Information

Pain Management During Surgery


Dr. Phil Zeltzman is a traveling, board-certified surgeon in Allentown, PA. His website is www.DrPhilZeltzman.com. He is the co-author of “Walk a Hound, Lose a Pound” (www.WalkaHound.com).

Kelly Serfas, a Certified Veterinary Technician in Bethlehem, PA, contributed to this article.

Bailey, an eight-year-old Lab, had knee surgery today. Obviously, medical procedures like this could potentially be accompanied by pain, but you might be surprised by all of the techniques veterinarians utilize to keep dogs like Bailey comfortable. See if you can count the ways as I recount his story!

Pain relief before surgery
During the initial consultation, Bailey's veterinarian prescribed two pain medications to help out until the day of surgery. One drug was a non-steroidal, anti-inflammatory medication (NSAID), which fights pain indirectly by reducing irritation. The other drug was tramadol, which is strictly a pain killer and in the same family as morphine.

Pain relief on the morning of surgery
On the day of surgery, Bailey was dropped off at the clinic in the morning. An IV catheter was placed in his leg. He received three different injectable pain medications though the catheter. Then he was hooked up to an IV bag that contained the same three pain medications. This is called a constant rate infusion (CRI). The slow drip of a CRI delivered a steady flow of the three pain medications into Bailey's body. A CRI has 3 important benefits:

  • It allows us to use much smaller doses of medications (decreasing potential side effects)
  • It prevents the need for multiple injections
  • It provides non-stop pain relief

Once he was relaxed enough, Bailey was brought into the treatment room, where an IV sedative was given. Then a tube was placed through his mouth into his wind pipe. Through the tube, a mixture of oxygen and anesthetic gas was delivered. The gas kept our patient asleep and provided pain relief.

An antibiotic and an NSAID were given IV. Then an epidural was administered into the spine (just like when a woman is about to deliver a baby). The epidural numbed Bailey’s back leg.

The leg was shaved and scrubbed; Bailey had an injection of a local pain medication directly into the knee (similar to what we get at the dentist to numb our teeth).

Bailey was moved to the operating room where he had knee surgery.

Pain relief after surgery
As Bailey woke up from a successful surgery, an ice pack was placed on his knee. This simple technique is an effective way to decrease inflammation and pain.

The pain drip was then slowly tapered off overnight, while Bailey was switched over to oral medications. At one point, Bailey became agitated, so a tranquilizer (acepromazine) was given IV. This is not technically a pain reliever, but calming him down ultimately decreased his pain level by preventing him from moving too much.

Pain relief at home
Veterinary prescribed painkillers an NSAID and an antibiotic were continued for one week once Bailey went home.

Keeping an E collar (plastic cone) around Bailey’s neck prevented licking and an infection. You could say that an E-collar is yet another way to decrease pain; it ensures that Bailey won’t have to come back to have stitches re-sutured!

Note: Although not necessarily relevant to Bailey, one could very easily argue that weight loss at home is another way to decrease pain – although it’s a longer term project. Less weight can make a huge difference to relieve pressure on sore joints.

So, how many ways to relieve Bailey’s pain did you count? I counted over a dozen. In my practice, all patients are provided with this same level of pain management. We always do whatever we think is necessary for our patients to be as comfortable as possible. Don’t forget to ask your veterinarian what her procedures are, before surgery.

Despite what some clients may believe, we can’t perform miracles. Surgery cannot possibly be 100% comfortable; fortunately, in the vast majority of cases, we can keep patients mostly pain-free.

By the way, the bulk of these pain-relieving techniques are administered by our wonderful nurses, which is a great reminder that they are a critical part of patient care and patient comfort.

If you have any questions or concerns, you should always visit or call your veterinarian -- they are your best resource to ensure the health and well-being of your pets.


Pain Management During Surgery - pets

Is Postoperative Pain Management Important in Dogs and Cats?


James S. Gaynor, DVM, MS, Dipl. ACVA
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, 80523

- Substantial advances in our understanding of acute pain physiology and therapy in animals and people have occurred in recent years. Despite the availability of numerous pain-relieving techniques and drugs in veterinary medicine, many animals remain untreated after potentially painful events such as surgery and trauma. This article discusses why these animals may be under-treated for pain, as well as the biologic role and physiologic consequences of pain.
Why is pain undertreated? Veterinarians may not administer analgesics to dogs and cats for several reasons. Some veterinarians still think that dogs and cats do not feel pain. Others think that if an animal can walk and eat it must not be in pain. But behavioral changes exhibited after routine surgeries (e.g. ovariohysterectomy) suggest that animals, even those walking and eating, may be in great pain. Some veterinarians do not provide analgesia to their patients because they lack knowledge about available drugs. Another reason veterinarians may not aggressively treat pain is because they have difficulty assessing it. There are no perfect ways to assess pain, but several scoring systems are available to help practitioners do so more objectively. Many people recommend that animal-care providers simply assume that pain occurs in animals under the same circumstances as in people. Finally, the cost of analgesic drugs and the need to charge clients more may inhibit appropriate pain management. The financial aspects of pain management will be discussed next month in Part 2 of this symposium.

