1887

Principles and practice of analgesia

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Abstract

Pain is not just a sensation, but rather an 'experience' that includes both sensory-discriminative and motivational-affective components. The International Association for the Study of Pain (IASP) defines pain as:

‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.’

proposed a further definition of pain more specific to animals:

‘Pain is an aversive sensory and emotional experience representing awareness by the animal of damage or threat to the integrity of its tissues … producing a change in physiology and behaviour directed to reduce or avoid the damage, reduce the likelihood or recurrence and promote recovery.’

This chapter considers Physiology of nociception; Systemic responses to pain; Recognition of pain; Multimodal and pre-emptive analgesia; Analgesic plans and drug groups; and Summary and planning of rational multimodal analgesia.

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Figures

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14.3 The Short Form of the Glasgow Composite Measure Pain Scale (CMPS-SF), which measures pain score quickly and reliably in a clinical setting. (© University of Glasgow)
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14.4 Structure for the basic approach to analgesia of the surgical patient.
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14.10 Nerves can be bathed in local anaesthetic during surgery, prior to transection for procedures such as amputation; or local anaesthetic can be splashed on to the muscle layers during closure to augment postoperative analgesia.
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14.11 Intratesticular local anaesthetic injection appears to improve analgesia clinically. Always aspirate prior to injection to avoid intravascular injection.
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14.12 Custom-made wound catheters placed during wound closure to ensure maximum coverage. The wound catheters exit remotely from the wound closure and are secured in place with a Chinese finger-trap suture. Wound catheters should be clearly marked to avoid confusion with wound or chest drains.
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14.15 Nerve locator used in a number of limb blocks to locate motor nerves and allow placement of smaller volumes of local anaesthetic immediately adjacent to the nerves.
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14.16 Retrobulbar nerve block in a cat performed with a curved needle introduced via the conjunctiva and guided around the globe. The needle should be aspirated to check for blood prior to injection of local anaesthetic. Alternatively, a spinal needle can be curved and introduced in the same way. The globe should rotate centrally once the local block takes effect.
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14.18 Intravenous regional analgesia (IVRA). Following placement of an intravenous catheter, an Esmarch bandage is placed and secured. The lidocaine is injected through the catheter to provide analgesia distal to the tourniquet until its release. The catheter is removed following injection.

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