# Perioperative Analgesia Protocols for Major Soft Tissue Surgery


## Key Takeaways

- Multimodal analgesia, combining opioids, NSAIDs, and local anesthetics, is essential for major soft tissue surgery to address diverse nociceptive inputs and minimize opioid-related adverse effects.
- Preoperative administration of NSAIDs is supported by clinical trial evidence in dogs for reducing postoperative rescue analgesia requirements, with short-term use (days) generally considered safe, though contraindications (renal, hepatic, GI disease) and effects on anastomotic healing require careful consideration.
- Local anesthetic techniques, including incisional infiltration and regional blocks, significantly reduce opioid requirements and provide site-specific analgesia without systemic adverse effects, with ongoing research exploring sustained-release formulations for prolonged action.
- Opioid selection should be tailored to procedure duration and expected pain trajectory, with full mu agonists for severe pain, and a defined rescue analgesia plan with a pre-established pain score threshold is critical for timely intervention.
- Pain assessment requires validated composite scales appropriate to species (e.g., Glasgow Composite Pain Scale, University of Melbourne Pain Scale) and must be integrated with physiological monitoring (heart rate, respiratory rate, sedation) to interpret trends rather than isolated values.
- Protocol design should be tiered based on the expected nociceptive load of the procedure, with Tier 1 for moderate procedures (e.g., ovariohysterectomy), Tier 2 for major resection/reconstruction, and Tier 3 for procedures with high risk of ileus or anastomotic complications, necessitating careful NSAID selection and emphasis on locoregional techniques.

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Major soft tissue procedures in dogs and cats generate nociceptive input from skin incision, muscle retraction, visceral manipulation, and tissue ischemia. A single analgesic agent rarely controls this input adequately across the entire perioperative period. This article provides a framework for designing multimodal protocols that match analgesic intensity to surgical insult, patient comorbidity, and species-specific physiology. It is written for practicing veterinarians who perform or supervise soft tissue surgery and who must balance effective pain control against the risks of opioid-related adverse effects, NSAID contraindications, and local anesthetic toxicity.

The clinical question addressed is practical: how should an analgesic plan be constructed before, during, and after major soft tissue surgery in dogs and cats? The answer draws on the principle that perioperative analgesia should be multimodal to improve pain relief and reduce opioid use, thereby limiting opioid-related adverse effects that impair recovery. This principle is articulated in a review of NSAID effects on postoperative healing, which also notes that short-term NSAID use of less than two weeks is not precluded by available human data. The same review acknowledges that animal data on NSAID interference with healing are contradictory across bone, soft tissue, wound, and anastomosis models. That uncertainty matters clinically when deciding whether to include an NSAID in a protocol for gastrointestinal or reconstructive surgery.

## At a Glance

| Parameter | Clinical Decision Point |
|---|---|
| Analgesic modality | Combine opioid, NSAID, local anesthetic, and adjunct agents instead of relying on one drug class |
| NSAID timing | Preoperative administration is supported by clinical trial evidence in dogs, verify current label guidance |
| NSAID duration | Short-term use (days) is supported, extended use requires reassessment of healing and renal risk |
| Local anesthetic technique | Incisional, wound infiltration, or regional blocks reduce opioid requirements, topical application to ovarian pedicle has shown benefit in laparoscopic ovariectomy |
| Opioid selection | Choose agent based on procedure duration, species, and expected postoperative pain trajectory |
| Pain scoring | Use a validated composite scale appropriate to species and reassess at fixed intervals |
| Rescue analgesia | Define a threshold score that triggers intervention before surgery begins |
| Monitoring | Assess sedation, respiratory rate, heart rate, and pain score together, do not interpret vital signs in isolation |

## Physiology of Surgical Pain and the Rationale for Multimodal Therapy

Surgical trauma activates nociceptors through direct mechanical injury, release of inflammatory mediators, and sensitization of peripheral and central pain pathways. Each of these mechanisms responds to different drug classes. Opioids act on central and spinal receptors to modulate ascending pain transmission. NSAIDs reduce prostaglandin synthesis at the site of tissue damage, attenuating peripheral sensitization. Local anesthetics block sodium channels and prevent afferent signal generation entirely. Combining these mechanisms produces additive or synergistic analgesia while allowing lower doses of each agent.

