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Topic:Analgesia
Analgesia in horses involves the use of medications and techniques to alleviate pain caused by injury, surgery, or chronic conditions. Effective pain management is important for the welfare and recovery of equine patients, as unmanaged pain can lead to complications and prolonged healing. Common analgesic agents used in horses include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and local anesthetics. These agents work through various mechanisms to reduce pain perception and improve comfort. This page compiles peer-reviewed research studies and scholarly articles that explore the pharmacology, application, and clinical outcomes of analgesic strategies in equine medicine.
Medical Therapies for the Treatment of Osteoarthritis in the Horse – 20 years later…. Osteoarthritis (OA) is a debilitating joint disease, characterized by a degenerative catabolic cascade resulting in detrimental changes to all aspects of the joint including the irreversible destruction of articular cartilage. In 2006, a narrative review by Goodrich and Nixon outlined the available treatments for the medical management of OA; however, since that time substantial progress has been made. In recent years the therapeutic options for veterinarians managing horses with OA has increased significantly with a multitude of products available on the market. While many of the conventional...
Clinical Efficacy of Varying Dosages of Intravenous Phenylbutazone in a Reversible Model of Equine Foot Lameness. The objective of this experiment was to compare the clinical efficacy of various dosages of phenylbutazone (PBZ) with a negative control. The hypothesis was that higher PBZ doses would result in improved efficacy in a dose-dependent manner. Eight horses were shod with adjustable heart bar shoes on one front foot. Grade 4.0/5.0 lameness was induced every 2 to 4 weeks by tightening a set screw against the heart bar. Heart rate (HR) and lameness score (LS) were monitored at rest; every 20 min after lameness induction for 5 h; and hourly for another 8 h. One hour after lameness induction, treatmen...
Liposomal bupivacaine local analgesia reduces systemic inflammatory responses following equine laparoscopic surgery. Liposomal local anesthetics have been shown to extend analgesia duration and improve pain scores dose-dependently in horses. Our objective was to assess concurrent impact on systemic inflammatory markers. Unassigned: 18 mares (age, 2 to 20 years) with normal ovarian anatomy were enrolled. Laparoscopic bilateral ovariectomies were performed standing with sedation. Local analgesia was: 80 mL bupivacaine hydrochloride (BHCl; n = 6), 30 mL 0.75% BHCl + 20 mL (low-dose) liposomal bupivacaine (LB) expanded to 80 mL with saline (LB20, n = 6), or 30 mL 0.75% BHCl + 40 mL (high-dose) LB expanded to equ...
Simplified ultrasound-guided technique improves accuracy of median nerve perineural injection compared to “blind” techniques in equine ex vivo specimens. To assess the feasibility of a simplified ultrasound-guided technique (SUGT) for perineural injection of the median nerve ex vivo, to determine and compare the accuracy of 3 techniques for perineural injection of the median nerve (SUGT, "blind" proximal, and "blind" distal), and to evaluate and compare the dye distribution following perineural injection of the median nerve following each technique. Unassigned: This was an ex vivo experimental study performed on thoracic limbs (from April through October 2025). Simplified ultrasound-guided technique and blind proximal were performed in paired l...
Use of a caudal intercostal block in horses undergoing surgery for colic. In humans and companion animals, regional anaesthesia is used in multimodal analgesic protocols for abdominal wall surgery. Benefits include earlier patient mobilisation and improved pain scores. Regional anaesthetic techniques for horses undergoing abdominal surgery could provide similar benefits and warrant investigation. Objective: To evaluate the safety and efficacy of a caudal intercostal block for abdominal surgery (CIBAS) in horses undergoing surgery for colic. Methods: Blinded, randomised clinical trial. Methods: Horses (n = 22) undergoing exploratory celiotomy for colic were rando...
