2022-05-26

Building optimal analgesic
protocols with the2022 ISFM acute pain
management guidelines
Paulo Steagall MV, MSc, PhD, Diplomate ACVAA
Professor of Veterinary Anaesthesia and Pain Management
www.felinegrimacescale.com

Consultancy services
Boehringer Ingelheim, Dechra, Elanco andZoetis
Key-opinion leader

Disclosure

Boehringer Ingelheim, Dechra, Elanco,
Vetoquinol and Zoetis
Speaker honoraria
Boehringer Ingelheim, Dechra, Elanco andZoetis
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Steagall P 2022

‘Pain management is not only about
giving an analgesic drug: the emotional
needs of thecat must be considered, and the patient
should always be treated with respectand empathy’
Steagall et al. 2022 - ISFM guidelines

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Feline drug metabolism
and excretion• Possible impact onanalgesia and drug choice• Drugs via metabolic
conjugation, oxidation orunchanged

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Feline comorbidities
and analgesia• Chronic kidney disease• Ketamine• NSAIDs• Gabapentin

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Building an analgesic plan
Each cat is unique4

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Preventive analgesia

Principles ofacute pain
management

Multimodal analgesia
Combination of pharma andnon-pharma therapies
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Preventiveanalgesia• Preventive analgesia refers to all types of
perioperative techniques and efforts todecrease postoperative pain
• Analgesic treatment is administered at any
time and for any duration needed for pain relief
in the perioperative period

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Multimodal analgesia: pharmacological options

NSAIDLA

OpioidAlpha-2 Agonists

Ketamine
Gabapentin
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The four questions in acute pain
1 – Is there a local anesthetic block that I can use?
2 – What is the opioid of preference?
• Need, doses and routes of administration
3 – Are there contra-indications for NSAIDadministration?
4- Is there a need for adjuvant analgesics?
• Tramadol, gabapentin, ketamine CRI, etc.
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2022-05-26• Intraperitoneal

Local anaesthetic blocks• Incisional• Intratesticular

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Opioid analgesics• Which one? When? What route?
• Methadone• Buprenorphine• Butorphanol• Opioid shortage or unavailability• The concept of opioid-free and opioid-sparing
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NSAIDs• Inflammation and acute pain
• Contraindications• Fear of NSAID-induced adverse effects• Which one?
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Adjuvant analgesics
Dexmedetomidine (premedication)

Ketamine infusion

Tramadol (PO or IM/IV)

Gabapentin (PO)Steagall P 2022

Choosing
theanalgesic
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Nursing care

More thananalgesic
drugs…

Anxyolisis andantiemetics

Homemedication

Environment(home andclinic)

Non-pharma
therapy

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Anxiety and stressduring transportation:
gabapentin• Premedication starts at home
• 100 mg/cat PO; 90 minutes
before the veterinary visit

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Gabapentin–Perioperativeuse

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Antiemetics: maropitant• NK-1 receptor antagonist blocking substance P• Patient Comfort• Reduced vomiting and discomfort after opioids• CKD• Clinical use• Reduced vomiting, improved recovery and appetite• 1 mg/kg SC, 1h before opioid administration• 8 mg/cat PO, 2.5h or 20h before premedication
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Nursing care
• Patient positioning• Nutrition• Fluid therapy• Bladder care
• Management of constipation

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Non-pharmacological therapy• Wound care
• Comfortable bandaging• Cold therapy

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Environment (clinic)• Cat Friendly Clinic• ISFM Cat Friendly Clinic accreditation• AAFP Cat Friendly Practice Program• Away from dogs
• Comfortable bed• Somewhere to hide
• Gentle handling and stress reduction

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Environment and home meds
• Comfortable and quiet• Sleeping/resting area
• A place to hide
• Easy access to resources (food, water, litter box)
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A BRIGHT FUTURE FOR
FELINE PAIN MANAGEMENT• Feline Health in first place• Avoiding fear, stress and anxiety• Feline friendly handling techniques• Understanding of feline behaviors• Automation of feline pain assessment• Novel drugs for feline pain management

FDA-APPROVED TRANSDERMAL BUPRENORPHINE

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PAIN
ASSESSMENT
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FINAL REMARKS•

Basics•Simple and practical•

TLC
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Thank you

P Steagall 2022

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