FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / Animals (Basel) / Comparison of Flunixin Meglumine, Meloxicam and Ketoprofen o...
Animals : an open access journal from MDPI2022; 12(4); doi: 10.3390/ani12040526

Comparison of Flunixin Meglumine, Meloxicam and Ketoprofen on Mild Visceral Post-Operative Pain in Horses.

Abstract: The analgesic efficacy of meloxicam and ketoprofen against equine visceral pain is unclear. The aim of this study was to compare the analgesic efficacy of meloxicam (M) and ketoprofen (K) to flunixin meglumine (F) following inguinal castration. Horses undergoing inguinal castration under general anesthesia were randomly assigned F (1.1 mg/kg), M (0.6 mg/kg) or K (2.2 mg/kg) intravenously two hours pre-operatively and 24 h later. A pain score (out of 31) was recorded blindly by a senior clinician and veterinary student before NSAIDs administration (T0), and after the first (T1) and second (T2) administrations, using a modified post-abdominal surgery pain assessment scale (PASPAS). Pain was classified as mild (score ≤ 7), moderate (score = 8-14) or severe (score > 14). Thirty horses (12 F, 10 M, 8 K) aged 6.2 ± 4.9 years, mostly warmbloods, were included. Horse welfare was not compromised regardless of the drug assigned. There was no statistically significant effect of NSAIDs on pain score. Mean pain scores were significantly higher at T1 than T0 for each NSAID (F: 5.08 ± 2.50 vs. 1.58 ± 1.38 (p < 0.001); M: 4.60 ± 2.32 vs. 1.10 ± 1.20 (p < 0.001); K: 5.25 ± 1.39 vs. 1.50 ± 1.51 (p < 0.0001)) and lower at T2 than T1 for F (2.92 ± 2.423 vs. 5.08 ± 2.50 (p < 0.001)) and M (2.90 ± 1.37 vs. 4.60 ± 2.32 (p < 0.0325)). At T1, senior pain scores were significantly different than for junior (5.56 ± 0.54 vs. 3.22 ± 0.62, p = 0.005). This study indicates that meloxicam and ketoprofen provide a similar level of analgesia to flunixin meglumine for the management of mild visceral pain in horses. PASPAS is not reliable for junior evaluators.
Get Full Text
Publication Date: 2022-02-21 PubMed ID: 35203234PubMed Central: PMC8868280DOI: 10.3390/ani12040526Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

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 research compares the pain-relieving effects of three different medications in horses after surgery. The results suggest that the medications meloxicam, ketoprofen, and flunixin meglumine are similarly effective in managing mild post-surgical pain in this species.

Study Design and Methodology

  • This is a comparative analysis of the efficacy of three different nonsteroidal anti-inflammatory drugs (NSAIDs) – flunixin meglumine, meloxicam, and ketoprofen – in managing visceral pain in horses following a specific kind of surgery: inguinal castration.
  • The horses were given either of the drugs two hours before the surgery and again 24 hours after.
  • The researchers used a modified Post-Abdominal Surgery Pain Assessment Scale (PASPAS) to measure the level of pain in the horses. This scale measures pain from a low score of 0 up to a high score of 31.
  • The pain was categorized into mild, moderate, and severe based on PASPAS scores.

Results and Findings

  • Thirty horses, mostly warmbloods, participated in the study. The ages ranged from 6.2 ± 4.9 years.
  • The results indicated that all three NSAIDs were able to effectively manage pain in horses, with no significant difference found between the effectiveness of each drug.
  • The mean pain scores were significantly higher before administration of the NSAIDs and decreased after each administration. This indicates that all three medications were effective in reducing post-operative pain.
  • However, it was found that the PASPAS might not be a reliable tool for junior evaluators. Pain scores reported by senior clinicians were significantly higher compared to the scores from junior evaluators at the same time point (T).
  • In general, the welfare of the horses was not compromised, regardless of the NSAID administered.

