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.AAHA Clinical G…

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.AAHA Clinical G… 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.AAHA Clinical G… 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.AAHA Clinical G…

NSAIDs are strongly recommended after dental extractions and are generally continued for 3–7 days postoperatively, calibrated to the extent of the oral procedure.WSAVA Global Gu… 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.AAHA Clinical G… 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.WSAVA Global Gu… Prolonged NSAID administration is often necessary after multiple extractions even when opioids and local anesthetic techniques are used perioperatively.WSAVA Global Gu…

For maxillofacial trauma or complex invasive procedures such as maxillectomy or mandibulectomy, pain is severe enough to warrant balanced anesthesia and multimodal analgesia — typically a continuous rate infusion combining an opioid with lidocaine and ketamine — during the initial perioperative period of 24–48 hours, combined with NSAIDs.WSAVA Global Gu… Continuous infusions are especially important when oral analgesic administration is not feasible due to severe trauma or masticatory muscle spasm.WSAVA Global Gu…

Adjunctive oral analgesics should ideally be combined with NSAIDs for home management. Options include tramadol, amitriptyline, gabapentin, and amantadine.WSAVA Global Gu… Gabapentin is appropriate for patients with pre-existing neuropathic pain at a minimum dose of 10 mg/kg PO q8h; it is unlikely to provide analgesia for acute inflammatory pain alone.AAHA Clinical G… Tramadol provides minimal acute pain relief in dogs; it is potentially more efficacious in cats when used multimodally, though cats are particularly averse to its taste.AAHA Clinical G…

Cats require opioid analgesia for up to 72 hours postoperatively in some cases for optimal pain control, and they display specific pain-associated behaviors after dental extractions — becoming less playful and less active — which should be used as monitoring endpoints.WSAVA Global Gu…

Recovery monitoring and nursing care are integral to post-extraction management. The endotracheal tube should remain in place until the patient is swallowing and in sternal recumbency; for dental patients specifically, positioning the nose slightly lower than the back of the head and leaving the cuff slightly inflated during extubation helps clear blood clots and debris from the trachea, reducing aspiration risk.AAHA Clinical G… Intravenous catheters should remain in place until the patient is extubated and physiologic parameters have returned to normal.AAHA Clinical G… Body temperature support and intravenous fluid continuation should be maintained as needed through recovery, with continuous vital sign monitoring and recording until the patient is fully awake.AAHA Clinical G…

Discharge instructions must be provided both verbally and in writing, including the pain management schedule, a hands-on demonstration of medication administration (especially for cats), and clear guidance on adverse drug effects and when to seek follow-up.AAHA Clinical G… Home oral hygiene instruction and VOHC-accepted products should be discussed at discharge.AAHA Clinical G…

Would you like specific locoregional nerve block techniques (e.g., infraorbital, inferior alveolar, or maxillary blocks) for dental extractions in dogs and cats?