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.
Effects of acepromazine, butorphanol and buprenorphine on thermal and mechanical nociceptive thresholds in horses. To investigate the antinociceptive effects of buprenorphine administered in combination with acepromazine in horses and to establish an effective dose for use in a clinical environment. Objective: To evaluate the responses to thermal and mechanical stimulation following administration of 3 doses of buprenorphine compared to positive (butorphanol) and negative (glucose) controls. Methods: Observer blinded, randomised, crossover design using 6 Thoroughbred geldings (3-10 years, 500-560 kg). Thermal and mechanical nociceptive thresholds were measured 3 times at 15 min intervals. Horses then rec...
Evaluation of sedation and analgesia in standing horses after administration of xylazine, butorphanol, and subanesthetic doses of ketamine. To evaluate the sedative and analgesic effects of subanesthetic doses of ketamine in horses sedated with xylazine, with or without butorphanol. Methods: Prospective, randomized, controlled study. Methods: 10 adult horses. Methods: Each horse was sedated multiple times by administration of xylazine (treatment X), xylazine and butorphanol (treatment XB), xylazine with 1 of 2 dosages of ketamine (treatment XK1 or XK2), or xylazine and butorphanol with 1 of 2 dosages of ketamine (treatment XBK1 or XBK2). Head height and various behaviors, including responses to noise, insertion of a dental float, ...
Clinical Evaluation of Xylazine-Butorphanol-Guaifenesin-Ketamine as Short-Term TIVA in Equines. Xylazine (1.1 mg/kg), butorphanol (0.02 mg/kg), guaifenesin 5% (20 mg/kg), and ketamine (2.2 mg/kg) combinations were able to induce short-term surgical anaesthesia for 23.33 ± 2.57 min in Spiti ponies with excellent to good muscle relaxation and analgesia. Urination and neighing was a constant feature during recovery period. Biphasic P wave, biphasic T wave, and depressed PR segment were common electrocardiographic findings. Biochemical attributes were within physiological limits except a significant increase in ALT values during anaesthesia. The values returned to normal during re...
Acupuncture and Chinese herbal medicine for treating horses. Acupuncture exerts diffuse analgesic effects through the release of endogenous opioids and other locally and centrally acting mediators. Successful therapeutic interventions for various musculoskeletal conditions in horses are well documented, and acupuncture may significantly enhance performance. The use of acupuncture is specifically supported in treating nonsurgical gastrointestinal disorders, in which specific techniques can alter motility and contribute to visceral analgesia. This article describes the use of acupuncture and Chinese herbal medicine for equine reproductive management and f...
Intravenous and sublingual buprenorphine in horses: pharmacokinetics and influence of sampling site. To describe the pharmacokinetics and adverse effects of intravenous (IV) and sublingual (SL) buprenorphine in horses, and to determine the effect of sampling site on plasma concentrations after SL administration. Methods: Randomized crossover experiment; prospective study. Methods: Eleven healthy adult horses between 6 and 20 years of age and weighing 487-592 kg. Methods: In the first phase; buprenorphine was administered as a single IV or SL dose (0.006 mg kg(-1)) and pharmacokinetic parameters were determined for each route of administration using a noncompartmental model. In the second phas...
Colic after swimming exercise in racehorses: an investigation of incidence, management, surgical findings and outcome. The incidence of colic following swimming exercise (SC) in a racehorse population examined over 3 years was 0.08%. Following 167,977 swims, 136 cases were reported. Colic resolved spontaneously in 2 horses, medically in 129 or surgically in 5. In a separate study, 21 horses were subject to exploratory laparotomy for SC. Findings included non-strangulating displacements in 7 horses, strangulating displacements in 7, a combination of non-strangulating and strangulating displacements in 1, prominent gaseous intestinal distension in 5 and no abnormalities in 1 horse. A poor response to analgesia p...
Continuous peripheral neural blockade to alleviate signs of experimentally induced severe forelimb pain in horses. To investigate the efficacy and safety of a low-volume, single-catheter, continuous peripheral neural blockade (CPNB) technique to locally deliver bupivacaine to alleviate signs of severe forelimb pain resulting from experimentally induced tendonitis in horses. Methods: Randomized controlled experimental trial. Methods: 14 horses and 5 forelimbs from equine cadavers. Methods: Horses underwent collagenase-induced superficial digital flexor tendonitis in the midmetacarpal region of 1 forelimb. To deliver analgesia, a closed-tip catheter was placed from lateral to medial, approximately 12 cm dist...
