The use of ketamine peri-operatively as part of a multimodal analgesia regimen in dogs

The role of a registered veterinary nurse (RVN), involves nursing patients to a high standard of care, which requires the understanding and awareness of a patient's level of comfort and wellbeing. RVNs have an ethical responsibility to ensure patients are not suffering and an understanding of analgesics is required for RVNs to be able to assist in alleviating pain. Pain is now well recognised as something that animals feel (Owen, 2011), probably in much the same way as humans. It is no longer accepted that pain is beneficial by preventing any further injury, and it is understood that it may in fact be detrimental to long-term wellbeing (Hoad, 2013). RVNs therefore play an integral role in recognising pain and its symptoms, whether it be through the use of pain scoring charts or observation of behaviour.

RVNs play an important role in anaesthesia; although the veterinary surgeon (VS) is by law solely responsible for administration of anaesthetics, RVNs may act on behalf of the VS. Currently, under Schedule 3 of the Veterinary Surgeon's Act 1966 RVNs may administer a specific quantity of a drug to induce or maintain anaesthesia, but incremental dosing or dosing to effect must be done by the VS. However, the adjustment of a volatile agents by the VS would be difficult in practice as they would usually be aseptically involved in an operation, therefore RVNs are able to perform this adjustment on behalf of the VS. By monitoring physiological parameters of a patient under anaesthetic, the RVN can compile information that helps them assess the depth of anaesthesia and the amount of volatile agent needed to maintain an anaesthesia to an adequate depth. It is important that where multimodal analgesia is used, RVNs recognise that an effect on the patient's physiology will be produced, and the amount of other drugs required for a balanced anaesthesia may change.