The clinical consequence of inadequate perioperative analgesia extends beyond patient comfort. Pain-induced neuroendocrine responses increase catecholamine and cortisol release, which can impair wound healing, delay gastrointestinal motility, and prolong recovery. Opioid-related adverse effects, including ileus, nausea, and sedation, can similarly slow return to normal function. A multimodal approach that reduces total opioid dose therefore addresses both pain and recovery quality simultaneously.

## NSAIDs in the Perioperative Plan

NSAIDs are a central component of most canine soft tissue protocols. A prospective, randomised, blinded, placebo-controlled study of deracoxib administered at label dose for three days around soft tissue surgery in dogs found that significantly fewer NSAID-treated dogs required rescue analgesia compared with placebo-treated dogs. Pain scores were numerically lower in the treatment group throughout the postoperative period. A separate randomised field study of cimicoxib in dogs undergoing orthopedic or soft tissue surgery demonstrated non-inferior efficacy and tolerability compared with carprofen, with both drugs well tolerated over a seven-day monitoring period.

These trials support the use of a preoperative NSAID dose followed by short-term postoperative continuation. The decision to include an NSAID must account for patient factors including hydration status, renal function, hepatic function, and gastrointestinal disease. For procedures involving intestinal anastomosis, the prescriber must weigh the contradictory animal data on anastomotic healing against the analgesic benefit. The review of NSAID effects on healing concludes that short-term use is not precluded by available evidence, but it also notes that well-designed trials are required to resolve the question definitively. In cats, NSAID selection is narrower due to species-specific pharmacokinetics and a lower margin of safety. Current formulary and label references must be consulted for approved agents, doses, and duration limits in each species.

## Local Anesthetic Techniques as Opioid-Sparing Components

Local anesthetics provide site-specific analgesia without systemic adverse effects. For open soft tissue procedures, incisional infiltration or regional nerve blocks performed before incision reduce intraoperative anesthetic requirements and provide several hours of postoperative comfort. For laparoscopic procedures, topical application of local anesthetic to the ovarian pedicle has been evaluated in dogs undergoing laparoscopic ovariectomy. In a prospective, randomised, controlled trial, bupivacaine applied topically to the ovarian pedicle was compared with saline using the same technique, with postoperative pain assessed using the University of Melbourne Pain Scale. The study design reflects a broader principle: local anesthetic delivery at the site of visceral manipulation can reduce nociceptive input even when the tissue is not accessible to conventional infiltration.

The duration of action of standard local anesthetics is limited to hours, which may be insufficient for the first postoperative night after major surgery. Research in rodent models has explored sustained-release formulations of ropivacaine using injectable microbubbles that provide real-time ultrasound visualization during delivery and prolong mechanical analgesia for days. These formulations are not yet clinical products for veterinary use, but they illustrate the direction of regional anesthesia development and the clinical need for longer-acting options.

## Opioid Selection and the Role of Rescue Protocols

Opioid choice depends on the expected intensity and duration of postoperative pain. Full mu agonists provide the most reliable dose-dependent analgesia for major procedures. Partial agonists and agonist-antagonists have ceiling effects that limit their utility for severe pain. In cats, opioid selection must account for species-specific responses, including the potential for behavioral excitation with some agents at higher doses. The same drug class that provides profound analgesia in one patient may cause dysphoria in another, and the distinction between pain-related behavior and opioid-related behavior requires careful assessment.

Every protocol must include a rescue plan defined before surgery begins. A validated pain scale appropriate to the species should be applied at fixed intervals, and a threshold score that triggers rescue analgesia should be established in advance. The Glasgow Composite Pain Scale and the University of Melbourne Pain Scale are examples of validated instruments used in canine studies. When a patient exceeds the threshold, the rescue agent should be selected based on the drugs already administered. If an NSAID is already on board, rescue with an opioid is appropriate. If the patient is already receiving a full mu agonist, rescue may require dose escalation or the addition of a local anesthetic technique instead of the addition of another systemic agent.

## Species-Specific Considerations and Monitoring

Cats present distinct challenges in perioperative pain assessment. Behavioral signs of pain in cats are often subtle and may be limited to changes in food intake, posture, and facial expression. The same difficulty applies to other small mammal species, as demonstrated by a survey of German veterinarians assessing perioperative pain in pet rabbits, which found that food intake and behavioral observation were the most commonly used indicators while grimace scales were used by fewer than a quarter of respondents. Although that survey concerns rabbits, it highlights a broader principle: pain assessment tools are only useful when clinicians actually apply them. For cats, a species-appropriate composite scale should be selected and used consistently by all team members.

