Constant-rate infusions: part one. 2009. (accessed 6th July 2016)

Bergadano A, Andersen OK, Arendt-Nielsen L, Theurillat R, Thormann W, Spadavecchia C Plasma levels of a low-dose constant-rate-infusion of ketamine and its effect on single and repeated nociceptive stimuli in conscious dogs. Vet J.. 2009; 182-60

Bonnet F, Marret E Postoperative pain management and outcome after surgery. Best Practice & Research. 2007; 21:99-107

Bromley N. Analgesic constant rate infusions in dogs and cats. In Practice. 2013; 34:512-16

Buvanendran A, Kroin JS Useful adjuvants for postoperative pain management. Best Pract Res Clin Anaesthesiol. 2007; 21:31-49

Challis K, Seymour C Advanced anaesthesia and analgesia.(eds). Gloucester: British Small Animal Veterinary Association; 2008

Clapham L. The VN's role in pain management. Veterinary Nursing Journal. 2012; 26:446-8

De Kock MF, Lavand'homme PM The clinical role of NMDA receptor antagonists for the treatment of postoperative pain. Best Pract Res Clin Anaesthesiol. 2007; 21:(1)85-98

De Kock M, Lavand'homme P, Waterloos H Balanced analgesia in the perioperative period: is there a place for ketamine?. Pain. 2001; 92:373-80

Epstein M E, Rodan I, Griffenhagen G AAHA/AAFP Pain Management Guidelines for Dogs and Cats. J Feline Med Surg. 2015; 15:251-72

Erhan OL, Goksu H, Alpay C, Bestas A Ketamine in post-tonsillectomy pain. International Journal of Pediatric Otorhinolaryngology. 2007; 71:735-39

Flaherty D. Analgesia, 2nd Edition. (ed). Oxford: Wiley-Blackwell; 2009a

Flaherty D. Anaesthetic Drugs, 2nd Edition. (ed). Oxford: Wiley-Blackwell; 2009b

Grape S, Tramer MR Do we need preemptive analgesia for the treatment of postoperative pain?. Best Practice and Research Clinical Anaesthesiology. 2007; 21:(1)51-63

Gurney MA Pharmacological options for intra-operative and early postoperative analgesia: an update. J Small Anim Pract. 2012; 53:377-86

Hadi BA, Daas R, Zelko R A randomised, controlled trial of a clinical pharmacist intervention in microdiscectomy surgery - Low dose intravenous ketamine used as an adjunct to standard therapy. Saudi Pharmaceutical Journal. 2013; 21:169-75

The analgesic effects of epidural ketamine in dogs with a chemically induced synovitis; A comparison between pre - or post - injury administration. 2003. (accessed on 3rd November 2013)

Hellyer P, Rodan I, Brunt J, Downing R, Hagedorn JE, Robertson SA AAHA/AAFP Pain Management Guidelines For Dogs & Cats. J Am Anim Hosp Assoc. 2007; 43:235-48

Hoad J. Immediate postoperative recovery – Part 1. Veterinary Nursing Journal. 2013; 28:44-46

Love L, Egger C, Rohrbach B, Cox S, Hobbs M, Docherty T The effect of ketamine on the MACBAR of sevoflurane in dogs. Vet Anaesth Analg. 2011; 38:(4)292-300

Merskey H, Bogduk N Part III: Pain Terms, A Current List with Definitions and Notes on Usage, 2nd edn. (eds.). Seattle: IASP Press; 1994

Orpet H. How well do you know your patient? The need for nursing assessment. Veterinary Nursing Journal. 2011; 26:(7)242-5

Owen A. Proactive pain control. Veterinary Nursing Journal. 2011; 26:432-4

Roberts L Pain management: the nurse's role. BVNA Congress Times. 2008; 8-9

Sarrau S, Jourdan J Effects of postoperative ketamine infusion on pain control and feeding behaviour in bitches undergoing mastectomy. J Small Anim Pract. 2007; 48:670-6

Schmid RL, Sandler AN, Katz J Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes. Pain. 1999; 82:111-25

Self I. Approaches to treating pain. Veterinary Times. 2012; 14-16

Slingsby L. Multimodal analgesia for postoperative pain relief. In Practice. 2008; 30:208-12

The pain process. Veterinary Anaesthesia & Analgesia Support Group. 2004. (accessed 29th September 2013)

Vedpathak HS, Tank PH, Karle AS, Mahida HK, Joshi DO, Dhami MA Pain Management in Veterinary Patients. Veterinary World. 2009; 2:360-3

Visser E, Schug SA The role of ketamine in pain management. Biomed Pharmacother. 2006; 60:(7)341-8

Wagner A E, Walton JA, Hellyer PW, Gaynor JS, Mama KR Use of low dose ketamine administered by constant rate infusion as an adjunct for postoperative analgesia in dogs. J Am Vet Med Assoc. 2002; 221:(1)72-5

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

02 December 2016
9 mins read
Volume 7 · Issue 10


The registered veterinary nurse (RVN) plays a crucial role in managing their patients' level of anaesthesia and analgesia, and must have a sound understanding of the different drugs commonly used in day to day anaesthetic protocols. Ketamine, as part of a low dose or sub-anaesthetic multimodal analgesia regimen, can be useful in facilitating the reduction of the amount of volatile agent needed and reduce the need for ‘rescue’ analgesics peri-operatively. Alleviating pain helps speed the recovery of patients by providing comfort and the relief of stress, helping to minimise the occurrence of wound complications. This article explains the pain process and how ketamine augments the overall analgesia and anaesthesia process, enabling a smoother anaesthetic with reduced side effects and what this means to the RVN.

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.

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