Anesthetic Recovery Following a Midazolam-Containing Co-Induction Protocol in Horses Undergoing Total Intravenous Anesthesia. Anesthetic recovery is a critical phase in horses under field conditions, and induction protocols may influence recovery quality during total intravenous anesthesia. Objective: To compare two anesthetic induction protocols, one including midazolam and the other based solely on xylazine and ketamine, regarding anesthetic induction and recovery quality, total recovery time, and attempts to achieve standing in horses undergoing total intravenous anesthesia. Methods: Twelve healthy male horses older than 2 years were randomly assigned to XC (xylazine 1 mg/kg and ketamine 2 mg/kg) or XCM (xylazine ...
Recovery quality and antinociceptive effects following rectus abdominis sheath block in dorsally recumbent horses: an experimental study. To evaluate recovery quality and antinociception following rectus abdominis sheath (RAS) block performed with bupivacaine in dorsally recumbent anesthetized horses. Methods: Randomized, crossover experimental study. Methods: Six healthy adult horses. Methods: Each horse was anesthetized twice using a standardized isoflurane protocol and underwent bilateral two-point RAS injections (total of 1 mL kg) of either 0.2% bupivacaine treatment (BT) or 0.9% NaCl treatment (ST) under ultrasound guidance. Horses remained anesthetized for 1 hour after the block. During anesthesia recovery, accelerometry-d...
Analgesic use, safety and pharmacokinetics of acetaminophen in equids: A structured scoping review. Despite its frequent use in equine clinical practice, scientific data on the use of acetaminophen in horses remain limited. Objective: To map and critically appraise the available evidence on the analgesic use, safety and pharmacokinetics of acetaminophen in horses. Methods: Structured scoping review. Methods: A comprehensive search was performed in accordance with the PRISMA Extension for Scoping Reviews using the terms '(paracetamol OR acetaminophen) AND (pain OR safety OR toxicosis OR pharmacokinetics) AND (horse OR pony OR donkey OR mule)' across Web of Science, Scopus, and PubMed from dat...
Epidural 0.125% ropivacaine is safe but insufficient for induced tibiotarsal joint pain. Epidural injection of a low concentration of the local anaesthetic ropivacaine produces analgesia without neurological deficits or ileus in people. Objective: To determine if epidural 0.125% ropivacaine mitigates induced hindlimb lameness in horses while preserving neurological function and gastrointestinal (GI) motility. Methods: Randomised, blinded, controlled, crossover study. Methods: Eight healthy, sound horses underwent two treatments in random order, separated by at least 3 weeks: epidural saline or epidural ropivacaine. For each treatment, an epidural catheter was inserted at the fir...
Quantifying the Equine Pain Response to Paracetamol Administration in Horses With Chronic Lameness Already Receiving Non-Steroidal Anti-Inflammatories. Paracetamol is used in horses alongside non-steroidal anti-inflammatories (NSAIDs) for multi-modal analgesia; however to date there are few studies published which have investigated its analgesic effect in the horse. Horses were recruited to this study from a population of geriatric horses at The Horse Trust. Horses were selected based on the following inclusion criteria; documented naturally occurring chronic lameness and being treated with an NSAID at the licensed dose and dosing interval. This population was assessed with a five-point subjective lameness grading system performed live by two...
Pelvic axial rotation in hindlimb lame horses changes after diagnostic analgesia. Visual assessment of mild to moderate hindlimb lameness has low sensitivity and specificity, potentially leading to flawed diagnostic procedures. Pelvic axial rotation (roll) makes the assessment more complex but is also a potential source of information. Objective: To describe pelvic roll patterns in horses with unilateral hindlimb lameness before and after diagnostic analgesia. Methods: Retrospective study. Methods: Optical motion capture data from 20 horses with unilateral hindlimb lameness before and after successful local analgesia (assessed visually and objectively) were retrospectively ...
Comparison of xylazine-ketamine-guaifenesin and xylazine-tiletamine-zolazepam protocols for constant rate infusion anesthesia in horses undergoing field castration. The common use of "triple drip" (xylazine, ketamine, and guaifenesin; XKG) is a popular protocol for constant rate infusion (CRI) in equine practice. However, due to restrictions on ketamine and guaifenesin in many countries, tiletamine-zolazepam (TZ) could serve as an alternative. To date, there have been limited studies evaluating the use of xylazine in combination with TZ (XTZ) administered via CRI to maintain surgical anesthesia in equine field practice. Objective: To compare the effectiveness and safety of XTZ infusion with the classical XKG protocol for field anesthesia. Methods: Twelve ...