Monitoring must integrate pain scores with physiological parameters. Tachycardia, hypertension, and tachypnoea can indicate pain, but they can also reflect hypovolemia, hyperthermia, or anxiety. Conversely, a painful patient may be bradycardic or normotensive, particularly if an opioid is on board. Pain scores should therefore be interpreted in the context of the full clinical picture instead of as isolated numbers. Serial assessments are more informative than single measurements, and the same observer should ideally perform repeated scoring to reduce inter-observer variability.

## Building the Protocol: Procedure-Tiered Analgesic Planning

A workable perioperative plan begins before the patient is premedicated. The procedure itself dictates the intensity and duration of analgesia required. Major soft tissue surgery encompasses a wide range of tissue trauma, from ovariectomy to extensive resection and reconstruction, and a single protocol cannot serve all cases. Tier the plan by expected nociceptive load, anticipated recovery trajectory, and the patient's systemic reserve.

### Tier 1: Moderate Soft Tissue Procedures

This tier covers procedures such as routine ovariohysterectomy, cystotomy, and uncomplicated mass removal. These surgeries generate moderate, short-lived nociceptive input. A pre-emptive NSAID, an opioid for intraoperative and early postoperative coverage, and a local anesthetic block at the incision or relevant nerve distribution provide adequate control in most healthy patients. The NSAID is continued for 48 to 72 hours postoperatively, with the duration guided by the degree of tissue handling and the patient's renal and hepatic status. Rescue analgesia should be available and administered if pain scores exceed the threshold defined by the chosen scoring instrument.

### Tier 2: Major Resection and Reconstruction

Procedures such as large tumor resection with advancement flaps, amputations, thoracotomy, and extensive abdominal surgery require a more aggressive approach. The inflammatory burden is higher and the recovery period longer. Consider a continuous local anesthetic infusion via an indwelling catheter placed at the surgical site or a regional block performed under ultrasound guidance. This reduces the reliance on systemic opioids and provides sustained analgesia beyond the immediate postoperative period. The opioid component should be scheduled instead of rescue-only for the first 12 to 24 hours, then transitioned to as-needed dosing based on serial pain scoring.

### Tier 3: Procedures with High Risk of Postoperative Ileus or Anastomotic Complications

Gastrointestinal resection and anastomosis, particularly in patients with peritonitis or compromised perfusion, require particular care. The concern is not whether to provide analgesia but how to do so without exacerbating ileus or masking deterioration. Opioids, especially those with significant mu-receptor activity, reduce gastrointestinal motility. This is where the multimodal approach earns its keep. An NSAID, if the patient is hemodynamically stable and renal function is adequate, provides a non-opioid analgesic base. A locoregional technique, such as a transversus abdominis plane block or an epidural, can provide substantial somatic analgesia with minimal systemic effect. The evidence on NSAID effects on enteral anastomotic healing remains contradictory, with animal data suggesting potential harm but human data not precluding short-term use of less than two weeks, as summarized in [a review of NSAID effects on postoperative healing](https://pubmed.ncbi.nlm.nih.gov/34072128/). In the individual patient, the decision rests on perfusion, blood pressure stability, and the perceived integrity of the anastomosis.

## The Protocol Table: Drug Options, Doses, and Monitoring

The following table provides a framework for protocol design. It is not a dosing chart. Current formulary and label references must be consulted for specific doses, contraindications, and approved indications in each species.

