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There are several very important facts that we know about pain. We know that pain actually increases inflammation as well as increases healing time. We also know that although animals appear at times not to show pain that they do indeed feel it and are simply conditioned to not show any weakness. And lastly, we know that we must treat pain preemptively (prior to occurring) to achieve the most effective pain relief available. There are 4 basic areas in which we can stop or prohibit pain in our patients. We call these four areas transduction (sensory nerve endings – i.e. tissue trauma or surgical incisions), transmission (the path of the sensory nerve on the way to the spinal cord), modulation (the message that the spinal cord receives and delivers to the brain), perception (the message that the brain sends out to the body – “Ouch that really hurts!!”). These 4 areas are always working whether animals (or humans) are under anesthesia or unconscious. The brain is always sending messages reacting to the messages it receives and this is why simply administering anesthesia alone is not effective in treating pain in our patients. Being that we have 4 different areas that we can stop these pain “signals” at we are afford many options. The purpose of the Anesthesia and Pain Management group at the University is to alleviate all of the aforementioned pain to a degree that maintains a high quality of life. We have many specialized modalities in which we are trained to provide relief to our patients. Below is a list of commonly used modalities in the University of Wisconsin Veterinary Medical Teaching Hospital Anesthesia and Pain Management Section.
Brachial Plexus Block
An injection administered whilst under anesthesia to numb the area below the shoulder area to alleviate pain in the forelimb. Excellent for procedures involving the forearm below the site of injection.
Dental Nerve Blocks
There are numerous local block techniques that we can employ both in and outside the oral cavity to assist in pain control in areas of the mouth, jaw, aural (ear) and nasal regions. These are just like the injections that your dentists’ use. These can help deal with pain associated with tooth extractions, fractures, biopsies and so on. These types of blocks are also performed while the patient is under anesthesia and can last up to 6-8 hours.
Dispensable Oral Medications
With our large crew of veterinary anesthesia and analgesia experts we can keep up to date on the most cutting-edge therapies available to relieve pain via oral (pill or liquid) form. We can assist clients and clinicians alike in provide the best choices with the least side effects for our patients at home pain.
Epidurals
This method of pain relief can be used either as a single dose method or long term if an epidural catheter is placed. The single dose is used for patients that will be going home shortly thereafter surgery (orthopedic cases – knee and hip surgeries like cruciates, TPLO’s, FHO’s, abdominal surgery – mammary gland tumor removal, anal gland sac removal surgery’s, or any other case in which we determine a benefit from this type of block). The multi-dose catheter method is used to control more painful, long term cases (serious fractures, chest and heart surgeries, or amputations) by giving us the ability to maintain a catheter in the epidural space to administer analgesics on a regular basis without getting undesirable side effects. When using this method we have to shave a portion on the patient’s back towards the tail in order to keep the site free of hair and sterile. This procedure is also performed while under anesthesia. One of the many benefits of this method is that we can see pain relief effects from single injections for 12 hours.
Infiltrative Blocks
These are blocks that are used to numb very superficial skin areas. This technique is excellent for quick biopsies that are not extremely painful such as dermal punch biopsies or bone marrow biopsies. They are inexpensive and extremely effective in preventing pain for 2-6 hours.
Intercostal Nerve Blocks
These blocks are used to numb the rib cage. These are most commonly during thoracotomies or other surgical procedures involving the rib cage. These typically last up to 12 hours and can be repeated as needed. They are minimally invasive and provide a great deal of pain relief locally.
Interpleural Analgesia
This is a method by which we can infuse the chest cavity with a numbing agent to provide hours of relief. This method is most commonly used when we have the need to place a chest tube. These infusions typically last 6-12 hours and can be repeated as needed. They are typically used with chest cases such as chest surgeries (such as lung lobectomies or thoracotomies). These too are very effective and an inexpensive method to control pain.
Intra-Articular Blocks
This modality is most commonly performed by the veterinary surgeon. It is a method by which we can place a numbing analgesia directly into the joint to control pain. This method is extremely useful in any procedure involving the joints. It too is both an excellent analgesic and cost effective.
Intravenous CRI’s
The acronym CRI stand for continuous rate of infusion. This method allow us to systematically deliver a constant infusion of analgesics via a syringe pump to the patient to control pain as well as to reduce the amount of anesthetic gas that we use during surgical procedures. By reducing anesthetic gas we are able to provide a safer environment to the patient. We can use this modality before, during and after surgery to control pain. It allows us to adjust the dose of analgesic over a very short period of time to provide the best relief for the patient.
Radial/Ulnar/ Median Nerve Blocks
This is an incredibly effective, inexpensive method used primarily during feline declaw procedures to numb the paw for 4-8 hours to alleviate the surgical trauma of declawing. When we employ this technique prior to declawing cats we see greatly improved recovery and healing times.
Transdermal Patches
The use of transdermal patches in veterinary medicine is a fairly new method which has been adopted from the human medicine world. These patches (as shown) contain a drug reservoir which, for our use, holds an opioid which is delivered through contact with the patients skin. These can be helpful in delivering a more potent form of pain medication outside of the hospital or to assist in relieving pain post-operatively, post-radiation (tissue burn patients). We even make use of them preoperatively (such as in fracture cases) that are not immediately stable to be surgically repaired. These patches take 12-24 hours to take effect and are effective for approximately 72 hours. It is important that when using this form of “go-home” delivery system that the patch stays in good contact with the skin, is not exposed to high or low temperatures for extended periods of time (this increases and/or decreases the dose being delivered) and is disposed of properly (returned to the hospital).
