Page 22 - BSAVA Guide to Pain Management in Small Animal Practice

3 | Acute and perioperative pain

VetBooks.ir management is the coupling of analgesic drug duration of action of the analgesic drugs, for
he third essential element to e ective pain
example methadone may be prescribed every
administration to the recognition and
is that animals are over analgesed, resulting in
uanti cation of pain. he use of pain scoring 4 hours. An inherent risk with this approach
tools can be extremely helpful for improving the an increased incidence of side e ects such as
uanti cation of pain in animals. lasgow sedation or dysphoria arising from opioid
University has recently developed two tools for administration. owever, this approach is
the uanti cation of pain in dogs and cats; the more likely to prevent upregulation of the
lasgow Composite Pain Scale Canine and pain pathways, which is advantageous in
lasgow Composite Pain Scale eline. Both terms of facilitating longer term pain relief
scales can be freely downloaded from the and potentially reducing the likelihood of
internet, follow a similar framework to each chronic pain.
other, and are simple to use. hey comprise a
series of uestions about the animal, starting
with the appearance of the animal from outside Authors’ perspectives on
of the cage, their response to interaction, how cases
the animal reacts to application of gentle
pressure around the surgical wound, and nally A number of di erent drug classes are
uestions about the general impression of the commonly used for the provision of
demeanour of the animal. he maximum perioperative analgesia. pioids remain the
possible score for the canine scale is either , backbone of perioperative analgesia, not least
in patients that are non ambulatory, or 4 in because of their important role as part of
ambulatory patients. In cats, the maximum premedication protocols. owever, there is
possible score is . Importantly, the critical widespread evidence for the analgesic e cacy
score above which rescue analgesia is re uired of di erent opioid drugs in cats and dogs,
has been de ned for both cats and dogs. In supporting their use in the perioperative period.
dogs, scores of or 6 4 indicate that Similarly, NSAI s also form a valuable
additional analgesia is needed, whereas in cats component of analgesia regimens for acute
a score of has been set as the pain because there is good evidence of e cacy
intervention level. for acute pain states and there are a variety of
wo di erent approaches have been drugs licensed for perioperative administration
advocated to combine pain scoring with drug to cats and dogs. ther classes of drug that are
administration. he rst approach is to delay used include local anaesthetics, ketamine and
drug administration until the animal shows alpha agonists. hen the authors consider
signs of pain and reaches the criteria for multimodal analgesia the acronym N LAN is
rescue analgesic administration. he useful; where N NSAI , opioids, L local
disadvantage of this approach is that it re uires anaesthetics, A alpha agonists and
the animal to become painful before analgesia N N methyl aspartate N A antagonists
is administered, driving upregulation of e.g. ketamine . P for paracetamol can be added
sensory processing. o ensure good patient for dogs. Logical approaches to drug selection
welfare it also re uires that pain assessment is
very fre uent, for example every hours, within each class of drug are given below.
which may be di cult to achieve in a busy General considerations for
practice setting. An alternative approach, analgesia in all surgical cases
favoured by the authors, is to prescribe
analgesia after surgery, irrespective of the pain he selection of drugs for perioperative
score, but tailor the dose according to pain analgesia will depend on the surgery to be
assessment. he timing of analgesic performed, the individual animal and the
administration is determined by the expected availability of drugs.

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