The construction of a comprehensive, multimodal approach to surgical patients is within the reach of any clinical practice.
The fundamental elements generally include, insofar as possible, anxiolytics, opioids, local blocks and NSAIDs, with additional
modalities used at the clinican's discretion. Pain management systems so constructed would likely find themselves in the top
tier of veterinary practices.
Dr. Epstein is president of the International Veterinary Academy of Pain Management and medical director at the Total Bond
Animal Hospital in Gastonia, N.C.
1. Gramke HF, de Rijke JM, van Kleef M, et al. The prevalence of postoperative pain in a cross-sectional group of patients after
day-case surgery in a university hospital. Clin J Pain 2007;23(6):543-548.
2. Bell RF, Dahl JB, Moore RA, et al. Perioperative ketamine for acute postoperative pain. Chochrane Database Syst Rev 2006;25(1):CD004603.
3. Bell RF, Dahl JB, Moore RA, et al. Peri-operative ketamine for acute post-operative pain: a quantitative and qualitative systematic
review. Acta Anaesthesiol Scand 2005;49(10):1405-1428.
4. Elia N, Lysakowski C, Tramèr MR. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective
cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses
of randomized trials. Anesthesiology 2005;103(6):1296-1304.
5. Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic
review. Anesth Analg 2004;99(2):482-495.
6. Malchow RJ, Black IH. The evolution of pain management in the critically ill trauma patient: emerging concepts from the global
war on terrorism. Crit Care Med 2008;36(Suppl):S346-S357.
7. Lascelles BDX, Capner CA, Waterman-Pearson AE. Current British veterinary attitudes to perioperative analgesia for cats and
small mammals. Vet Rec 1999;145:601-604.
8. Hewson CJ, Dohoo IR, Lemke KA. Perioperative use of analgesics in dogs and cats by Canadian veterinarians in 2001. Can Vet J 2006;47(4):352-359.