Pain Management and Analgesia
Pain management tests assessment, multimodal planning, and dose safety. The examiner wants you to treat pain proactively rather than waiting for obvious crying.
Assessment and strategy
- Use a validated scale such as the Glasgow Composite Measure Pain Scale for dogs; physiologic signs include tachycardia, hypertension, tachypnea, dilated pupils, and salivation.
- Multimodal analgesia combines opioids, NSAIDs, local anesthetics, and adjuvants such as gabapentin or ketamine.
- NSAIDs are contraindicated with gastrointestinal ulceration, renal disease, dehydration, and concurrent corticosteroids; monitor renal and hepatic values with long-term use.
- Local anesthetic limits matter: lidocaine in dogs is commonly capped at 4-6 mg/kg; bupivacaine at 1-2 mg/kg. Cats are far less tolerant of lidocaine.
Worked example
A 5 kg cat needs an incisional block with bupivacaine at 1 mg/kg. Dose = 5 mg. A 0.5% solution is 5 mg/mL, so the volume is 1 mL. Confirm the concentration on the vial, calculate again, and record the site and total dose.
Traps that cost marks
Assuming a sleeping patient is comfortable; using an NSAID and a corticosteroid together; giving a full canine lidocaine dose to a cat; and forgetting that pain increases anesthetic requirements.