what post-operative care instructions and pain management are appropriate after dental extractions in dogs and cats?

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Accepted Answer

Post-extraction pain management begins preemptively and continues multimodally through the perioperative and home-care periods. The core protocol for any dental extraction combines opioids, a nonsteroidal anti-inflammatory drug (NSAID), and local anesthetics as the first-tier approach, supplemented by cold therapy and appropriate nursing care.5 Local anesthetics are the most effective analgesic available in small animal practice and should be used in every dental surgical procedure. Lidocaine is dosed at 2–4 mg/kg in cats and 4–6 mg/kg in dogs; bupivacaine at 1 mg/kg in cats and 2 mg/kg in dogs; ropivacaine at 1 mg/kg in cats and 2 mg/kg in dogs.7 These are administered as locoregional nerve blocks to provide preemptive analgesia at the site of extraction. Opioids are effective for perioperative pain and carry proven preemptive benefit when incorporated into the preanesthetic protocol.5 They are used alone or in combination with tranquilizers as preanesthetic medications in dental patients; anxiolytics and sedatives support but do not replace opioid analgesia.1 NSAIDs are strongly recommended after dental extractions and are generally continued for 3–7 days postoperatively, calibrated to the extent of the oral procedure.4 Pre-emptive NSAID administration may be more effective than postprocedural dosing, but NSAIDs are contraindicated in patients with hypovolemia, dehydration, chronic renal disease, or azotemia.1 NSAIDs can also be administered to cats for several days postoperatively, which is particularly important following aggressive oral surgery such as radical extraction for feline chronic gingivostomatitis; some NSAIDs are licensed for long-term daily administration in cats in certain regions.4 Prolonged NSAID administration is often necessary after multiple extractions even when opioids and local anesthetic techniques are used perioperatively.2 For maxillofacial trauma or complex invasive procedures such as maxillectomy or mandibulectomy, pain is severe enoug