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Cover
Preface
1 General Considerations for Pain Management upon Initial Presentation and during Hospital Stay
1. References
2. Further Reading
2 Physiology and Pathophysiology of Pain
1. I. Pain versus Nociception
2. II. The Pain Pathway in Physiologic Pain
3. III. The Pain Pathway in Pathologic Pain
4. IV. Specific Types of Pain
5. References
6. Further Reading
3 Physiologic and Pharmacologic Applications to Manage Neuropathic Pain
1. I. Physiology of Neuropathic Pain
2. II. Clinical Relevance of Physiology to Pharmacology
3. III. Diagnosing Neuropathic Pain
4. IV. Neuropathic Pain Associated Conditions
5. V. Primary Lesions of the Peripheral or central Nervous System
6. VI. Neuropathic Pain and Management of Visceral Origin
7. VII. Treatment
8. VIII. Future Therapeutic Modalities
9. IX. Conclusion
10. References
11. Further Reading
4 Physiology and Pharmacology: Clinical Application to Abdominal and Pelvic Visceral Pain
1. I. Neurophysiology Reviews [1–3]
2. II. Clinical Relevance of Physiology to Pharmacology
3. III. Sources of Abdominal Pain
4. IV. Pelvis and Perineum [3, 5]
5. V. Visceral Pain Associated with Pelvis, Vertebral and Spinal Cord Injury or Illness
6. VI. Modulatory Influences on Visceral Nociception
7. References
5 Physiology and Management of Cancer Pain
1. References
6 Movement‐Evoked and Breakthrough Pain
1. References
7 Pain: Understanding It
1. I. Objective Markers of Pain
2. II. Definitions of Pain Mechanisms
3. III. The Outcome of the Inappropriate Management of Pain
4. IV. Pain Scoring Systems
5. V. Pain Assessment Scales Adapted for Veterinary Patients
6. VI. Clinical Utility of Pain Assessment Methods
7. VII. Misconceptions
8. References
9. Further Reading
8 Recognition, Assessment and Treatment of Pain in Dogs and Cat
1. I. Key Points in Assessment of Pain in Animals
2. II. Clinical Utility of Pain Assessment Methods
3. III. Assessing Pain
4. IV. Dogs: Assessing Pain Behaviours
5. V. Cats: Assessing Pain Behaviours
6. References
7. Further Reading
9 Pharmacologic and Clinical Application of Sedatives
1. I. Acepromazine
2. II. Alpha2 Adrenergic Receptor (Alpha2) Agonists
3. III. Benzodiazepines
4. References
10 Pharmacologic and Clinical Application of Opioid Analgesics
1. I. Opioid General Considerations
2. II. Mu‐Agonists
3. III. Partial Mu‐Agonists
4. IV. Kappa‐Agonist, Mu‐Antagonist
5. V. Oral Opioid Drugs
6. References
11 Pharmacologic and Clinical Application of Non‐Steroidal Anti‐Inflammatory Analgesics
1. I. Pharmacology
2. II. Veterinary‐Approved NSAIAs
3. III. Indications
4. IV. Safety
5. V. Contraindications [32]
6. VI. Comments and Other Considerations
7. References
8. Further Reading
12 Pharmacologic and Clinical Principles of Adjunct Analgesia
1. I. Injectable Adjunctive Analgesics
2. II. Oral Adjunctive Analgesics
3. III. Tricyclic Antidepressants, Selective Serotonin Reuptake Inhibitors, Monoamine Oxidase Inhibitors
4. IV. Corticosteroids (Prednisone, Dexamethasone, Prednisolone, Methylprednisolone)
5. V. Magnesium
6. VI. Non‐Pharmacologic Modalities for Pain Management
7. VII. Case Example of Utilizing Adjunctive Analgesics
8. References
9. Further Reading
13 Pharmacologic and Clinical Application of General Anesthetics
1. I. Injectable Anesthetics
2. II. Inhalational Anesthesia
3. Further Reading
14 Local Anesthetic Techniques
1. I. Toxicity of Local Anesthetics
2. II. Preparation for Blocks
3. III. Head Blocks
4. IV. Thoracic Limb Block
5. V. Thoracic Block
6. VI. Abdomen, Perineum and Pelvic Limb Blocks
7. VII. Intra‐Articular Block
8. VIII. Intravenous Regional Anesthesia (IVRA) or Bier Block
9. IX. Wound Management Block