Conclusions

  • This study suggests that meloxicam, ketoprofen, and flunixin meglumine provide similar levels of analgesia or pain relief for post-operative visceral pain in horses.
  • Therefore, it is viable to use any of these three NSAIDs for managing mild visceral pain in horses after surgeries like inguinal castration.
  • However, there may need to be considerations when using the PASPAS scale for pain evaluation, especially with less experienced evaluators.

Cite This Article

APA
Lemonnier LC, Thorin C, Meurice A, Dubus A, Touzot-Jourde G, Couroucé A, Leroux AA. (2022). Comparison of Flunixin Meglumine, Meloxicam and Ketoprofen on Mild Visceral Post-Operative Pain in Horses. Animals (Basel), 12(4). https://doi.org/10.3390/ani12040526

Publication

Animals : an open access journal from MDPI
ISSN: 2076-2615
NlmUniqueID: 101635614
Country: Switzerland
Language: English
Volume: 12
Issue: 4

Researcher Affiliations

Lemonnier, Louise C
  • Department of Clinical Sciences, Equine Veterinary Teaching Hospital (CISCO), Oniris, Route de Gachet, F-44000 Nantes, France.
Thorin, Chantal
  • Nutrition PhysioPathologie et Pharmacologie, University of Nantes, Oniris, F-44000 Nantes, France.
Meurice, Antoine
  • Department of Clinical Sciences, Equine Veterinary Teaching Hospital (CISCO), Oniris, Route de Gachet, F-44000 Nantes, France.
Dubus, Alice
  • Clinique Vétérinaire de Bel Air, Allée Marcel Doret, F-41000 Blois, France.
Touzot-Jourde, Gwenola
  • Department of Clinical Sciences, Equine Veterinary Teaching Hospital (CISCO), Oniris, Route de Gachet, F-44000 Nantes, France.
  • UMR Inserm U1229-Regenerative Medecine and Skeleton, Department of Veterinary Clinical Sciences, University of Nantes, Oniris, F-44000 Nantes, France.
Couroucé, Anne
  • Department of Clinical Sciences, Equine Veterinary Teaching Hospital (CISCO), Oniris, Route de Gachet, F-44000 Nantes, France.
  • Biotargen, Normandie University, Unicaen, F-14000 Caen, France.
Leroux, Aurélia A
  • Department of Clinical Sciences, Equine Veterinary Teaching Hospital (CISCO), Oniris, Route de Gachet, F-44000 Nantes, France.
  • l'Institut du Thorax, Université de Nantes, CHU Nantes, CNRS, INSERM, F-44000 Nantes, France.

Conflict of Interest Statement

The authors declare no conflict of interest.

