● Reduced level of maintenance of inhalant anesthesia that can significantly minimize the risks of potential adverse side effects, such as hypotension, hypothermia, and respiratory depression. Also, using less gas will allow the patient to return to consciousness more quickly after surgery. While record keeping can be cumbersome in a multimodal analgesia approach because of the various controlled substances that can be involved, the quantities of substances are smaller, providing greater safety against accidental overdose and potential side effects. Treatment of pain should involve the following approaches: ● Pharmacologic treatment is the primary and most important aspect of pain therapy. Acute surgical, traumatic, and disease-related pain is generally treated with one or more analgesic, or pain-relieving, drugs. The selection of the most effective medication or drug combination is based on the predicted pain severity, the overall health of the pet, and the particular medications that are beneficial for the species (IASP, Table 3: Drugs Used for Pain Management in Small Animals Drug Indication/s
2023). To achieve optimal pain management, a combination of medications with distinct mechanisms of action is used (e.g., opioids, NSAIDs, local anesthesia). ● Non-pharmacological interventions should supplement rather than be a substitute for medicine: ○ In addition to relieving pain, physical therapy can reduce fear and anxiety, improve physical function, and alter physiological responses to pain (e.g. thermotherapy, cryotherapy, laser therapy, electrotherapy, manual therapies). ○ Neuromodulating treatments are designed to stimulate the pain systems. Stimulating the pain inhibitory systems can help reduce pain and enhance the quality of life for patients suffering from chronic pain (e.g., percutaneous nerve electrostimulation (TENS), peripheral nerve stimulation, acupuncture, and vibration. (Alamrew et al., 2021). ○ Invasive techniques (e.g., individual nerve blocks, by intrathecal administration of drugs, neurosurgery).
Common Examples
Mode of Action Side Effects
Important Notes
Opioids (narcotic analgesics)
• Morphine • Fentanyl • Hydro- morphone • Methadone • Meperidine
• The effect of an opioid depends on additional factors, including
• Decreased locomotor activity • Respiratory depression
Act on central and peripheral opioid receptors (primarily, G protein-coupled receptors), cause hyperpolarization of the neurons, and lessen the secretion of excitatory neurotransmitters to interrupt the
Considered the gold standard to manage mild to intense, short, or long-term pain and represent a perioperative protocol to improve recovery times and decrease post-surgical pain scores
whether the animal is in pain, the overall health of the animal, the administration of other drugs at
sluggishness (sedation), change in
• Sufentanil • Alfentanil • Buprenorphine • Butorphanol • Tramadol
mood (good or bad), and euphoria • Hyperthermia in cats • A reduction in gastrointestinal tract motility, vomiting (morphine) • Dogs may pant following high doses • Anti-tussive properties • In animals with biliary obstruction or pancreatitis,
the same time, and individual sensitivity to opioid effects
transduction, transmission,
modulation, and perception of a noxious stimulus
• Tramadol is a suitable
therapeutic option for cats and should preferably be used as a component of multimodal analgesia in both species, particularly dogs
• For severe pain: ° morphine and methadone • For mild- moderate pain: buprenorphine
morphine should be avoided as sphincter
contraction can exacerbate the conditions
Page 29
Book Code: VFL1526
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