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.
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| 26
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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.