References

This article includes 44 references
  1. Duz M, Marshall JF, Parkin TD. Proportion of nonsteroidal anti-inflammatory drug prescription in equine practice.. Equine Vet. J. 2019;51:147–153.
    doi: 10.1111/evj.12997pubmed: 30048005google scholar: lookup
  2. Bowen IM, Redpath A, Dugdale A, Burford JH, Lloyd D, Watson T, Hallowell GD. BEVA primary care clinical guidelines: Analgesia.. Equine Vet. J. 2020;52:13–27.
    doi: 10.1111/evj.13198pubmed: 31657050google scholar: lookup
  3. MacAllister C, Morgan S, Borne A, Pollet R. Comparison of adverse effects of phenylbutazone, flunixin meglumine, and ketoprofen in horses.. J. Am. Vet. Med. Assoc. 1993;202:71–77.
    pubmed: 8420909
  4. Raidal SL, Hughes KJ, Charman A-L, Nielsen SG, Phillips JK, Noble GK. Effects of meloxicam and phenylbutazone on renal responses to furosemide, dobutamine, and exercise in horses.. Am. J. Vet. Res. 2014;75:668–679.
    doi: 10.2460/ajvr.75.7.668pubmed: 24959734google scholar: lookup
  5. Noble G, Edwards S, Lievaart J, Pippia J, Boston R, Raidal SL. Pharmacokinetics and Safety of Single and Multiple Oral Doses of Meloxicam in Adult Horses.. J. Vet. Intern. Med. 2012;26:1192–1201.
    doi: 10.1111/j.1939-1676.2012.00976.xpubmed: 22860573google scholar: lookup
  6. Dalla Costa E, Minero M, Lebelt D, Stucke D, Canali E, Leach MC. Development of the Horse Grimace Scale (HGS) as a Pain Assessment Tool in Horses Undergoing Routine Castration.. PLoS ONE 2014;9:e92281.
    doi: 10.1371/journal.pone.0092281pmc: PMC3960217pubmed: 24647606google scholar: lookup
  7. Abass M, Picek S, Garzón JFG, Kühnle C, Zaghlou A, Bettschart-Wolfensberger R. Local mepivacaine before castration of horses under medetomidine isoflurane balanced anaesthesia is effective to reduce perioperative nociception and cytokine release.. Equine Vet. J. 2018;50:733–738.
    doi: 10.1111/evj.12947pmc: PMC6175468pubmed: 29660154google scholar: lookup
  8. Trindade PHE, Taffarel MO, Luna SPL. Spontaneous Behaviors of Post-Orchiectomy Pain in Horses Regardless of the Effects of Time of Day, Anesthesia, and Analgesia.. Animals 2021;11:1629.
    doi: 10.3390/ani11061629pmc: PMC8230028pubmed: 34072875google scholar: lookup
  9. Barletta M, Young CN, Quandt JE, Hofmeister EH. Agreement between veterinary students and anesthesiologists regarding postoperative pain assessment in dogs.. Vet. Anaesth. Analg. 2016;43:91–98.
    doi: 10.1111/vaa.12269pubmed: 25920011google scholar: lookup
  10. Viñuela-Fernández I, Jones E, Chase-Topping ME, Price J. Comparison of subjective scoring systems used to evaluate equine laminitis.. Vet. J. 2011;188:171–177.
    doi: 10.1016/j.tvjl.2010.05.011pubmed: 20541956google scholar: lookup
  11. Mackenzie C. Clinical insights: Equine analgesia.. Equine Vet. J. 2021;53:407–409.
    doi: 10.1111/evj.13421pubmed: 33834534google scholar: lookup
  12. Robert MP, Chapuis RJJ, de Fourmestraux C, Geffroy OJ. Complications and risk factors of castration with primary wound closure: Retrospective study in 159 horses.. Can. Vet. J. 2017;58:6.
    pmc: PMC5394602pubmed: 28487590
  13. Graubner C, Gerber V, Doherr M, Spadavecchia C. Clinical application and reliability of a post abdominal surgery pain assessment scale (PASPAS) in horses.. Vet. J. 2011;188:178–183.
    doi: 10.1016/j.tvjl.2010.04.029pubmed: 20627635google scholar: lookup
  14. Leroux A. Les anti-inflammatoires non stéroïdiens: Mise à jour des connaissances et impact sur les pratiques d’utilisation.. Prat. Vet. Equine. 2021;211:6–14.
  15. Knych HK. Nonsteroidal Anti-inflammatory Drug Use in Horses.. Vet. Clin. N. Am. Equine Pract. 2017;33:1–15.
    doi: 10.1016/j.cveq.2016.11.001pubmed: 28190614google scholar: lookup