Perineural dexamethasone does not prolong bupivacaine sensory blockade in equine palmar digital nerve blocks: a randomized crossover trial. To determine whether dexamethasone sodium phosphate (dexamethasone SP) prolongs the sensory blockade produced by perineural bupivacaine during medial and lateral palmar digital nerve blocks in horses. Unassigned: 8 healthy adult horses were enrolled in a blinded, randomized 4 X 4 crossover trial. Each horse received 1 of 4 perineural treatments over the palmar digital nerves of the left forelimb: bupivacaine, bupivacaine + dexamethasone SP, dexamethasone SP alone, or saline. A minimum 7-day washout was used between treatments. Mechanical nociceptive threshold (MNT) was measured at baseline and...
USE OF GUAIFENESIN-KETAMINE-XYLAZINE INFUSION FOR MAINTENANCE OF ANESTHESIA IN CAPTIVE PREZEWALSKI HORSES (EQUUS FERUS PRZEWALSKI ): A CASE SERIES. This case series documents the use of triple drip, a combination of IV guaifenesin, ketamine, and xylazine (GKX) to extend the length of anesthesia in zoo-owned Przewalski horses (). In three separate procedures involving two different animals, GKX was used to prolong and deepen the plane of anesthesia for 90 to 120 min beyond an initial induction dart containing ketamine, butorphanol, azaperone, and medetomidine. The depth of anesthesia was sufficient to permit surgical excision of SC abscesses and other procedures. Throughout the anesthetic events, the horses breathed spontaneously and maint...
Assessment of pharmacokinetic parameters, oral bioavailability, and physiological effects of amantadine in horses. Without adequate pain management, central nervous system plasticity can result in acute or adaptive pain developing into chronic or maladaptive pain. This is difficult to manage and often unresponsive to traditional analgesics. An important mechanism associated with maladaptive pain is central sensitization which results in part from increased NMDA (N-methyl-D-aspartate) receptor activation. Amantadine is an NMDA receptor antagonist that has been used in combination with opioids and NSAIDs in humans and dogs for the treatment of conditions associated with central sensitization. The goal of the...
Characterization of the Pharmacokinetics and Physiological Effects of Tapentadol in Horses. Tapentadol is a dual mechanism analgesic utilizing both μ-opioid receptor (MOR) agonism and norepinephrine reuptake inhibition (NRI). This study evaluated the pharmacokinetics and pharmacodynamics of tapentadol as a potential analgesic with the goal of treating pain in horses. Pharmacokinetics of both tapentadol and tapentadol-O-glucuronide were elucidated. Six horses received three separate escalating single oral doses (1, 3, and 5 mg/kg) and a single intravenous (0.32 mg/kg) dose of tapentadol in a four-period sequential design. Concentrations of tapentadol and tapentadol-O-glucuronide ...
Morbidity associated with inhalation anesthesia in horses: the role of opioid use in a university teaching hospital. Despite concerns among equine practitioners, the effects of opioid administration on intraoperative complications during inhalation anesthesia remain incompletely characterized. This retrospective study evaluated intraoperative complications and perianesthetic mortality in horses undergoing inhalation anesthesia according to opioid use. Medical records from a university veterinary hospital were reviewed (2014-2025) and grouped based on opioid inclusion in anesthetic protocols and surgery type (colic vs. non-colic). Intraoperative hypotension (MAP < 70 mmHg), hypothermia (temperature 65 mmH...
