, they all typically include an opioid, an NSAID, alpha-2 agonists, dissociatives, as well as local analgesics. The following recommendations are guidelines only and you may choose to alter them to fit your preferences. However, it is important to address peri-operative pain in a multi-modal fashion and protocols should be similar to the ones listed below. These drugs can be easily purchased through your local vendor. Antibiotic recommendations are also listed below.

These are general protocols only and should be adjusted based on patient needs, co-morbidities or concurrent medications.

Examples of anesthetic protocols are listed by species and procedure type below. If you choose to provide epidural analgesia to your patients, this can be performed by your MOVES surgery partner pre-operatively. Your MOVES partner may also be willing to train dedicated staff to safely and successfully perform epidural injections. Please discuss these protocols with your MOVES partner and reach out to them directly with any questions or concerns.

Canine Orthopedic Surgery

Preoperative

  • Hydromorphone 0.1mg/kg IM 15 minutes prior to induction
  • Midazolam 0.2mg/kg IM 15 minutes prior to induction (can combine with hydro for one IM injection)
  • Carprofen 2.2mg/kg SQ
  • +/- Cerenia 1mg/kg IV

Induction

  • Propofol 4 – 6mg/kg IV slow and to effect
  • Duramorph epidural 0.1mg/kg

Maintenance

  • Isoflurane

Immediate Postoperative

  • Hydromorphone 0.05mg/kg IM during recovery
  • Hydromorphone 0.1mg/kg IM or IV q4-6 hours while in hospital
  • Fentanyl patch transdermal, size closest to patient weight in pounds (12-24 hour lag period)
  • Can also consider an HLK CRI while in hospital (CRI drug calculator available):
    • Hydromorphone
    • Lidocaine
    • Ketamine

Later Postoperative

  • Carprofen 2.2mg/kg PO q12 (or 4.4mg/kg PO q24)
  • Tramadol 4mg/kg PO q8-12 or Gabapentin 10mg/kg PO q12

Antibiotics

  • Cefazolin 22mg/kg IV at induction (30 minutes prior to first cut)
  • Repeat q90 minutes intra-op
  • Repeat q8 hours post-op while in hospital (up to 24 hours)
  • Cephalexin 22mg/kg PO q12 x 7 days

Feline Orthopedic Surgery

Preoperative

  • Hydromorphone 0.1mg/kg IM 15 minutes prior to induction (OR Fentanyl 0.003mg/kg IV at induction)
  • Midazolam 0.2mg/kg IM 15 minutes prior to induction (can combine with hydro for one IM injection)
  • Meloxicam 0.1mg/kg SQ
  • +/- Cerenia 1mg/kg IV

Induction

  • Propofol 4 – 6mg/kg IV slow and to effect
  • Duramorph epidural 0.1mg/kg

Maintenance

  • Isoflurane

Immediate Postoperative

  • Hydromorphone 0.1mg/kg IM or IV q4-6 hours while in hospital (OR consider a Fentanyl CRI)

Later Postoperative

  • Meloxicam 0.05mg/kg PO q24 x 3 – 5 days
  • Buprenorphine 0.01mg/kg PO q8-12 x 7 days

Antibiotics

  • Cefazolin 22mg/kg IV at induction (30 minutes prior to first cut)
  • Repeat q90 minutes intra-op
  • Repeat q8 hours post-op while in hospital (up to 24 hours)
  • Convenia 8mg/kg SQ

Canine Soft Tissue Surgery

Preoperative

  • Hydromorphone 0.1mg/kg IM 15 minutes prior to induction
  • Midazolam 0.2mg/kg IM 15 minutes prior to induction (can combine with hydro for one IM injection)
  • +/- Cerenia 1mg/kg IV
  • +/- Famotidine or Pantoprazole 1mg/kg IV if GI surgery
    Carprofen 2.2mg/kg SQ (if not GI)

Induction

  • Propofol 4 – 6mg/kg IV slow and to effect

Maintenance

  • Isoflurane

Immediate Postoperative

  • Hydromorphone 0.1mg/kg IM or IV q4-6 hours while in hospital (OR consider HLK CRI)
  • Fentanyl patch transdermal, size closest to patient weight in pounds (12-24hr lag period)

Later Postoperative

  • Tramadol 4mg/kg PO q8-12 or Gabapentin 10mg/kg PO q12
  • Carprofen 2.2mg/kg PO q12 or 4.4mg/kg PO q24 (if not GI)

Antibiotics

  • Cefazolin 22mg/kg IV at induction (30 minutes prior to first cut)
  • Repeat q90 minutes intra-op
  • Can repeat q8 hours in hospital but should not require antibiotics at home unless there was gross contamination

Feline Soft Tissue Surgery

Preoperative

  • Hydromorphone 0.1mg/kg IM 15 minutes prior to induction (OR Fentanyl 0.003mg/kg IV at induction)
  • Midazolam 0.2mg/kg IM 15 minutes prior to induction (can combine with hydro for one IM injection)
  • Meloxicam 0.1mg/kg SQ (if not GI)
  • +/- Cerenia 1mg/kg IV
  • +/- Famotidine or Pantoprazole 1mg/kg IV

Induction

  • Propofol 4 – 6mg/kg IV slow and to effect

Maintenance

  • Isoflurane

Immediate Postoperative

  • Hydromorphone 0.1mg/kg IM or IV q4-6 hours while in hospital
    • OR consider a Fentanyl CRI
    • OR Buprenorphine 0.01mg/kg IV/IM/PO q8

Later Postoperative

  • Meloxicam 0.05mg/kg PO q24 x 3 – 5 days (if not GI)
  • Buprenorphine 0.01mg/kg PO q8-12 x 5 – 7 days

Antibiotics

  • Cefazolin 22mg/kg IV at induction (30 minutes prior to first cut)
  • Repeat q90 minutes intra-op
  • Can repeat q8 hours post-op while in hospital (up to 24 hours) but should not need antibiotics to go home unless there was gross contamination