  16. Richardson LM, Whitfield-Cargile CM, Cohen ND, Chamoun-Emanuelli AM, Dockery HJ. Effect of selective versus nonselective cyclooxygenase inhibitors on gastric ulceration scores and intestinal inflammation in horses.. Vet. Surg. 2018;47:784–791.
    doi: 10.1111/vsu.12941pubmed: 30094858google scholar: lookup
  17. Beretta C, Garavaglia G, Cavalli M. COX-1 and COX-2 inhibition in horse blood by phenylbutazone, flunixin, carprofen and meloxicam: An in vitro analysis.. Pharmacol. Res. 2005;52:302–306.
    doi: 10.1016/j.phrs.2005.04.004pubmed: 15939622google scholar: lookup
  18. Ziegler AL, Freeman CK, Fogle CA, Burke MJ, Davis JL, Cook VL, Southwood LL, Blikslager AT. Multicentre, blinded, randomised clinical trial comparing the use of flunixin meglumine with firocoxib in horses with small intestinal strangulating obstruction.. Equine Vet. J. 2019;51:329–335.
    doi: 10.1111/evj.13013pmc: PMC6788450pubmed: 30156312google scholar: lookup
  19. Di Salvo A, Giorgi M, Nannarone S, Lee HK, Corsalini J, della Rocca G. Postoperative pharmacokinetics of meloxicam in horses after surgery for colic syndrome.. J. Vet. Pharmacol. Therap. 2018;41:369–373.
    doi: 10.1111/jvp.12461pubmed: 29057473google scholar: lookup
  20. Ziegler A, Fogle C, Blikslager A. Update on the use of cyclooxygenase-2-selective nonsteroidal anti-inflammatory drugs in horses.. J. Am. Vet. Med. Assoc. 2017;250:1271–1274.
    doi: 10.2460/javma.250.11.1271pmc: PMC5588883pubmed: 28509650google scholar: lookup
  21. Little D, Brown SA, Campbell NB, Moeser AJ, Davis JL, Blikslager AT. Effects of the cyclooxygenase inhibitor meloxicam on recovery of ischemia-injured equine jejunum.. Am. J. Vet. Res. 2007;68:614–624.
    doi: 10.2460/ajvr.68.6.614pubmed: 17542694google scholar: lookup
  22. Davis JL. Pharmacologic Principles.. Equine Internal Medicine 2018. pp. 79–137.
  23. Jackman BR, Moore JN, Barton MH, Morris DD. Comparison of the Effects of Ketoprofen and Flunixin Meglumine on the in vitro Response of Equine Peripheral Blood Monocytes to Bacterial Endotoxin.. Can. J. Vet. Res. 1994;58:138–143.
    pmc: PMC1263680pubmed: 8004539
  24. Arifah AK, Landoni MF, Lees P. Pharmacodynamics, chiral pharmacokinetics and PK-PD modelling of ketoprofen in the goat: PK-PD modelling of ketoprofen.. J. Vet. Pharmacol. Ther. 2003;26:139–150.
    doi: 10.1046/j.1365-2885.2003.00455.xpubmed: 12667184google scholar: lookup
  25. Landoni MF, Lees P. Pharmacokinetics and pharmacodynamics of ketoprofen enantiomers in the horse.. J. Vet. Pharmacol. Ther. 1996;19:466–474.
    doi: 10.1111/j.1365-2885.1996.tb00084.xpubmed: 8971676google scholar: lookup
  26. Naylor RJ, Taylor AH, Knowles EJ, Wilford S, Linnenkohl W, Mair TS, Johns IC. Comparison of flunixin meglumine and meloxicam for post operative management of horses with strangulating small intestinal lesions: Does meloxicam improve survival in horses following small intestinal strangulation?. Equine Vet. J. 2014;46:427–434.
    doi: 10.1111/evj.12224pubmed: 24372991google scholar: lookup
  27. Gobbi FP, Di Filippo PA, de Macêdo Mello L, Lemos GB, Martins CB, Albernaz AP, Quirino CR. Effects of Flunixin Meglumine, Firocoxib, and Meloxicam in Equines After Castration.. J. Equine Vet. Sci. 2020;94:103229.
    doi: 10.1016/j.jevs.2020.103229pubmed: 33077071google scholar: lookup
  28. Fogle C, Davis J, Yechuri B, Cordle K, Marshall J, Blikslager A. Ex vivo COX-1 and COX-2 inhibition in equine blood by phenylbutazone, flunixin meglumine, meloxicam and firocoxib: Informing clinical NSAID selection.. Equine Vet. Educ. 2021;33:198–207.
    doi: 10.1111/eve.13280google scholar: lookup
  29. Longo E, Autefage A, Bayle R, Keister M, Gool EV. Efficacy of a non-steroidal anti-inflammatory, ketofen 10% (ketoprofen) in the treatment of colic in horses.. J. Equine Vet. Sci. 1992;12:311–315.
