Page 120 - BSAVA Guide to Pain Management in Small Animal Practice

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Trauma and

emergency pain

In emergency situations there are many factors wait for the peak time of e ect to be reached; if
that the veterinary team need to consider and the animal is still in pain give half of the starting
manage. It should be paramount to alleviate dose again. If using fentanyl, make the bolus
pain by the most reliable and safe method. e ual the background e.g. if 1 g kg is given as
Physical examination parameters and pain a bolus, then start 1 g kg hr continuous rate
scores are often unreliable in the acute setting infusion CRI . Increase the bolus and
to evaluate pain in our patients; therefore, background by after the peak time of
analgesia should always be given if in any e ect if the patient is still in pain.
doubt. A fast-acting, potent, titratable drug It is important to remember that mu opioids
would be ideal, making full mu agonist opioids can be antagonized by naloxone although other
the preferred choice. As with the administration methods of providing analgesia must be
of any drug, the ve rights patient, drug, dose, considered if naloxone is used. The
route, time) apply and in addition, veterinary cardiorespiratory side e ects of mu agonists are
surgeons veterinarians might be limited by the highly unlikely to be signi cant at clinical doses
availability of speci c drugs and vascular access in veterinary species.
in the patient. For reliable delivery, the
intravenous route is preferable, and
intraosseous is better than intramuscular.
Fentanyl has a faster onset of action and is
more potent times than morphine or
methadone. Although pethidine has a fast onset This should be considered if the pain has not
of action it should only be administered been adequately controlled after two rational
intramuscularly. increases in opioid dose. The next analgesic to
he bene t of opioids being titratable add would be either ketamine or lidocaine in
cannot be overlooked. That being said, it is dogs only). Ketamine is good for peritoneal pain
important to start at the lower end of the dose and at low doses augments opioid analgesia as
range starting dose), be tempted to give opioid sensitivity is mediated through
more as the patient looks worse, and always N-methyl- aspartate N A receptors.

BSAVA Guide to Pain Management in Small Animal Practice. Edited by Ian Self. ©BSAVA 2019 115

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