| Procedure Tier | Drug Class Options | Route and Timing | Monitoring Parameters | Rescue and Adjustment Triggers |
|---|---|---|---|---|
| Tier 1: Moderate soft tissue | NSAID (e.g. carprofen, meloxicam, deracoxib, cimicoxib) | Preoperative, then daily for 48 to 72 hours | Pain score every 4 to 6 hours, appetite, activity level, renal values if prolonged use | Pain score above threshold, vomiting or diarrhea, reduced urine output |
| Tier 1: Moderate soft tissue | Opioid (e.g. methadone, buprenorphine, butorphanol) | Premedication, intraoperative as needed, postoperative scheduled for 12 to 24 hours | Sedation score, respiratory rate, pain score, gastrointestinal motility | Excessive sedation, respiratory depression, pain score above threshold despite scheduled dosing |
| Tier 1: Moderate soft tissue | Local anesthetic (e.g. bupivacaine, lidocaine) | Incisional line block or regional nerve block preoperatively | Pain score, signs of local anesthetic toxicity (tremors, seizures, arrhythmias) | Inadequate block duration, toxicity signs |
| Tier 2: Major resection | NSAID | Preoperative if no contraindication, then daily for 3 to 5 days | Pain score, renal and hepatic values, gastrointestinal signs, surgical site assessment | Deteriorating renal function, gastrointestinal signs, pain score above threshold |
| Tier 2: Major resection | Opioid | Premedication, intraoperative CRI or intermittent, postoperative scheduled for 24 hours then as needed | Sedation, respiratory rate, pain score, ileus signs | Respiratory depression, prolonged ileus, inadequate analgesia |
| Tier 2: Major resection | Local anesthetic infusion | Indwelling catheter at surgical site or regional block, continuous or intermittent | Pain score, catheter site integrity, signs of toxicity | Catheter dislodgement, infection at site, toxicity signs |
| Tier 3: GI anastomosis | NSAID (select patients only) | Preoperative or early postoperative, only if hemodynamically stable | Blood pressure, renal values, perfusion parameters, anastomotic site if accessible | Hypotension, azotaemia, suspected leakage |
| Tier 3: GI anastomosis | Opioid (short-acting, titrated) | Intraoperative and early postoperative, lowest effective dose | Pain score, gastrointestinal motility, sedation, respiratory rate | Ileus, excessive sedation, inadequate analgesia |
| Tier 3: GI anastomosis | Locoregional block (e.g. TAP block, epidural) | Preoperative or intraoperative | Pain score, motor function if epidural, blood pressure | Hypotension, inadequate block, motor weakness beyond expected duration |

## Monitoring Parameters and What Each Detects

Serial pain scoring is the backbone of postoperative monitoring, but it must be paired with physiological parameters to detect complications early. The Glasgow Composite Pain Scale and the University of Melbourne Pain Scale are validated instruments for dogs. For cats, behavioral observation and interaction-based scoring are more reliable than static observation alone. The survey of German veterinarians assessing pain in rabbits found that food intake and behavioral observation were the most commonly used indicators, with the Rabbit Grimace Scale used by fewer than a quarter of respondents, highlighting the gap between available tools and clinical uptake in less common species.

Heart rate and respiratory rate are non-specific but useful trend indicators. A rising heart rate in a patient previously comfortable may signal inadequate analgesia, but it may also indicate hypovolemia, fever, or distress. Blood pressure is similarly non-specific. The value of these parameters lies in their trajectory, not their absolute number at a single time point. Sedation scoring is essential when opioids are used, as excessive sedation may precede respiratory depression. Appetite and gastrointestinal motility are practical indicators of recovery quality, particularly after abdominal surgery.

## Documentation and Escalation Pathways

Document the pain score, physiological parameters, and any rescue analgesia administered at each assessment point. This creates a trend that supports clinical judgment and provides a defensible record. Define the escalation pathway before surgery. If the pain score exceeds the threshold, the first step is a rescue opioid bolus. If the score remains elevated after two rescue doses within a defined period, reassess the patient for surgical complications, reconsider the analgesic plan, and consider adding a different drug class instead of repeating the same agent. The [American College of Veterinary Surgeons' resources on surgical conditions and postoperative management](https://www.acvs.org/small-animal/) provide procedure-specific guidance on expected recovery and complication recognition.

## Species and Patient Status Modifications

Cats require particular attention to opioid selection and dosing. They metabolise some opioids differently from dogs, and the risk of dysphoria is higher with certain agents. Buprenorphine is well tolerated and provides good visceral analgesia in cats. Methadone is also suitable. NSAIDs in cats require careful attention to hydration status and renal function, and the duration of use is generally shorter than in dogs. The [MSD Veterinary Manual](https://www.msdvetmanual.com/) provides species-specific pharmacology and dosing guidance that should be consulted before finalising any protocol.

Patient status changes the plan more than the procedure does. A patient with chronic kidney disease may not be a candidate for an NSAID, and the opioid and local anesthetic components must carry more of the analgesic burden. A patient with hepatic disease may have altered opioid metabolism and prolonged effects. A hypotensive patient under anesthesia may not be a candidate for an epidural. The protocol is a starting point, not a fixed prescription. Each component must be justified against the individual patient's physiology, and the plan must be revised when the patient's status changes intraoperatively or postoperatively.