    doi: 10.1016/S0737-0806(06)81340-7google scholar: lookup
  30. Lees P, Sedgwick AD, Higgins AJ, Pugh KE, Busch U. Pharmacodynamics and pharmacokinetics of miloxicam in the horse.. Br. Vet. J. 1991;147:97–108.
    doi: 10.1016/0007-1935(91)90099-9pubmed: 1868324google scholar: lookup
  31. Toutain P-L, Reymond N, Laroute V, Garcia P, Popot M-A, Bonnaire Y, Hirsch A, Narbe R. Pharmacokinetics of meloxicam in plasma and urine of horses.. Am. J. Vet. Res. 2004;65:1542–1547.
    doi: 10.2460/ajvr.2004.65.1542pubmed: 15566093google scholar: lookup
  32. Landoni MF, Lees P. Comparison of the anti-inflammatory actions of flunixin and ketoprofen in horses applying PK/PD modelling.. Equine Vet. J. 1995;27:247–256.
    doi: 10.1111/j.2042-3306.1995.tb03073.xpubmed: 8536660google scholar: lookup
  33. Owens JG, Kamerling SG, Barker SA. Pharmacokinetics of ketoprofen in healthy horses and horses with acute synovitis.. J. Vet. Pharmacol. Ther. 1995;18:187–195.
    doi: 10.1111/j.1365-2885.1995.tb00577.xpubmed: 7674454google scholar: lookup
  34. Knych HK, Arthur RM, Steinmetz S, McKemie DS. Pharmacokinetics of ketoprofen enantiomers following intravenous and oral administration to exercised Thoroughbred horses.. Vet. J. 2016;207:196–198.
    doi: 10.1016/j.tvjl.2015.09.018pubmed: 27152386google scholar: lookup
  35. Sams R, Gerken DF, Ashcraft SM. Pharmacokinetics of ketoprofen after multiple intravenous doses to mares.. J. Vet. Pharmacol. Ther. 1995;18:108–116.
    doi: 10.1111/j.1365-2885.1995.tb00563.xpubmed: 7629924google scholar: lookup
  36. Cook VL, Meyer CT, Campbell NB, Blikslager AT. Effect of firocoxib or flunixin meglumine on recovery of ischemic-injured equine jejunum.. AJVR 2009;70:992–1000.
    doi: 10.2460/ajvr.70.8.992pubmed: 19645580google scholar: lookup
  37. Ziegler AL, Blikslager AT. Sparing the gut: COX-2 inhibitors herald a new era for treatment of horses with surgical colic.. Equine Vet. Educ. 2020;32:611–616.
    doi: 10.1111/eve.13189pmc: PMC8297937pubmed: 34305336google scholar: lookup
  38. Giovanni G, Giovanni P. Do non-steroidal anti-inflammatory drugs and COX-2 selective inhibitors have different renal effects?. J. Nephrol. 2002;15:480–488.
    pubmed: 12455713
  39. Wallace JL. Prostaglandins, NSAIDs, and Gastric Mucosal Protection: Why Doesn’t the Stomach Digest Itself?. Physiol. Rev. 2008;88:1547–1565.
    doi: 10.1152/physrev.00004.2008pubmed: 18923189google scholar: lookup
  40. Valros A, Hänninen L. Animal Ethical Views and Perception of Animal Pain in Veterinary Students.. Animals 2018;8:220.
    doi: 10.3390/ani8120220pmc: PMC6315997pubmed: 30477084google scholar: lookup
  41. Sutton GA, Paltiel O, Soffer M, Turner D. Validation of two behaviour-based pain scales for horses with acute colic.. Vet. J. 2013;197:646–650.
    doi: 10.1016/j.tvjl.2013.04.007pubmed: 23993390google scholar: lookup
  42. Maskato Y, Dugdale AHA, Singer ER, Kelmer G, Sutton GA. Prospective Feasibility and Revalidation of the Equine Acute Abdominal Pain Scale (EAAPS) in Clinical Cases of Colic in Horses.. Animals 2020;10:2242.
    doi: 10.3390/ani10122242pmc: PMC7760242pubmed: 33260428google scholar: lookup
  43. Engelhardt G, Homma D, Schlegel K, Utzmann R, Schnitzler C. Anti-inflammatory, analgesic, antipyretic and related properties of meloxicam, a new non-steroidal anti-inflammatory agent with favourable gastrointestinal tolerance.. Inflamm. Res. 1995;44:423–433.
    doi: 10.1007/BF01757699pubmed: 8564518google scholar: lookup
  44. Gleerup KB, Lindegaard C. Recognition and quantification of pain in horses: A tutorial review.. Equine Vet. Educ. 2016;28:47–57.
    doi: 10.1111/eve.12383google scholar: lookup

