BY: SAMANTHA BARTLETT, DVM
Opioids often go on backorder or undergo shortages due to varying circumstances. Additionally, opioids may not be the most appropriate choice for certain veterinary patients. Many alternative therapies exist to help with analgesia before, during and after surgery. Often, non-opioid analgesia management is a multi-modal approach to ensure adequate pain relief is achieved.
Prior to arrival at the clinic, the client can administer oral medication to reduce anxiety. Gabapentin can be used in dogs and cats for calming. Trazodone is another option for pre-arrival anxiety in dogs. Acepromazine or alprazolam may be other options for some patients. Oromucosal dexmedetomidine is also an option for calming the pre-anesthetic canine patient. Gabapentin and/or tramadol are often used to lower anxiety and provide some analgesia although studies on their analgesic effects in pets are ongoing.
Before onset of anesthesia, an NSAID may be administered orally if medically appropriate for the patient. Given enough time to reach tissue concentration will provide some analgesia post-operatively. Side effects during surgery include increased risk of renal damage if the patient becomes hypotensive. Often it is easier and faster to give injectable pain medications pre- or peri-operatively. Dexmedetomidine in healthy patients is often used as a pre-medication to provide analgesia and sedation. Side effects include bradycardia and vasoconstriction and require careful monitoring during anesthesia. Dexmedetomidine can also be administered as a CRI for analgesia and to reduce the amount of anesthesia required.
Finally, the use of local and nerve blocks can reduce the amount of inhalant anesthesia required for a procedure and, depending on the product use, can provide pain relief post-operatively. Lidocaine is often used for testicular blocks in castration and line blocks to the abdominal wall for OVH procedures with good effect. Ropivacaine and bupivacaine can also be used if longer duration of analgesia is desired.