## Recognized Complications and Early Detection

The most common analgesic failure modes in major soft tissue surgery are inadequate baseline coverage, premature cessation of therapy, and unrecognised dose-related adverse effects. Each presents with distinct clinical signatures.

Inadequate analgesia typically manifests as tachycardia, hypertension, tachypnoea, and behavioral change within the first 4 to 6 hours after recovery from anesthesia. Pain scoring tools such as the Glasgow Composite Pain Scale or the University of Melbourne Pain Scale provide serial, objective tracking when applied at consistent intervals by the same observer. A rising trend across two consecutive assessments, even below the rescue threshold, warrants escalation instead of continued observation.

Opioid-related adverse effects cluster around the gastrointestinal tract and central nervous system. Reduced fecal output, inappetence, and progressive abdominal distension may signal ileus, particularly after laparotomy. Sedation that deepens beyond the expected postoperative level, or that fails to lighten within 12 hours, should prompt review of cumulative opioid dosing and consideration of concurrent metabolic derangement. Dysphoria, characterized by vocalisation, pacing, and unresponsiveness to comfort measures, is often mistaken for pain and treated with additional opioid, which worsens the clinical picture. The discriminating feature is that dysphoric animals do not settle with gentle handling, whereas painful animals typically show at least transient improvement with position change or wound palpation.

NSAID-related complications are less common with short perioperative courses but remain clinically significant. Reduced urine output, vomiting, or melaena in the first 48 to 72 hours postoperatively should trigger immediate drug cessation and assessment of renal parameters and packed cell volume. The debate over NSAID effects on tissue healing is longstanding, animal data are contradictory across bone, soft tissue, and anastomotic models, while human data do not preclude short-term postoperative use of less than two weeks. For enterotomy or anastomosis patients, this uncertainty supports limiting NSAID duration to the immediate perioperative period and relying on other modalities once oral intake resumes.

Local anesthetic toxicity is rare when doses are calculated from lean body weight and divided across sites, but systemic absorption increases with vascular injection or repeated boluses. Early signs include perioral twitching, tremors, and arrhythmias. Continuous rate infusions require dedicated intravenous access and regular assessment of infusion site patency, as extravasation of concentrated solutions causes tissue irritation.

## Common Errors and Corrective Actions

Less experienced clinicians frequently underdose opioids out of concern for respiratory depression, then compensate with additional intraoperative volatile agent. The result is a patient that is slow to recover, hypothermic, and painful upon arousal. Corrective action is to titrate opioids to effect during anesthesia using heart rate and blood pressure responses to surgical stimulation, and to accept that recovery will be smoother with adequate intraoperative analgesia.

A second recurring error is discontinuing analgesia at discharge without a tapering or transition plan. Owners are rarely equipped to recognize subtle pain behaviors, and the return of normal appetite and activity may lag behind tissue healing by several days. Provide written instructions that specify which drug to continue, at what interval, and which signs should prompt re-examination.

A third error is combining multiple NSAIDs or overlapping an NSAID with a corticosteroid. Verify the complete medication history, including any products the owner administers without veterinary oversight, before prescribing. Document the washout period applied and the rationale in the medical record.

## Limitations of Current Evidence and Divergent Expert Opinion

The evidence base for perioperative analgesia in dogs and cats relies heavily on clinical trials of individual NSAIDs. Deracoxib administered at 1 to 2 mg/kg daily for three days significantly reduced rescue analgesia requirements after soft tissue surgery in dogs, and cimicoxib demonstrated non-inferiority to carprofen across orthopedic and soft tissue procedures. These studies support NSAID use but do not resolve questions about optimal duration, combination with specific opioid regimens, or effects on anastomotic healing.

Expert opinion diverges on three points. First, whether preoperative NSAID administration is preferable to postoperative initiation. Proponents cite pre-emptive analgesia and smoother recovery, opponents cite the theoretical risk of intraoperative renal hypoperfusion in hypotensive patients. Second, whether local anesthetic wound infiltration provides meaningful benefit beyond systemic analgesia in open procedures. The evidence for topical application to the ovarian pedicle during laparoscopic ovariectomy shows improved pain scores and reduced inflammatory markers, but extrapolation to open laparotomy is uncertain. Third, whether routine opioid use should be minimized in favour of non-opioid strategies. Multimodal analgesia is intended to improve pain relief while reducing opioid requirements and their adverse effects, but the optimal balance varies by procedure, patient, and available monitoring.

