SOUTH AFRICA

Perioperative Pain Management

When Your Dog Has Surgery

It can be difficult to see your dog undergo surgery. Many questions arise, not the least of which is whether your dog will experience pain after the procedure. Your veterinarian will be able to answer your questions, including details about the procedure, and how you can manage any pain that might result from the procedure.

In recent years, the veterinary community has made great progress in understanding how dogs feel pain and how to treat that pain. We now know that surgery can cause pain in dogs the same way it causes pain in people. The difference is that dogs instinctively try to hide their pain. But, because we now know more about how dogs feel pain, we now know how to recognize and manage it.

What Your Veterinarian Will Do

The severity and nature of surgical pain varies with each dog and the type of surgery, but if left untreated, surgical pain tends to be most severe around 24 hours after surgery, then diminishes as the surgical wounds heal over the next few days. Your veterinarian will begin administering pain medication an hour or two before starting surgery. This will allow pain management to be on-board before the surgery begins, and help keep your dog more comfortable during the critical hours immediately following the surgery.

What You Can Do

You play an important part in your dog’s recovery after surgery. Pain management is an important aspect of the healing process.

  • Keep your dog calm and comfortable – isolated from other animals and children for at least 12 hours
  • Check the incision daily for swelling, bleeding, discharge, redness or reopening. Call your veterinarian if you see any of these symptoms
  • Prevent the dog from scratching, licking or biting the surgical site
  • Administer a Non-steriodal anti-inflammatory daily as advised by your veterinarian

When you want to understand Perioperative Pain Management better

Painful veterinary procedures continue to be performed each year without the benefit of analgesia, although analgesic use in conjunction with surgeries appears to be growing.

Obviously, veterinarians have shown increased awareness of companion animal pain management during the past several years, which has been reflected in the program content of professional meetings and in the articles published in the profession’s scientific journals. And, for many veterinarians, the topic of pain management is stimulating a renewed interest in clinical practice. Now, addition of an injectable formulation of Zoetis’ non-steroidal palliative product and a perioperative pain management indication to the caplet and chewable tablet labels offers veterinarians more tools to proactively control iatrogenic pain in dogs.

While some confusion surrounds the terms anesthesia and analgesia, the misunderstanding results mostly from the presumption that all anesthetics provide analgesia, which is not the case. Clinically and practically, anesthesia may or may not equate with analgesia. Under general anesthesia, an animal may not perceive pain, but noxious stimuli associated with tissue trauma still are transmitted to and processed by the central nervous system (CNS). Although this nociceptive information isn’t then perceived consciously as pain, central sensitization can develop in the spinal cord and brain, resulting in perception of intense, acute postoperative pain as the animal regains consciousness.

Anesthetics. Anesthetics are drugs that produce anesthesia by depressing the activity of nervous tissue locally, regionally or within the CNS. Local anesthetics administered at the surgical site can improve intraoperative or postoperative analgesia for orthopedic procedures, lateral ear resections or total ear canal ablation, dew claw removal, feline declawing (onychectomy) and ear crops.

Sedation. Sedation is a state of mild central nervous system depression in which the animal is awake, calm and yet likely to be drowsy. Sedation reduces anxiety, irritability, stress and excitement. Although “sedation” is often used interchangeably with “tranquilization,” they are not synonymous.

Sedatives. Considerable confusion surrounds the terminology applied to sedating, tranquilizing and hypnotizing drugs, and specialists in veterinary anesthesiology are not satisfied with one single classification. A sedative is almost universally recognized
as a drug that relieves a patient’s anxiety by reducing activity and excitement and, as a result, allowing the patient to rest. These medications target the cerebral cortex of the brain and are usually associated with drowsiness.

Tranquilization. Tranquilization is a state of altered behavior in which the patient is calm, quiet and relaxed, but is aware of surroundings and may be indifferent to minor pain.Generally, tranquility is not accompanied by drowsiness, analgesia or unconsciousness, but the animal is reluctant to move. A tranquilized animal still experiences pain.

Tranquilizers. These drugs relieve anxiety without producing unnecessary sedation, affecting an animal’s response to pain by targeting key centers of the brain. Some tranquilizers also provide muscle relaxation.6 Tranquilizers do not provide analgesia and, although they may act synergistically with analgesics such as opioids, tranquilizers should not be the only drugs administered to a veterinary patient in pain. Tranquilizing an animal is appropriate only after adequate analgesia has been provided.

