Updated 12 Feb 2020 to include updates from ACVC (2019), VMX, and WVC (2020)
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Check out the ultrasound post for links to various ultrasound-guided nerve blocks
Pure mu-agonist opioids
| Drug (duration) | Route | Dose for dog | Dose for cat | Notes |
| Fentanyl | IV CRI | 2-5mcg/kg/h | 2-5mcg/kg/h | Dose titrated to desired effect |
| Fentanyl
(15-20 min) |
IV | 2-5mcg/kg | 2-5mcg/kg | |
| Hydromorphone | IV CRI | 0.015-0.05mg/kg/h | 0.015-0.05mg/kg/h | |
| Hydromorphone
(2-6h) |
IV, IM, SC | 0.05-0.2mg/kg | 0.05-0.1mg/kg | |
| Methadone
(2-6h) |
IV, IM, SC | 0.2-0.5mg/kg | 0.2-0.5mg/kg | Also NMDA receptor antagonist |
| Morphine | IV CRI | 0.1-0.3mg/kg/h | 0.1-0.2mg/kg/h | |
| Morphine
(2-4h) |
IV (slowly),
IM, SC |
0.5-1mg/kg | 0.2-0.5mg/kg | Give slowly IV |
| Oxymorphone
(2-4h) |
IV, IM, SC | 0.05-0.4mg/kg | 0.02-0.1mg/kg | |
| Common side effects include panting, nausea, sedation, mydriasis, hypothermia, hyperexcitability, bradycardia, respiratory depression. Urine retention has been reported with fentanyl.
IV – intravenous; IM – intramuscular; SC – subcutaneous |
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Partial mu-agonist opioids
| Drug (duration) | Route | Dose for dog | Dose for cat | Notes |
| Buprenorphine
(6-12h) |
IV, IM, SC | 5-20mcg/kg | 5-20mcg/kg | Sedation apparent in 15 minutes but requires 30-45min for analgesia to occur |
| Buprenorphine [Simbadol] (24h) | SC | NA | 0.24mg/kg | Note mg, not mcg |
| Buprenorphine | OTM | NA | 10-20mcg/kg | OTM bioavailability in dogs is ~5% and not recommended |
| The partial mu-agonists antagonize the pure mu-agonists
OTM – oral transmucosal |
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Agonist-antagonist opioids
| Drug (duration) | Route | Dose for dog | Dose for cat | Notes |
| Butorphanol
(1-4h) |
IV, IM, SC | 0.1-0.4mg/kg | 0.1-0.4mg/kg | |
| Butorphanol | IV CRI | 0.03-0.4mg/kg/h | 0.03-0.4mg/kg/h | 0.1-0.4mg/kg IV |
| Moderate to strong sedative depending on dose, generally weak analgesic. Will antagonize pure-mu agonists. | ||||
Local Anesthetic Drugs
| Drug (duration) | Route | Dose for dog | Dose for cat | Notes |
| Bupivicaine | Local infiltration,
Nerve blocks, IA |
Up to 2mg/kg | Up to 1mg/kg | Can dilute 1:1 with saline |
| Lidocaine | Local infiltration,
Nerve blocks, IA |
Up to 12mg/kg
Total dose |
Up to 6mg/kg
Total dose |
|
| Lidocaine | IV CRI | 30-80mcg/kg/min
(1.8-5mg/kg/h) |
Not recommended | 1-2mg/kg IV loading dose |
| Cats are more sensitive to the cardiac depression and CNS effects of local anesthetics compared to dogs. Use with caution IV in cats. Do NOT use preparations with epinephrine IV. | ||||
NSAIDS
| Drug (duration) | Route | Dose for dog | Dose for cat | Notes |
| Acetaminophen
|
PO | 10-15mg/kg
q8-12h |
Do NOT use in cats | |
| Carprofen | SC, PO | 2-4.4mg/kg/d | Off label in USA | |
| Deracoxib | PO | 1-2mg/kg q24h | ||
| Etodolac | SC, PO | 5-15mg/kg q24h | ||
| Meloxicam | IV, SC, PO | 0.1-0.2mg/kg q24h | 0.1-0.2mg/kg ONCE | |
| Robenacoxib | SC, PO | 1-2mg/kg q24h | 1-2.4mg/kg q24h | |
| Critically ill or injured patients: should have normal blood pressure and kidney function for 12-24h, off vasopressors, prior to starting NSAIDs. | ||||
Other Analgesic Drugs
| Drug (duration) | Route | Dose for dog | Dose for cat | Notes |
| Amantadine | PO | 2-5mg/kg q24h | 2-5mg/kg q24h | |
| Dexmedetomidine | IV, IM | 125-250mcg/m2 | 150-300mcg/m2 | |
| Dexmedetomidine | IV CRI | 0.5-2mcg/kg/h | 1-2mcg/kg/h | |
| Gabapentin | PO | 3-10mg/kg q8-24h | 2-5mg/kg q8-12h | |
| Ketamine | Intermittent IV | 0.5mg/kg | 0.5mg/kg | |
| Ketamine | IV CRI | 0.3-1.2mg/kg/h | 0.3-1.2mg/kg/h | |
| Trazodone | PO | 25-50mg total dose per cat | Anxiolytic, not analgesic |
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