Veterinary Anesthesia Nerds cover common drug myths

Content sponsored by Jurox

The Anesthesia Nerds—including Mike Barletta, DVM, MS, PhD, DACVAA; Bryce Dooley, DVM, MS, DACVAA; Darci L. Palmer, BS, LVT, VTS (Anesthesia); Stephen Niño Cital, RVT, SRA, RLAT, CVPP, VTS; and Tasha McNerney, BS, CVT, CVPP, VTS—tackled common anesthesia drug myths during their presentation at the 2022 Fetch dvm360® Conference in San Diego, California.¹

The lecture offered an interactive experience for attendees as the Anesthesia Nerds asked for their insight and questions on the topic for the conversation to flow organically. Below are 2 myths from their session.

Myth #1

Cerenia (Maropitant Citrate) functions as a visceral analgesic.

Barletta first offered his insight and said that though Cerenia’s mechanism of action demonstrates it can theoretically be used for visceral pain, it doesn’t work as a visceral analgesic at the dose veterinary anesthesiologists are using it for. “There are some studies where it’s used at a way higher dose, like 10 times that…but definitely you should not use it for visceral pain, that is not going to work.” Cital agreed with him on this topic and added further notes. “It’s important when we're reading scientific papers that come out like that, where you read the conclusions…and then there's some difference with a discussion that says it might be good for analgesia, it's really important to look at the clinical dosages that we're using in practice compared to the CRI, and the super high doses that they're using in those studies.” Cital also advised to review the methods section of the paper and see if the claims made in the discussion were even evaluated to fully understand the aim of the study.

Dooley said that though Cerenia doesn’t help address pain, she uses it in patients for its intended antiemetic purposes and to decrease nausea. It’s important to note though, according to Palmer, that this drug can help prevent vomiting if given at the appropriate time ahead of when you’re giving premeds, but it doesn’t do anything for regurgitation. “I use it as long as it's not contraindicated for the patient to vomit. And I don't know if it might be an unpopular opinion, but I don't care if my patients vomit in the preoperative period. But I'm going to give it as a premed because I want it to help with the postoperative nausea,” Dooley shared.

Myth #2

Three days of postoperative Gabapentin provides a sufficient level of analgesia.

Barletta argues that while Gabapentin is excellent for chronic pain, it is not useful for acute, surgical, or postoperative pain. Dooley commented, “Gabapentin [for] that acute postoperative period is really not going to work as an analgesic the way a non-steroidal inflammatory drug [NSAID] is, an opioid, those sorts of things. Again, potential adjunct, sure, especially for chronic pain and neuropathic pain. And if you want to start it a little bit before this big surgery that you're planning…but you don't want it to be your only acute postoperative pain control medication.”

An attendee then asked if a patient is already on steroids, so you don't want to use an NSAID, if you increase your steroid dose for the post-operative pain or use an additional drug? Dooley answered that surrounding a surgery trip to the hospital, she increases their steroid dose anyway because of the stress response. However, that is a circumstance where Gabapentin can be added and serve as an adjunctive medication.

Reference

Barletta M, Dooley B, Palmer DL, Cital SN, McNerney T. Common myths and misconceptions in veterinary anesthesia and pain management. Presented at: Fetch dvm360® Conference; San Diego, California. December 2-4, 2022.