10. X. Local Anesthetics for Pediatric Patients
11. References
12. Further Reading
15 Integrative Techniques for Pain Management
1. I. Traditional Chinese Veterinary Medicine
2. II. Manual Therapy Techniques
3. III. Animal Physical Rehabilitation
4. IV. Emotional Component to Pain Management
5. Acknowledgements
6. References
16 The Veterinary Technician/Nurse’s Role in Pain Management
1. I. Analgesic Orders
2. II. The Patient Advocate
17 Optimal Nursing Care for the Management of Pain
1. I. The Nursing Care Plan
2. II. Formulating the Pain Plan: The Team Approach [5]
3. III. Anesthetic Recovery
4. References
18 Preparation and Delivery of Analgesics
1. I. Bolus Dosing
2. II. Continuous Rate Infusion
3. III. Drug Infusions Using a Burette
4. IV. Standardized Concentration Infusions
5. V. Drug Infusion Using an Elastomeric Pump
6. VI. Drug Infusions Using a Syringe Pump
7. VII. Drug Compatibility
8. Further Reading
19 Cardiovascular Disease as a Co‐Morbidity for Anesthesia and Analgesia of Non‐Related Emergencies
1. I. Analgesic Considerations and Drug Choices
2. II. Anesthetic Considerations
3. References
20 Kidney Disease as a Co‐Morbidity for Anesthesia and Analgesia of Non‐Related Emergencies
1. I. Analgesia Considerations for Patients with Kidney Disease
2. II. Anesthetic Considerations for Patients with Kidney Disease/Injury
3. References
21 Liver Disease as a Co‐Morbidity for Anesthesia and Analgesia of Non‐Related Emergencies
1. I. Analgesia Considerations for Patients with Liver Disease
2. II. Anesthetic Considerations for Patients with Liver Disease
3. III. Specific Anesthetic Considerations
4. References
22 Managing the Aggressive Patient
1. I. General Handling Strategies
2. II. Sedation/Anesthesia for the Aggressive/Fractious Patient
3. Further Reading
23 Analgesia and Anesthesia for Pregnant Cats and Dogs
1. I. Physiological Changes in the Pregnant Cat and Dog Affecting Analgesic Selection and Dosing [2]
2. II. Which Analgesics Can Be Administered to Pregnant Patients?
3. III. Anesthesia during Pregnancy
4. IV. Anesthesia Protocols
5. V. Anesthesia for Cesarean Section
6. References
24 Analgesia and Anesthesia for Nursing Cats and Dogs
1. I. Analgesics
2. II. Adjunctive Analgesics
3. III. Sedatives
4. IV. Local Anesthetics
5. V. NMDA‐Receptor Antagonists
6. VI. Alpha2 Adrenergic Agonists
7. VII. Herbal Analgesic Medications
8. VIII. Anesthetics
9. IX. General Anesthesia
10. X. Discharge Home
11. References
12. Further Reading
25 Physiologic and Pharmacologic Application of Analgesia and Anesthesia for the Pediatric Patient
1. I. Physiologic Importance of Preventing Pain [2, 3]
2. II. Physiologic Aspects to Consider When Managing Pain [2, 3]
3. III. Pain Assessment
4. IV. Analgesics
5. V. Sedatives
6. VI. Local Anesthetics for All Age Groups: General Considerations
7. VII. Non‐Pharmacological Interventions [23, 24]
8. VIII. Anesthesia
9. References
26 Analgesia and Anesthesia for the Geriatric Patient
1. I. General Considerations [1]
2. II. Physiologic Features of the Geriatric Patient Affecting Dosages, Drug Metabolism and Excretion
3. III. Analgesia and Pain Assessment Considerations [1]
4. IV. Anesthetic Considerations [1]
5. V. Optimal Nursing Care during Hospital Stay and Influence on Pain Management
6. References
7. Further Reading
27 Analgesia and Anesthesia for Head and Neck Injuries or Illness
1. I. Initial Management
2. II. Specific Injury Management
3. III. Specific Illness Management
4. References
5. Further Reading
28 Torso, Thorax and Thoracic Cavity: Illness and Injury
1. I. Analgesia and Anesthesia
2. II. Local and Epidural Analgesic/Anesthetic Techniques
3. III. Post‐Procedural Analgesia
4. IV. Nursing Considerations