Case Report: Oral and topical chronic administration of THC-rich and CBD-rich cannabis oil as palliative care in a rescued horse with open wound, sarcoid and chronic pain. Cannabinoid-based therapies have shown analgesic, anti-inflammatory, and wound-healing potential across veterinary species; however, clinical data on long-term use of THC-rich formulations in horses remain scarce. This case report describes the use of combined oral and topical THC-rich and CBD-rich full-spectrum cannabis oils as part of a palliative care strategy in a rescued horse with severe chronic disease. A senior mixed-breed gelding was rescued with a large, chronic ulcerative lesion of the left hind limb, severe malnutrition, non-weight-bearing lameness (AAEP grade 5/5), and refractory ...
Use of Intraperitoneal Lidocaine in Horses Undergoing Laparotomy for Colic. Perioperative lidocaine is widely used in horses with acute abdomen for its analgesic, prokinetic, anti-inflammatory, and anti-endotoxic effects, although evidence of its visceral analgesic efficacy remains inconclusive. Given the potential of alternative routes of administration for local anaesthetics, this prospective, randomised, unblinded clinical trial evaluated whether intraperitoneal (IP) lidocaine improves early postoperative recovery, including recovery from anaesthesia and the first 24 h after laparotomy for colic. A Multifactorial Numerical Rating Composite Pain Scale for equines wa...
The immediate effect of whole-body vibration therapy on mechanical nociceptive thresholds in horses with thoracolumbar pain. Treating primary back pain in horses can be challenging and often necessitates a multimodal approach. Whole-body vibration therapy (WBV) has been used in both horses and humans to alleviate pain and strengthen muscles. A recent study showed worsening back pain following a 30-minute session of WBV; however, the immediate effects of WBV were not evaluated. The purpose of this study was to assess the immediate effects of whole-body vibration therapy on horses with back pain after a single session of WBV. Objective: The objective of the current study was to determine the immediate effects on mecha...
Effects of vatinoxan in horses sedated with detomidine and butorphanol for gastroscopy: a randomized clinical study. The peripheral alpha2-adrenoceptor antagonist vatinoxan attenuated the side effects of alpha2-adrenergic sedatives in experimental studies in horses. This clinical study investigated the effects of vatinoxan in horses sedated for gastroscopy with detomidine and butorphanol. Client-owned horses were randomly allocated to receive one of the following two intravenous treatments: detomidine hydrochloride (HCl) (12μg/kg) + butorphanol tartrate (12μg/kg) (DB; n=11) or DB + vatinoxan HCl (200μg/kg) (DBV; n=11). Borborygmi score and heart rate were recorded by auscultation. Sedation level was evalu...
Behavioral and cardiorespiratory effects of a medetomidine and tramadol combination in horses. The use of combinations of sedative and analgesic drugs during standing procedures in horses is necessary to provide reliable sedation with minimal ataxia and reduced responses to surgical or other stimuli in horses. Objective: This study assessed the behavioral and cardiorespiratory effects of medetomidine (M) administered with and without tramadol (T) in horses. Methods: Eight horses were sedated intravenously with M (5 µg/kg) alone or with T (2 mg/kg) in a arandomized, blind, two-way crossover trial. Behavioral responses, including head height above the ground (HHAG), postural instability ...
Pharmacokinetics of 2 mg/kg Bupivacaine in a Rectus Abdominis Sheath Block in Horses. Administering large volumes of bupivacaine in the rectus abdominis sheath (RAS) block in horses could cause local anesthetic toxicity. This study aimed to evaluate the pharmacokinetics of 2 mg/kg bupivacaine in RAS blocks and the associated toxicity risk. Six healthy adult horses were sedated with xylazine and received an ultrasound-guided bilateral 2-point RAS block. Plasma samples were collected at baseline and from 5 min to 24 h after the block and analyzed using liquid chromatography-tandem mass spectrometry. A noncompartmental analysis was performed to determine the maximum concentr...
Pharmacokinetics of Intramuscularly Administered Ketamine at Subanaesthetic Dosage in Horses. Subanaesthetic doses of ketamine (0.5 mg kg) provide analgesia in several species, but there is limited information on the pharmacokinetics and clinical effects of intramuscularly administered ketamine in horses. This study investigated the pharmacokinetics of ketamine and norketamine, and evaluated clinical effects, ataxia, and vital parameters, following intramuscular and intravenous administration of 0.5 mg kg ketamine in nine healthy horses, using a randomized two-period crossover design with a 1-week washout period. Plasma concentrations were analyzed using Ultra-High Performance ...
