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As fifth-year vet students, we've attended analgesia lectures. We've also acquired skills through practical classes, helped administer analgesics during clinical EMS, studied our course notes and even passed an exam. But do we know what we need to know to be good vets?
I experienced my first general anaesthetic a few months ago as I underwent a bilateral tonsillectomy. The anaesthetist gave me a pre-anaesthetic health check and, when he discovered that I was a vet student, started talking about the drugs he would use for anaesthesia and analgesia. I recognised the names – fentanyl, propofol and isoflurane, followed by tramadol, paracetamol and ibuprofen for postoperative pain relief – so I felt pretty confident that I knew what to expect. I was wrong.
The experience opened my eyes to an area of medicine that I had greatly underappreciated, and I feel, with no evidence to support my argument, that it may also be underappreciated more generally in veterinary medicine. This is perhaps unsurprising, as it is often difficult for veterinary students and surgeons to place themselves in the ‘shoes’ of their patients.
Before surgery, I had not appreciated the relationship between the degree of pain experienced by the patient and the amount of time that had elapsed post-operation. This was despite having performed minor operations and administered analgesics to animals on numerous occasions. I expected that the pain would climax soon after the operation and decrease gradually thereafter. However, I was warned, and most definitely discovered, that postoperative pain and swelling was far worse three to five days after the operation than the initial discomfort immediately following anaesthesia. Swallowing, coughing, yawning, turning my head and even moving my tongue was painful. I also found that, as well as taking a combination therapy of paracetamol and ibuprofen, drinking very cold water and eating ice lollies were excellent for numbing the pain for short periods of time. The first week after the operation was quite unpleasant, but after three weeks the pain had gone.
While reflecting on this experience, I have been deliberating over whether I have learnt anything that I can extrapolate to the field of veterinary medicine to improve the way in which I manage pain in future patients.
For me, the experience has reinforced the importance of questioning oneself on a case-by-case basis. One should consider, first, whether the pharmacological postoperative pain management prescribed to an animal is adequate and, secondly, but of equal importance, whether it is of sufficient duration for the animal's needs. Is prescribing a week's worth of analgesics enough in all cases when, in fact, pain may be at its worst five days post-operation?
Analgesia should be tailored towards the individual patient's needs, rather than a ‘standard protocol’ for all operations. Is the same ‘standard’ analgesic protocol appropriate for dog castration, bitch neutering and canine dental work? How often do vets recommend non-pharmaceutical pain management options such as providing cold water to an animal that has had a dental extraction? Why not put ice cubes in a dog's water bowl; it might help. How often is a temporary change of diet to a softer, more palatable, food product recommended by veterinarians to facilitate eating and make life more pleasurable for the animal?
It's a rare occasion when we, as veterinary professionals, can put ourselves in the ‘shoes’ of our patients, but can we learn from these experiences?
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