Emergency and critical care pain

WSAVA guideline

Key findings

• Opioids = mainstay of immediate ICU analgesia; most also sedate, facilitating restraint; IV access ASAP to correct volume deficits (trauma/hypovolaemia, e.g. GDV) and titrate drugs to effect (card).
• Titration rule: start with 10–20% of the recommended dose, increase incrementally until pain relief without adverse effects; CRI afterwards, adjusted as the patient is stabilised and frequently assessed (card).
• Ketamine infusion prevents/treats central sensitisation in severe pain with a neuropathic component (trauma); boluses are short-acting and more likely to induce behavioural changes (card).
• Lidocaine IV (loading + infusion) in dogs and cats, but cautiously in cats — haemodynamic compromise risk (card).
• CRI rates adjusted on assessment: up for breakthrough pain, down if heavily sedated/difficult to arouse (card).
• NSAIDs withheld until volume/CV/renal status stabilised and no GI disease; when not contraindicated they decrease secondary inflammatory cascades (card; §2.3: hypovolaemia/dehydration/hypotension are contraindications).
• Low-dose α2 agonists (dexmedetomidine, medetomidine) give sedation + muscle relaxation; manage stress/fear/anxiety with trazodone, acepromazine or gabapentin + nursing care + low-stress handling (card).
• Systemic opioids may not fully eliminate acute-trauma/emergency visceral pain (e.g. GDV); give analgesia early, sometimes before full examination; opioids are widely used for pancreatitis, burns, trauma, meningitis (§2.2, §1.4).

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.

• Short-acting opioid (titrated; e.g. fentanyl, Table 12) (Dog & Cat)

• Ketamine (Dog & Cat)

• Lidocaine CRI (Dog)

• Lidocaine CRI (Cat)

• NSAID (e.g. carprofen; cat single dose only) (Dog & Cat)

• Dexmedetomidine/medetomidine (Dog & Cat)

• Trazodone / acepromazine (0.01–0.03 mg/kg) / gabapentin (Dog & Cat)

Recommendations

• Give analgesia early in every injured/critically ill patient

  Expert consensus (GPC)

• Opioids first-line, titrated IV, before/alongside diagnostics

  Expert consensus (GPC)

• Establish IV access ASAP; correct volume deficits; titrate

  Expert consensus (GPC)

• Withhold NSAIDs until volume/CV/renal stability, no GI disease

  Expert consensus (GPC)

• Ketamine by CRI (never bolus-reliance) for central sensitisation

  Expert consensus (GPC)

• Lidocaine CRI cautious in cats

  Stated caution (GPC)

• Low-dose α2 agonists as multimodal sedation/analgesia

  Expert consensus (GPC)

• Manage stress/anxiety (trazodone/ACP/gabapentin + nursing)

  Expert consensus (GPC); Lefman & Prittie 2019

• Reassess frequently; adjust CRIs up (breakthrough)/down (over-sedation)

  Expert consensus (GPC)

Related drugs in this reference (0)

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