Pain Control & Use of Analgesics in Small Animals Flashcards

(79 cards)

1
Q

It is mandatory to treat pain if an animal has…

A

undergone a painful procedure OR has chronic pain requiring treatment of that pain

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2
Q

What is the official definition of pain?

A

“An unpleasant sensory and emotional experience, associated with actual or potential tissue damage or described in terms of such damage”

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3
Q

Pain has an essential protective function to announce…

A

the presence of a potentially harmful stimulus

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4
Q

Pain that has no useful function may be caused by

A

disease, trauma, or surgery and can delay recovery due to stress if left untreated

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5
Q

Appropriate analgesia results in

A
  • a more rapid return to normal function
  • a shorter hospital stay
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6
Q

When you undergo Surgery, you don’t perceive pain; but when you wake up after without appropriate pain meds on board, then…

A

you get excruciating pain when you wake up which is more difficult to treat

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7
Q

We use analgesics in veterinary patients because pain…

A
  • increases distress and suffering
  • increases the stress response
  • increases the metabolic & energy demands
  • increases conditions associated w/ prolonged recumbency
  • self-mutilation
  • ethical obligation for humane care
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8
Q

Studies in humans demonstrate that improperly controlled acute pain can…

A

precipitate a chronic pain syndrome that can be very difficult to control where pain itself becomes the primary disease

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9
Q

Pain assessment is the keystone of

A

pain management

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10
Q

if anything is done to the thorax, there are impacts to … and pain management should be used to facilitate it.

A

Ventilation

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11
Q

For successful treatment of pain, you must…

A

look for & recognise it

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12
Q

pain is now considered the 4th

A

vital sign monitored alongside TPR

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13
Q

Treat…

A

predictable pain

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14
Q

Pain assessment should be performed how often?

A

every 2-4 hours for acute pain

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15
Q

Pain assessment is key to determining

A

the degree & duration of pain treatment BUT should not replace treating predictable pain

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16
Q

Perioperative pain extends for at least… and should be managed accordingly

A

24-72 hours

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17
Q

All invasive procedures, trauma, & medical illnesses cause pain & may leave animals

A

unable to demonstrate pain behaviour

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18
Q

the worse the tissue injury, the worse the pain EXCEPT…

A

neuropathic pain which can be extremely intense despite relatively small tissue injury

