Page 26 - BSAVA Guide to Pain Management in Small Animal Practice

3 | Acute and perioperative pain

VetBooks.ir an experimental model, Bergadano et al. preoperatively in these cases as the animals are
NSAI s can often be administered
9 investigated the e ect of a loading
generally healthy, although in some cases there
dose of ketamine . mg kg i.v. followed by a
1 g kg min CRI on nociceptive withdrawal is a risk of haemorrhage and therefore
re exes N R in dogs and found minimal administration should be delayed. here is no
modulation of the N R, suggesting that at the evidence to suggest that one NSAI is safer
doses studied intravenous ketamine does not than another for perioperative administration
modulate spinal sensory processing. here are unt et al., 1 b and generally there is also
no clinical studies investigating the e ects of a no evidence to indicate that as a class of drug
ketamine CRI on pain in cats. he con icting one NSAI preparation is more e cacious in
data in dogs make it di cult to make terms of analgesia than another. he only study
evidence based recommendations about the to show superior analgesia for one NSAI over
use of ketamine in the perioperative period in another was conducted in cats undergoing
dogs and cats. In humans, ketamine is used ovariohysterectomy and showed robenacoxib to
speci cally to reduce the re uirement for be superior to meloxicam amata et al., 1 .
perioperative opioids Carstensen and ller, owever, it is important to note that in this study
1 and it is recommended that ketamine be pain scores were very low in all animals, so the
used alongside opioids in dogs and cats. It is clinical relevance of the lower pain scores in the
important that a loading dose is administered robenacoxib group can be uestioned.
e.g. . mg kg and infusion rates of 1 g In dogs undergoing castration 1 mg kg
kg min ketamine are suggested. Pain scoring lidocaine in ected into each testicle has been
to con rm the e cacy of ketamine in the cases shown to reduce the re uirement for iso urane
where it is used postoperatively is mandatory. and is a simple and cheap method of enhancing
analgesia c illan et al., 1 .
Example regimens As the ma ority of neutering procedures are
Castration and spay short, alpha agonists may help to provide
hese cases are generally considered routine additional analgesia despite their short duration
in veterinary practice and are generally of action.
performed on healthy, young animals. In these
cases, perioperative analgesia should include Simple fractures
preferably methadone or buprenorphine in here is evidence that methadone provides
the premedication. Recent evidence suggests superior analgesia to buprenorphine in dogs
that pain scores are lower for the rst 8 hours undergoing orthopaedic surgery unt et al.,
after surgery in bitches undergoing 1 . he study by unt et al. 1 supports
ovariohysterectomy that received methadone the selection of methadone as the premedicant
for premedication compared with those that opioid for animals expected to experience
received buprenorphine Shah et al., 18 , moderate to severe surgical pain.
supporting selection of methadone for Buprenorphine is more suitable for animals
premedication prior to ovariohysterectomy in expected to experience mild pain during
dogs. In cats, there have been no studies that surgery or moderate pain if a multimodal
have directly compared the analgesic e cacy analgesia techni ue employing local
of buprenorphine and methadone in surgical anaesthesia techni ues is utili ed.
models. here is good evidence in cats Local or locoregional techni ues should be
undergoing ovariohysterectomy and used where possible in these cases; details of
premedicated with aceproma ine that techni ues can be found in Appendix .
butorphanol provides inade uate analgesia
for the procedure with high pain scores Mass removal
reported in the postoperative period arne Perioperative analgesia should be provided
et al., 1 ; 14 . based on the site and extent of the mass to be

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