Cervical Epidural Spinal Analgesia for Acute Management of Severe Unilateral Forelimb Lameness: Case Report.
Abstract: A 20-year-old Quarter Horse gelding was presented with severe right forelimb lameness (5/5 AAEP Lameness Scale) due to a tear of the superficial digital flexor muscle which was diagnosed via palpation of swelling and ultrasonography revealing major muscle fiber disruption and hematoma formation. When traditional systemic therapy (non-Steroidal anti-inflammatories) did not restore clinically acceptable comfort and the risk of supporting limb laminitis became a reasonable concern, a cervical epidural catheter was placed between the first and second cervical vertebrae in the standing, sedated patient using ultrasound guidance. The gelding was treated with epidural morphine (0.1 mg/kg every 24 h then decreased to 0.05 mg/kg every 12 h) and was pain-scored serially following treatment. Spinal analgesia was provided for 3 days. Pain scores significantly decreased following each treatment with morphine, and the gelding was successfully managed through the acutely painful period without any adverse effects associated with the C1-C2 epidural catheter placement technique, the epidural morphine, or contralateral limb laminitis. At the 2-month follow-up, the gelding was walking sound with no complications seen at the catheter insertion site. In this case, spinal analgesia using epidural morphine administered via a cervical epidural catheter was an effective and technically achievable option for pain management associated with severe forelimb muscle injury in a horse.
Copyright © 2021 Watkins, Hopster, Levine and Hurcombe.
Publication Date: 2021-11-04 PubMed ID: 34805340PubMed Central: PMC8599274DOI: 10.3389/fvets.2021.749713Google Scholar: Lookup
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Summary
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The research article is about a case study where spinal analgesia was used to successfully manage severe pain in a horse’s forelimb due to a muscle injury, after traditional treatment methods were ineffective.
Case Overview
- The study focuses on a specific case involving a 20-year-old Quarter Horse gelding that had a severe tear in its superficial digital flexor muscle, causing extreme lameness in the right forelimb. This was diagnosed using palpation of swelling and ultrasound that revealed major muscle injury and hematoma formation.
Initial Treatment and Its Limitations
- Initially, traditional systemic therapy involving non-steroidal anti-inflammatories was employed; however, it did not provide clinically satisfactory pain relief.
- Faced with an increased risk of secondary complications like supporting limb laminitis (an inflammation of the hoof’s sensitive tissues), alternate treatments options were explored.
Application of Cervical Epidural Spinal Analgesia
- The researchers decided to use cervical epidural spinal analgesia. This involved placing a cervical epidural catheter between the first and second cervical vertebrae in the standing, sedated horse under ultrasound guidance.
- The horse was then treated with epidural morphine for three days, gradually decreasing the dose after the first 24 hours. The horse’s pain levels were closely monitored following each morphine administration.
Success of the Treatment
- After each treatment, the horse’s pain scores significantly decreased, indicating the success of the analgesia in managing the acute pain.
- Notably, there were no adverse effects observed from the specific technique used for catheter placement, the use of epidural morphine, or from the development of contralateral limb laminitis.
- Two months following the treatment, the horse was seen walking normally, with no evident complications at the catheter insertion site.
Conclusion
- The article concludes that administering epidural morphine through a cervical epidural catheter was an effective solution for the acute pain management associated with severe forelimb muscle injury in the horse.
Cite This Article
APA
Watkins AR, Hopster K, Levine D, Hurcombe SD.
(2021).
Cervical Epidural Spinal Analgesia for Acute Management of Severe Unilateral Forelimb Lameness: Case Report.
Front Vet Sci, 8, 749713.
https://doi.org/10.3389/fvets.2021.749713 Publication
Researcher Affiliations
- Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States.
- Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States.
- Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States.
- Department of Clinical Sciences, New Bolton Center, 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.
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