5. V. Thoracic Cavity Injury
6. VI. Discharge Analgesia Plan for All Injuries
7. VII. Thoracic Cavity: Illness
8. Reference
9. Further Reading
29 Torso and Abdomen: Illness and Injuries
1. I. Analgesia, Sedation and Anesthesia (General and Local)
2. II. Discharge Home Analgesia
3. III. General Nursing Considerations for the Patient with Abdominal, Pelvic or Perineal Injury or Illness
4. IV. Injured Patient
5. V. The Ill Patient/Foreign Body Ingestion
6. VI. For All Patients
7. VII. Urogenital System
8. Further Reading
30 Pelvic Cavity/Abdomen, Perineum and Torso: Illness and Injuries Urogenital System and Perineum
1. I. Analgesia, Sedation and Anesthesia (General and Local)
2. II. Sedatives in General
3. III. Local Anesthesia (LA) Techniques
4. IV. Discharge Home Analgesia
5. V. Anesthesia in General
6. VI. General Nursing Considerations for the Patient with Pelvic or Perineal Injury or Illness
7. VII. Injuries
8. VIII. Illness
9. Further Reading
31 Musculoskeletal Injuries and Illness
1. I. Analgesia and Sedation
2. II. Injury
3. III. Medical‐Associated Musculoskeletal Pain
4. References
5. Further Reading
32 Vertebral Column (Vertebrae and Spinal Cord)
1. I. Analgesia
2. II. Sedatives
3. III. Post‐Assessment and Discharge Analgesia and Management
4. IV. Anesthesia
5. V. Nursing Care
6. VI. Injury/Intervertebral Disc Herniation Management
7. VII. Illness
8. Further Reading
33 Integument Injuries and Illness
1. I. Analgesia, Sedation and Anesthesia
2. II. Injuries
3. III. Illness
4. References
5. Further Reading
34 Environmental Injuries
1. I. Analgesia
2. II. Sedatives
3. III. Anesthesia
4. IV. Injury
5. V. Hyperthermia
6. VI. Immersion (Near Drowning)
7. VII. Snake Envenomation
8. VIII. Porcupine Quill Injury
9. IX. Smoke Inhalation
10. Further Reading
Index
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List of Tables

Chapter 08
1. Table 8.1 A guide to pain assessment and analgesic selection.
2. Table 8.2 Behavioural characteristics associated with pain in CATS and DOGS.
3. Table 8.3 DOGS Suggested analgesic regimens based on behaviour associated with pain severity in dogs. Note: all suggested dosages are based on ideal body weight in the overweight or obese
4. Table 8.4 Suggested Analgesia for Various Levels of Ongoing Pain in DOGS NOTE : The drugs and doses given are suggestions. If the pain is not being managed, then increase to effect (not NSAIAs). If administered IV, morphine must be administered slowly to prevent hypotension in all animals. Ketamine 1‐2+ mg/kg IV, or 10 mg/kg per os (fractious dogs), may be an alternative to control pain quickly if opioids are not available and hypertrophic cardiomyopathy is not a concern. General anesthesia is another alternative (refer to Pharmacologic and Clinical Application of Anesthetics Chpt13).
5. Table 8.5 Adjunctive analgesics suggested dosages based on ideal body weight in overweight or obese dogs
6. Table 8.6 CATS Suggested analgesic regimens associated with behaviour in cats all dosages are based on ideal body weight in the overweight or obese
7. Table 8.7 CATS Suggested analgesia for various levels of ongoing pain in cats. Note: all suggested dosages are based on ideal body weight in the overweight or obese cat. Opioids, ketamine, as a CRI can be combined in IV crystalloid fluids (lactated Ringer’s or Ringer’s may not be compatible due to calcium content). For Preparation and delivery of analgesics by CRI refer to Chapter 18 for details. Where available, syringe pumps with individual analgesics may also be used. Titrate analgesics to effect.
8. Table 8.8 CATS Adjunctive analgesics suggested dosages for cats based on ideal body weight in the overweight or obese.