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19
Q

Very sick patients may feel pain during

A

routine procedures & nursing

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20
Q

Species, breed, age, illness, temperament, drug admin influence…

A

behavioural responses to pain

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21
Q

compare an animal’s behaviour…

A

before & after the onset of pain if possible…

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22
Q

some animals respond to pain through

A

withdrawal

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23
Q

response to appropriate treatment is the gold standard to measure

A

the presence and degree of pain

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24
Q

always use a validated

A

pain scale, if available

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25
What is the least subjective pain score?
composite scales where the observer interacts w/ the animal & assesses its behaviour & physiology
26
What is the best validated pain scale?
Glasgow Vet School Composite Measure Pain Scale (GCMPS)
27
What are signs of pain in the dog?
- change in posture or body position (hunching/praying position, not resting normal) - change in demeanour - altered/reduced interaction w/ people (aggression) - vocalisations (barking, growling, whining) - attention to/guarding affected area - reduction in appetite - altered mobility (lameness, reluctance to move)
28
What are the 2 validated pain scales in cats?
Glasgow Botucatu
29
What things are assessed in the pain scales in cats?
posture, demeanour, vocalisations, interactions w/ the observer
30
The glasgow CMPS-F also addresses
facial expression
31
UNESP-Botucatu MCPS in cats includes
BP measurement as an optional variable
32
The Glasgow CMPS-F is appropriate for assessing
medical, surgical, and trauma-associated acute pain
33
UNESP-Botucatu MCPS was validated for
pain following OVH
34
When assessing pain in rabbits, what pain score constitutes further pain investigation?
Pain score of 2 in any category
35
In rabbits, what categories are used to watch for pain?
- ear shape & position - orbital tightening - nostril shape - cheek flattening - whisker change & position
36
When should analgesics be used?
Pre-operatively, intra-operatively, and post-op
37
Why do we use pre-op analgesics?
to provide pre-emptive analgesia to facilitate handling/sedate animals
38
Why do we use intra-op analgesics?
to reduce response to noxious stimuli to reduce anaesthetic requirements
39
Why do we use post-op analgesics
to control acute pain, reduce distress & suffering, etc to prevent the development of chronic pain
40
Multimodal analgesia is...
the concomitant use of analgesics from separate pharmacological drug groups to provide analgesia by differing modes of action
41
Multimodal analgesia allows for
- better control of intra & post-op pain - promotes haemodynamic stability - minimises incidence of chronic pain - reduces dose & side effects of most drugs
42
How do you build a multimodal analgesic protocol for P's undergoing surgery?
- Start w/ NSAID, opioid, or both - Add local anaesthetic - Add CRI - Add ancillary techniques
43
Why are local anaesthetics so important?
they are the most efficient way of providing analgesia to the area & stop pain stimulus from getting to the brain & will not be perceived upon waking
44
Locals exert action by...
blocking action potentials from being propagated along sensory neurons by blocking the sodium channels and preventing depolarisation of the membrane required to trigger an action potential
45
Local anaesthetics completely block
the pain pathway from ever generating a response
46
Locals reduce the need for...
other intra-operative analgesia
47
What are the main local anaesthetics used?
Lidocaine, bupivacaine, ropivacaine
48
What is the main difference between the different types of local anaesthetics?
onset & duration of action
49
The speed of onset of action of local anaesthetics depends on...
pKa Near 7.4 = fast onset of action Higher? = slower onset of action
50
Duration of action of locals depends on...
protein binding
51
Potency of local anaesthetics depends on...
lipid solubility
52
more lipid solubility in locals =
more protein binding
53
What is the onset & duration of effect of lidocaine?
Onset of effect: fast Duration of effect: short
54
What is the onset & duration of effect of bupivicaine?
Onset of effect: slow duration of effect: long
55
What is the onset & duration of effect of ropivacaine?
Onset of effect: intermediate duration of effect: intermediate
56
What are signs of local anaesthetic toxicity?
CNS first affected (except bupivicaine) then CV depression then death
57
Local anaesthetics should not be given... EXCEPT...
IV Except Lidocaine at slow rate in dogs
58
If using lidocaine spray for intubation, the amount of lidocaine used...
needs to be taken into consideration in total lidocaine dosing
59
If you give too much lidocaine during GA, you won't see signs of toxicity... the patient may just...
have a seizure or go into coma
60
What techniques are used with local anaesthetics?
Splash block Tissue infiltration Intratesticular injection Bier block (IVRA) Epidural Cat sacrococcygeal epidural Dental blocks Wound catheters intra-articular block specific nerve blocks
61
What is a splash block?
Direct topical application of local anaesthetic to incision/wound prior to closure OR during laparotomy
62
What is a tissue infiltration block?
Injection of local into SQ tissues around/directly into the incision or wound which blocks the surgery site Targets nerves: cutaneous nerves of area
63
What is an intratesticular injection?
Injection of local into the testicles to desensitise spermatic cord and associated structures and provides analgesia for castration
64
What is a Bier block?
Block of the distal limb for a short surgical procedure (<90 mins)
65
What are indications for epidural?
- Sx on hind legs & perineal area - Abd & thx procedures
66
What are contraindications for epidural?
- sepsis, bacteraemia - Hypovolaemia, hypotension in large animals - Pyoderma or neoplastic changes in injection site - clotting disorders, thrombocytopaenia - abnormal anatomy
67
When do you do a sacrococcygeal epidural in a cat?
- Sx on tail, penis, vulva, or perineal area - Dystocia - Urethral block - Hindlimb & pelvic Sx
68
When are contraindications present with a cat sacrococcygeal epidural?
Pyoderma Anatomical abnormalities/no tail --> Manx cats
69
What are some common problems associated with epidural injection?
- Hypotension - Urinary retention - Subarachnoid injection - Blood in hub of needle (inj off midline)
70
What are rare problems associated with epidural injections?
- Cranial spread of local causing respiratory depression - Pruritis
71
What are the uses for a dental block under GA?
- Dental extraction - Mandibulectomy & maxillectomy
72
What drugs are used in dental blocks?
lidocaine or bupivicaine
73
When doing local dental blocks, what do you have to remember about injecting the medications?
you have to divide the volume btw various injection sites which may require diluting the drug
74
Where are dental blocks given?
- infraorbital maxillary block - caudal maxillary block - rostral mandibular (mental) block - caudal mandibular block
75
What other analgesic techniques can be used?
CRI, Paracetamol, Gabapentin, Tramadol, Fentanyl Transdermal patches
76
What CRI can be used in dogs for analgesia?
morphine, lidocaine, ketamine (MLK) fentanyl, lidocaine, ketamine (FLK) or any alone Medetomidine or dexmedetomidine
77
What CRI are used in cats for analgesia?
morphine, ketamine (MK) fentanyl, ketamine (FK) or any alone Medetomidine or dexmedetomidine
78
Paracetamol can only be used in what species of small animals?
DOGS
79
what animal cannot receive lidocaine IV?
Cats!