Strategies for pain management

Recognizing and managing perioperative pain is not only a central issue in veterinary medicine, but it’s also an extremely important component of compassionate veterinary care. In fact, providing pain relief is as important as choosing the appropriate sedative, muscle relaxant, and injectable or inhalant anesthetic for a particular patient and surgical procedure.

The question, “Which is the best analgesic in a particular pain context?” is not easy to answer, even for pain management specialists. Why? Because pain is a unique, individual experience and no two patients respond in the same way to a particular drug or technique. Effective pain management must be tailored to the individual animal and based in part on:

  • the species, breed, age, health status and behavioral characteristics of the patient;
  • the procedure performed, degree of tissue trauma and degree of pain (mild, moderate and severe) anticipated with a specific procedure or disease process; and
  • the availability of analgesic drugs, knowledge of pain management and surgical techniques, and stage (preoperative, intraoperative and postoperative) at which pain will be controlled.

Understanding the pain pathways and the mechanisms of action of analgesic medications can help veterinarians manage pain before it occurs, a practice known as preemptive analgesia.
Although it’s a relatively new and controversial approach to treating pain, preemptive analgesia is one of three strategies advocated by veterinary pain management specialists for controlling companion animal pain. (The other two strategies are perioperative analgesia and multimodal, or balanced, analgesia.)
Preemptive analgesia simply means analgesia is provided prior to tissue trauma (before surgery). The goal of preemptive analgesia is to prevent or reduce the development of any nervous system “memory” of the nociceptive stimuli produced by surgical manipulation and to block the peripheral and central hypersensitivities that can amplify pain perceived postoperatively.

A second strategy that is gaining recognition in veterinary medicine is multimodal analgesia (balanced analgesia). Multimodal analgesia takes advantage of the synergistic effects that result from combining two or more classes of analgesic drugs to alter more than one physiological process (transduction, transmission and modulation) of nociception and/or pain perception.

A third emerging pain management strategy is perioperative analgesia — the use of analgesics before, during and after surgery (preoperatively, intraoperatively and postoperatively, respectively). Recent studies demonstrate that administering perioperative analgesia is the most effective way to provide comfort and compassionate care for surgical patients.

Perioperative and preemptive analgesia have a lot in common with preventive medicine, which is not a new concept. But preventive medicine certainly is entrenched in many areas of medicine. For example, many companion animals are routinely vaccinated to prevent infectious diseases, even though the prevalence of some of these diseases is low. In contrast, scientists, physicians and veterinarians acknowledge that every surgical procedure causes some pain and that some procedures are more painful than others. Although applying the concept of prevention to pain management is in its infancy, it is becoming more widely accepted and even expected.

Dogs undergoing surgical and some diagnostic procedures experience varying degrees of nociceptive stimulation, even though animals under general anesthesia do not consciously perceive pain. However, nociceptive input into the CNS still occurs during surgery and may alter the processing of pain signals in the spinal cord. This can lead to altered perception of postoperative pain when animals regain consciousness. As with preemptive analgesia, the underlying objective of perioperative analgesia is to interrupt or substantially reduce the barrage of nociceptive impulses that result from surgical manipulation and tissue trauma, consequently preventing the peripheral and central sensitization phenomena that cause intensified pain.

Effective perioperative pain management takes advantage of several practices used successfully in human medicine, including:

  • using analgesics as early as possible, beginning preoperatively (preemptive analgesia);
  • using more than one class of analgesics, with each drug acting at a different point along the pain pathway (multimodal analgesia); and
  • matching analgesics, based on dosage and duration of action, to the degree of expected surgical trauma and postoperative pain.

Disclaimer: Zoetis takes no responsibility for any claims that may arise from information contained in this information sheet. Individual situations may vary from location to location and it is recommended that you consult your veterinarian before any management or treatment decisions are implemented.

Vrywaring: Zoetis neem geen verantwoordelikheid vir enige eise wat mag voortspruit uit inligting vervat in hierdie inligtingsdokument. Individuele situasies varieer van plek tot plek en dit word voorgestel dat u eers u veearts kontak alvorens enige bestuurs- of behandelingsbesluite geïmplementeer word.