Technical note: a 2-stage cecal cannulation technique in standing horses. Cecal cannulation is necessary for sampling of intestinal contents for a variety of nutritional or digestive physiology studies. This report describes a 2-stage technique for permanent cecal cannulation in standing horses. For the first procedure, a right flank laparotomy is performed and a small pouch of the cecal base exteriorized and sutured to the body wall. The second procedure is performed approximately 1 wk later. During the second procedure, the exposed cecal pouch is removed and the cannula inserted. Ten horses were cannulated using this technique. After the first procedure, 1 horse d...
Thermal and mechanical nociceptive threshold testing in horses: a review. This review evaluates the thermal and mechanical nociceptive threshold testing techniques that have been used in horses and discusses them with reference to their applications, limitations and the factors which can influence both the testing procedure itself and the animal's responses. Methods to optimise the reliability and repeatability of the testing procedures are suggested and the potential clinical applications discussed. Methods: Web of Science and Medline. Conclusions: Thermal and mechanical nociceptive threshold testing techniques have valuable roles in both the identification of alte...
Sensory nerve conduction and nociception in the equine lower forelimb during perineural bupivacaine infusion along the palmar nerves. The purpose of this investigation was to study lateral palmar nerve (LPN) and medial palmar nerve (MPN) morphology and determine nociception and sensory nerve conduction velocity (SNCV) following placement of continuous peripheral nerve block (CPNB) catheters along LPN and MPN with subsequent bupivacaine (BUP) infusion. Myelinated nerve fiber distribution in LPN and MPN was examined after harvesting nerve specimens in 3 anesthetized horses and processing them for morphometric analysis. In 5 sedated horses, CPNB catheters were placed along each PN in both forelimbs. Horses then received in one ...
Recognition of pain and use of analgesia in horses by veterinarians in New Zealand. To explore attitudes towards and use of analgesia in horses by veterinarians in New Zealand. Methods: A postal questionnaire was sent out to 457 veterinarians identified as working with horses in New Zealand. Questions covered demographics and practice data; analgesic drugs available for use and used in practice; analgesic management of specific conditions including assessment of pain, drugs used, and frequency of cases; factors influencing the choice and use of analgesic agents; and attitudes and personal experience. Results: Ninety-seven questionnaires containing useable data were received, ...
Opioid analgesia in horses. Opioid analgesics have been the foundation of human pain management for centuries, and their value in animals has increased since it was proposed that it is the veterinarian's duty to alleviate pain whenever it may occur. Compared with other domesticated species, the horse has benefitted less from the increased understanding of opioid pharmacology in animals, because early literature was overlooked and later work, which examined adverse side effects rather than analgesia, concluded that analgesic and excitatory doses were irreconcilably close. More recent studies have indicated a widening role...
NMDA receptor antagonists and pain: ketamine. N-Methyl-D-aspartate (NMDA) is a synthetic chemical binding molecule (ligand) that selectively binds to the "slow response" glutamate NMDA receptor (NMDAR). NMDARs are important for normal brain function and play a central role in learning, memory, and the development of central nervous system hyperactive states. Diverse chemicals belonging to various drug families have demonstrated NMDAR antagonistic effects. Ketamine has been shown to produce antihyperalgesic effects produced by incision and tissue or nerve damage, and has become popular in equine practice as an anesthetic and more recently ...
Local anesthetics as pain therapy in horses. This article describes the rationale behind the use of systemically administered lidocaine as an analgesic. The analgesic efficacy of intravenously administered lidocaine is well documented by studies in human patients and laboratory animals. The mechanism by which systemically administered lidocaine produces analgesia is uncertain but is thought to include action at sodium, calcium, and potassium channels and the N-methyl-D-aspartate acid receptor. In addition, the anti-inflammatory actions of lidocaine are important in producing analgesia because inflammatory mediators augment neuronal excit...
Spinal anesthetics and analgesics in the horse. In the past 10 years, there have been many recent advances in spinal techniques in horses, both epidural and subarachnoid, to identify drugs or drug combinations that have sensory effects without motor nerve paralysis, thus providing pain control without these horses becoming recumbent. Opioids, alpha-2 agonists, dissociative drugs, and others have been investigated. Many of these drugs, which have serious side effects when injected systemically in horses, have been shown to have useful analgesic effects when injected spinally. Morphine-like opioids have the greatest potential for spinal use a...