Aside from moral and ethical considerations, tremendous evidence suggests that pain and the resulting stress response can have marked, if not catastrophic, physiologic effects. Providing analgesia to people helps blunt the stress-response and the adverse sequelae. Evidence suggests that veterinary patients similarly benefit from analgesia. Pain management should be instituted in all veterinary patients who may experience pain to minimize the likelihood of cardiovascular, pulmonary, fluid and electrolyte, or gastrointestinal problems.

VIN SUMMARY:

This introductory article discusses the biologic and physiologic role of pain.

The treatment of pain in patients is predominantly underused. Since our patients can not tell us if they are in pain, we must observe the patient, make some assumptions, and treat to alleviate the pain.

Biologic role of pain

Pain has a biologic role in survival.

Pain signals actual/impending tissue damage this may cause animals to attempt to avoid further harm.

Pain immobilizes (or decreases use) of the body (damaged tissue). However, excessive immobilization can cause decreased musculoskeletal and cardiopulmonary function.

Pain results in neurohumoral responses which can aid healing. However, if excessive, this can cause increased morbidity & mortality.

Physiologic consequences of pain

Acute injury stimulates a generalized stress response -- increased ACTH, cortisol, antidiuretic hormone (ADH), catecholamine, aldosterone, renin, angiotensin II, & glucose concentrations, and decreased insulin & testosterone concentrations.

Stress response produces (can be manifested in the immediate postoperative period):

a general catabolic state (muscle protein catabolism & lipolysis, water & sodium retention, and potassium excretion).

a slower rate of healing, if the stress response is prolonged.

changes in the cardiovascular systems

­ catecholamine, angiotensin II, & ADH lead to cardiovascular changes which include:

­ vascular resistance due to arteriolar constriction (seen as higher blood pressure)

­ venous constriction (results in decreased venous capacitance)

­ cardiac contractility

­ heart rate

These responses may be initially beneficial, but ultimately result in myocardial oxygen consumption.

Myocardial O2 consumption + Ї myocardial perfusion = myocardial hypoxia or ischemia (with resultant cardiac dysrhythmias)

changes in the respiratory systems

­ metabolism and changes in pulmonary vascular tone

impaired respiratory function

This combination results in ­ carbon dioxide production, oxygen consumption, ventilation-perfusion mismatching, & atelectasis, all of which predispose the patient to hypoxemia.

fluid and electrolyte imbalances

­ aldosterone concentrations lead to ­ sodium retention

­ catecholamine & cortisol concentrations contribute to potassium wasting

(Fluid retention and decreased urine output are very serious in heart or renal disease patients.)

­ catecholamine concentrations lead to Ї bowel motility and Ї blood flow to viscera. As gastrointestinal edema increases and bowel motility decreases, bacterial overgrowth, bowel ischemia, & bacterial translocation occur.

Pain and the resulting stress response can have marked-to-catastrophic physiologic effects. Pain should be controlled in order to minimize the cardiovascular, pulmonary, fluid & electrolyte, and gastrointestinal complications.


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vinid = JA013427, date0499
Journal info: ISSN 8750-7943 VM

All rights reserved, copyright, Veterinary Information Network, Inc., 1999


What Research Shows

Various studies in humans and rodent models utilizing ketamine via constant rate infusion (CRI) or transdermal patch revealed that actual pain scores are not lowered significantly however, there are individual studies which demonstrate that the modality: 1,4-6

  • Reduces opioid consumption by 30%
  • Improves rehabilitation after arthroplasty
  • Reduces analgesic drug requirements after abdominal and gynecologic surgery
  • Results in superior pain control compared to intermittent morphine for musculoskeletal trauma
  • Provides dose-dependent analgesia for third molar extraction
  • Demonstrates use as rescue analgesic in opioid-tolerant and opioid-hyperalgesic patients
  • Possibly reduces phantom-limb pain postamputation.

Looking at the totality of human literature regarding the utility of ketamine as a pain-modifying agent, a recent systematic review revealed the following evidence-based conclusions: 7

Level I Evidence (Meta-Analyses)

  • Considered to have “preventive” effects on pain in acute postoperative period
  • Opioid-sparing
  • Safe
  • Most effective as low-dose CRI for acute pain management

Level II Evidence (> One Properly-Designed Randomized Clinical Trial)

  • Most effective as “antihyperalgesic,” “anti-allodynic,” or “tolerance-protective” treatment
  • Effective as rescue analgesic for opioid-tolerant patients
  • Reduces peripheral neuropathic and spinal cord injury pain
  • Improves fibromyalgia symptoms
  • Intranasal route reduces breakthrough chronic pain (cancer and noncancer patients)

When your pet needs surgery, it’s hard not to worry.

