# Multimodal Analgesia Provides Superior Postoperative Pain Control Following Orthopedic Surgery in Small-Breed Dogs

## TL;DR

Multimodal analgesia provides better pain control with fewer side effects in small-breed dogs after orthopedic surgery compared to single-drug treatments.

## Contribution

This study demonstrates that a multimodal analgesia approach is superior for postoperative pain management in small-breed dogs.

## Key findings

- Multimodal analgesia achieved the fastest and most complete pain relief in small-breed dogs.
- Dogs receiving multimodal analgesia reached pain resolution by 48 hours.
- Hydromorphone alone had more adverse effects compared to multimodal analgesia.

## Abstract

Orthopedic surgeries in small-breed dogs often cause significant postoperative pain. Providing effective pain relief is essential not only for recovery but also for animal welfare. In this study, we compared five common pain management protocols used after orthopedic procedures, including a comprehensive multimodal approach combining local anesthetics, opioids, and anti-inflammatory drugs. We assessed pain levels over 72 h in 205 small dogs using a behavioral pain scale. The results showed that dogs receiving multimodal analgesia had the fastest and most complete pain relief, with fewer serious side effects compared to those receiving only opioids or single-drug treatments. Our findings support the routine use of multimodal analgesia in small-breed dogs undergoing surgery, especially in more invasive procedures. This evidence-based approach can improve recovery outcomes and reduce suffering, guiding veterinarians to make better postoperative pain management decisions.

Effective pain control after orthopedic surgery is essential in veterinary practice, particularly in small-breed dogs with low physiological reserves. This study aimed to compare the analgesic efficacy and tolerability of five postoperative pain protocols across nine surgical procedures. A retrospective analysis was conducted in 205 small-breed dogs (≤7 kg) undergoing orthopedic surgeries. Dogs were assigned to one of five analgesic protocols: (A) carprofen, (B) tramadol–lidocaine–ketamine continuous-rate infusion, (C) butorphanol continuous-rate infusion, (D) hydromorphone continuous-rate infusion, and (E) multimodal analgesia combining local anesthetics, hydromorphone, and meloxicam. Pain was assessed at 6, 12, 24, 48, and 72 h using the Glasgow Composite Measure Pain Scale—Short Form. Analgesic efficacy was evaluated using pain trajectories, area-under-the-curve analysis, and pain resolution rates, and adverse effects were recorded. Dogs receiving multimodal analgesia achieved the most rapid and sustained pain relief, with all patients reaching pain resolution by 48 h. Hydromorphone alone showed comparable efficacy but was associated with more adverse effects, while tramadol–lidocaine–ketamine showed delayed pain relief and the highest rate of severe side effects. Multimodal analgesia provides superior pain control with acceptable safety in small-breed dogs undergoing orthopedic surgery, supporting its use based on surgical invasiveness and individual patient response.