General guidelines for managing pain safely and effectively: 1. Treat pain early and aggressively. The longer the duration of the pain, the more difficult it is to alleviate. 2. Take a pre-emptive approach whenever possible. This includes opioid pre medication, opioid use intra-operatively, pre surgical local nerve blocks and epidural analgesia. 3. Administer analgesics on a predetermined schedule rather than on an "as needed " basis. This will reduce the incidence of breakthrough pain. Breakthrough pain reduces the effectiveness of analgesic drugs thus increasing dose requirements. 4. Whenever possible, combine local analgesic techniques with systemic drugs for surgical procedures. Examples include: Epidural morphine and bupivicaine for procedures involving the abdomen, hind limbs and perineum Epidural morphine for thoracic and forelimb procedures Brachial plexus nerve blocks for manipulations of the distal forelimb (below the elbow) Oral nerve blocks for dental extraction, nasal or facial surgery. Intercostal nerve blocks for thoracic procedures. metacarpal ring blocks for digit surgery including declaw procedures. Administer opioids intra-operatively so that they are providing pain relief upon return of consciousness. Reserve NSAID use for short term mild to moderate postoperative pain relief in well-hydrated patients without coagulation, hepatic,gastrointestinal or renal function impairment. Reserve butorphanol and buprenorphine for mild to moderate pain. Use oxymorphone, hydromorphone,morphine and fentanyl for moderate to severe pain.
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