placed on IV fluids with ketamine CRI. Femoral and sciatic regional nerve block performed with bupivacaine, and IA hydromorphone. Patient prepped and surgery performed. Long‐acting (liposome‐encapsulated) bupivacaine infused into several layers of closure. Post‐op cold compression, continue ketamine ± opioid CRI for 4–6 hours. Patient discharged with NSAID, gabapentin PO, and physical rehabilitation instructions (or referral), to include therapeutic laser if available.
Example 4 : 12‐year‐old golden retriever with a BCS of 7/9 stiff in the mornings and after exercise; owner has to help up onto the couch. Physical exam reveals straight‐legged conformation and atrophy rear quarters, discomfort, physical examination, and radiographic signs consistent with hip dysplasia and advancing OA. Priority is to place patient on NSAID or PRA of choice and switched to an EPA‐rich diet formulation that also promotes weight loss to BCS of 6 and ultimately a lean 5. If owners agreeable, patient is also placed on polysulfated glycosaminoglycan, or alternatively, a high‐quality and reputable nutraceutical; exercise program implemented that includes vigorous walks and inclines but unrestricted activity is limited. If and when eventually deemed appropriate and available, choice (and/or combination of) pain‐modifying analgesic medication (e.g., amantadine, gabapentin) is prescribed as adjunct to the NSAID or PRA, IA biologic injections, and anti‐NGF mAb treatments are implemented. Acupuncture, therapeutic laser, pulsed electromagnetic field, myofascial trigger point, referral for aggressive physical rehabilitation, and other nonpharmacological modalities can be utilized at any time.
Underrecognized and undermanaged pain inflicts very real physiological and medical consequences, resulting in significant patient morbidity and in the extreme can contribute to mortality.
Through the process of peripheral and central hypersensitization (“wind‐up”), pain becomes maladaptive, exaggerated in scope, severity, character, duration, and field; a number of factors will place a patient at risk for maladaptive pain, including (but not limited to) nerve injury, severe trauma, chronic inflammation, heritable tendency.
Assessment of both acute postsurgical and chronic OA‐related pain is possible with validated CMIs.
Evidence‐based industry guidelines and consensus statements are available to direct veterinary clinicians to the highest, wisest, safest multimodal strategies for acute and chronic pain.
Veterinarians are advised to adopt the emerging trend of reducing, full mu agonist opioid usage, insofar as possible and still maintain patient comfort, in favor of buprenorphine and butorphanol along with multiple opioid‐sparing modalities and strategies.
2.16.5 Cautions
With an aggressive multimodal approach to peri‐perative pain management, anesthetic requirements may be significantly reduced; adjust induction doses and vaporizer settings accordingly.
Abbreviation
BCSBody condition score
References
1 1 Bonica, J.J. (1979). International for the study of pain: pain definition. The need of a taxonomy. Pain 6 (3): 247–248.
2 2 Tony Buffington, C.A., Westropp, J.L., and Chew, D.J. (2014). From FUS to Pandora syndrome: where are we, how did we get here, and where to now? J. Feline Med. Surg. 16 (5): 385–394.
3 3 Mathews, K., Kronen, P.W., Lascelles, D. et al. (2014). Guidelines for recognition, assessment and treatment of pain: WSAVA Global Pain Council. J. Small Anim. Pract. 55 (6): E10–E68.
4 4 Epstein, M., Rodan, I., Griffenhagen, G. et al. (2015). 2015 AAHA/AAFP pain management guidelines for dogs and cats. J. Am. Anim. Hosp. Assoc. 51 (2): 67–84.
5 5 Muir, W.W., Berry, J., Boothe, D.M., et al. (2018). Opioid‐Sparing Pain Therapy in Animals: Working Task Force. https://ivapm.org/wp‐content/uploads/2018/12/Op‐Sparring‐Task‐Force‐WP.pdf
6 6 Fan, T.M., de Lorimier, L.P., O'Dell‐Anderson, K. et al. (2007). Single‐agent pamidronate for palliative therapy of canine appendicular osteosarcoma bone pain. J. Vet. Intern. Med. 21 (3): 431–439.
7 7 Ray, L., Lipton, R.B., Zimmerman, M.E. et al. (2011). Mechanisms of association between obesity and chronic pain in the elderly. Pain 152 (1): 53–59.
Recommended Reading
1 Rodan, I., Sundahl, E., and Carney, H. (2011). AAFP and ISFM feline‐friendly handling guidelines. J. Feline Med. Surg. 13 (5): 364–375.et al., for the American Animal Hospital Association
2 Yin, S. (2009). Low Stress Handling, Restraint and Behavior Modification of Dogs and Cats: Techniques for Developing Patients Who Love Their Visits. Davis, CA: Cattledog Publishing.
2.17 Emergency Preparedness
Lori Massin Teller, DVM, BS (Vet Sci), DABVP (Canine/Feline Practice)
Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
2.17.1 Summary
Disasters, man‐made or natural, can be devastating. Lives can be disrupted or lost, property damaged or destroyed. It is important to prepare yourself, your family, your clients, and your practice ahead of time for a disaster. There are some disasters that you may be forewarned about, such as hurricanes or blizzards. Others may happen without warning, such as earthquakes, tornadoes, fires, or terrorist attacks. Disaster plans should include contingencies for both local emergencies, such as a building fire or flooding from a burst water main, as well as a community‐wide event, such as a chemical spill or massive flooding from a hurricane or wind damage from a tornado. It is vitally important that veterinary practices have a written disaster plan to cover emergency relocation of animals, back‐up of medical records, continuity of operations, security, fire prevention, and insurance and legal issues.
2.17.2 Terms Defined
Incident Command System (ICS ): Defined command and control system to manage the emergency. Activities of all responding agencies and people are coordinated through the ICS.
For disasters in which there is forewarning, such as hurricanes or blizzards, it is important for veterinarians and staff to have their personal preparations, including plans for family, animals, and property, stabilized before
