Optimizing Post-Operative Pain Management
There are 4 central tenets to optimizing post-operative analgesia: (1) provide preemptive analgesia, (2) use multi-modal pain management, (3) deliver overlapping/continuous analgesia, and (4) match the analgesic plan to the severity of surgical pain.4 In order to follow these guidelines, veterinarians must consider methods of minimizing the transduction and transmission of pain in peripheral tissue, attenuating modulation of pain in the spinal cord, and reducing the conscious perception of pain. The use of analgesics with complementary modes of action can be employed to target these various points along the pain pathway (Table 2).
The use of local anesthetics as part of multimodal analgesia for postoperative pain is the standard of care recommended by the WSAVA4 and the 2015 Pain Management Guidelines from the AAHA and AAFP3. Furthermore, analgesia needs to be continued for at least 72 hours postoperatively, during which time most dogs and cats have been discharged from the hospital.
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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.
4. Mathews K. Kronen PW, Lascelles D, et al. Guidelines for recognition, ossessment and treatment of pain. J Small Ani. 2014;55(6):E10-E68.
11. KuKanich B. Pharmacokinetics of acetaminophen, codeine, and the codeine metabolites morphine and codeine-6-glucoronide in healthy greyhound dogs. J Vet Pharmacol Ther. 2010;33(1):15-21.
12. KuKanich B, Spade J. Pharmacokinetics of hydrocodone and hydromorphone after oral hydrocodone in healthy greyhound dogs. Vet J. 2013;196(2):266-268.