Managing Post-Operative Pain
"The California Bulldogge" Feature Article
from "Blue Ravine News" edited by Edie Gaertner
Pain is generally thought of as something that is best avoided, but, at times, potentially painful medical procedures are necessary for long-term health. But his does not mean that pain is a necessary evil. In addition to the distress pain causes, untreated pain can prolong the healing process and progress to more serious pain levels that become much more difficult to treat. One of the jobs of the veterinary team is to make a concerted effort to avoid pain where possible, and alleviate it when necessary.
For many years, postoperative pain was considered protective for pets as it caused them to limit their movement, thereby helping prevent injury. This belief has been changing more recently, however, as greater understanding has developed in the neurophysiology of pain. It has now been established that the neural pathways of cats and dogs are similar to those of humans, and it is very likely that animals experience pain similar to that experienced by humans. Given the negative physical effects of untreated pain, focus has subsequently been placed on the anticipation and prevention (or management) of pain in pets.
While preemptive treatment of pain associated with unexpected trauma is not possible, preemptive treatment of pain from surgery is. A preemptive approach includes anticipating what procedures will be painful and planning for them. In the case of surgery, this means providing pain medications such as opiods to reduce the chance of heightened sensitivity to pain and a worsening of acute pain (Fig. 1); providing satisfactory intraoperative analgesia such as local blocks; and ensuring that postoperative analgesia is provided by using nonsteroidal anti-inflammatory drugs.
Fig. 1: DRUGS USED TO MANAGE POSTOPERATIVE PAIN
||Usually used intraoperatively to block pain in a local area
||Short-term analgesia and sedation
||Short-acting analgesics used primarily in hospital
||As anxiety can enhance pain, anxiolytics may be used before the pet's appointment or as a preanesthetic
||For analgesia and anti-inflammatory effects
Pain has traditionally been thought of in terms of its duration: acute or chronic. Another way to categorize pain is as 'adaptive' or 'maladaptive'. Adaptive pain occurs as a normal response to tissue damage and includes inflammation, which is seen after surgery. Adaptive pain can progress to maladaptive pain if it is not properly managed. If it continues unmanaged, it is more difficult to control.
When your pet is hospitalized, recovering from a painful procedure (Fig. 2), the veterinary team acts as advocates for the patient's comfort. Recognizing that a pet is experiencing pain can be challenging; signs of pain (Fig. 3) can be so subtle they are overlooked. The veterinary team will assess and monitor your pet's pain and then communicate clearly and in detail with the veterinarian for necessary treatment, perhaps medication and perhaps calming by interaction and/or handling. Once the pet is discharged, the veterinarian will communicate clearly with the pet owner as they hand back the role of advocate for the animal's comfort.
Fig. 2: POTENTIALLY PAINFUL COMMON HOSPITAL PROCEDURES(not a complete list)
- Onychectomy (declawing)
- Dew claw removal
- Ear flushing and cleaning
- Deep dental cleaning
- Superficial tumor removal
- Anal gland expression
- Bite-wound and abscess treatment
- Urinary and intravenous catheter placement
- Restraint (particularly in an animal already in pain)
Fig. 3: RECOGNIZING POSTOPERATIVE PAIN
- Vocalization, thrashing, and/or restlessness or agitation
- Immobilization, no appetite, and/or disinterest in surroundings
- Biting or vocalization when surgical site is touched
- Hunched back; sitting or lying in an abnormal position
- Guarding of surgical site
- Pain in areas where no surgery occurred
- Increased heart rate
- Increased respiratory rate
- Increase in body temperature
- Increased blood pressure
- Profuse salivation
- Self-mutilation of surgical site
It is critical that the owner follow instructions carefully for care and pain management. The veterinary team will explain medications and if necessary show how to give them. It is important that the pet be comfortable and for the owner to continue any pain medications as long as necessary, which may mean for more than just 1 or 2 days, depending on the procedure performed and the individual pet's tolerance to pain. With proper education and communication between clients and the veterinary team, pets can stay comfortable throughout the pre- and post-surgical process. Key to this process is paying attention to the behavioral and physical symptoms of the patient. In addition, when the patient goes home, the owner must keep in touch with the veterinary care givers if unusual symptoms arise. Although pain medication is necessary, please be aware all medications can have adverse reactions and you should consult your veterinarian if you have concerns.
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