Overview of Post-Operative Pain Management
Many surgical patients experience pain of moderate to extreme intensity during the first few days of postsurgical recovery.1 Provision of adequate perioperative pain control is important for an expedient and successful patient recovery, in addition to being an ethical obligation of all veterinarians. Unlike some chronic pain conditions, most acute, perioperative pain is predictable and is directly related to the type and degree of tissue injury.
Insufficiently managed acute pain can lead to central sensitization, possibly culminating in chronic, maladaptive pain through the process of neuroplasticity, or remodeling of the pain pathways.2 Chronic, maladaptive pain is very difficult to manage, whereas a number of techniques, both pharmaceutical and nonpharmaceutical, have been proven to minimize acute, postsurgical pain.
Controlling Post-Operative Pain with a Multi-Modal Analgesic Regimen
Post-operative pain can typically be well-controlled in hospitalized patients using a multi-modal analgesic regimen that involves an appropriate combination of opioids, cyclooxygenase (COX)-inhibiting nonsteroidal anti-inflammatory drugs (NSAIDs), local anesthetics, alpha2 agonists, and/or N-methyl-D-aspartate receptor antagonists.3 However, most veterinary patients that undergo soft-tissue or orthopedic surgery are discharged from the veterinary hospital within 24 to 48 hours post-operatively. Therefore, analgesics that provide continued pain relief must be prescribed and/or delivered in the home environment. Currently, there are limited U.S. Food and Drug Administration (FDA)–approved options available for the treatment of post-operative pain in dogs (Table 1 – On Next Page).
Most veterinary patients that undergo soft-tissue or orthopedic surgery are discharged from the veterinary hospital within 24 to 48 hours post-operatively. Therefore, analgesics that provide continued pain relief must be prescribed and/or delivered in the home environment.
1. Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014;30(1):149-160.
2. Ray AL. Neuroplasticity, sensitization, and pain. In: Deer TR, Leong MS, Ray AL, eds. Treatment of Chronic Pain by Integrative Approaches: The American Academy of Pain Medicine Textbook on Pain Management. New York, NY: Springer Science+Business Media; 2015:15-24.
3. Epstein ME, Rodanm I, Griffenhagen G, et al. 2015 AAHA/AAFP pain management guidelines for dogs and cats. J Feline Med Surg. 2015;17(3):251-272.