Opioid use and perioperative pain management practices in dogs and cats in Latvia: A national survey highlighting regional disparities and generational differences.

Background and Aim: Effective pain management is fundamental to animal welfare and successful perioperative care. Although multimodal analgesia incorporating opioids is considered the standard of care in companion animal practice, opioid availability and clinical use vary considerably among countries because of differences in regulations, access, and professional training. Information regarding opioid prescribing and pain management practices in the Baltic region is lacking. This study aimed to evaluate opioid availability, opioid use patterns, perioperative pain management practices, and pain assessment approaches among veterinarians in Latvia, with particular emphasis on regional disparities, surgical activity, and generational differences in clinical practice. Materials and Methods: A national cross-sectional survey was conducted using a structured online questionnaire comprising 24 multiple-choice items distributed to licensed veterinarians in Latvia between December 2023 and January 2024. The questionnaire collected information on respondent demographics, opioid availability and use, perioperative analgesic practices, pain assessment methods, adverse effects, and factors influencing opioid selection. Descriptive statistics were used to summarize responses. Associations between categorical variables were evaluated using the chi-square test, whereas relationships between professional experience and opioid availability were examined using Spearman's rank correlation and binary logistic regression. Results: A total of 101 veterinarians completed the survey, representing 10.4% of registered Latvian Veterinary Association members. Opioids were used routinely in 80.0% of practices, most commonly in combination with non-steroidal anti-inflammatory drugs as part of multimodal analgesia. Butorphanol and buprenorphine were the most widely available opioids, whereas fentanyl and methadone availability was significantly associated with higher surgical caseloads (p < 0.01). Fentanyl availability was greatest in Rīga and surrounding regions but was absent in Latgale, demonstrating marked regional disparities. Veterinarians with fewer years of professional experience reported significantly greater access to fentanyl and more frequent use of standardized pain assessment tools. Opioid selection generally reflected perceived pain severity, with butorphanol preferred for mild pain, buprenorphine for moderate pain, and fentanyl and methadone for severe pain. Despite widespread opioid adoption and positive attitudes toward analgesia, only one-third of respondents routinely used validated pain scoring systems. Conclusion: This study provides the first national overview of opioid use and perioperative pain management practices among companion animal veterinarians in Latvia and the Baltic region. The findings demonstrate broad adoption of evidence-based multimodal analgesia while identifying important regional inequalities in opioid availability and persistent underuse of standardized pain assessment tools. These results highlight priorities for continuing professional education, wider implementation of validated pain assessment methods, and improved access to essential analgesics to promote consistent, evidence-based pain management in veterinary practice.