Survey data from veterinary practice reveal substantial variation in perioperative protocols, including inconsistent use of preoperative analgesia and reliance on a narrow range of drug combinations. This variation reflects both the limited comparative evidence and the influence of regional availability and regulatory constraints.

## Referral, Consultation, and Reporting

Referral or specialist consultation is warranted when pain remains refractory to escalating doses of two different opioid classes combined with an NSAID and regional techniques. This pattern suggests either an undiagnosed surgical complication, such as seroma, infection, or tissue ischemia, or a neuropathic component requiring adjunctive therapy. Laboratory involvement is indicated for unexplained postoperative fever, progressive anemia, or rising inflammatory markers, as these may signal infection or hemorrhage instead of inadequate analgesia.

Regulatory reporting obligations vary by jurisdiction. Where controlled substance use is governed by national or regional law, accurate recording of opioid acquisition, administration, and disposal is mandatory. The World Organization for Animal Health terrestrial standards address animal welfare in surgical contexts and may inform institutional policy, but specific reporting requirements should be confirmed with the relevant national authority. Professional practice resources from organizations such as the American Veterinary Medical Association provide guidance on opioid stewardship and record-keeping expectations.

| Observation | Likely Cause | Discriminating Check |
| --- | --- | --- |
| Tachycardia, hypertension at 4 h postop | Inadequate analgesia | Pain score rising, response to rescue opioid |
| Vocalisation, pacing, unresponsive to handling | Opioid dysphoria | No improvement with repositioning, consider sedation trial |
| Progressive abdominal distension, no fecal output | Ileus | Abdominal ultrasound, assess hydration and electrolyte status |
| Reduced urine output, vomiting at 48 h | NSAID-related renal injury | Serum creatinine, urea, packed cell volume, urine specific gravity |
| Tremors, arrhythmia after local block | Local anesthetic toxicity | Serum drug level if available, electrocardiography, supportive care |
| Fever, wound erythema at 72 h | Surgical site infection | Cytology, culture, leukocyte count, imaging for deep infection |

## Frequently Asked Questions

### How Do I Build an Effective Analgesic Protocol When NSAIDs Are Contraindicated?

When NSAIDs are not an option, the plan must rely more heavily on locoregional techniques, opioids, and adjuncts such as ketamine or lidocaine infusions. The evidence base for NSAID use in the perioperative period is strongest for short-term administration, but patients with renal, hepatic, or gastrointestinal disease require alternative strategies. A review of current knowledge on NSAIDs and surgical healing notes that human data do not preclude short-term postoperative use, yet individual patient risk must guide the decision. For NSAID-ineligible patients, extend local anesthetic blocks, schedule opioids at regular intervals instead of as needed, and consider continuous rate infusions. Document the contraindication clearly in the medical record so that rescue analgesia is not delayed by uncertainty.

### What Is the Minimum Acceptable Analgesic Plan When Cost Limits the Options?

Cost constraints should not eliminate multimodal therapy entirely. Prioritize interventions with the highest analgesic yield per unit cost. A single preoperative NSAID dose, an incisional line block with bupivacaine, and a short course of oral analgesia often provide acceptable coverage for moderate procedures. Opioids are the most expensive component in many regions, so reserve them for intraoperative use and immediate recovery. Local anesthetics are inexpensive and underused. The German survey of perioperative pain management in rabbits found that multimodal protocols were common, but opioids and local anesthetics were used less frequently than systemic non-opioid analgesics, suggesting a pattern that may reflect cost or familiarity. When resources are limited, document the financial discussion with the owner and the specific compromises made.

### How Should I Adjust the Protocol for a Cat Undergoing Major Soft Tissue Surgery?

Cats metabolise many analgesics differently from dogs, and their pain behavior is subtler. Opioid requirements vary widely, and some cats show dysphoria instead of sedation. Local anesthetic techniques are particularly valuable in cats because they reduce systemic drug burden. Avoid relying on owner observation alone for pain scoring, use a validated feline pain scale at fixed intervals. NSAID selection requires attention to renal status and hydration, especially in older cats. The evidence for perioperative NSAID use in dogs is stronger than in cats, so extrapolate cautiously. Consider extended monitoring after discharge, as cats often hide pain until it becomes severe. Provide written instructions to owners that describe specific behaviors to observe, including litter box use, grooming, and appetite changes.

