Page 143 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir The basic analgesic Moderate to severe
periodontitis
routine
The optimum form of pain therapy is continuous Moderate to severe periodontitis where
remedial therapy will involve extensive
preventive analgesia, constantly preventing the subgingival curettage and multiple tooth
establishment of sensitization. The administration extractions. Use opioids as required
of opioids or local anaesthetic drugs blocks intraoperatively ± local anaesthesia
central sensitization and non-steroidal anti-in- intraoperatively. Postoperative pain relief would
ammatory drugs NSAI s reduce the severity be opioids and or NSAI s. Local anaesthesia
of the peripheral in ammatory response. he could also be used to provide postoperative
combined use of an opioid and an NSAI is more analgesia. In addition, a day course of
e ective than using either drug alone. Local NSAI s may facilitate recovery.
anaesthetics can produce complete pain relief by
blocking all sensory input from the a ected area. Trauma
A basic analgesic routine, which can be
modi ed as re uired, is as follows Traumatic injuries with dental and/or skeletal
fracture where treatment involves tooth
■ Include an opioid (such as buprenorphine) extraction ± jaw fracture repair. The analgesic
in the premedication regime will be similar to that used for moderate
■ Administer additional opioids as required to severe periodontitis.
intraoperatively
■ Consider using local anaesthetic Gingivostomatitis
preoperatively/intraoperatively/ For cases of chronic feline gingivostomatitis,
postoperatively where treatment involves extraction of most
■ ive opioids and or NSAI s postoperatively teeth, consider adding intra- and postoperative
■ Administer NSAI s during recovery.
local anaesthesia to the basic regime. An added
The author routinely includes an opioid in advantage of using local anaesthesia with
the patient’s premedication. The animal is then vasoconstrictors intraoperatively is a reduction
anaesthetized and a meticulous oral in haemorrhage, which allows for better
examination is performed, including dental visualization and easier surgery.
radiographs. Based on the ndings, a list of
problems and a treatment plan is drawn up. The Maxillectomy/mandibulectomy
individual analgesic regime will then be procedures
decided based on type and severity of disease In patients undergoing maxillectomy/
and the type of remedial procedure that will be mandibulectomy procedures, consider adding
performed. As shown below, the basic analgesic intra- and postoperative local anaesthesia to
routine is exible and can be modi ed to suit the basic regime.
the individual animal.
Gingivitis or early periodontitis Local anaesthesia
ingivitis only or early periodontitis a ecting
only a few teeth where treatment will consist of Local anaesthesia can be used to provide
supragingival scaling and polishing, minor intra- and postoperative analgesia. In contrast
subgingival debridement and either no with human patients, dogs and cats are not
extractions or just a few teeth that require amenable to local anaesthetic injection if
extraction. In such cases, the inclusion of an conscious, so the techniques are used when
opioid in the premedication is generally the animal is anaesthetized. When given prior to
su cient and no further analgesics or NSAI s at the start of a procedure, the use of local
the end of the procdure are required. anaesthetic drugs may reduce the requirement

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