Perioperative Pain Management in Veterinary Surgery

When your pet needs surgery, one of the most important questions you can ask is: how will their pain be managed? At Bentonville Veterinary Specialists, pain management is not an afterthought — it is a core part of every surgical plan, built in from the moment we schedule a procedure to the day your pet goes home.

Modern veterinary anesthesia and analgesia have advanced dramatically. We now have tools that reduce the amount of general anesthetic a patient needs, block pain signals before they ever reach the brain, and provide hours — sometimes days — of relief after the procedure is over. Here is how we put those tools to work for your pet.

Why Pain Management Starts Before the First Incision

Pain is not just a sensation — it is a physiological process. When tissue is cut or manipulated, the nervous system generates a cascade of signals that, if left unchecked, can sensitize the spinal cord and brain to pain. This phenomenon is called wind-up pain, and it is one of the most important concepts in modern anesthesia.

Wind-up occurs when repeated or intense pain signals cause the spinal cord to amplify its response over time. The result is a patient who feels more pain than the injury itself would normally produce — and who may remain hypersensitive long after the wound has healed.

The most effective way to prevent wind-up is to interrupt the pain pathway before it starts. That means administering analgesics before the first incision, not after the patient wakes up. This preemptive approach is the foundation of everything we do.

Local and Regional Nerve Blocks

One of the most powerful tools in our pain management toolkit is the local or regional nerve block — an injection of local anesthetic directly around the nerves that supply the surgical site. By numbing those nerves before surgery begins, we accomplish two things at once.

First, we reduce anesthetic requirements. A patient whose surgical site is already numb does not need as much gas anesthetic to stay comfortable. Lower anesthetic doses mean a more stable cardiovascular system, better oxygen delivery to tissues, and a smoother, faster recovery. For older patients, those with heart or respiratory disease, or any patient where anesthetic depth is a concern, this reduction in drug load can be genuinely life-saving.

Second, we provide prolonged analgesia. Local anesthetics continue working for hours after the procedure ends. When your pet wakes up, the nerve block is still active — meaning the first hours of recovery, which are often the most uncomfortable, are already covered.

Epidurals

For procedures involving the hindlimbs, pelvis, abdomen, or perineum, an epidural is one of our most valuable regional techniques. A small volume of local anesthetic and/or opioid is injected into the epidural space at the base of the spine, where it bathes the nerve roots that carry sensation from the entire rear half of the body.

Epidurals are particularly useful for orthopedic procedures like TPLO surgery, where the knee and surrounding structures need dense, reliable analgesia. A well-placed epidural can provide up to eight hours of profound pain relief — often covering the entire procedure and the early recovery period — while allowing us to use significantly less inhalant anesthetic during surgery.

Other Regional Techniques

Depending on the procedure, we may also use:

• Brachial plexus blocks for forelimb surgeries
• Femoral and sciatic nerve blocks for stifle and distal hindlimb procedures
• Intercostal nerve blocks for chest wall procedures
• Incisional (splash) blocks for abdominal surgeries, where local anesthetic is applied directly to the wound edges before closure

Each block is selected based on the specific nerves involved in the procedure and the anatomy of the individual patient.

Multimodal Analgesia: Attacking Pain from Multiple Directions

No single drug addresses every component of pain. That is why we use a multimodal approach — combining agents that work through different mechanisms to provide broader, more complete relief while keeping the dose of any one drug as low as possible.

Think of it like treating a fire from multiple angles rather than relying on a single hose. Each drug targets a different part of the pain pathway, and together they provide coverage that none could achieve alone.

Anti-Inflammatory Drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs reduce the production of prostaglandins — chemical messengers that sensitize nerve endings and amplify the inflammatory response at the surgical site. By blocking this peripheral sensitization, NSAIDs reduce the volume of pain signals reaching the spinal cord in the first place.