Alpha-2 agonists as pain therapy in horses. Alpha-2 agonists, such as xylazine, clonidine, romifidine, detomidine, medetomidine, and dexmedetomidine, are potent analgesic drugs that also induce physiologic and behavioral changes, such as hypertension, bradycardia, atrioventricular block, excessive sedation and ataxia, all of which can potentially limit their systemic use as analgesics in some clinical cases. The use of medetomidine and dexmetomidine has been introduced for equine anesthesia/analgesia, and although not approved in this species, their increased specificity for alpha-2 receptors may offer some potential advantages over the...
Clinical significance of osseous spurs on the dorsoproximal aspect of the third metatarsal bone. Osseous spurs on the dorsoproximal aspect of the third metatarsal bone (MtIII) are common, but their clinical significance is unknown. Objective: To verify the sites of insertion of the dorsal metatarsal ligament and the tendons of tibialis cranialis and fibularis tertius in order to determine if periarticular osteophytes and entheseophytes could be differentiated radiologically; and to determine the frequency of occurrence of osseous spurs on the dorsoproximal aspect of MtIII. Objective: The frequency of osseous spurs on the dorsoproximal aspect of MtIII would be higher in lame than in clinic...
The use of sedatives, analgesic and anaesthetic drugs in the horse: an electronic survey of members of the American Association of Equine Practitioners (AAEP). To determine the sedative, analgesic and anaesthetic drugs and techniques that are used by equine veterinarians. HYPOTHESIS OR OBJECTIVES: To provide equine veterinarians with information concerning veterinary use of anaesthetic techniques, a reflection of the collective experiences of the profession. Methods: A survey was conducted of those members of the American Association of Equine Practitioners (AAEP) with an electronic mail address on file with the organisation using proprietary, web-based software. The survey was comprised of 30 questions divided into 8 sections: nonsteroidal anti-infl...
Distribution of radiodense contrast medium after perineural injection of the palmar and palmar metacarpal nerves (low 4-point nerve block): an in vivo and ex vivo study in horses. Evidence-based information is limited on distribution of local anaesthetic solution following perineural analgesia of the palmar (Pa) and palmar metacarpal (PaM) nerves in the distal aspect of the metacarpal (Mc) region ('low 4-point nerve block'). Objective: To demonstrate the potential distribution of local anaesthetic solution after a low 4-point nerve block using a radiographic contrast model. Methods: A radiodense contrast medium was injected subcutaneously over the medial or the lateral Pa nerve at the junction of the proximal three-quarters and distal quarter of the Mc region (Pa inject...
Intra-articular opioid analgesia is effective in reducing pain and inflammation in an equine LPS induced synovitis model. Intra-articular administration of morphine as a local analgesic and anti-inflammatory drug is widely used in human medicine. In equids, little is known about its clinical analgesic and anti-inflammatory efficacy. Objective: To use an inflammatory orthopaedic pain model to investigate the analgesic and anti-inflammatory effects of intra-articularly administered morphine as a new treatment modality in horses with acute arthritis. Methods: In a crossover study design, synovitis was induced in the left or right talocrural joint by means of intra-articular injection of 0.5 ng lipopolyssacharide (LP...
Clinical application and reliability of a post abdominal surgery pain assessment scale (PASPAS) in horses. The aim of this study was to refine a multi-dimensional scale based on physiological and behavioural parameters, known as the post abdominal surgery pain assessment scale (PASPAS), to quantify pain after laparotomy in horses. After a short introduction, eight observers used the scale to assess eight horses at multiple time points after laparotomy. In addition, a single observer was used to test the correlation of each parameter with the total pain index in 34 patients, and the effect of general anaesthesia on PASPAS was investigated in a control group of eight horses. Inter-observer variabilit...
Neuropathic pain management in chronic laminitis. Managing pain in horses afflicted by chronic laminitis is one of the greatest challenges in equine clinical practice because it is the dreadful suffering of the animals that most often forces the veterinarian to end the battle with this disease. The purpose of this review is to summarize our current understanding of the complex mechanisms involved in generating and amplifying pain in animals with laminitis and, based on this information, to propose a modified approach to pain therapy. Furthermore, a recently developed pain scoring technique is presented that may help better quantify pain and t...