Chapter 10
1. Table 10.1 Potency of opioid analgesics compared with morphine.
Chapter 11
1. Table 11.1 Veterinary‐approved injectable NSAIAs.
Chapter 12
1. Table 12.1 Adjunct Analgesics.
Chapter 14
1. Table 14.1 Opioids used for epidural analgesia.
2. Table 14.2 Local anesthetics used for epidural anesthesia.
Chapter 22
1. Table 22.1 American Society of Anesthesiologists (ASA) risk factor for anesthesia‐ adverse events.
2. Table 22.2 Sedative, analgesic and anesthetic drugs.
Chapter 25
1. Table 25.1 Opioid analgesic dosages for pediatric patients. (Suggestions only. Higher dosages may be required.)
2. Table 25.2 Sedation and anesthetic dosages for neonatal: Pediatric patients. (Dosages are suggestions only. Titrate to effect where possible.) Healthy patients of all age groups may require dosages closer to those listed for the next older age group. As previously discussed, the dosages of many analgesic drugs are not decreased.

List of Illustrations

Chapter 01
1. Figure 1.1 Placement of nasal cannulae following placement of 2–3 drops of ophthalmic local anesthetic.
2. Figure 1.2 A clean, warm and comfortable environment reduces stress and, therefore, pain.
Chapter 02
1. Figure 2.1 Under normal conditions, innocuous sensations or a low‐intensity stimulus, such as touch or vibration, is transmitted from the periphery to laminae III and IV of the dorsal horn by means of A‐beta fibres; the signal is then relayed to the brain by way of the dorsal column somatosensory pathway. Noxious thermal or mechanical input (transduction), the protective nociceptive “first pain” experience, activates the A‐delta fibres, which have small receptive fields, and functions as a warning and is protective to the animal. With increased intensity of the stimulus, C‐fibres also conduct impulses along with A‐delta fibres. C fibres have a larger receptive field compared with A‐delta fibres and are responsible for the “second pain” experience. The A‐delta and C fibres enter the dorsal horn of the spinal cord, wherein A‐delta fibres almost solely and C fibres predominantly terminate in laminae I and II. The A‐delta and C‐fibre ganglions express Substance‐P (S‐P), and the neurokinin‐1 (NK1 (S‐P)) receptors are expressed in the neurons of lamina II. The signal is then relayed to the brain by way of the spinothalamic tract.
Chapter 03
1. Figure 3.1 Nerve‐injury‐induced structural and neurochemical reorganization.
2. Figure 3.2 Normal transduction and transmission of touch (A‐beta fibre) and nociception (A‐delta and C fibres) to the dorsal horn.
3. Figure 3.3 Neuroma at tail amputation site resulting in persistent abnormal behaviour which resolved with revision of the amputation site and removal of tail dock amputation site (Figure 3.4).
4. Figure 3.4 Eighteen‐month‐old Doberman pinscher prior to neuroma removal and after surrender to Humane Society. New owners noted a great difference following tail dock revision.
5. Figure 3.5 Doberman following revision of tail‐dock site and removal of a neuroma.
Chapter 05
1. Figure 5.1 Algorithm for peripheral evaluation of patients presenting with gait abnormalities.
2. Figure 5.2a Post‐operative forelimb amputation due to osteosarcoma. A wound diffusion catheter was placed during surgery as described in Chapter 14.
3. Figure 5.2b Access port to wound diffusion catheter.
Chapter 08
1. Figure 8.1 Gratitude.
2. Figure 8.2 Post‐laparotomy. Pain exhibited by slightly hunched back, elbows abducted due to high abdominal pain, hang dog look, low tail carriage and motionless standing. Slight touch on the abdomen resulted in splinting and vocalization. Appropriate monitoring and analgesic administration will avoid post‐operative pain.
3. Figure 8.3 The “praying” posture due to pain resulting from a foreign body present in the stomach. A similar posture may be noted with distal esophageal pain/obstruction.
4. Figure 8.4 Acute pancreatitis prior to analgesic administration.
5. Figure 8.5 Acute pancreatitis post‐analgesic administration.
6. Figure 8.6 a and b Typical appearance of a painful cat; however, illness alone may be the problem. Careful examination and assessment for pain is required unless obvious trauma is present.
7. Figure 8.7 Recently admitted cat with fractured femur about to be assessed for analgesic efficacy and to obtain IV line access. Ears drawn back, pupils dilating moments prior to an “attack” on the caregiver.
8. Figure 8.8 A happy cat.
9. Figure 8.9 A 4‐month‐old puppy, post‐femoral fracture repair, with Elizabethan collar placed in assumption that she was licking the surgical wound.