Effects of various perineural analgesia techniques on decreasing experimentally-induced lameness of the equine metacarpophalangeal joint. Recent evidence has shown that perineural analgesia may be less specific than previously thought. Objective: To compare the effects of four distal limb perineural analgesia techniques on resolving synovitis-induced lameness of the equine metacarpophalangeal joint (MCPJ). Methods: Nine horses had one MCPJ injected with 75ng of recombinant equine interleukin-1β (reIL-1β). Ten hours later, horses underwent one of two blocking patterns: (1) a palmar digital (PDNB) followed by an abaxial sesamoidean (ASNB) nerve block or (2) a palmar metacarpal (PMNB) followed by a palmar (PaNB) nerve block. Skin...
Preliminary Investigation of a Transcutaneous Ultrasound-Guided Technique for Pudendal Nerve Block in Six Horse Cadavers. Regional anaesthesia of the equine anogenital tract is limited to local infiltration, extradural, blind palpation and nerve stimulator-guided techniques which risk iatrogenic damage, recumbency and ataxia. This study aimed to describe and assess the feasibility of transcutaneous ultrasound-guided (USG) pudendal nerve staining in equine cadavers. An initial pilot phase used two fresh equine cadavers and one standing unsedated horse to image the intrapelvic anatomy using ultrasound. One fixed equine cadaver specimen was also dissected to identify the pudendal nerve and refine the dissection appr...
Client-specific outcome measure for chronic osteoarthritis pain assessment in horses. Osteoarthritis (OA) is a prevalent cause of chronic pain and lameness in horses. Whereas lameness can be quantified using objective measures, the assessment of OA-associated pain remains challenging. This study aimed to evaluate the applicability of the Client-Specific Outcome Measure (CSOM), a tool widely used in small animals, for the assessment of chronic OA pain in horses through caretaker evaluation. Unassigned: Seventeen privately owned horses with confirmed OA were enrolled in a 20-week randomized, double-blind, placebo-controlled study. For each horse, three individual pain-related ind...
Extracorporeal shock wave therapy in equine and canine practice. To describe the proposed mechanism of action of shock wave therapy and discuss treatment considerations and guidelines for use in equine and canine practice. Unassigned: Client-owned animals with owner consent. Unassigned: Shock wave therapy is proposed to stimulate healing by generating forces that cause cells to undergo microtrauma and release anti-inflammatory cytokines and growth factors into the treated tissues. While the 4 types of shock wave therapies are discussed, electrohydraulic and piezoelectric are described in detail, as they are most utilized in veterinary medicine for the treat...
Investigating the effect of surface cryotherapy on equine patient compliance to infraorbital nerve block placement. To investigate the effect of applying ice to the skin overlying the infraorbital canal on the compliance of healthy adult horses to infraorbital nerve block placement during standing sedation. Methods: Blinded, randomized crossover trial. Methods: Thirty healthy adult horses [16 ± 3.9 years old (mean ± standard deviation), weighing 594 ± 63 kilograms (kg)]. Methods: Each horse acted as its own control with a minimum of 7 days between treatments. Horses were sedated using detomidine hydrochloride, and sedation level was evaluated using a published simple descriptive scale. Horses were random...
Effect of palmar digital perineural analgesia (as a model for “nerving”) on forelimb loading over varied surfaces at the walk and trot – a pilot study. Navicular syndrome is characterized by palmar foot pain and is a common cause of lameness in horses. Palmar digital neurectomy (nerving) removes sensation to the heel region of the hoof and may serve as a treatment for navicular-afflicted horses, while analgesia (blocking) results in temporary loss of sensation. Objective: The purpose of this pilot study was to examine the effect of loss of sensation in the heel on the forelimb area and force while tracking on soft and hard ground at the walk and trot. Methods: Three horses that scored a 0 or 1 on the AAEP lameness scale were fitted to Tekscan...