Pararectal cystotomy for urolith removal in nine horses. To report outcome of horses after standing pararectal cystotomy for removal of uroliths. Methods: Case series. Methods: Horses (n=9) with cystic calculi. Methods: Medical records (December 1998-May 2007) of horses with cystic calculi that had standing pararectal cystotomy were reviewed. Signalment; urolith number, size, and type; surgical technique; sedation and analgesia protocols; intra- and postoperative complications and outcome were analyzed. Results: Uroliths (mean diameter, 6.37 cm; median, 6 cm; range, 3-10 cm) were removed intact without need for fragmentation. Eight (89%) horses had ...
Enantioselective CE analysis of hepatic ketamine metabolism in different species in vitro. Ketamine, an injectable anesthetic and analgesic consisting of a racemic mixture of S-and R-ketamine, is routinely used in veterinary and human medicine. Nevertheless, metabolism and pharmacokinetics of ketamine have not been characterized sufficiently in most animal species. An enantioselective CE assay for ketamine and its metabolites in microsomal preparations is described. Racemic ketamine was incubated with pooled microsomes from humans, horses and dogs over a 3 h time interval with frequent sample collection. CE data revealed that ketamine is metabolized enantioselectively to norketamine...
Analgesic efficacy of intra-articular morphine in experimentally induced radiocarpal synovitis in horses. To compare the analgesic effect of intra-articular (IA) and intravenous (IV) morphine in horses with experimentally induced synovitis. Methods: Eight adult horses. Methods: Randomized, observer blinded, double dummy trial with sequential crossover design. Methods: Radiocarpal synovitis was induced by IA injection of lipopolysaccharide on two occasions separated by a 3-week washout period. In one study period horses received treatment IA; morphine IA (0.05 mg kg(-1)) plus saline IV and in the other study period they received treatment IV; saline IA plus morphine IV (0.05 mg kg(-1)). Lameness an...
Pharmacokinetics of intra-articular morphine in horses with lipopolysaccharide-induced synovitis. To describe the pharmacokinetics of intra-articularly (IA) administered morphine. Methods: Experimental randomized, cross-over study. Methods: Eight adult healthy mixed breed horses aged 6.5 +/- 2.3 (mean +/- SD) years and weighing 535 +/- 86 kg. Methods: Unilateral radiocarpal synovitis was induced by IA injection of 3 microg lipopolysaccharide (LPS) on two occasions (right and left radiocarpal joint, respectively) separated by a 3-week wash-out period. Treatments were administered 4 hours post-LPS-injection: Treatment IA; preservative free morphine IA (0.05 mg kg(-1)) plus saline intravenous...
Determination of oral tramadol pharmacokinetics in horses. The determination of the pharmacokinetic parameters of tramadol in plasma and a better characterization of its metabolites after oral administration to horses is necessary to design dosage regimens to achieve target plasma concentrations that are associated with analgesia. The purpose of this study was to determine the pharmacokinetics and elimination pattern in urine of tramadol and its metabolites after oral administration to horses. Tramadol was administered orally to six horses and its half-life, T(max) and C(max) in plasma were 10.1, 0.59 h, and 132.7 ng/mL, respectively. The half-life, T...
Plasma concentrations, behavioural and physiological effects following intravenous and intramuscular detomidine in horses. Detomidine hydrochloride is used to provide sedation, muscle relaxation and analgesia in horses, but a lack of information pertaining to plasma concentration has limited the ability to correlate drug concentration with effect. Objective: To build on previous information and assess detomidine for i.v. and i.m. use in horses by simultaneously assessing plasma drug concentrations, physiological parameters and behavioural characteristics. Objective: Systemic effects would be seen following i.m. and i.v. detomidine administration and these effects would be positively correlated with plasma drug con...
Pharmacokinetic profile in relation to anaesthesia characteristics after a 5% micellar microemulsion of propofol in the horse. To define the pharmacokinetic profile of propofol 5% microemulsion formulation in horses. Methods: First, propofol was administered as bolus injection (2 mg kg(-1)) to six xylazine-sedated horses. Secondly, after sedation and bolus injection, propofol was maintained with continuous infusion for 3 h [8.1 (sd 3.2) mg kg(-1) h(-1)] to the same six horses. Thirdly, in two horses, a commercial propofol was used for comparison. Response to noxious stimulation was used to evaluate analgesia. Venous blood samples were obtained to measure propofol plasma concentration using liquid chromatography-mass s...