Monday, July 23, 2007

Forget the torbugesic

One of my biggest frustrations is the vast number of people who are sent home with nothing more for their pet's post-surgical pain than butorphanol, also called torbutrol or torbugesic. This is a drug that really has no place in the management of pain in dogs and cats, and I devoutly wish vets would stop prescribing it.

The entire four-part series on managing surgical pain in dogs and cats on the website of the Veterinary Anesthesia Support Group is actually entitled, "Looking Beyond Butorphanol." This drug is seriously, seriously useless for pain:
Often the sedation outlasts the analgesia. Canine studies have failed to demonstrate analgesia past 45 minutes[i],[ii]. Feline studies have failed to show analgesia past 90 minutes[iii],[iv]. In fact some studies have failed to show analgesia of any significance in dogs and cats[v],[vi].
Are vets prescribing it because it's cheaper than the alternatives? No:
In general, butorphanol does NOT give you much bang for the buck. Butorphanol costs about ten times more than morphine, per dose, while providing much more limited analgesia of much shorter duration.
Please, vets: Why are you using this drug for pain? It doesn't work. There are dozens of better choices, including what I consider the gold standard, customized combinations of different pain relievers that attack pain in different ways.

If your vet is still prescribing torbugesic, torbutrol, or butorphanol (different names for the same drug) for your dog or cat's pain, please ask him or her to read this series of articles:

Perioperative Pain Management: Looking beyond butorphanol
By Robert Stein, DVM, AAPM
Part 1
Part 2
Part 3
Part 4

And in case you, or your vet, want to know: Dr. Stein is a Veterinary Information Network consultant on pain management, is board certified by the American Academy of Pain Management, is on the Executive Board Advisory Committee of the International Academy of Pain Management, and also belongs to the American Pain Society, the American Society of Regional Anesthesia and Analgesia, and the International Association for the Study of Pain.

3 Comments:

At 5:56 PM, Blogger Nancy Campbell RVT said...

Thanks for posting this Christie, its use for pain is actually one of my pet peeves.
Most of the vets I work with only use it for sedation when a pet owner doesn't want to pay for a quick procedure using general anesthesia. The pain control is handled by local injections during the procedure and other drugs post-op.
However, I can't seem to get them to use something else for post-op declaws, which baffles me. They hate declaws, and even cry or curse while doing the procedure, apologizing to the cat and question the wisdom of even providing the service and yet they use "torb" for post-op pain! *sigh*

I will too, along with pet owners, print the documents and post them in our treatment room. Maybe that will do the trick, eh?

 
At 3:45 PM, Blogger Amy said...

This post touched a nerve with me as well. Butorphanol has no place in the management of pain. With all fo the advancements in veterinary pain management, I don't how this "old school" drug is still around (aside from potentially being appropriately used as an anti-tussive). In my opinion, we may as well be spitting at an animal in pain. It would give us the same results as in injection of butorphanol.

Kudos!

 
At 4:34 PM, Blogger ihuffin said...

i am adopting a puppy and she is haveing surgry thi s week Wednesday, the Vet says " if nothing else she i strongly recomend me using the Torbugesix "2 dosage 10 mg/ml 50ML @32.42. after reading the blog i am so confrused being a new dog/puppy owner. is there another drug that i should request that would ease the pain?

 

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