Vet360 Vet360 Vol 05 Issue 03 - Page 26

DENTISTRY DENTISTRY Figure 4A. Unsterile surgical instruments; note the dog hairs. Figure 4D 10 Say no to extractions without regional anaesthesia and postoperative pain medication No animals under our care should experience pain when it can be prevented. The benefits of regional anaesthesia include decreased pain during and after surgical procedures, decreased risk of vagally mediated reflex bradycardia, lower inhalant requirements, and a level plane of general anaesthesia reducing the variation of anesthetic depth when painful stimulation occurs. Figure 4B. Instruments in the author's extraction pack. The three most common regional blocks in veterinary dentistry are the caudal maxillary, infraorbital and caudal mandibular blocks. Frequently administered single-agent local anaesthetics include lidocaine and bupivacaine. Many practices use a combination of 0.5% bupivacaine hydrochloride with epinephrine (Marcaine) (1 mg/kg) and lidocaine 2% (1 mg/kg) in a 4:1 ratio. Mixing 0.8 ml of bupivacaine with 0.2 ml of lidocaine in the same tuberculin syringe accomplishes the 4:1 ratio. The recommended volume for regional anaesthesia is 0.1- 0.3 ml per injection site. Maximum patient dosage of this mixture is 0.2 ml/kg bupivacaine, or approximately 0.25 ml per jaw quadrant (in case all quadrants need anaesthesia for a 5-kg cat or dog). Figure 4C. Sharpening stone and oil. vet360 Issue 03 | JULY 2018 | 26 Issue 04 | AUGUST 2017 26 Another option is to mix small volumes of an opioid with a local anaesthetic. Buprenorphine has been shown to extend anaesthetic duration up to threefold compared with bupivacaine alone. Small volumes of buprenorphine 0.003 mg/kg can be mixed with bupivacaine hydrochloride in the patient’s regional block volume.All dogs and cats should receive postoperative pain relief medication after extractions for at least three days.