10. Figure 8.10a Attentive, non‐painful cat after opioid administration. Note dilated pupils.
11. Figure 8.10b Pain‐free cat responsive to presence of caregiver.
12. Figure 8.11 (a) Excessive panting due to opioid overdose.(b) Opioid overdose. (c) Naloxone reversal.
Chapter 14
1. Figure 14.1 Nerves originating from the trigeminal nerve and providing sensory input to the head. (A) Optic canal; (B) Orbital fissure; (C) Round foramen in rostral alar canal; (D) Oval foramen; (E) Infraorbital foramen. The maxillary nerve (1) divides into the (i) infraorbital nerve (2), which enters the infraorbital canal through the maxillary foramen and branches the incisivomaxillary nerve (3) before exiting through the infraorbital foramen, and (ii) the greater palatine nerve (4), which enters the posterior palatine foramen to exit in the palate through the anterior palatine foramen. The ophthalmic nerve (5) divides into the lacrimal nerve (6), frontal nerve (7) and nasociliary nerve (8). The latter divides into the ethmoidal nerve (9) and the infra‐trochlear nerve (10). The mandibular nerve (11) divides into the auriculo‐temporal nerve (12), the buccal nerve (13), the lingual nerve (14) and the inferior alveolar nerve (15), which enters the mandibular foramen.
2. Figure 14.2 Lateral view of the mandible of the dog. The mandibular nerve (1) continues as the inferior alveolar nerve (2), which enters the mandibular foramen (A) on the medial aspect and emerges from the mandibular canal as the caudal mental nerve (3) through the caudal mental foramen (B) on the lateral aspect, the middle mental nerve (4) through the middle mental foramen (C) on the lateral aspect and the incisive nerve (cranial mental nerve) (5) at the cranial mental foramen on the cranial aspect (not shown).
3. Figure 14.3 Maxillary block in a dog using the transcutaneous maxillary approach. (A) A spinal needle is inserted through the skin at a 90° angle, ventral to the border of the zygomatic arch and caudal to the lateral canthus, advanced towards the pterygopalatine fossa, avoiding the ramus of the mandible, and directed caudal immediately after until it comes in contact with the fossa, near the round foramen in the rostral alar canal. The needle should then be withdrawn a short distance and the local anesthetic slowly injected after an aspiration test to rule out blood. (B) Needle placement for the maxillary block with the needle directed caudally. (C) Needle placement for an eye block with the needle directed cranially.
4. Figure 14.4 Infraorbital nerve block by injection in the infraorbital canal. A catheter is threaded into the infraorbital canal until the tip of the catheter reaches an imaginary line drawn perpendicular to the lateral canthus. The catheter can be introduced through the mucosa by elevating the upper lip and locating the infraorbital foramen or through the skin without elevation of the skin. Alternatively, the block can be done with a needle introduced into the infraorbital canal through the infraorbital foramen to the level of the first maxillary molar and the local anesthetic injected while gentle digital pressure is applied to the infraorbital foramen in order to force the local anesthetic into the canal and a large volume of local anesthetic is injected to reach the maxillary nerve within the orbit.
5. Figure 14.5 Rostral maxillary or infraorbital block in a dog. The infraorbital foramen is located approximately halfway between the medial canthus and the base of the maxillary canine, above the third premolar tooth. The needle is introduced slightly through the infraorbital foramen into the canal to facilitate the spread of the local anesthetic along the nerve.
6. Figure 14.6 Rostral maxillary or infraorbital block in a cat. The needle is directed dorsally from above the second premolar to the site of the foramen or ventrally aligned with the second premolar, and the anesthetic volume injected in the surrounding area.
7. Figure 14.7 Transcutaneous inferior alveolar block in a dog. The mandibular foramen is midway between the angular process of the mandible and the last molar tooth, halfway on the medial side of the mandible. It can also be located above the point of maximum concavity of the mandible, just rostral to the angular process. A needle is introduced perpendicular and medial from the ventral edge of the mandible, where the concavity can be palpated.
8. Figure 14.8 Rostral mandibular block in a dog. The needle is located at the middle mental foramen, ventral to the second premolar, to block the middle mental nerve. It can also include the caudal mental nerve by aiming the needle at the caudal mental foramen, ventral to the third premolar. Not shown is the incisive nerve (cranial mental nerve), which exits the mandible at the cranial mental foramen, located on the cranial aspect of the mandible, under the first incisor, just lateral to the symphysis.
