Effective perioperative pain management in dogs is critical to patient safety and comfort during and after sedated or anesthetized procedures. Pain assessment and treatment should be proactive and tailored to each patient, not reactive or provided only when pain becomes intolerable for pets.
Good pain management requires thinking ahead. Consider the pain level expected with the scheduled procedure; appropriate analgesics for the pet’s size, age, and health status; and the signs the team should look for to identify breakthrough pain during and after anesthesia.
Here are several key considerations for perioperative pain management in dogs undergoing anesthetized or sedated procedures, including pre-emptive treatment strategies, application of multimodal drug therapy, and ideal recovery and home care protocols.
Pain is a physiological and emotional experience. While pain is adaptive in that it signals to pets (and people) to protect a potentially damaged area, it can also quickly become maladaptive. Pain activates the central nervous system and can trigger the stress response in hospitalized patients, potentially impacting the outcome of their procedure.
Unmanaged pain can:
Treating pain as early as possible helps to minimize nociceptive input and avoid wind-up, or central pain sensitization. Analgesia administered before a painful stimulus means dogs need less gas anesthetic or injectable sedation to maintain an appropriate anesthetic plane, which in turn supports better overall condition stability and faster recovery.
Clinicians and veterinary teams managing patients who will undergo a painful procedure should develop a pain management plan that begins with patient admittance. The entire team must be aligned on the pain plan and trained to recognize and manage side effects and signs of breakthrough pain.
A multimodal approach to perioperative pain management in dogs targets different pain pathways to synergistically improve efficacy and reduce side effects with smaller doses of each drug in the protocol. Local anesthetics, including incision site and regional blocks, are valuable additions to multimodal protocols that may allow dramatic reductions in systemic drug doses.
A patient who is challenging to keep appropriately anesthetized—who keeps “waking up”— is receiving too much stimulation. If you’re noticing frequent spikes in heart rate, spontaneous movements, or increased respiratory rate despite an appropriate vaporizer setting, the patient may not have adequate pain control on board. Team members should monitor anesthetized patients and advocate for reassessment of the anesthetic and post-operative plan if they notice intraoperative signs of pain.
The 2022 AAHA Pain Management Guidelines recommend a tiered approach to pain control based on expected pain severity. Other factors to consider include drug availability, patient health and safety factors, and the patient’s response to pain during and after procedures. Here is a brief overview of the tier system.
For mild pain (e.g., minor soft tissue procedures, sedated imaging), consider:
Perioperative pain management in dogs requires careful attention to individual patient needs. Here are a few special populations that may need specialized protocols:
Pain management must extend beyond the procedure itself into the immediate and extended recovery periods. Proactive pain control during recovery helps prevent maladaptive pain pathways from developing, which can lead to difficult-to-treat chronic pain that impacts a pet’s quality of life. Continuous, overlapping analgesic doses that leave some leeway for rescue doses help to control pain at all times.
Use validated tools like the Colorado State or Glasgow pain scales to assess pain status while pets are still in the hospital— choose one and ensure the team understands how to use the scale and does so consistently. Create a quiet, warm, comfortable, and low-stress recovery environment after procedures, and provide pet owners with training to identify signs of pain in their pet.
Owner engagement and frequent communication between the veterinary team and home care team are critical for successful perioperative pain management in dogs. Explain to clients that managing pain goes beyond simple patient comfort and can shorten healing time and improve recovery outcomes. Send pet parents home with detailed instructions regarding pain medications, including how to manage side effects and when to contact the team with questions or concerns.
Pain management is an integral part of the anesthesia experience and requires attention and careful planning from premed to post-op. A proactive, multimodal approach is best to improve outcomes, reduce complications, and support pets and pet owners through recovery.
Want to learn more about pain control in dogs? Parnell's Foundations of Anesthesia and Sedation certificate program offers a practical, evidence-based guide to safe, effective anesthesia practices, including how to integrate pain management from premed to recovery.