Page 122 - BSAVA Guide to Pain Management in Small Animal Practice

7 | Trauma and emergency pain

VetBooks.ir e ex p e Caesarean section

HISTORY AND PRESENTATION TREATMENT
There are many fetal and maternal causes Antiemetics are often given as patients are at
leading to the re uirement for a Caesarean risk of aspiration. Premedication should ideally
section. Brachycephalic breeds are over- include an opioid; methadone might be the
represented and these are often elective most appropriate, buprenorphine can be used
procedures. Number of fetuses should be postoperatively. Although methadone can
known prior to surgery, which requires cause fetal bradycardia, it can be antagonized.
radiographs to be taken. If there is concern about narcotic e ects on
the neonates then opioids can be given to the
bitch ueen after delivery and prior to
CLINICAL SIGNS
recovery. A local anaesthetic line block can be
These include agitation; other signs can be considered and or an epidural, depending on
related to hypocalcaemia and time and technical ability, and being cognisant
hypoglycaemia. of the side e ects hypotension intraopera-
tively, motor de cits postoperatively . he
epidural dose can be reduced to one-third of
SIGNS OF PAIN
that used in non parturient patients volumet-
These can be related to contractions, ric 1 1 lidocaine bupivacaine has been
abnormal fetal presentation in the birth canal, suggested to extend the duration of analgesia;
and fetopelvic disproportion. There might however, this is controversial and might lead to
not be any obvious signs of pain with an un predictable blockade . NSAI s are likely
uterine inertia. to be bene cial without compromising the
neonates, as only small levels reach the milk.

e ex p e 3 Septic abdomen

HISTORY AND PRESENTATION excessive in ammatory response and sepsis.
Patients are often neurologically obtunded,
In dogs this is often secondary to foreign body which could be related to the in ammation or
ingestion, or the use of NSAI s. owever, it metabolic e ects of sepsis e.g.
can occur secondary to trauma, neoplasia and hypoglycaemia).
biliary tract leakage, amongst other causes.
Patients present with variable signs SIGNS OF PAIN
depending on cause, from lethargy and
inappetance to marked vomiting and collapse. These can vary from mild to marked abdom-
inal pain from the peritonitis itself; there may
CLINICAL SIGNS be a tense or guarded abdomen on palpation
with groaning. If the patient is neurologically
These are often related to cardiovascular impaired it would likely mask obvious
compromise and re ect appropriate or signs of pain and discomfort.

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