Managing pain in the postoperative patient

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“Osteoarthritis is not something that we are going to cure, but we certainly can manage,” Tasha McNerney, BS, CVT, CVPP, VTS (Anesthesia & Analgesia) said to start off her joint session with Feliza Lopez, LVT, VTS (ECC) at the Directions in Veterinary Medicine symposium in Miami, Florida.¹ The 2 veterinary technicians shared their professional advice for caring for a painful patient, especially postoperative patients.

One thing McNerney was quick to mention was that understanding pain in a patient can also include emotional and behavioral changes, rather than just a physical presentation. She said, “I also think that people forget that there is an emotional component.” And with that, McNerney explained that understanding a patient’s pain can incorporate all symptoms including physical, emotional, and behavioral. For example, McNerney said, “If we are seeing some signs of behavior changes, and now this cat has become cranky and you cannot touch this cat, then I'm going to investigate that a lot more.” From there, there are questionnaires clients can fill out based on their pet’s behavior and actions, as well as pain scoring scales.

Once you have determined pain level in a patient, McNerney and Lopez advised attendees that using both pharmacological and non-pharmacological interventions is best for pain management. With pharmacological treatments, McNerney stated, “Hopefully, we've drilled home, that if anything, you're going to leave this this conference knowing that we definitely need analgesia and we need to be doing more local blocks. And hopefully, you'll get a little more comfortable utilizing ketamine as an analgesic in your practice.” According to McNerney and Lopez, the use of opioids and continuous rate infusions (CRI) can be effective in managing postoperative pain in veterinary patients. The dose and frequency of administration should be based on the patient's pain level and response. Opioids, such as fentanyl, morphine, and hydromorphone, are commonly used for pain relief, while analgesic CRIs include ketamine and lidocaine.

For non-pharmacological treatment options, McNerney and Lopez recommended using heat therapy, cold therapy, circulation massage, and hydrotherapy. These therapies can often aid in stress relief in addition to pain management.

To close out their discussion, McNerney said, “Closing thoughts are that you can utilize your technicians. The technicians really should be doing communication with the owners and can help the owners understand what are some behaviors to look out for when [their pet] is signaling pain.”

Reference

Lopez F, McNerney T. That's PURRRFECT. Optimal Nursing Care for the Management of Pain. Presented at: Directions in Veterinary Medicine; Miami, Florida. May 19-20, 2023.