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Clinic operations30 minLevel: AdvancedUpdated on August 17, 2026

Assessing and managing post-operative pain in practice

Assessing and treating post-operative pain in practice: pain scales for dogs and cats, a multimodal analgesia protocol and how to monitor the inpatient.

Audience
Veterinarians
Species
Dog, Cat
Scope
Valid everywhere, Italy, European Union

What you need before you start

  • Una scala di dolore validata per specie, stampata e disponibile in reparto degenza
  • Il formulario analgesico aggiornato della struttura, con dosi, vie e intervalli per specie
  • Una cartella del degente che permetta di registrare punteggio di dolore, farmaco e ora a ogni controllo

Post-operative pain remains one of the most underrated parts of hospitalisation, not for want of drugs but for want of measurement. An animal cannot describe pain in words, and teams tend to gauge it by eye, with the result that two staff members assign very different levels to the same patient. The consequence is stop-start analgesia, strong in theatre and absent overnight, which slows recovery and turns a well manageable acute pain into a chronic suffering that is hard to reverse. This guide sets out a method for making pain measurable with validated scales, building a multimodal analgesia protocol and organising inpatient monitoring that survives the handover between shifts. The molecules named here are general references: doses, routes and contraindications follow the current formulary and the responsible clinician's judgement.

Measure pain before you treat it

You cannot manage what you do not measure. The first step of a good protocol is not choosing a drug, it is adopting a pain scale validated for the species and using it in exactly the same way at every check. Composite scales, which combine observation from a distance, response to interaction and reaction to wound palpation, cut subjectivity and make different assessors' scores comparable. The working rule is simple: whoever assesses always follows the same sequence, first undisturbed observation in the kennel, then interaction, finally palpation.

Building multimodal analgesia

A single drug rarely covers surgical pain well. Multimodal analgesia combines molecules that act on different mechanisms, so each works at lower doses and side effects fall. Start before the incision, not after: preventing central sensitisation costs less than switching it off once it is alight. The table sums up the most used classes and their role, not the doses, which stay in the formulary.

Analgesic classes and their role in surgical pain. Indications, doses and contraindications follow the formulary and the individual patient.
ClassRoleMain caution
OpioidsMainstay of moderate to intense acute painSedation, effects on gastrointestinal motility
Non-steroidal anti-inflammatoriesBaseline anti-inflammatory component in the suitable patientRenal function, blood pressure and hydration status
Local anaestheticsLoco-regional blocks that lower the systemic requirementMaximum dose per weight and block technique
AdjunctsManagement of neuropathic or difficult painTitration and monitoring of the response

The monitoring protocol on the ward

  1. Set the baseline score at recovery

    Record the first pain score as soon as the patient is awake enough to be assessed. It is the reference against which you will compare every later check.

  2. Define the intervention threshold

    Decide in advance the score above which rescue analgesia is given, so the decision does not hang on the sensitivity of whoever is on shift at that moment.

  3. Schedule checks at fixed intervals

    Assess pain at regular times, not only when the patient looks distressed. A tighter interval in the first hours and after major surgery catches pain before it turns intense.

  4. Reassess after every dose

    After rescue analgesia, recheck within the drug's time to peak. If the score does not fall, the problem is not a missed dose but a protocol that needs revising.

  5. Write everything in the inpatient record

    Every line carries time, score, drug, route and dose, and the initials of the assessor. It is the only way the next shift knows exactly where things stand.

  6. Hand over on pain, not only on vitals

    At the shift change communicate the trend of the score and the response to interventions, not just the last value. The trajectory says more than a single number.

Signs of uncontrolled pain not to ignore

Between checks the staff passing through the ward are the first line of alarm. It is worth sharing with the whole team a list of signs that call for immediate reassessment, without waiting for the scheduled check.

  • A persistent hunched posture, reluctance to move or to change position.
  • Insistent attention to the wound, with licking or attempts to bite the area.
  • Tachycardia and tachypnoea not explained by other causes, or rising blood pressure.
  • New aggression or intolerance in a patient previously calm to handling.
  • In the cat, total stillness, a fixed stare and the loss of grooming and interest in the surroundings.

Untreated acute pain does not stay acute: it sensitises the nervous pathways and lays the ground for chronic pain, far harder to switch off.

Shared principle of small animal pain management guidelines

Frequently asked questions

Why use a scale if an experienced clinician recognises pain by eye?
Because the experienced eye is not comparable between people or over time. The inpatient is assessed by several staff across several shifts, and without a shared scale each uses their own threshold: what is moderate pain to one is mild to another, and analgesia becomes inconsistent. The scale does not replace clinical judgement, it makes it repeatable and transferable, so the decision to treat does not depend on who happens to be present.
How often should post-operative pain be reassessed?
There is no single interval: it depends on the size of the surgery, the molecule used and the trajectory of the score. In general checks are more frequent in the first hours and after major procedures, and they space out as pain settles below the intervention threshold. The practical rule is to always reassess within the time to peak of the drug just given, to confirm it is actually working.
How do I manage analgesia in a patient where NSAIDs are contraindicated?
Multimodal analgesia offers exactly this flexibility. In a patient with contraindications to non-steroidal anti-inflammatories, for renal disease, hypotension or ongoing steroid therapy, you lean more on opioids, on loco-regional blocks with local anaesthetics and on adjuncts for difficult pain. The point is to cover several mechanisms with the classes available, not to push a molecule that is unsafe for that patient.
Is sedation after an opioid always a good sign of analgesia?
No, and it is a common misconception. A sedated patient may still be in pain: sedation removes reactivity but does not necessarily switch off pain perception, and it risks masking the very signs you would use to assess it. That is why the scale also includes the response to wound palpation and does not rely on general appearance alone. If the patient is too sedated to assess, review the protocol with the responsible clinician.

What to do next

Adopt a pain scale validated for the species and use it the same way every time, build multimodal analgesia that starts before the incision, set a shared intervention threshold, and reassess at scheduled intervals and after every dose. Write score, drug and time in the inpatient record and hand over on the pain trajectory, not just the last value.

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Assessing and managing post-operative pain in practice · Animiyo