Okaw Veterinary Clinic

140 W. Sale
Tuscola, IL 61953

(217)253-3221

www.okawvetclinic.com

Reduction of Aggression & Increased Staff Safety during Veterinary Exams using Topical Lidocaine Combination Cream

 

Abstract:

A method of using Lidocaine combination cream (Lidocaine 2.5% prilocaine 2.5%) to reduce pain and aggression during veterinary exams was developed at Okaw Veterinary Clinic Tuscola. The objective was to develop a fast acting topical pain reducer for cases where tranquilization was not feasible. Reduction of patient aggression patient was also paramount to improve staff safety. The technique is to apply a small amount of the cream to the pinna and ear canal after positive muzzling.  A few minutes later, cytology samples are taken. Ear cleaning, examination and treatment is continued. Lidocaine combination creams are easy to administer, readily available through human pharmacies and veterinary distributors, non irritating to tissues, and do not interfere with cytology results or the effectiveness of common ear medications. Routine use of this product is  one way to reduce pain and related anxiety with veterinary exams, and to increase staff safety through reduced patient aggression. Creams can be dispensed to clients to aid in pain reduction for home care, increasing client compliance with treatment. Lidocaine cream can also be used for anal gland treatment, broken nail treatment and other procedures.

Introduction:

Often pets are presented in small animal practice with painful body areas. Examination of these areas can trigger aggression, increasing the difficulty for examination and treatment. (1) Topical Lidocaine combination creams have been used in veterinary medicine for short procedures and found to have an analgesic effect. An equine study found topical lidocaine - prilocaine 2.5% cream to be as analgesic as inject able lidocaine with less twitching time for episioplasty (2) In our office, use of topical lidocaine - prilocaine 2.5% combination cream reduces pain within minutes, decreasing aggressive behavior and increasing staff safety for ear and anal exams.

 

Materials :      

Dr. Foote with Lidocaine creamLidocaine - Prilocaine cream in a 1 oz tube

cotton tipped swabs

muzzles

high valued treats - peanut butter, liver paste, or a/d food

latex gloves

Method:

 For dogs or cats presenting with evidence of ear pain, use a long q-tip or gloved finger to quickly swab the inner surface of the pinna and ear canal with lidocaine - prilocaine cream 2.5% before  examination. Wait 3-5 minutes. Examination of other areas, or further history may be taken in this time. Obtain cytology and culture samples. Proceed with ear cleaning and examination.      

Anal gland expression: Prior to rectal examination, apply a small amount of cream to the external anal area and inside the anus. Wait 5 minutes. Then proceed with rectal examination and anal gland expression. Anal gland flush can also be performed easily at this point. The cream will not aggravate inflammation, or interfere with antibiotic administration.  

 

Case 1: Ear treatment in "Nicco"

lidocain creamAfter initial history taking, Nicco was  fitted with a nylon muzzle with peanut butter, fed though the opening at the mouth. Nicco was restrained by staff on the exam table.   As Nicco was rewarded, a 5 mm bead of lidocaine cream was applied to the inner pinna and opening of the ear canal using a gloved finger. Physical examination and extended history taking continued while waiting 3 - 5 minutes for the cream to take effect. A cotton tipped swab was used to obtain a cytology sample that was prepared on a plain microscope slide. Swabs of ear discharge were stained using Diff Quick stain and examined during the appointment time. Ear canal cleaning and treatment proceeded with the Nicco continuing to take rewards through the muzzle. After cleaning and otoscope exam, results of the cytology were reviewed and the best plan for treatment was determined. Pain management for home treatment was discussed and Lidocaine cream was prescribed along with appropriate NSAID pain relief. Recheck examination 1 week later was short and Nicco was very happy to come into the office, be on the table and have follow up exam. He was easy to muzzle using food rewards and examination did not elicit any tension or aggression. 

 

Case 2: Anal expression in puppy "Lucy"

A 14 week old puppy was presented for rubbing the anal area on the floor. A 5 mm bead of lidocaine combination cream was applied to the anal area and opening prior to anal gland expression. After waiting 3 minutes, the anal gland area was expressed as the puppy ate treats out of the owner and technicians hands. Upon recheck the puppy did not show any fear or anxiety about the exam table, staff or handling around the tail.

Results:

Using lidocaine combination creams for moderately painful procedures reduced the anxiety in our canine and feline patients. Aggression towards staff has reduced using this protocol. Dogs are easier to restrain and using rewards facilitated in handling as well as positively conditioning the dogs to the procedure. Dogs remained positively conditioned to the veterinary clinic and exam upon re-examination.   

Discussion:

            Examinations of painful areas around the head present a high risk for staff  injury. Many of these patients were tense, or moderately aggressive prior to analgesia. The use of lidocaine combination cream reduced the pain and  level of anxiety and aggression in these  patients. In my experience, the majority of pets did  not need additional analgesia for examination after using the topical anesthetic. Using Diff Quick stain, ear cytology morphology and staining characteristics of cells and organisms was unaltered by using lidocaine combination creams compared to samples where cream was not used.     .

             Okaw Veterinary Clinic has been using lidocaine - combination cream protocol approximately 4 years now, and has seen a marked reduction of exam related aggression without hampering office appointment efficiency. These creams are readily available through veterinary distributors or human pharmacies and cost under $10 per 2 oz tube. They are stable at room temperature and clients can administer these creams to facilitate home treatment. Adding this procedure to other in office  pain reducing strategies is one way to minimize pet anxiety, aggression and reduce staff injury in a veterinary office.

Acknowledgement:

Certified Veterinary Technicians Rachael Green, Debbie Gass, and Leeza Chapman employees of Okaw Veterinary Clinic

Clients of Okaw Veterinary Clinic Tuscola, Il

 

References:

  1. I Rodan, J. Brunt, R. Downing, J. Hagedorn, S. Robertson AAHA/AAFP Pain Management Guidelines for dogs and cats Journal of Feline Medicine and Surgery (2007) 9 pg 466-480

  2. Ekert RS, Macallister CG, et al Comparison of topical lidocaine/prilocaine cream and local infiltration of 2% injectable lidocaine for episioplasty in mares J Vet Pharm Ther.  2005 Jan 28(3) 299-304

 

Key Words:

aggression, anxiety, pain relief, positive conditioning, staff safety, veterinary exam