Page 23 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir NSAIDs inhibition of platelet thromboxane A
production, also have a well recogni ed e ect of
here is very good evidence for the e cacy of
decreasing platelet aggregation Luna et al.,
NSAI s as a component of analgesia regimens
for acute pain in dogs and cats amata et al., 7 , although clinically this does not lead to
1 ; ruet et al., 1 , and as such they are overt bleeding in animals receiving NSAI s over
widely used for this purpose. he optimal timing a prolonged time. It is not necessary to stop
of perioperative analgesic administration of NSAI administration prior to surgery in healthy
NSAI s remains contentious. Preoperative animals receiving chronic NSAI therapy.
administration is recommended in animals that owever, the perioperative administration of
are cardiovascularly stable where blood loss or NSAI s is probably unwise in animals with
other causes of cardiovascular instability are not recogni ed disorders of haemostasis. In terms of
expected during surgery. owever, the potential decision making around which NSAI to choose
e ects of NSAI s on renal homeostasis are well for perioperative administration to cats and
recogni ed and renal ischaemia may result from dogs, there are a number of factors to
systemic hypotension during surgery when take into consideration. Be aware that not all
NSAI s have been administered. herefore, NSAI s are licensed for perioperative
NSAI s should be delayed until such a time that administration so it is imperative to check and
the animal is normovolaemic and normotensive select one that is licensed for this use. It is also
after anaesthesia and surgery in patients that are important to consider ease of administration and
cardiovascularly unstable or when instability due whether there is an in ectable preparation that
to signi cant haemorrhage is expected. he use may be easier to administer perioperatively than
of perioperative NSAI s in patients with an oral tablet.
concurrent chronic kidney disease C is also
debated. Although NSAI s have not been Opioids
shown to hasten the progression of C or Selection of the appropriate opioid for
decrease longevity in cats with osteoarthritis premedication is pivotal to ade uate
owan et al., 11; 1 , the e ect of management of perioperative analgesia. he
perioperative NSAI s in cats and dogs with C two most commonly administered licensed
is unknown and the authors advise delaying opioid drugs for premedication to cats and dogs
administration of NSAI s until these patients are are methadone and buprenorphine. his is
normally hydrated and normotensive. Another because both drugs have a medium duration of
area of contention surrounding perioperative action methadone 4 hours, buprenorphine
NSAI administration is their use in patients that 6 8 hours and therefore will provide a
have undergone gastrointestinal I surgery meaningful duration of action throughout the
where the negative e ects of NSAI s on healing perioperative period in the ma ority of surgeries
of the I tract might be detrimental Luna et al., performed in veterinary practice. Pethidine, a
7; onteiro Steagall et al., 1 . In the licensed full mu agonist, provides good
absence of evidence to the contrary, it is analgesic e cacy in cats and dogs but is short
recommended to avoid NSAI use in patients acting 6 9 minutes , necessitating fre uent
that have undergone signi cant I trauma where redosing in the perioperative period, which is
delayed healing of the I tract is likely to be disadvantageous. Butorphanol, a kappa agonist,
clinically problematic. Administration of provides inferior analgesia to both methadone
intravenous paracetamol might be an alternative and buprenorphine and its use as a
option for additional analgesia alongside opioids premedicant prior to most surgical procedures
in this patient group. Paracetamol is generally is to be discouraged. entanyl, a short acting
considered to be less detrimental to the I tract full mu agonist opioid, is occasionally used for
than NSAI s, although there are no data in dogs premedication, usually in combination with
to support this statement. Paracetamol is mida olam, for cardiovascularly unstable
contraindicated in cats. NSAI s, through patients. In this instance the predominant role of

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