9. Figure 14.9 Motor blockade of the eyelid in a dog is achieved by blocking the auriculopalpebral nerve (2), a branch of the facial nerve (1), which emerges from the stylomastoid foramen. The block is performed on the dorsal aspect of the zygomatic arch, just behind the lateral canthus and into the temporal fossa, near the auriculopalpebral division into the auricular (3) and palpebral (4) branches. Sensory blockade is achieved injecting anesthetic along the eyelids to include the branches of the frontal nerve (5), a branch of the ophthalmic nerve that emerges from the cranium at the orbital fissure.
10. Figure 14.10 Medial aspect of the right forelimb of a dog depicting the nerves to the brachial plexus and limb.
11. Figure 14.11 Brachial plexus block via axillary approach. The lateral tuberosity of the humerus (point of the shoulder joint) is identified and the needle is advanced from this point along the medial aspect of the scapula, in a parallel fashion to both the spine and costochondral joints, for a distance that places the tip of the needle slightly cranial to the first rib.
12. Figure 14.12 Brachial plexus block via a perpendicular approach caudal to the shoulder joint. With this approach, the needle is introduced perpendicularly to the skin caudal to the shoulder joint, to a depth above the thoracic wall at the level of the brachial plexus and cranial to the first rib.
13. Figure 14.13 Brachial plexus block via a paravertebral approach. The transverse process of C6 is identified as the largest process in front of the scapula and a needle is inserted in a dorsoventral direction until it contacts the dorsal aspect of the transverse process of C6, then the needle is walked off the cranial and caudal margins of the transverse process to block the ventral branch of C6 cranially and the ventral branch of C7 caudally. For C8, the needle is walked off the caudal margin of the transverse process of C7. For T1, the head of the first rib is palpated and the needle directed towards the cranial border of the proximal third of the rib where the nerve tends to emerge on its way to the plexus and the injection can be performed at this site.
14. Figure 14.14 Intercostal block in a dog that includes the intercostal nerve where the incision occurred (I) and the next 1–2 intercostal nerves immediately cranial and caudal to the incision.
15. Figure 14.15 Lumbosacral epidural block. The lumbosacral space (L7–S1) is located by palpation of the anterior aspect of both iliac crests with the thumb and middle finger of the operator’s hand that is cranial to the patient’s pelvis and tracing an imaginary line that crosses over the L6–7 space between both fingers. The operator then palpates the L6 spinous process caudal to the index finger of that same hand, so it can locate the space cranial to the finger (L6–7) to then continue advancing the finger over the spinous process of L7 to finally locate the lumbosacral space.
16. Figure 14.16 Example of an epidural catheter placed at the lumbosacral space.
17. Figure 14.17 Femoral and saphenous block in a dog. Relevant anatomical structures include the femoral triangle, formed by the base of the inguinal area, the sartorius muscle (1) running downwards and cranial, and the pectineus muscle (3) running downwards and caudally. (A) To block the femoral nerve and the saphenous nerve at the femoral triangle, the pulsating femoral artery is palpated in the triangle and the femoral nerve is cranial to the artery at this location; therefore, the needle is inserted cranial to the artery. (B) To block only the saphenous nerve, the needle is inserted into the middle third of the thigh, in front of the adductor muscle (2) and gracilis muscle (4), and caudal to the sartorius muscle (1), by palpating the pulsating femoral artery, and the saphenous nerve is cranial to the artery at this location.
18. Figure 14.18 Sciatic, common peroneal and tibial nerve block in a dog. (A) To block all three nerves, a needle is inserted with a 45° angle between the major trochanter (MT) of the femur and the ischiatic tuberosity (IT), closer to the former since the sciatic nerve descends over the pelvis to the femur at this location. (B) To block the common peroneal and tibial nerve, a long needle is advanced in a caudal‐to‐cranial direction in the middle third of the thigh in the space between the biceps femoris muscle laterally and the semitendinosus muscle medially until it reaches the caudal surface of the femur and is slightly withdrawn for the injection at that location.
19. Figure 14.19 Example of an intra‐articular injection in the stifle joint after closing of the capsule and before final closing of the layers above.
Chapter 15
1. Figure 15.1 The stimulation of this acupuncture point (Shan Gen) helps stimulate appetite and can be useful in patients with anorexia.
2. Figure 15.2 Massages can help in mobilizing specific muscles or bones.
3. Figure 15.3(a–c) A gentle passive range of motion can be performed post‐operatively to prevent joints from freezing and keep muscles flexible. Two hands are necessary to move a joint in a controlled and safe manner. The dog should be relaxed and slow movements are used in the early phase to avoiding causing discomfort.
