Pain Management in Veterinary Practice

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More recently, the ACVA updated its title to the American College of Veterinary Anesthesia and Analgesia, highlighting the increased awareness of the importance of analgesia among veterinary specialists.

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Small-animal medicine includes dogs and cats. Large-animal medicine includes horses, cattle, swine, sheep, goats, llamas, and alpacas.

Exotic animal medicine encompasses all zoo animals, wildlife, and nondomestic pets. It is impossible to cover the topic of regional anesthesia in veterinary species in one brief article. This topic is far more appropriate for a textbook. However, the following will provide an overview of this ever-expanding field of veterinary analgesia. In veterinary medicine, regional anesthesia is used for many reasons, including improved postoperative pain control, decreased systemic opioid use, and improved quality of recovery.

Most regional anesthetic techniques used at this time have been adapted from human medicine.

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However, veterinarians face limitations and challenges that are oftentimes not encountered in the practice of adult human medicine. First, since nonhuman patients are nonverbal, they cannot communicate their degree of pain or the efficacy of an analgesic technique that has been employed. Veterinary medical professionals must rely on various assessment tools to estimate the degree of pain. Another challenge is that of patient compliance. Animals generally lack self-restraint, and most will require heavy sedation or general anesthesia prior to administration of locoregional anesthesia.

Regional anesthesia in feline patients, for example, can be more challenging than regional anesthesia in canine patients. Cats have increased sensitivity to local anesthetics when compared with other species, necessitating much lower maximum doses be used.

Anatomically, the dural sac of cats terminates further caudally than in human or canine counterparts, often resulting in a subarachnoid injection rather than an epidural injection. Intraoral blocks also can be more challenging in cats, as the proximity of feline orbits to their oral and nasal structures makes techniques such as caudal maxillary or infraorbital blocks more challenging.

Small breeds of dogs present similar challenges. Globe rupture and retrobulbar hematomas are known complications of intraoral techniques in these species. Patients presenting for surgery of the pelvic limbs typically receive either an epidural or combination femoral and sciatic nerve blocks.

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Following femoral and sciatic blockade, surgical procedures of the knee and distal pelvic limb have been reported under sedation rather than general anesthesia in dogs. Locoregional anesthesia for procedures involving the thorax, mammary chain, or abdomen can provide significant pain relief. The transversus abdominis plane block has been used for lower abdominal procedures. Epidural anesthesia is used for abdominal surgeries or procedures that require manipulation of perianal or external reproductive and urinary organs.

Analgesia for thoracotomies may be provided via thoracic epidurals or paravertebral or intercostal nerve blocks Figure 2. For thoracic limb surgery distal to the midhumerus, brachial plexus blocks are commonly used. For ophthalmic procedures, typically enucleations, retrobulbar and peribulbar blocks result in excellent intraoperative and postoperative analgesia. Other techniques commonly performed in veterinary patients include infraorbital and various intraoral blocks. While the field of regional anesthesia for small animals is rapidly growing, regional anesthesia for large animal species has remained ever present for several years.

This is due, in large part, to the hurdles of general anesthesia for large animal patients. A general anesthetic event for a horse, for example, requires specialized equipment and carries a much higher risk of complications such as long-bone fractures, myopathy, and neuropathy simply based on sheer size. Equine anesthetic mortality is reported to be to fold greater than for dogs and cats. Large-animal surgical procedures are therefore commonly performed under sedation with local and regional anesthesia.

It is important to note that these patients require marked strength in all four limbs to remain upright and do not tolerate motor blockade, which results in paralysis or paresis. As such, lumbosacral epidurals, common among small-animal anesthetic techniques, are rarely performed with local anesthetics. To date, femoral or sciatic blocks have not been reported among adult horses or cattle.

Distal limb procedures can be performed using intravenous regional anesthesia or blockade of peripheral nerves. Fracture repair, arthroscopy, or proximal limb surgical procedures typically require a general anesthetic at a specialty veterinary practice with systemic analgesics. Anesthesia for laparotomy in cattle is typically achieved by proximal and distal paravertebral blockade of T13, L1, L2, and L3 spinal segments.

The abdomen of cattle can also be blocked using infiltration of local anesthetic along the posterior aspect of the last rib and a line extending posteriorly along the transverse processes of the lumbar vertebrae the inverted L block; Figure 3. Similarly, surgical approaches to the ventral abdomen can be performed with the sedated animal restrained in the supine position with local infiltration of the projected incisional path with local anesthetic Figure 4.

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Equine patients more commonly require general anesthesia for laparotomy because of their highstrung temperament, but regional anesthetic techniques combined with heavy sedation can allow surgeons to perform abdominal procedures with the patient standing. Segmental thoracolumbar anesthesia has been reported in addition to infiltration of the surgical site with local anesthetic.

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Surgical procedures involving the reproductive tract are commonly performed among large animals. Castration is commonly performed in the field and is one of the most common surgical procedures performed in large animals. Caudal epidural anesthesia is commonly performed in the sacrococcygeal interspace to allow surgical procedures of rectum, vagina, and tail. Regional anesthesia of the head can be performed via blockade of proximal and distal branches of sensory nerves.

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For instance, blockade of the cornual nerve, a distal branch of the trigeminal nerve, can be performed for dehorning procedures of cattle. Ophthalmic procedures can be performed in the standing animal via a number of local blocks. The Peterson eye block, for instance, desensitizes branches of the oculomotor, trochlear, abducens, and trigeminal nerves and allows enucleation to be performed in the sedated animal.

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Egger Lydia Love Tom Doherty. First published: 20 December About this book Pain Management in Veterinary Practice provides veterinary practitioners with the information needed to recognize and manage pain in a wide range of large, small, and exotic animal species. Author Bios Christine M. Free Access. Summary PDF Request permissions. Tools Get online access For authors.

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