Guidelines for Recognition, Assessment and Treatment of Pain

Analgesia in the Perioperative Period

Untreated or undermanaged perioperative pain has systemic effects that may negatively impact a patient's welfare and return to function. A consistent analgesic plan that assesses a patient's pain and comfort at regular intervals during the perioperative period should be incorporated into practice. Validated pain assessment tools are available for use in dogs and cats. Multimodal analgesic plans should be created for individual patients and modified according to pain assessments. These plans, based on a thorough history, physical examination, and knowledge of the expected pain, should be combinations of an opioid, a nonsteroidal anti-inflammatory drug, a local anesthetic, and nonpharmacologic analgesic techniques.

Practical use of opioids in cats: a state-of-the-art, evidence-based review

RATIONALE

Recent recognition of the need to improve pain management in cats has led to the investigation of the pharmacokinetics and efficacy of opioid analgesic drugs in this species. The results of these studies may be difficult to interpret because the effect of these drugs varies with dose, route of administration and the method used to assess them. As equipotency of different opioids is not known, it is hard to compare their effects. Animals do not verbalise the pain they feel and, in cats, it may be more difficult to recognise signs of pain in comparison with other species such as dogs.

AIM

This article reviews the use of opioid analgesics in cats. It must be remembered that not all drugs are licensed for use in cats, and that marketing authorisations vary between different countries.

Animals Used in Research and Education, 1966-2016: Evolving Attitudes, Policies, and Relationships

Since the inception of the Association of American Veterinary Medical Colleges (AAVMC), the use of animals in research and education has been a central element of the programs of member institutions. As veterinary education and research programs have evolved over the past 50 years, so too have societal views and regulatory policies. AAVMC member institutions have continually responded to these events by exchanging best practices in training their students in the framework of comparative medicine and the needs of society. Animals provide students and faculty with the tools to learn the fundamental knowledge and skills of veterinary medicine and scientific discovery. The study of animal models has contributed extensively to medicine, veterinary medicine, and basic sciences as these disciplines seek to understand life processes. Changing societal views over the past 50 years have provided active examination and continued refinement of the use of animals in veterinary medical education and research. The future use of animals to educate and train veterinarians will likely continue to evolve as technological advances are applied to experimental design and educational systems. Natural animal models of both human and animal health will undoubtedly continue to serve a significant role in the education of veterinarians and in the development of new treatments of animal and human disease. As it looks to the future, the AAVMC as an organization will need to continue to support and promote best practices in the humane care and appropriate use of animals in both education and research.

Postoperative analgesic effects of either a constant rate infusion of fentanyl, lidocaine, ketamine, dexmedetomidine, or the combination lidocaine-ketamine-dexmedetomidine after ovariohysterectomy in dogs

OBJECTIVE

To evaluate the postoperative analgesic effects of a constant rate infusion (CRI) of either fentanyl (FENT), lidocaine (LIDO), ketamine (KET), dexmedetomidine (DEX), or the combination lidocaine-ketamine-dexmedetomidine (LKD) in dogs.

STUDY DESIGN

Randomized, prospective, blinded, clinical study.

ANIMALS

Fifty-four dogs.

METHODS

Anesthesia was induced with propofol and maintained with isoflurane. Treatments were intravenous (IV) administration of a bolus at start of anesthesia, followed by an IV CRI until the end of anesthesia, then a CRI at a decreased dose for a further 4 hours: CONTROL/BUT (butorphanol 0.4 mg kg(-1), infusion rate of saline 0.9% 2 mLkg(-1) hour(-1)); FENT (5 μg kg(-1), 10 μg kg(-1) hour(-1), then 2.5 μg kg(-1) hour(-1)); KET (1 mgkg(-1) , 40 μg kg(-1) minute(-1), then 10 μg kg(-1) minute(-1) ; LIDO (2 mg kg(-1), 100 μg kg(-1) minute(-1), then 25 μg kg(-1) minute(-1)); DEX (1 μgkg(-1), 3 μg kg(-1) hour(-1), then 1 μg kg(-1) hour(-1)); or a combination of LKD at the aforementioned doses. Postoperative analgesia was evaluated using the Glasgow composite pain scale, University of Melbourne pain scale, and numerical rating scale. Rescue analgesia was morphine and carprofen. Data were analyzed using Friedman or Kruskal-Wallis test with appropriate post-hoc testing (p < 0.05).

RESULTS

Animals requiring rescue analgesia included CONTROL/BUT (n = 8), KET (n = 3), DEX (n = 2), and LIDO (n = 2); significantly higher in CONTROL/BUT than other groups. No dogs in LKD and FENT groups received rescue analgesia. CONTROL/BUT pain scores were significantly higher at 1 hour than FENT, DEX and LKD, but not than KET or LIDO. Fentanyl and LKD sedation scores were higher than CONTROL/BUT at 1 hour.

CONCLUSIONS AND CLINICAL RELEVANCE

LKD and FENT resulted in adequate postoperative analgesia. LIDO, CONTROL/BUT, KET and DEX may not be effective for treatment of postoperative pain in dogs undergoing ovariohysterectomy.