4. Figure 15.4 In physical therapy specific exercises are used for specific muscles and joint uses as well as weight distribution. Notice the mental engagement of the dog getting this exercise.
5. Figure 15.5 In physical therapy specific exercises can help stretch and flex specific parts of the body.
6. Figure 15.6 An ice‐filled Dixie cup is used to ice specific muscles or joints. The Dixie cup is rotated on the area to prevent freezing of the skin.
7. Figure 15.7 Laser therapy performed on an elbow.
Chapter 17
1. Figure 17.1 A patient referred to manage a severe decubital ulcer following one week of lateral recumbency. Ulcers can form rapidly and the skin must be observed closely for any irritation.
2. Figure 17.2 A toy from home and comfortable environment reduces stress and, therefore, pain.
3. Figure 17.3 A little TLC.
4. Figure 17.4 Providing padding between limbs to maintain natural position and reduce strain on joints and pressure points.
5. Figure 17.5 Typical posture of a patient with intervertebral disc disease (IVDD). Gently assisting the patient into a recumbent position will often help them to sleep.
6. Figure 17.6 Recumbent patients are unable to reach a water bowl and appreciate water being offered by syringe.
Chapter 18
1. Figure 18.1 Label to be applied to drug infusions.
2. Figure 18.2 “Anatomy” of a syringe and needle.
3. Figure 18.3 The drug dilution method.
Chapter 24
1. Figure 24.1 A 4‐year‐old German shepherd post‐femoral fracture repair receiving oxymorphone analgesia.
Chapter 25
1. Figure 25.1 A 4‐month‐old German shepherd puppy requesting that the noise and light be reduced.
Chapter 27
1. Figure 27.1 Slant board to raise upper body 15°. For larger animals head and thorax are placed on the board where no kinking of the neck will occur. Dimensions to make the slant for 15° [6” high], 24” wide, 30” long. Painted with exterior paint (washable).
2. Figure 27.2a Neck wounds acquired from a dog attack. Oxygen is delivered via a tube passed beyond the injury.
3. Figure 27.2b Importance of rapid examination of the bite wounds. A tracheal tear is present requiring tracheostomy distal to the tear (Figure 27.2c) to facilitate anesthesia during tracheal repair and healing.
4. Figure 27.2c Patient in 27.2a upon completion of tracheostomy and tracheal tear repair.
5. Figure 27.3 Luxated mandibular joint following reduction. Nasoesophageal tube placed due to restriction of prehension and mastication required for ~3 days.
6. Figure 27.4 Traumatic proptosis immediately prior to enucleation.
7. Figure 27.5a Auriculopalpebral block.
8. Figure 27.5b Auriculopalpebral block.
Chapter 28
1. Figure 28.1 A human pediatric oxygen hood allowing oxygenation and physical examination.
2. Figure 28.2 A female Shetland sheepdog was referred for management of three fractured ribs and fractured pelvis. In addition, a healing second‐degree burn was noted, alerting us to an abusive owner and contact with the Humane Society.
3. Figure 28.3 A male Shih tzu presented following a dog attack with bite wounds and flail chest.
4. Figure 28.4 The dog above after anesthesia and preparation for surgical exploration and repair of flail chest.
5. Figure 28.5 The above dog at exploratory thoracotomy
6. Figure 28.6 A German shorthaired pointer impaled on a tree branch which entered between the forelimbs, skimmed along the sternum and entered the abdomen and pelvis exiting the left lateral to the vulva. Diagnostic imaging was not performed to prevent movement and potential further injury. Minimal movement from the ER to prep room. Exploratory surgery determined extent of injury and appropriate, successful management.
7. Figure 28.7 The “praying position” due to pain resulting from a foreign body present in the distal esophagus. A similar posture may be noted with abdominal pain.
Chapter 29
1. Figure 29.1 Stretched out “praying posture” indicating abdominal or lower esophageal pain.
2. Figure 29.2 Linear FB results in severe abdominal pain.
3. Figure 29.3 Acute, severe pancreatitis at post‐mortem examination.
4. Figure 29.4a Typical position of a cat with abdominal pain. This cat has pancreatitis.
5. Figure 29.4b The above cat following maropitant and fentanyl analgesia for ~24 h. Fentanyl was replaced with buprenorphine OTM for discharge home.
