Nerve blocks, even for pluckers (were looking at you!)


Are you ready for the 12-year-old Yorkie that needs 24 teeth extracted? Theres no cookie-cutter approach in veterinary medicine! Heres help.

Dental patients are often at high risk, so you need to be sure you're monitoring and offering pain control. Tasha McNerney, MS, CVT, cofounder of Veterinary Anesthesia Nerds and Mary Berg, RVT, VTS (Dentistry), say you need a dedicated anesthetist, a multimodal pain approach … oh heck, just watch the video: 

Don't have time to watch the video? Well, OK. Are you sure? There's a not-to-be-missed anecdote from Mary Berg at 2:19 … OK, watch it later on your lunch break. (Stop sniggering, I'm trying to think positive here. It could happen. Your lunch break. Think positive!)

Here's a quick summary, because you “don't have time” (read: spent too much time on Facebook already):

Pain control philosophy:

> Mary Berg: “I believe really strongly in doing nerve blocks on every extraction, even those really simple, what we call plucker extractions. … Even if you're doing any deep root cleaning, we need to do pain management for those patients. It hurts.”

It's important to do a lot of different levels of pain management. What does that look like?

> Preemptive pain management. (Tasha McNerney says, “It's so important to control the pain before we even create the pain.”)

> Intraoperative pain management, including local blocks and multimodal constant rate infusions.

> Postoperative pain management, including multimodal “to-go-home” medications. For example, an NSAID plus an opioid.

An important note: Plan discussions with the pet owner to discover whether the pet owner can give medications. If clients can't give the medication, consider alternatives, such as hospitalizing the pet and offering continuous injections, to make sure pets get the pain control that they need.

> “We don't do a cookie-cutter approach where everybody goes home on the same two drugs,” Mary says. “It really is based upon their blood work, what their owners are able to do and what the animal can handle as far as pain management.”

Want to know what Mary says is the greatest joy for her? Ha ha, we're not telling you. Watch the video.

> You MUST HAVE a team approach to dentistry. Really. We're not kidding. One technician can't do everything. (You can tell your boss we said that.)

What does this look like? It's simple. Whoever is doing the dentistry under a doctor's supervision is not in charge of the anesthesia and pain management. This means you need a dedicated anesthetist for each dentistry patient, like you would for a surgery patient.

Another really, really important note about anesthesia: You need to use more than your monitors.

“You also need to use your eyes, ears, your hands-your stethoscope is one of your most important monitors,” Tasha says. “When you have a technician who's dedicated to the anesthesia and pain management, while you're focused on the teeth, they can come in and adjust a CRI if needed or add in more opioid if needed, if the patient's reacting under anesthesia.”

There. Now wouldn't it have been faster to just watch? It's OK, the video's still at the top of the page if you wanna watch. We won't judge.


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