492 Canine Sports Medicine and Rehabilitation
Two different PRP derivative products
include: (1) autologous protein solution
(APS), which is produced by passing a
whole‐blood solution over polyacryla-
mide beads to extract and concentrate
therapeutic cytokines; it contains leuko-
cytes (Franklin et al., 2015); and (2) autol-
ogous conditioned plasma (ACP), which
is leuko‐reduced PRP (Franklin & Cook,
2013).Management of acute pain
There exists a general consensus, supported by
best evidence, for the four basic elements that
contribute to optimal patient management for
the prevention and treatment of postoperative
pain. Thereafter, clinicians employ an array of
adjunctive pain‐modifying pharmacological
interventions, each with evidence to make them
worthy of clinical consideration.
The basic four elements are:
(1) Anxiolytics: Pharmacological and non‐
pharmacological strategies (e.g., low‐stress,
fear‐free environment)
(2) NSAIDs
(3) Opioids
(4) Local anesthetics.
The best of the rest(1) Topical dermal/epidermal local anesthetic:
(a) Transdermal lidocaine ± prilocain for
i.v. catheter placement
(b) Lidoderm® patch: applied para‐inci-
sionally to especially painful sites for
up to 5 days; bandaging is necessary
to prevent ingestion.
(2) Subanesthetic ketamine CRI: Especially in
patients at risk for maladaptive pain
(nerve injury, significant tissue damage,
pre‐existing inflammatory conditions, e.g.,
OA).
(3) Cold compression: The beneficial effects of
cooling damaged tissue should not be
underestimated, diminishing inflamma-
tion and pain through a variety of proposed
mechanisms. Even modest application to
injured soft tissue has been shown to
reduce pain and speed return to function
(Drygas et al., 2011).
(4) Pain‐modifying analgesic drugs: For
patients whose procedure may generate
more significant pain, or comes to experi-
ence unexpected pain:
(a) Gabapentin
(b) Acetaminophen + hydrocodone or
codeine
(c) ± Tramadol.Case Study 19.1 Thoracic limb amputationSignalment: 4‐y.o. M/C 20 kg lab mix undergoing
thoracic limb amputation due to ischemic injury.History:(1) Already on NSAID from previous injury;
morning dose administered preadmission,
along with gabapentin 100 mg p.o.
(2) Morphine‐acepromazine s.c. premedication; cath-
eter i.v. area clipped and topical EMLA® applied
(3) Intravenous catheter placed; i.v. bolus of keta-
mine 5 mg and Normosol‐R w/ 60 mg/L keta-
mine administered 200 mL/h
(4) Propofol induction; isoflurane maintenance
(5) Brachial plexus block w/ nerve locator: 25 mg
of 0.5% bupivacaine (5 mL) + 0.1 mL morphine
(6) During closure, placement of 5 Fr diffusion
catheter s.c., exiting dorsal to incision line; or:layered s.c. application of Nocita® (liposome‐
encapsulated bupivacaine).Postoperative management:(1) Cold compression applied to incision site
(2) IVF w/ ketamine CRI 50 mL/h × 24 hours
(3) If wound diffusion catheter used instead of
Nocita®: bupivacaine 0.5% 5 mL + 0.1 mL
morphine through diffusion catheter q8h for
32 hours (removed prior to discharge at end of
day 1 postop)
(4) Gabapentin 100 mg p.o. q8h × 3 days
(5) Therapeutic laser and/or acupuncture if
available
(6) NSAIDs continued for 7 days
(7) Rehabilitation to facilitate return to function
on three legs.