Tilly, a Miniature Schnauzer, was referred to our hospital for management of severe acute pancreatitis associated with marked abdominal pain and progressive anorexia. On presentation, she was profoundly uncomfortable despite aggressive multimodal analgesia, including multiple intravenous infusions. Ongoing pain remained a significant barrier to recovery and patient comfort.
Acute pancreatitis can result in significant visceral pain that is challenging to manage effectively with systemic medications alone. In patients with refractory abdominal pain, advanced regional anaesthesia techniques can provide a significant improvement in both analgesia and overall clinical recovery.
Given the severity of Tilly’s pain, our anaesthesia specialist elected to place an epidural catheter under general anaesthesia. This highly specialised technique involves careful placement of a fine catheter into the epidural space surrounding the spinal cord, allowing targeted delivery of analgesic medications directly to the nerves responsible for transmitting pain from the abdomen.
Unlike systemic analgesics, which must circulate throughout the entire body leaving sometimes significant adverse effects such as worsened anorexia and nausea, epidural analgesia allows local anaesthetic agents and opioid medications to act directly at the level of the spinal cord and nerve roots. This creates a much more effective blockade of pain transmission while reducing the need for escalating systemic opioid doses and their associated adverse effects.
The epidural catheter allowed continuous titration of analgesia tailored specifically to Tilly’s pain scores and clinical response. Through the use of regional anaesthetic techniques, our anaesthesia team was able to achieve a level of pain control that had not been possible with intravenous medications alone.
Within 12 hours of epidural analgesia initiation, Tilly demonstrated a marked improvement in comfort and demeanour. She became brighter, ambulatory, interactive, and voluntarily resumed eating. Systemic opioid requirements were subsequently reduced as her comfort improved.
The epidural catheter remained in place throughout the acute phase of disease and was removed uneventfully following sustained improvement. Tilly continued to recover well with supportive care and was discharged with an excellent outcome.
This case highlights the value of specialist-led advanced pain management techniques in veterinary critical care. Epidural catheter analgesia can provide profound benefits in patients with severe visceral pain and represents an important component of modern multimodal analgesia in complex hospitalised patients.