We administer NSAIDs as part of the preoperative protocol when appropriate, and continue them for several days at home. They are a cornerstone of postoperative comfort for most orthopedic and soft-tissue procedures.

Opioids

Opioids act centrally, binding to receptors in the brain and spinal cord to reduce the perception of pain. We use them both during anesthesia (to reduce the amount of gas anesthetic needed) and in the immediate postoperative period.

Fentanyl patches are a particularly useful tool for sustained postoperative analgesia. Applied to a shaved area of skin before or during surgery, the patch delivers a steady, low-level dose of fentanyl through the skin for 72 hours or more. This provides a continuous analgesic background that smooths out the peaks and valleys of pain that can occur between oral medication doses — especially important for the first few nights at home.

Nocita (Bupivacaine Liposome Injectable Suspension)

Nocita is a long-acting local anesthetic formulation that represents a significant advance in postoperative pain control. Unlike standard bupivacaine, which lasts four to six hours, Nocita is encapsulated in tiny lipid spheres that slowly release the drug over 72 hours.

A single injection at the surgical site — around the incision or into the tissue planes — provides three days of local analgesia without the need for repeated injections or additional oral medications. For procedures like stifle surgery or soft-tissue resections, Nocita can dramatically reduce the amount of systemic opioid needed in the days following surgery, which means fewer side effects and a more alert, comfortable patient.

Other Agents

Depending on the patient and procedure, our protocol may also include:

• Gabapentin, which modulates neuropathic pain and is particularly useful for procedures involving nerve manipulation or chronic pain conditions
• Ketamine, used at sub-anesthetic doses to block NMDA receptors in the spinal cord — one of the primary mechanisms of wind-up pain
• Dexmedetomidine, an alpha-2 agonist that provides sedation, muscle relaxation, and analgesia while reducing overall anesthetic requirements
• Maropitant (Cerenia), which has both anti-nausea and visceral analgesic properties, making it valuable for abdominal procedures

Tailoring the Protocol to the Patient

There is no single pain management protocol that is right for every patient. A healthy three-year-old Labrador undergoing TPLO surgery has very different needs from a twelve-year-old cat with chronic kidney disease undergoing a soft-tissue procedure.

Before every surgery, our team reviews each patient's:

• Age and body weight
• Breed-specific sensitivities (some breeds metabolize certain drugs differently)
• Concurrent health conditions, particularly cardiac, hepatic, or renal disease
• Current medications that may interact with analgesics
• The nature and duration of the planned procedure
• Expected level of postoperative discomfort

This individualized assessment allows us to build a protocol that provides the most effective analgesia with the lowest risk — not a one-size-fits-all approach, but a plan designed specifically for your pet.

What This Means for Your Pet's Recovery

Effective perioperative pain management is not just about comfort — it has measurable effects on outcomes. Patients who are well-managed for pain:

• Wake up more smoothly from anesthesia, with less agitation and distress
• Begin eating and drinking sooner after surgery
• Are more willing to bear weight on an operated limb, which supports early rehabilitation
• Have lower stress hormone levels, which supports immune function and wound healing
• Require fewer rescue analgesics in the hospital and at home

Pain that is poorly controlled in the immediate postoperative period can also contribute to chronic pain sensitization — the same wind-up phenomenon we work to prevent during surgery. Getting pain management right from the start is one of the most important investments we can make in your pet's long-term quality of life.

Questions to Ask Before Your Pet's Surgery

If your pet is scheduled for a procedure — here or anywhere — these are worth asking:

• What analgesics will be given before the procedure begins?
• Will a local or regional nerve block be used?
• How will pain be managed in the first 24–72 hours after surgery?
• What will I be sending home, and how do I know if it is working?

At Bentonville Veterinary Specialists, we welcome these questions. Pain management is one of the areas where board-certified surgical training makes a real difference, and we are happy to walk you through exactly what we have planned for your pet.

If you have questions about an upcoming procedure or would like to discuss pain management options, contact our team at [email protected].