Ingles Cirugia

As veterinarians in the twenty-first century, we have an ethical responsibility to our
patients and clients to avoid, or at least to reduce significantly, pain in animals under
our care. The American Animal Hospital Association and the American Association of
Feline Practitioners have joined to promote an emphasis in veterinary medicine on
pain management.1 Although this mandate can bestretched to cover a range from
‘‘less than appropriate’’ management to ‘‘unnecessary extremes’’ in analgesia administration, this article attempts to define a safe, practical, and yet suitable approach to
management of pain in the perioperative period. Treatment for pain that approaches
either extreme should be addressed by observation and refinement, because exact
recipes do not suit allindividuals, even animals that have undergone a similar procedure. Veterinarians must use their best judgment related to a starting point (often
beginning with guidelines), monitor the patient’s response to such treatment, and
adjust accordingly. Clearly, the veterinarian’s role in pain management is not
complete after establishment of an analgesic plan.
ADJUNCTS TO PAIN MANAGEMENT

Usually, we thinkof analgesic drugs when the topic of pain management is mentioned,
but it is important to keep in mind the other aspects that contribute to successful pain
control. Anxiety, stress, and uncomfortable surroundings have an impact on the individual ’s ability to handle pain. We recognize the comfort of our own bed in a quiet
home with loving people, familiar objects nearby, and appetizing food assignificant
determinants in our overall feeling of well-being. Research has also shown that psychologic and physical aspects have an impact on the achievement of pain control.2
Veterinarians may be able to reduce anxiety and uncomfortable surroundings with
simple actions. Noise, temperature, and light can be maintained at a more optimal
level for our patients. Quiet rooms can be defined toisolate the patient to keep it
from disturbing others or to provide a calmer environment for the more sensitive

Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph,
Ontario, Canada N1G 2W1
E-mail address: ddyson@ovc.uoguelph.ca
Vet Clin Small Anim 38 (2008) 1309–1327
doi:10.1016/j.cvsm.2008.06.006
0195-5616/08/$ – see front matter ª 2008 Published byElsevier Inc.

vetsmall.theclinics.com

1310

Dyson

animal. Nursing care that includes provision of clean bedding, comforting words, petting, cuddling, and playing with the pet should contribute significantly to the management of mild pain and supplement the pharmacologic treatment of more severe pain,
as has been reported in human infants.3 Many practices encourage family visits duringhospital stays to help reduce patient stress and gain insight on other interventions toward analgesia for the individual involved. Further information on good nursing care for
surgical patients can be found in the article by Shaffron, Fagella, and Taylor elsewhere
in this issue.
Nonanalgesic pharmacologic approaches can also provide calming effects that intensify the pain relief from specificanalgesic drugs. This is the principle behind neuroleptanalgesia, which is able to provide better results than analgesia alone when minor
surgical procedures are required. Therefore, the use of sedatives and tranquilizers is
considered along with the administration of analgesic drugs, when appropriate.
ADVANCE APPLICATION OF ANALGESIA

Fentanyl patches require advance application to beeffective for perioperative pain
management. Animals that are admitted the night before can have a patch placed if
this is an option for postoperative management. The advantage of this method is
achievement of a steady-state level of analgesia in 12 hours (cats) to 24 hours (dogs)
and lasting 72 hours. Fentanyl plasma concentrations vary significantly among individuals, however, and it may not be...