References

Animal Welfare Act. Animal Welfare Act 2006. 2006. https://www.legistlation.gov.uk/ukpga/2006/45/contents (accessed 4 November 2020)

Benito J, Monteiro B, Lavoie AM, Beauchamp G, Lascelles BDX, Steagall PV. Analgesic efficacy of intraperitoneal administration of bupivacaine in cats. J Feline Med Surg. 2016; 18:(11)906-912 https://doi.org/10.1177/1098612X15610162

Chahar P, Cummings KC Liposomal bupivacaine: a review of a new bupivacaine formulation. J Pain Res. 2012; 5:(28)257-264

Corletto J, Jolliffe C. Pharmacological treatment of pain. In: Self I Gloucester: BSAVA; 2019

Crombie IK. The Pocket Guide to Critical Appraisal.London: BMJ Publishing Group; 1996

Duke-Novakovski T. Pain management II: Local and regional anaesthetics techniques, 3rd Edition. In: Duke-Novakovski T, De Vries M, Seymour C (eds). Gloucester: BSAVA; 2017

Dytham C. Choosing and using statistics: a biologist's guide, 3rd Edition. Chichester: Wiley-blackwell; 2011

Fudge JM, Page B, Mackrell A, Lee I. Evaluation of targeted bupivacaine for reducing acute postoperative pain in cats undergoing routine ovariohysterectomy. J Feline Med Surg. 2020; 22:(2)91-99 https://doi.org/10.1177/1098612X19826700

Goldberg ME. Be the pain-attacking offensive midfielder – local anaesthetic blocks every practice can utilise. Veterinary Nursing Journal. 2017; 32:(11)329-338 https://doi.org/10.1080/17415349.2017.1373612

Gordon-Evans WJ, Suh HY, Guedes AG. Controlled, non-inferiority trial of bupivacaine liposome injectable suspension. J Feline Med Surg. 2020; 22:(10)916-921 https://doi.org/10.1177/1098612X19892355

Hoad JG. Spaying bitches: why, when, how?. Vet Nurs. 2018; 9:(8)418-421 https://doi.org/10.12968/vetn.2018.9.8.418

Kalchofner Guerrero KS, Campagna I, Bruhl-Day R, Hegamin-Younger C, Guerrero TG. Intraperitoneal bupivacaine with or without incisional bupivacaine for postoperative analgesia in dogs undergoing ovariohysterectomy. Vet Anaesth Analg. 2016; 43:(5)571-578 https://doi.org/10.1111/vaa.12348

Klinck M, Troncy E. The Physiology and Pathophysiology of Pain, 3rd Edition. In: Duke-Novakovski T., De Vries M., Seymour C. (Eds). Gloucester: BSAVA; 2017

Malik A, Bradbury GA. How can nurses improve pain management within the veterinary Clinic?. Veterinary Nursing Journal. 2016; 31:(5)140-143 https://doi.org/10.1080/17415349.2016.1153989

Milella L, Gurney M. Dental and Oral Surgery, 3rd Edition. In: Duke-Novakovski T, De Vries M, Seymour C (eds). Gloucester: BSAVA; 2017

Murphy S. Post-operative pain assessment in dogs. Veterinary Nursing Journal. 2016; 31:(11)334-339 https://doi.org/10.1080/17415349.2016.1218310

Murrell J, Alderson B. Acute and perioperative pain. In: Self I (ed). Gloucester: BSAVA; 2019

Pang DSJ. Inhalant anaesthetic agents, 3rd Edition. In: Duke-Novakovski T, De Vries M, Seymour C (eds). Gloucester: BSAVA; 2017

RCVS. ‘Code of Professional Conduct for Veterinary Nurses’. 2020. http://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-professional-conduct-for-veterinary-nurses/ (accessed 4 November 2020)

Richmond M. Should pain be the fourth vital sign?. Veterinary Nursing Journal. 2016; 31:(8)249-252 https://doi.org/10.1080/17415349.2016.1192966

Self I, Grubb T. Physiology of Pain. In: Self I (ed). Gloucester: BSAVA; 2019

Steagall PV, Monteiro BP, Ruel HLM Perceptions and opinions of Canadian pet owners about anaesthesia, pain and surgery in small animals. J Small Anim Pract. 2017; 58:(7)380-388 https://doi.org/10.1111/jsap.12674

Steagall PVM, Benito J, Monteiro B, Lascelles D, Kronen PW, Murrell JC, Robertson S, Wright B, Yamashita K. Intraperitoneal and incisional analgesia in small animals: simple, cost-effective techniques. J Small Anim Pract. 2020; 61:(1)19-23 https://doi.org/10.1111/jsap.13084

Vicente D, Bergström A. Evaluation of intraoperative analgesia provided by incisional lidocaine and bupivacaine in cats undergoing ovariohysterectomy. J Feline Med Surg. 2018; 20:(10)922-927 https://doi.org/10.1177/1098612X17735167

Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011; 152:(3)S2-S15 https://doi.org/10.1016/j.pain.2010.09.030

The potential benefit of local anaesthetics during routine ovariohysterectomy

02 October 2021
12 mins read
Volume 12 · Issue 8
Figure 1. The above technique demonstrates the administration of local anaesthetic bupivacaine as a splash block over the muscular layer before closure.

Abstract

Registered veterinary nurses (RVNs) play an essential and responsible role in pain management by identifying and alerting the veterinary surgeon (VS) to allow the appropriate management of pain. This comes with a legal and moral obligation in accordance with the Animal Welfare Act (2006) and the Code of Professional Conduct for Veterinary Nurses to provide prompt analgesia to their patients. Ovariohysterectomy is a common procedure performed within veterinary practices. It is a painful procedure and appropriate analgesia is paramount otherwise there could be compromises to the patient's recovery. Patients with inappropriately managed analgesia are more likely to interfere with their wound and have an increased risk for surgical site infections. Using local anaesthetics during the procedure is likely to show intraoperative and postoperative benefits to the patient. RVNs can be the leading force for a multimodal analgesia approach by using current evidence-based research, utilising their skills and applying their knowledge to collaborate with the VS to provide exceptional care for their patients. This will provide further evidence and justification towards the protection the RVN title.

Pain can be detrimental to a patient's recovery because of the negative emotional experience, protracted recovery and an increased risk of malnutrition, which collectively lead to an impaired immune system (Murphy, 2016). Pain is linked to the stimulation and release of catecholamines and adrenal hormones such as cortisol (Self and Grubb, 2019). This will contribute to weight loss, wound dehiscence, leucocytosis and insulin resistance, leading to the development of chronic pathological pain, client dissatisfaction and a loss of time and money (Self and Grubb, 2019). Milella and Gurney (2017) identified surgeries that are moderate to severe in their pain scale and should have the combination of an opioid, non-steroidal anti-inflammatory drug (NSAID) and local anaesthetic to provide a multimodal analgesia approach; local anaesthetic agents prevent the pain stimulus reaching the central nervous system. Klinck and Troncy (2017) described pain as a mixture between the origin and stimulus creating a combination of various pain types, such as nociceptive, neuropathic and inflammatory. Klinck and Troncy (2017) explained the contribution of neuropathic pain which depends on the two factors, the type of surgery and the degree of surgical nerve injury.

Register now to continue reading

Thank you for visiting The Veterinary Nurse and reading some of our peer-reviewed content for veterinary professionals. To continue reading this article, please register today.