Veterinary Medicine - December 2008 - (Page 654)

2008 Practical advice from the presentations PEER-REVIEWED 2. This cat’s posture and facial expression are consistent with abdominal pain. 3. A friendly cat that played at the front of its cage before surgery hides afterward. (Figure 4). One of the many commonly reported problems after onychectomy is excessive licking and chewing of the feet.3 Cats will often shake their paws and try to bite at their feet if bandages are placed on onychectomy wounds. These behaviors could indicate postoperative pain, pain from an incorrectly placed bandage, or a dislike of the bandage, so it is important to differentiate among these. HOW OFTEN SHOULD PAIN BE ASSESSED? The patient’s health status, the extent of the surgery or injuries, and the anticipated duration of effect of the analgesic drugs administered determine the frequency and interval of evaluations. If a cat, for example, is resting comfortably (normal posture and facial expression) after postoperative buprenorphine administration, it may not need to be reevaluated for two to four hours. Allow animals to sleep after analgesic therapy. Vital signs can often be checked without unduly disturbing a sleeping animal. In general, do not wake an animal to check its pain status; however, the patient should still receive scheduled analgesics. Continuous, undisturbed observations coupled with periodic interactive observations (e.g. palpating the wound) are likely to provide more information than occasionally observing the animal through the cage door. Unfortunately, continuous observations are not practical for most clinical situations. But the more frequent the observations, the more likely that subtle signs of pain will be detected. REFERENCES 1. Lascelles B, Capner C, Waterman-Pearson AE. A survey of current British veterinary attitudes to peri-operative analgesia for cats and small mammals. Vet Rec 1999;145:601-604. 2. Waran N, Best L, Williams V, et al. A preliminary study of behaviour-based indicators of pain in cats. Anim Welfare 2007; 16(S):105-108. 3. Patronek GJ, Assessment of claims of short- and long-term complications associated with onychectomy in cats. J Am Vet Med Assoc 2001;219(7):932-937. 4. Palpating a bone graft site to assess for pain. Loss of normal behaviors The absence of normal behaviors in a speci c patient (e.g. grooming or playing with string) should prompt you to assess that patient for pain. Many cats that are fearful or stressed will stay at the back of their cages and hunch themselves up, but if you observe these cats before and after surgery, you can detect subtle changes. For example, if pain relief is inadequate, a cat may be even more hunched than before. And instead of just being at the back of the cage, it may actively try to hide under things (Figure 3), and its facial expression will be different from that before surgery. It is important to assess patients before and after surgery. Each cat is unique, and some will have altered behavior due to stress. The trick is to pick up small changes for that speci c cat that can be attributed to pain. However, stress and fear are aversive emotions that can worsen pain, so they should not be dismissed. Instead, give some thought as to how to also relieve stress and fear, such as by providing a cat-only area, boxes for cats to hide in, and favorite toys and blankets from home or by using a synthetic feline pheromone (Feliway—Ceva Santé Animale). Response to palpation Wound palpation is an important component of pain assessment; you should be able to apply gentle pressure to a surgical wound without a cat’s inching or turning to bite Do cats become dysphoric when given opioids? To hear Dr. Robertson talk about the use of opioids in cats, go to dvm360.com and click on “Medicine.” 654 December 2008 VETERINARY MEDICINE http://veterinarymedicine.dvm360.com/vetmed/Medicine/ArticleStandard/Article/detail/556344 http://veterinarymedicine.dvm360.com/vetmed/Medicine/ArticleStandard/Article/detail/556344 http://www.dvm360.com http://www.dvm360.com

Table of Contents Feed for the Digital Edition of Veterinary Medicine - December 2008

Veterinary Medicine - December 2008 Contents Letters Thanking Our Valued Reviewers Practical Matters Idea Exchange Why Do Dogs and Cats Eat Grass? Managing Atypical and Critical Cases of Primary Hypoadrenocorticism in Dogs Behaviors Suggestive of Postoperative Pain in Cats What to Consider When Considering Digital Radiography Avoid Common Bandaging Mistakes in Dogs and Cats IMHA: Diagnosing and Treating a Complex Disease CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - December 2008

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