1. Pain Management for the recovery and healing process
Angela Culp LVT

2. What is pain management?
Pain management is the easing of suffering and improving the quality of life of those living with pain. Inadequate pain prevention or management can lead to magnification of pain reception or a prolonged pain state. Pain has been categorized as acute or chronic based on the timeline, a more contemporary considers pain as adaptive or maladaptive. - Adaptive - pain, which produces behavior that promotes healing and recovery. - Maladaptive - pain that tends to persists long after the tissues have healed so that the pain becomes the problem.

3. CRI
A constant rate infusion/manually controlled infusion (CRI/MCI) of analgesic drugs is a simple and effective means of improving patient comfort.
This is chosen based on the amount of pain the patient is in and the procedure that was performed
There are a lot of drugs that are commonly used as a CRI pain management but the most used are Ketamine, Lidocaine and Morphine

4. “Gunner” McEvoy 7yr NM Pt presented to clinic for not using back legs.
Pt was rushed to the surgery center for emergency back surgery.
Gunner was diagnosed IVDD and had slipped his L2 and L3 disc.

5. Physical Exam T:101.5 P: 120 R: 32 WT: 15.2
Muscoskelatal : Painful along the back and motor reflexes were delayed. Still able to feel deep pain upon testing on toes.
All other systems were functioning within normal limits.
Veterinarians orders: Upon viewing images from the RDVM the Surgeon request a CT scan and bloodwork.

6. Bloodwork
Bloodwork is within normal limits.

7. Computed Tomography (CT scans)
In the image we noticed a L2 and L3 was herniated and was in need of emergency repair.

8. Surgery Pre-med: Acepromazine ,Glycopyrolate and Midazolam
Placed an IVC and started a CRI
Placed Gunner in a Dorsal Ventral position and prepped the dorsal area for surgery.
We did a surgical repair of the L2 and L3 and fused the 4 lumbar.

9. CRI Plasma Fluids and Morphine Drip 6.9 kgs
FENTANYL: mg/kg/hr. = mg = 24.0 ml = mg/ml
Fluid bag had 1000ml : we took out 24.0 ml out of the bag and added 24 ml of Fentanyl to the fluid bag to administer to the patient.
Planned fluid rate: 3ml/kg/hr. = 20.7 ml/hr.

10. Post Surgery
Post surgery is crucial for healing time. Pain management usually begins prior to waking the patient. Some animals awake and start thrashing. This can cause sudden injury and extend the recovery time.
For a back surgery we use a Fentanyl CRI to help with a continuous pain management and sedation.
We do this to keep the patient from moving after surgery. Expression of the bladder is done to limit the movement post surgery.
This is a process to assist with adaptive pain. The assisted pain management allows for the healing time after surgery to be the most beneficial.

11. Reference
Katy W. Waddell, R. V. (2010). DVM360. Retrieved from
Oxford Dictionary. (2016). Oxford Dictionary. Retrieved from
Stein, D. (2016). Veterinary Anesthesia & Analgesia Support Group. Retrieved from VASG: