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Frontiers in veterinary science2022; 9; 995299; doi: 10.3389/fvets.2022.995299

Caudal epidural catheterization for pain management in 48 hospitalized horses: A descriptive study of demographics, complications, and outcomes.

Abstract: The placement of caudal epidural catheters in horses has become more frequent as a multi-modal analgesic strategy. Despite its integration into clinical practice, there are limited reports describing the use of caudal epidural catheterization for prolonged use in horses. The purpose of this study was to characterize the hospitalized caseload undergoing epidural catheterization for long-term epidural analgesic administration, to report the response to epidural therapy and observed complications, and to describe patient outcomes. Medical records of hospitalized equine patients that underwent placement of a caudal epidural catheter for analgesic management between 2017 and 2021 were analyzed retrospectively. For the 62 catheters placed in the 48 cases, the most frequent diagnosis category prompting epidural analgesia was orthopedic (43/48, 89.6%). Synovial sepsis was the most frequent specific diagnosis prompting epidural catheter placement (11/48, 22.9%). The initial response to epidural therapy was characterized as positive for 37/62 (59.7%) catheters. Complications were documented for 46/62 (74.2%) catheters. However, most of these complications were classified as mild (51.6%) or moderate (14.5%), and exaggerated physiologic responses were observed most frequently. Of the horses studied, 52.1% survived to be discharged from the hospital. With awareness of potential complications and vigilant monitoring, caudal epidural catheters should be considered for equine patients as an analgesic strategy.
Copyright © 2022 Douglas, Midon, Shroff, Floriano, Driessen and Hopster.
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Publication Date: 2022-10-28 PubMed ID: 36387394PubMed Central: PMC9649785DOI: 10.3389/fvets.2022.995299Google 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.

This study analyzes the use and effects of caudal epidural catheterization as a method of pain management in hospitalized horses. The authors identified that despite certain complications, the strategy was largely successful in providing pain relief, and can be recommended with careful monitoring.

Research Context

  • The research looked into the use of caudal epidural catheterization in horses for long-term pain management. This technique involves positioning a tube (catheter) into the lower back part of the spinal cord (caudal epidural space) to deliver pain relief medication directly to nerves transmitting the pain signal.
  • This study was conducted due to limited literature on long-term use of this technique in horses, despite its increasing use clinically. The researchers aimed to assess the demographic characteristics of affected horses, report the complications encountered, evaluate the response to therapy, and present the outcomes of the patients.

Methodology and Findings

  • Medical records of horses that were hospitalized and underwent this procedure between 2017 and 2021 were evaluated.
  • In total, 62 catheters were placed in 48 different cases. The most common reason for using epidural analgesia was for orthopedic issues, with synovial sepsis, an infection in a horse’s joint or tendon sheath, being the most frequent specific diagnosis.
  • The initial response to the therapy was predominantly positive, with over half of the catheters (59.7%) resulting in some level of pain relief.
  • Regarding complications, there were recorded complications in about 74.2% of the catheters. However, these were mostly categorized as mild or moderate, with exaggerated physiological responses being the most commonly observed complication. An exaggerated physiological response implies any changes related to the body’s normal function such as heart rate or blood pressure that are beyond the typical ranges during pain management therapy.
  • In terms of patient outcomes, just over half (52.1%) of the horses under study survived and were able to be discharged from the hospital.

Conclusions

  • The study concludes that while complications do occur in a significant proportion of cases, most were mild or moderate in nature. Therefore, with careful monitoring and awareness of the potential complications, caudal epidural catheterization can be considered as an effective analgesic strategy for horses, particularly for conditions like orthopedic issues and synovial sepsis.

Cite This Article

APA
Douglas H, Midon M, Shroff K, Floriano D, Driessen B, Hopster K. (2022). Caudal epidural catheterization for pain management in 48 hospitalized horses: A descriptive study of demographics, complications, and outcomes. Front Vet Sci, 9, 995299. https://doi.org/10.3389/fvets.2022.995299

Publication

Frontiers in veterinary science
ISSN: 2297-1769
NlmUniqueID: 101666658
Country: Switzerland
Language: English
Volume: 9
Pages: 995299
PII: 995299

Researcher Affiliations

Douglas, Hope
  • Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States.
Midon, Monica
  • Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States.
Shroff, Kavita
  • Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States.
Floriano, Dario
  • Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States.
Driessen, Bernd
  • Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States.
Hopster, Klaus
  • Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

This article includes 58 references
  1. Bos EME, Hollmann MW, Lirk P. Safety and efficacy of epidural analgesia.. Curr Opin Anaesthesiol 2017 Dec;30(6):736-742.
    doi: 10.1097/ACO.0000000000000516pubmed: 28938298google scholar: lookup
  2. Martin-Flores M. Epidural and Spinal Anesthesia.. Vet Clin North Am Small Anim Pract 2019 Nov;49(6):1095-1108.
    doi: 10.1016/j.cvsm.2019.07.007pubmed: 31492542google scholar: lookup
  3. Natalini CC, Driessen B. Epidural and spinal anesthesia and analgesia in the equine. Clin Tech in Equine Pract (2007) 6:145–53.
    doi: 10.1053/j.ctep.2007.05.008google scholar: lookup
  4. Garcia-Pereira F. Epidural anesthesia and analgesia in small animal practice: An update.. Vet J 2018 Dec;242:24-32.
    doi: 10.1016/j.tvjl.2018.09.007pubmed: 30503540google scholar: lookup
  5. Goodrich LR, Nixon AJ, Fubini SL, Ducharme NG, Fortier LA, Warnick LD, Ludders JW. Epidural morphine and detomidine decreases postoperative hindlimb lameness in horses after bilateral stifle arthroscopy.. Vet Surg 2002 May-Jun;31(3):232-9.
    doi: 10.1053/jvet.2002.32436pubmed: 11994850google scholar: lookup
  6. Louro LF, Milner PI, Bardell D. Epidural administration of opioid analgesics improves quality of recovery in horses anaesthetised for treatment of hindlimb synovial sepsis.. Equine Vet J 2021 Jul;53(4):682-689.
    doi: 10.1111/evj.13338pubmed: 32852063google scholar: lookup
  7. Robinson EP, Natalini CC. Epidural anesthesia and analgesia in horses.. Vet Clin North Am Equine Pract 2002 Apr;18(1):61-82, vi.
    doi: 10.1016/S0749-0739(02)00010-Xpubmed: 12064183google scholar: lookup
  8. Natalini CC. Spinal anesthetics and analgesics in the horse.. Vet Clin North Am Equine Pract 2010 Dec;26(3):551-64.
    doi: 10.1016/j.cveq.2010.07.005pubmed: 21056299google scholar: lookup
  9. van Loon JP, Menke ES, L'ami JJ, Jonckheer-Sheehy VS, Back W, René van Weeren P. Analgesic and anti-hyperalgesic effects of epidural morphine in an equine LPS-induced acute synovitis model.. Vet J 2012 Aug;193(2):464-70.
    doi: 10.1016/j.tvjl.2012.01.015pubmed: 22342215google scholar: lookup
  10. Grubb TL, Riebold TW, Huber MJ. Comparison of lidocaine, xylazine, and xylazine/lidocaine for caudal epidural analgesia in horses.. J Am Vet Med Assoc 1992 Oct 15;201(8):1187-90.
    doi: 10.1111/j.1467-2995.1991.tb00580.xpubmed: 1429156google scholar: lookup
  11. DeRossi R, Maciel FB, Módolo TJ, Pagliosa RC. Efficacy of concurrent epidural administration of neostigmine and lidocaine for perineal analgesia in geldings.. Am J Vet Res 2012 Sep;73(9):1356-62.
    doi: 10.2460/ajvr.73.9.1356pubmed: 22924716google scholar: lookup
  12. MacAllister CG, Morgan SJ, Borne AT, Pollet RA. Comparison of adverse effects of phenylbutazone, flunixin meglumine, and ketoprofen in horses.. J Am Vet Med Assoc 1993 Jan 1;202(1):71-7.
    pubmed: 8420909
  13. Clutton RE. Opioid analgesia in horses.. Vet Clin North Am Equine Pract 2010 Dec;26(3):493-514.
    doi: 10.1016/j.cveq.2010.07.002pubmed: 21056296google scholar: lookup
  14. Driessen B, Zarucco L. Treatment of acute and chronic pain in horses. In:Egger CM, Love L, Doherty T, editors. Pain Management in Veterinary Practice. Ames, IA: John Wiley & Sons, Ltd; (2013). p. 323–348.
  15. van Eps A, Collins SN, Pollitt CC. Supporting limb laminitis.. Vet Clin North Am Equine Pract 2010 Aug;26(2):287-302.
    doi: 10.1016/j.cveq.2010.06.007pubmed: 20699176google scholar: lookup
  16. Driessen B, Bauquier SH, Zarucco L. Neuropathic pain management in chronic laminitis.. Vet Clin North Am Equine Pract 2010 Aug;26(2):315-37.
    doi: 10.1016/j.cveq.2010.04.002pubmed: 20699178google scholar: lookup
  17. Kjærulff LNR, Lindegaard C. A narrative review of caudal epidural anaesthesia and analgesia in horses. Part 1: safety and efficacy of epidural drugs. Equine Vet Ed (2022) 34:418–31.
    doi: 10.1111/eve.13488google scholar: lookup
  18. Martin CA, Kerr CL, Pearce SG, Lansdowne JL, Bouré LP. Outcome of epidural catheterization for delivery of analgesics in horses: 43 cases (1998-2001).. J Am Vet Med Assoc 2003 May 15;222(10):1394-8.
    doi: 10.2460/javma.2003.222.1394pubmed: 12762385google scholar: lookup
  19. Kjærulff LNR, Lindegaard C. A narrative review of caudal epidural anaesthesia and analgesia in horses. Part 2: clinical indications and techniques. Equine Vet Ed (2022) 34:432–42.
    doi: 10.1111/eve.13489google scholar: lookup
  20. Rodrigo-Mocholi D, Steblaj B, Vlaminck L, Gasthuys F, Schauvliege S. Continuous caudal epidural analgesia for perioperative pain control after bilateral mastectomy in a mare. Vet Rec Case Rep (2016) 4:e000275.
    doi: 10.1136/vetreccr-2015-000275google scholar: lookup
  21. Mirra A, Birras J, Diez Bernal S, Spadavecchia C. Morphine plasmatic concentration in a pregnant mare and its foal after long term epidural administration.. BMC Vet Res 2020 Jan 20;16(1):19.
    doi: 10.1186/s12917-020-2242-9pmc: PMC6971975pubmed: 31959188google scholar: lookup
  22. Valverde A, Little CB, Dyson DH, Motter CH. Use of epidural morphine to relieve pain in a horse.. Can Vet J 1990 Mar;31(3):211-2.
    pmc: PMC1480787pubmed: 17423538
  23. Skarda RT, Muir WW. Continuous caudal epidural and subarachnoid anesthesia in mares: a comparative study.. Am J Vet Res 1983 Dec;44(12):2290-8.
    pubmed: 6660618
  24. Sysel AM, Pleasant RS, Jacobson JD, Moll HD, Warnick LD, Sponenberg DP, Eyre P. Systemic and local effects associated with long-term epidural catheterization and morphine-detomidine administration in horses.. Vet Surg 1997 Mar-Apr;26(2):141-9.
    doi: 10.1111/j.1532-950X.1997.tb01477.xpubmed: 9068165google scholar: lookup
  25. Ortolani F, Nannarone S, Scilimati N, Gialletti R. Successful Surgical and Medical Management of a Pararectal Abscess in a Horse.. J Equine Vet Sci 2021 Apr;99:103387.
    doi: 10.1016/j.jevs.2021.103387pubmed: 33781413google scholar: lookup
  26. Natalini CC, Robinson EP. Effects of epidural opioid analgesics on heart rate, arterial blood pressure, respiratory rate, body temperature, and behavior in horses.. Vet Ther 2003 Winter;4(4):364-75.
    pubmed: 15136978
  27. Natalini CC, Paes SD, Polydoro ADS. Analgesic and Cardiopulmonary Effects of Epidural Romifidine and Morphine Combination in Horses.. J Equine Vet Sci 2021 Jul;102:103459.
    doi: 10.1016/j.jevs.2021.103459pubmed: 34119202google scholar: lookup
  28. Rioja Garcia E. Complications of loco-regional Anesthesia. In Rubio-Martinez LM, Hendrickson DA, editors. Complications in Equine Surgery. Hoboken, NJ: John Wiley & Sons, Inc; (2021). p. 118–134.
  29. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.. Ann Surg 2004 Aug;240(2):205-13.
    doi: 10.1097/01.sla.0000133083.54934.aepmc: PMC1360123pubmed: 15273542google scholar: lookup
  30. Sheats MK. A Comparative Review of Equine SIRS, Sepsis, and Neutrophils.. Front Vet Sci 2019;6:69.
    doi: 10.3389/fvets.2019.00069pmc: PMC6424004pubmed: 30931316google scholar: lookup
  31. Sysel AM, Pleasant RS, Jacobson JD, Moll HD, Modransky PD, Warnick LD, Sponenberg DP, Eyre P. Efficacy of an epidural combination of morphine and detomidine in alleviating experimentally induced hindlimb lameness in horses.. Vet Surg 1996 Nov-Dec;25(6):511-8.
    doi: 10.1111/j.1532-950X.1996.tb01452.xpubmed: 8923731google scholar: lookup
  32. van Loon JP, de Grauw JC, van Dierendonck M, L'ami JJ, Back W, van Weeren PR. Intra-articular opioid analgesia is effective in reducing pain and inflammation in an equine LPS induced synovitis model.. Equine Vet J 2010 Jul;42(5):412-9.
    doi: 10.1111/j.2042-3306.2010.00077.xpubmed: 20636777google scholar: lookup
  33. Hopster K, van Eps AW. Pain management for laminitis in the horse. Equine Vet Ed (2019) 31:384–92.
    doi: 10.1111/eve.12910google scholar: lookup
  34. Freitas GC, Carregaro AB, Gehrcke MI, De La Côrte FD, Lara VM, Pozzobon R, Brass KE. Epidural analgesia with morphine or buprenorphine in ponies with lipopolysaccharide (LPS)-induced carpal synovitis.. Can J Vet Res 2011 Apr;75(2):141-6.
    pmc: PMC3062925pubmed: 21731186
  35. Watkins AR, Hopster K, Levine D, Hurcombe SD. Cervical Epidural Spinal Analgesia for Acute Management of Severe Unilateral Forelimb Lameness: Case Report.. Front Vet Sci 2021;8:749713.
    doi: 10.3389/fvets.2021.749713pmc: PMC8599274pubmed: 34805340google scholar: lookup
  36. Hopster K, Watkins AR, Hurcombe SD. Comparison of cervical epidural morphine with intravenous morphine administration on antinociception in adult horses using thermal threshold testing.. Vet Anaesth Analg 2022 Jul;49(4):417-422.
    doi: 10.1016/j.vaa.2022.03.003pubmed: 35400580google scholar: lookup
  37. Hurcombe SD, Morris TB, VanderBroek AR, Habecker P, Wulster K, Hopster K. Cervical Epidural and Subarachnoid Catheter Placement in Standing Adult Horses.. Front Vet Sci 2020;7:232.
    doi: 10.3389/fvets.2020.00232pmc: PMC7239991pubmed: 32478105google scholar: lookup
  38. Natalini CC, Robinson EP. Evaluation of the analgesic effects of epidurally administered morphine, alfentanil, butorphanol, tramadol, and U50488H in horses.. Am J Vet Res 2000 Dec;61(12):1579-86.
    doi: 10.2460/ajvr.2000.61.1579pubmed: 11131602google scholar: lookup
  39. Martin-Flores M, Campoy L, Kinsley MA, Mohammed HO, Gleed RD, Cheetham J. Analgesic and gastrointestinal effects of epidural morphine in horses after laparoscopic cryptorchidectomy under general anesthesia.. Vet Anaesth Analg 2014 Jul;41(4):430-7.
    doi: 10.1111/vaa.12133pubmed: 24576158google scholar: lookup
  40. Toledano RD, Tsen LC. Epidural catheter design: history, innovations, and clinical implications.. Anesthesiology 2014 Jul;121(1):9-17.
    doi: 10.1097/ALN.0000000000000239pubmed: 24681579google scholar: lookup
  41. Swalander DB, Crowe DT Jr, Hittenmiller DH, Jahn PJ. Complications associated with the use of indwelling epidural catheters in dogs: 81 cases (1996-1999).. J Am Vet Med Assoc 2000 Feb 1;216(3):368-70.
    doi: 10.2460/javma.2000.216.368pubmed: 10668535google scholar: lookup
  42. Mousavi S, Moradi M, Khorshidahmad T, Motamedi M. Anti-Inflammatory Effects of Heparin and Its Derivatives: A Systematic Review.. Adv Pharmacol Sci 2015;2015:507151.
    doi: 10.1155/2015/507151pmc: PMC4443644pubmed: 26064103google scholar: lookup
  43. Wood CE, Goresky GV, Klassen KA, Kuwahara B, Neil SG. Complications of continuous epidural infusions for postoperative analgesia in children.. Can J Anaesth 1994 Jul;41(7):613-20.
    doi: 10.1007/BF03010002pubmed: 8087910google scholar: lookup
  44. Collier CB, Gatt SP. Dislodgement of epidural catheters in labour.. Anaesthesia 2001 Jun;56(6):604-5.
    doi: 10.1111/j.1365-2044.2001.2094-30.xpubmed: 11412198google scholar: lookup
  45. Combie J, Shults T, Nugent EC, Dougherty J, Tobin T. Pharmacology of narcotic analgesics in the horse: selective blockade of narcotic-induced locomotor activity.. Am J Vet Res 1981 May;42(5):716-21.
    pubmed: 6114692
  46. Mhuircheartaigh RJ, Moore RA, McQuay HJ. Analysis of individual patient data from clinical trials: epidural morphine for postoperative pain.. Br J Anaesth 2009 Dec;103(6):874-81.
    doi: 10.1093/bja/aep300pubmed: 19889750google scholar: lookup
  47. Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: a review.. J Clin Anesth 2003 May;15(3):234-9.
    doi: 10.1016/S0952-8180(02)00501-9pubmed: 12770663google scholar: lookup
  48. Burford JH, Corley KT. Morphine-associated pruritus after single extradural administration in a horse.. Vet Anaesth Analg 2006 May;33(3):193-8.
    doi: 10.1111/j.1467-2995.2005.00246.xpubmed: 16634946google scholar: lookup
  49. Kalchofner KS, Kummer M, Price J, Bettschart-Wolfensberger R. Pruritus in two horses following epidurally administered morphine. Equine Vet Ed (2007) 19:590–4.
    doi: 10.2746/095777307X254545google scholar: lookup
  50. Haitjema H, Gibson KT. Severe pruritus associated with epidural morphine and detomidine in a horse.. Aust Vet J 2001 Apr;79(4):248-50.
    doi: 10.1111/j.1751-0813.2001.tb11973.xpubmed: 11349409google scholar: lookup
  51. Kumar K, Singh SI. Neuraxial opioid-induced pruritus: An update.. J Anaesthesiol Clin Pharmacol 2013 Jul;29(3):303-7.
    doi: 10.4103/0970-9185.117045pmc: PMC3788225pubmed: 24106351google scholar: lookup
  52. Sano H, Martin-Flores M, Santos LC, Cheetham J, Araos JD, Gleed RD. Effects of epidural morphine on gastrointestinal transit in unmedicated horses.. Vet Anaesth Analg 2011 Mar;38(2):121-6.
    doi: 10.1111/j.1467-2995.2010.00588.xpubmed: 21303443google scholar: lookup
  53. Tessier C, Pitaud JP, Thorin C, Touzot-Jourde G. Systemic morphine administration causes gastric distention and hyperphagia in healthy horses.. Equine Vet J 2019 Sep;51(5):653-657.
    doi: 10.1111/evj.13090pubmed: 30835841google scholar: lookup
  54. Hendrickson DA, Southwood LL, Lopez MJ, Johnson R, Kruse-Elliott KT. Cranial migration of different volumes of new-methylene blue after caudal epidural injection in the horse. Equine Practice (1998) 20:12–4.
  55. Lindegaard C, Kjærulff LNR. Use of caudal epidural analgesia for management of orthopaedic limb pain in horses. Equine Vet Ed (2021) 33:513–5.
    doi: 10.1111/eve.13360google scholar: lookup
  56. Mattson S, Bouré L, Pearce S, Kerr C, Mattson S. Clinical observation: bilateral upward fixation of the patella following epidural administration of morphine.. J Am Vet Med Assoc 2001 Aug 1;219(3):298-9.
    doi: 10.2460/javma.2001.219.298pubmed: 11497039google scholar: lookup
  57. Tallon R, McMillan M, Ho N, Dunkel B. Presumed generalised seizure following caudal epidural administration of morphine and detomidine in a pony. Equine Vet Ed (2021) 33:e372–5.
    doi: 10.1111/eve.13342google scholar: lookup
  58. Phillips LR, McAbee KP, Stephenson N, Stanke NJ, Booms ML, Degner DD. Evaluation of complications and feasibility of indwelling epidural catheter use for post-operative pain control in dogs in the home environment.. N Z Vet J 2015 Mar;63(2):86-91.
    doi: 10.1080/00480169.2014.948521pubmed: 25084014google scholar: lookup

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