Chapter 30
1. Figure 30.1 Degloving motor vehicle injury. An attempt to pass a urinary catheter failed. The os penis was shattered requiring a perineal urethrostomy.
2. Figure 30.2 Penile hematoma secondary to trauma.
3. Figure 30.3 “Post‐surgical traumatic” paraphimosis. In addition to nursing management, a generous application of granulated sugar applied to the penis will reduce swelling. Rinse well and apply lidocaine gel. Replace penis into prepuce.
4. Figure 30.4 Nephrectomized kidney revealing peri‐renal abscesses in a 17‐month‐old male neutered Border collie.
5. Figure 30.5a Grape toxicity resulted in kidney swelling and pain.
6. Figure 30.5b Following 24 h fentanyl administration. A gradual improvement in behaviour and appetite was noted during the 24 h period.
Chapter 31
1. Figure 31.1 Streptococcal fasciitis. A 72 h history of lameness with the extent of the integumentary lesion appearing over a 6 h period.
2. Figure 31.2 A 5‐month‐old puppy with three‐day history of hind limb lameness. Extent of swelling noted here occurred within a one‐day period.
Chapter 32
1. Figure 32.1 French bulldog in a typical posture of IVD herniation. Note the dribbling of urine.
2. Figure 32.2a Post‐pelvic fracture surgical repair with neuropathic pain and allodynia. Compare the appearance of the head down and ears drawn back, to that in Figure 32.2b where the pain has resolved.
3. Figure 32.2b The above dog following resolution of the pudendal neuritis. Compare this bright, pain‐free appearance to that of 32.2a, when he was in pain.
4. Figure 32.3a A 2‐year‐old Doberman pinscher with a lifetime history of bizarre behaviour, flank sucking, circling and tail chewing.
5. Figure 32.3b Neuroma identified following exploration and amputation of tail docking site of the dog in Figure 32.3a. The dog’s behaviour improved following removal of the neuroma.
Chapter 33
1. Figure 33.1 Brittany spaniel proximal femoral/iliac fracture with associated perineal/vulva involvement and urinary incontinence. Systemic analgesics could not eliminate the perineal pain. Gentle washing of the area, followed by local application of 4% lidocaine cream (Maxilene 4^®), eliminated the pain and prevented urine scald dermatitis.
2. Figure 33.2 A young Beagle caught in a barn fire resulting in a third‐degree burn from head to tail.
3. Figure 33.3 Degloving injury incurred during an automobile accident.
4. Figure 33.4 A German shorthaired pointer impaled on a tree branch which entered between the forelimbs, skimmed along the sternum and entered the abdomen and pelvis exiting lateral to the vulva. Diagnostic imaging procedures were not performed prior to immediate surgical exploration where the branch was easily visualized and removed without complications.
5. Figure 33.5 Golden retriever three days post right femoral fracture appears to have been left in right lateral recumbency while waiting for referral for fracture repair. The hind limb urine scald was as painful as the contralateral fractured femur. A zinc‐based cream is shown on the associated scrotal dermatitis.
6. Figure 33.6 Streptococcal fasciitis. A 72 h history of lameness with the extent of the integumentary lesion appearing over a 6 h period.
7. Figure 33.7a Pseudomonas fasciitis following subcutaneous fluid administration to treat a vaccine anaphylactic reaction two days prior to referral.
8. Figure 33.7b Within 2 h following Figure 33.7a, while awaiting surgical management, the lesion rapidly expanded.
9. Figure 33.8 Streptococcal fasciitis. Five‐month‐old puppy with three‐day history of hind limb lameness. Extent of swelling noted here occurred within a one‐day period.
10. Figure 33.9a Gangrenous mastitis upon presentation.
11. Figure 33.9b Patient above after six days of raw honey treatment prior to closure.
12. Figure 33.10a Mastitis.
13. Figure 33.10b Above patient during mastectomy. Placement of a wound diffusion catheter (Chapter 14) is suggested where “mesh incisions” are not required to reduce tension on the suture line.
Chapter 34
1. Figure 34.1 Soft padding between the limbs to maintain upper limbs parallel.
2. Figure 34.2 Porcupine injury.
3. Figure 34.3 Severe porcupine quill injury to the level of the pharynx.

Analgesia and Anesthesia for the Ill or Injured Dog and Cat

List of Contributors

Preface

Acknowledgements