Soft tissue surgery pain

WSAVA guideline

Key findings

• Pain spans mild–severe; phase balance depends on pre-op pain and trauma location/magnitude; where NSAIDs fail, add alternatives e.g. regular opioid administration (§3.4, Tables 23–24).
• LA menu as printed: incisional and specific nerve blocks (e.g. intercostal), neuraxial (epidural), wound catheters — highly recommended in all cases; mandatory when opioids unavailable (§3.4).
• Perceived-pain table: mass-removal resection/reconstruction, mastectomy = moderate-to-severe; laparotomy/thoracotomy add aspiration-pneumonia risk (Table 11; §1).
• Major STS may cause chronic pain with neuropathic component; no veterinary gabapentin studies in nerve-damage surgery; human data suggest value (card; §3.4).
• Minor STS (Table 23): pre-/intra-op opioid + NSAID ± α2 ± ketamine + LA; post-op NSAID (if not pre-op) ± opioid + non-drug care.
• No-controlled tier: NSAID ± α2 + metamizole or paracetamol (not cats) ± gabapentin; injectable tramadol may replace the opioid; LA + IV lidocaine are critical (Tables 23–24).
• Major STS (Table 24): intra-op opioid/α2/ketamine/lidocaine infusions (unneeded with effective block); 24 h post-op NSAID + tapered infusions + adjuncts + wound catheters + cold therapy/acupuncture; later opioids titrated off + NSAIDs.

Drugs named in WSAVA’s own guideline text

As printed in WSAVA’s document, not this app’s own extracted data — see “Related drugs in this reference” below for that.

• Methadone (Cat (Box 8))

• Ketamine (Cat (Box 8))

• Midazolam (Cat (Box 8))

• Propofol (Cat (Box 8))

• Fentanyl (Cat (Box 8))

• Bupivacaine 0.5% (Cat (Box 8))

• Buprenorphine (Cat (Box 8))

• NSAID (approved) (Cat (Box 8))

• Paracetamol (**Dog only**)

• Metamizole (dipyrone) (Dog & Cat)

• Gabapentin (Dog / Cat)

Recommendations

• Preventive + multimodal analgesia with LA techniques whenever possible

  Expert consensus (GPC, §3.4)

• Incisional/specific nerve blocks (e.g. intercostal), epidural, wound catheters in all cases; mandatory without controlled drugs

  Expert consensus (GPC)

• If NSAIDs insufficient → add alternatives incl. regular opioids

  Expert consensus (GPC)

• Minor STS: opioid + NSAID ± α2 ± ketamine + LA; post-op NSAID ± opioid

  Tiered protocol (Table 23)

• Major STS: intra-op infusions, reduce/omit after effective block; taper 24 h + adjuncts + cold therapy/acupuncture

  Tiered protocol (Table 24)

• Non-controlled: NSAID ± α2 + metamizole or paracetamol (dog only) ± gabapentin; tramadol may replace opioid

  Tiered protocol (Tables 23–24)

• Perioperative gabapentin where major surgery risks neuropathic/chronic pain

  Expert consensus, low evidence (GPC)

• Same NSAID pre-/post-op; euthanasia when pain uncontrollable + poor prognosis

  Expert consensus (GPC card)

Related drugs in this reference (2)

The quoted line under each drug is its own already-extracted indication text that matched this condition — the reason it’s listed, not a paraphrase. Open a drug for its full species/route breakdown, calculator, and complete adverse-effect list.

Showing 2 of 2 linked drug records. Open a record for species, route and source details.

• CARPROFEN

  “® OstiFenis indicated for the relief of pain and inflammation associated with osteoarthritis and for the control of postoperative pain associated with soft tiss…”

  Source dose preview: 2.2 mg/kg q12h or 4.4 mg/kg q24h, q12–24h, PO or SC (Dog)

  Adverse-effect notes: GI (vomiting, anorexia, diarrhea) — Most common, usually mild (<2%) · Idiosyncratic acute hepatotoxicity — Rare (~0.05%), typically 2–3 weeks after starting

• ROBENACOXIB

  “maximum of 3 days. OstiRobe Injection is indicated for the control of postoperative pain and inflammation associated with soft tissue surgery in dogs ≥ 4 months…”

  Source dose preview: 1–2 mg/kg, q24h, PO (Dog)

  Adverse-effect notes: GI (vomiting, soft feces, diarrhea) — Most common, usually mild/self-limiting · ↑ Liver enzyme activity — With long-term oral use (not always associated with pathology)