### What Should I Record in the Medical Record to Defend My Analgesic Choices?

Record the preoperative pain score, the planned protocol and its rationale, and any contraindications that altered drug selection. Document the time of each analgesic administration, the route, and the response. Pain scores should be recorded at each reassessment interval, also when problems arise. If rescue analgesia is given, note the trigger that prompted it and the outcome. The AVMA practice resources emphasize that thorough medical records support clinical decisions and continuity of care. Include the owner's consent for the analgesic plan and any cost-related modifications. If a drug was withheld because of a perceived contraindication, state the specific finding that justified the decision. This level of detail protects both the patient and the practice.

### How Do I Explain the Analgesic Plan to an Owner Who Is Worried About Opioid Use?

Owners may associate opioids with addiction or excessive sedation. Explain that veterinary use is short-term, tightly monitored, and aimed at preventing pain before it becomes severe. Frame the discussion around recovery quality: animals that are comfortable eat sooner, move more, and heal faster. The American College of Veterinary Surgeons provides client-facing summaries of surgical aftercare that can reinforce this message. Offer a concrete description of what the owner will see, such as a quiet but responsive pet that accepts gentle handling. If the owner remains reluctant, discuss the rescue protocol and how pain will be reassessed. Never imply that opioid avoidance is safer, untreated pain carries its own physiologic costs.

### When Should I Refer a Case for Specialist Pain Management?

Refer when the patient has failed two or more analgesic classes despite dose optimization, when pain persists beyond the expected surgical timeframe, or when the procedure involves major reconstruction where regional techniques exceed your comfort level. Referral is also appropriate for patients with complex comorbidities such as cardiac disease or coagulopathies that complicate drug selection. The MSD Veterinary Manual provides species-specific pharmacology references that can support decision-making before referral. If you refer, send the complete analgesic history, including what was given, when, and the response. This allows the specialist to build on prior therapy instead of repeat it. Early referral is preferable to prolonged ineffective treatment, which erodes owner confidence and prolongs patient suffering.

## Related Clinical & Scientific Guides

* [Perioperative Antibiotic Prophylaxis: Timing and Selection](/knowledge/veterinary-medicine/veterinary-surgery/perioperative-antibiotic-prophylaxis-timing-selection)
* [Surgical Approaches to the Femur and Stifle](/knowledge/veterinary-medicine/veterinary-surgery/surgical-approaches-femur-stifle)
* [Fracture Healing Assessment: Radiographic and Clinical Evaluation](/knowledge/veterinary-medicine/veterinary-surgery/fracture-healing-assessment-radiographic-clinical)


## References and Further Reading

- [Do NSAIDs Really Interfere with Healing after Surgery?](https://pubmed.ncbi.nlm.nih.gov/34072128/). 2021.
- [Survey of German veterinarians' approaches to pain assessment and management of perioperative pain in pet rabbits.](https://pubmed.ncbi.nlm.nih.gov/41342384/). 2026.
- [Effects of Topical Administration of Bupivacaine HCl to the Ovarian Pedicle on Postoperative Pain, Antioxidant Enzyme Activity and Inflammatory Cytokines in Dogs Undergoing Laparoscopic Ovariectomy.](https://pubmed.ncbi.nlm.nih.gov/42554136/). 2026.
- [Efficacy and safety of deracoxib for control of postoperative pain and inflammation associated with soft tissue surgery in dogs.](https://pubmed.ncbi.nlm.nih.gov/22225463/). 2012.
- [Efficacy and safety of cimicoxib in the control of perioperative pain in dogs.](https://pubmed.ncbi.nlm.nih.gov/23710692/). 2013.
- [Sustained Release of Ropivacaine from Adhesive Injectable Microbubbles with Contrast-Enhanced Ultrasonography in Pain Management: An Animal Model Study.](https://pubmed.ncbi.nlm.nih.gov/41783573/). 2026.
- [American College of Veterinary Surgeons Animal Health Resources](https://www.acvs.org/small-animal/). American College of Veterinary Surgeons.
- [MSD Veterinary Manual, Professional Edition](https://www.msdvetmanual.com/). MSD Veterinary Manual.
- [American Veterinary Medical Association Practice Resources](https://www.avma.org/resources-tools). American Veterinary Medical Association.

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> This article is educational professional reference material for veterinary audiences. It is not a substitute for veterinary diagnosis, individual clinical judgment, current product labeling, or applicable regulatory requirements.