Louise Clark, Head of Anaesthesia at Davies Veterinary Specialists has put together seven top anaesthesia tips for colleagues in general practice.

Louise is an RCVS and EBVS European Specialist in Veterinary Anaesthesia and Analgesia, and a Past President of the Pain Medicine Section Council at the Royal Society of Medicine. She has also been an invited examiner on the European Diploma examination and a Treasurer of the Association of Veterinary Anaesthetists. She has headed the anaesthesia team at Davies since 2007.

Her tips are:

• Be aware of the multiple mechanisms that contribute to chronic pain – this is key to understanding the likely benefit of any pharmacological approach. 
• With ongoing chronic pain, it is unusual for a single medication to result in satisfactory pain relief in a unimodal, stand-alone fashion. 
• Combination pharmacologic treatment is an important aspect of multimodal chronic pain management. 
• A key component of treating pain with medications is finding the balance between effective treatment and acceptable side effects. “Effective treatment” is difficult to define because it will almost never mean a complete remission of pain. 
• Human chronic pain trials suggest that a reduction of pain by 30% is clinically meaningful, because it is at this this level that patient ratings demonstrate “much improved” pain. This returns us as veterinary surgeons to the complex issue of pain assessment. 
• A rational approach is to consider the mechanisms and assess potential targets that might respond to available analgesics; in the periphery, at the level of the spinal cord and within the brain/descending inhibitory pathways.  
• Appreciate the “type” of pain you are treating, the wrong " fire extinguisher" will expose the patient to the potential drug side effects without necessarily positively impacting the patient`s pain.

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