Citations

This article has been cited 6 times.
  1. da Silva NEOF, Trindade PHE, da Silva GV, de Oliveira FA, Taffarel MO, de Lima MT, Tomacheuski RM, Rosa GDS, Alves ALG, Luna SPL. Clinical validation of the Unesp-Botucatu acute pain scale in sheep undergoing orthopedic surgery. PLoS One 2025;20(5):e0323132.
    doi: 10.1371/journal.pone.0323132pubmed: 40354487google scholar: lookup
  2. Laves J, Wergin M, Bauer N, Müller SF, Failing K, Büttner K, Hagen A, Melzer M, Röcken M. The effect of Traumeel LT ad us. vet. on the perioperative inflammatory response after castration of stallions: a prospective, randomized, double-blinded study. Front Vet Sci 2024;11:1342345.
    doi: 10.3389/fvets.2024.1342345pubmed: 39415958google scholar: lookup
  3. Fikri F, Hendrawan D, Wicaksono AP, Purnomo A, Khairani S, Chhetri S, Purnama MTE, Çalışkan H. Colic incidence, risk factors, and therapeutic management in a working horse population in Tuban, Indonesia. Vet World 2024 May;17(5):963-972.
    doi: 10.14202/vetworld.2024.963-972pubmed: 38911082google scholar: lookup
  4. Citarella G, Heitzmann V, Ranninger E, Bettschart-Wolfensberger R. Analgesic Efficacy of Non-Steroidal Anti-Inflammatory Drug Therapy in Horses with Abdominal Pain: A Systematic Review. Animals (Basel) 2023 Nov 8;13(22).
    doi: 10.3390/ani13223447pubmed: 38003065google scholar: lookup
  5. Mercer MA, Davis JL, McKenzie HC. The Clinical Pharmacology and Therapeutic Evaluation of Non-Steroidal Anti-Inflammatory Drugs in Adult Horses. Animals (Basel) 2023 May 10;13(10).
    doi: 10.3390/ani13101597pubmed: 37238029google scholar: lookup
  6. Vullo C, Crupi R, Di Paola R, Cuzzocrea S, Gugliandolo E, Biondi V, Catone G. Intratesticular Versus Intrafunicular Lidocaine to Reduce Perioperative Nociception and Immunological Response in Ponies Undergoing Field Castration. Vet Sci 2022 Nov 28;9(12).
    doi: 10.3390/vetsci9120664pubmed: 36548825google scholar: lookup
Subscribe to our newsletter
Join 99,360 horse owners like you who receive our email updates on horse health and nutrition.