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Equine veterinary journal2019; 52(1); 13-27; doi: 10.1111/evj.13198

BEVA primary care clinical guidelines: Analgesia.

Abstract: Primary care guidelines provide a reference point to guide clinicians based on a systematic review of the literature, contextualised by expert clinical opinion. These guidelines develop a modification of the GRADE framework for assessment of research evidence (vetGRADE) and applied this to a range of clinical scenarios regarding use of analgesic agents. Key guidelines produced by the panel included recommendations that horses undergoing routine castration should receive intratesticular local anaesthesia irrespective of methods adopted and that horses should receive NSAIDs prior to surgery (overall certainty levels high). Butorphanol and buprenorphine should not be considered appropriate as sole analgesic for such procedures (high certainty). The panel recommend the continuation of analgesia for 3 days following castration (moderate certainty) and conclude that phenylbutazone provided superior analgesia to meloxicam and firocoxib for hoof pain/laminitis (moderate certainty), but that enhanced efficacy has not been demonstrated for joint pain. In horses with colic, flunixin and firocoxib are considered to provide more effective analgesia than meloxicam or phenylbutazone (moderate certainty). Given the risk of adverse events of all classes of analgesic, these agents should be used only under the control of a veterinary surgeon who has fully evaluated a horse and developed a therapeutic, analgesic plan that includes ongoing monitoring for such adverse events such as the development of right dorsal colitis with all classes of NSAID and spontaneous locomotor activity and potentially ileus with opiates. Finally, the panel call for the development of a single properly validated composite pain score for horses to allow accurate comparisons between medications in a robust manner.
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Publication Date: 2019-10-28 PubMed ID: 31657050DOI: 10.1111/evj.13198Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research presents new clinical guidelines for pain relief in horses. The guidance was developed by assessing existing research and combining it with expert opinions. Recommendations include changes to pain management during and after horse castration, and differences in effective medications for various types of pain.

Development of Guidelines

  • The guidelines were created by modifying the GRADE framework, a widely used system for assessing the quality of research.
  • This modified version, known as vetGRADE, was then applied to various scenarios involving the usage of pain-relieving drugs in horses.

Analgesia for Castration

  • The guidelines recommend that horses should always receive local pain relief during castration, regardless of the method used (certainty level high).
  • Non-steroidal anti-inflammatory drugs (NSAIDs) should be administered to horses prior to surgery.
  • The use of butorphanol and buprenorphine, common opiate painkillers, is not recommended as the only form of pain relief for castration (high certainty).
  • After castration, horses should continue to receive pain relief for at least three days (moderate certainty).

Pain Management for Hoof Pain and Colic

  • The panel found that phenylbutazone provided superior pain relief for hoof pain and laminitis compared to meloxicam and firocoxib, other common NASIDs (moderate certainty).
  • However, the increased efficacy of phenylbutazone was not demonstrated for joint pain.
  • In horses with colic, flunixin and firocoxib were found to be more effective than meloxicam or phenylbutazone (moderate certainty).

Controlled Usage and Monitoring

  • The guidelines stress the need for careful use of analgesic agents due to the risk of adverse events, including inflammation of the colon and potential ileus with opiate usage.
  • These drugs should only be used under the supervision of a veterinary surgeon who can develop a tailored plan and monitor for adverse effects.

Future Recommendations

  • The panel calls for the development of a single, validated score for measuring pain in horses. This would enable more accurate comparisons between different medications.

Cite This Article

APA
Bowen IM, Redpath A, Dugdale A, Burford JH, Lloyd D, Watson T, Hallowell GD. (2019). BEVA primary care clinical guidelines: Analgesia. Equine Vet J, 52(1), 13-27. https://doi.org/10.1111/evj.13198

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 52
Issue: 1
Pages: 13-27

Researcher Affiliations

Bowen, I M
  • Oakham Veterinary Hospital/University of Nottingham, Sutton Bonington, Loughborough, UK.
Redpath, A
  • Oakham Veterinary Hospital/University of Nottingham, Sutton Bonington, Loughborough, UK.
Dugdale, A
  • School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, UK.
Burford, J H
  • School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, UK.
Lloyd, D
  • ChesterGates Veterinary Specialists, Chester, UK.
Watson, T
  • Waterlane Equine Vets, Stroud, UK.
Hallowell, G D
  • Liphook Equine Hospital, Liphook, UK.

MeSH Terms

  • Analgesia / veterinary
  • Animals
  • Horse Diseases / drug therapy
  • Horses
  • Pain / drug therapy
  • Pain / veterinary
  • Practice Guidelines as Topic
  • Societies, Scientific / standards
  • United Kingdom
  • Veterinary Medicine / standards

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