For many pet owners, it’s the use of anesthesia that causes the most concern. Some pets may have a history of problems with anesthesia or a complicating illness. They could have a heart, kidney, or liver problem. Or they could have a respiratory disease or have trouble breathing. Any of these issues could create a higher risk with anesthesia.

But just like with anesthesiologists who help human patients, there are veterinary anesthesiologists who treat animal patients. These vets are actually specialists, with advanced training, who know how to deliver anesthesia to your pet in the safest possible way. Watch this video featuring anesthesiologist, Elizabeth Goudie, to learn more about the complexities of administering pain medication.

What You Should Know

Before surgery, the veterinary anesthesiologist examines your pet and creates a customized anesthesia plan. During the procedure, the anesthesiologist carefully monitors your pet’s vital signs to ensure the best possible outcome. Afterward, the anesthesiologist may work with other caregivers to help with pain management and recovery.

Board-Certified Anesthesia Specialists

Many BluePearl veterinary anesthesiologists are board-certified specialists. This means they have many years of intensive training in the field of veterinary anesthesiology. If your pet requires anesthesia for a procedure at a BluePearl hospital, you can trust our specialists to use the most advanced safety measures known in the industry.

Types of Services

Our veterinary anesthesiologists typically provide these services for pets.

  • Consultation with pet owners to help them better understand the risks of anesthesia
  • Pain management for pets before, during and after surgery
  • Chronic and acute pain management
  • Critical case management


by Janine DeVault - 10/14/19

Anyone who’s gone through their pet’s surgery will tell you that the worst part is the post-op recovery time. If dogs could talk, they’d surely say the same. Dog surgery is a bummer for you and your pet. Not only is your pup forced to wear the dreaded “cone of shame,” but it’s likely his mobility will be limited. Worst of all, depending on the surgery, recovery can be painful. While a certain level of pain is tolerable, it’s important that you keep a close eye on your dog to ensure he’s not suffering any more than necessary.

In this article we’ll offer our best tips for keeping your dog comfortable post-op to ensure a speedy recovery. We’ll also share what you can give your dog for pain (and what you can’t give him) if you sense that he’s suffering.

Helping Your Dog Post-Op

In many cases, recovering from surgery is a simple process, and it will take your dog only a few days to get back to normal. Regardless of your pup’s recovery time, there are a few things you can do to help keep her comfortable throughout the process.

Keep Her Hydrated

One of the most important things to do is ensure your dog stays hydrated. If she’s completely immobile after surgery, she won’t be able to wander over to the water dish as usual. Make sure you give her the opportunity to drink water regularly.

Give Him Extra Potty Breaks

During surgery your dog was likely flooded with a series of medications and fluids, which means he may need to urinate more than usual, especially right after his surgery. Again, it’s important to create opportunities for him to urinate, as he may not have the energy to go outside when nature calls. Be prepared to carry your dog outside every couple of hours if he can’t walk on his own.

Monitor Your Dog’s Wound It’s really important to carefully follow all instructions from your vet regarding wound care. Keep a close eye on your pup’s incision, and if it appears red, swollen, gooey or has a strong odor, take him to the vet immediately. Make sure the wound stays clean and dry at all times.

Signs Your Dog Is in Pain

While some pain is normal while your dog recovers from surgery, excessive pain should be treated. Since dogs can’t rank their pain from 1 to 10, it’s important that you be able to recognize the signs that your dog is in pain.

If you notice any of the following, there’s a good chance your dog is feeling worse for wear:

  • Excessive panting, even when it’s not hot and he hasn’t been exercising
  • Shaking or trembling
  • Whining

What Can You Give A Dog for Pain?

Once you’ve established that your dog is in excessive pain, it’s time to ease his suffering. It’s really important to consult your veterinarian before administering any medication to your dog, unless you’ve already received instruction to do so. Remember, human drugs are not recommended for canine consumption and may even be toxic to them. So, don’t share anything from your medicine cabinet with your pup. Speak to your veterinarian and have them assess your dog to determine the cause of his pain. Once the cause is known, the vet will determine a treatment plan, which will likely involve administering some form of pain medication. Pain in dogs can be treated with non-steroidal anti-inflammatory drugs (NSAIDs), Tramadol, Gabapentin or even supplements, depending on the severity.

Surgery is hard on dogs and their owners. Nobody wants to see their furry friend suffer, but it’s important to leave your dog’s pain management up to your veterinarian. If your dog is about to go through surgery, be sure to talk to your vet about pain management. Ask for tips on how to determine your dog’s pain levels and about red flags you should look out for after surgery. As always, staying informed is a surefire way to give your pup the best care.

Janine DeVault is a pet writer, animal rescue advocate and former celebrity dog walker. She lives in Mexico with her three rescue pets, Maia, Fozzy and Kesi.


Watch the video: Enhanced recovery after surgery: Role of pain management (September 2021).