Efficacy, chondrotoxicity and plasma concentrations of tramadol following intra-articular administration in horses undergoing arthroscopy: preliminary findings.
Abstract: Intra-articular administration of analgesics is performed to ensure good perioperative pain management avoiding undesirable systemic effects. To evaluate the effect of intra-articular injection of tramadol on postoperative pain after arthroscopy in horses and to determine whether tramadol had a local effect. Before the in vivo study, an in vitro test was performed aiming to evaluate the viability of equine chondrocytes after exposure to various concentrations of tramadol. The concentration identified as most appropriate was used to treat the horses' joints. Twelve horses affected by osteochondrosis were randomly assigned to two groups that were treated intra-articularly at the end of surgery with tramadol (4 mg/mL) and saline, respectively. At predetermined time-points a Composite Pain Scale was applied and blood samples were collected in order to define the extent of tramadol absorption into the systemic circulation. The Mann-Whitney test was used for statistical analysis. Serum of four out of six treated horses revealed traces of tramadol (range 10.6-19.3 ng/mL) sporadically between 0.5 and 4 hours post-treatment, while in the other two horses, no trace of drug was found. Findings suggested that any eventual effect was probably due to local action rather than systemic absorption. The pain scores obtained in tramadol-treated horses were lower between 1 and 6 hours post-administration, than those obtained in the control group, but the differences were not statistically significant. These preliminary results suggest that tramadol, at this concentration, is only mildly beneficial in the pain management of horses after arthroscopy.
Publication Date: 2019-02-19 PubMed ID: 30773122PubMed Central: PMC6831008DOI: 10.1080/01652176.2018.1546963Google 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.
- Clinical Trial
- Veterinary
- 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.
The study investigates the effect of applying tramadol, an analgesic, directly into the joints of horses undergoing arthroscopy, while assessing potential chondrotoxicity. The preliminary findings suggest that tramadol may mildly alleviate post-surgery pain, probably due to its local action, while also displaying a minimal presence in the horses’ systemic circulation.
Study Design and Objective
- The research primarily aimed at assessing the impact of tramadol when applied directly into the horse’s joints during arthroscopy on the post-surgery pain. This method was chosen to avoid any potential systemic side effects.
- As chondrotoxicity (harmful effects on cartilage) is a critical factor, the study also evaluated the effect of different tramadol concentrations on the viability of horse chondrocytes in an in vitro experiment.
- The concentration determined to be the most suitable was employed for treating the horses’ joints.
- Additionally, blood samples were collected at given time-points to evaluate the extent of tramadol absorption into the horses’ systemic circulation.
Methodology and Results
- 12 horses experiencing osteochondrosis were divided randomly into two groups. The first group received intra-articular tramadol (4 mg/mL) treatment at the end of surgery, while the second group (controls) were treated with saline solution instead.
- Post-treatment, the horses’ pain levels were assessed using a Composite Pain Scale at deterministic time intervals.
- Four out of six treated horses showed traces (range 10.6-19.3 ng/mL) of tramadol in their blood sporadically within 0.5 and 4 hours post-treatment. The two other horses displayed no sign of the drug in their system.
- The pain scores for the tramadol-treated horses were generally lower between 1 and 6 hours post-administration than those recorded in the control group, indicating some level of pain relief. However, these differences were not statistically significant according to Mann-Whitney test.
Implications and Conclusions
- The initial results imply that tramadol may offer mild pain management benefits to horses following arthroscopy when administered intra-articularly.
- The sporadic presence of tramadol in the systemic circulation implies that any pain relief observed may be due to its local effect.
- However, as the differences in pain relief between the tramadol-treated and control groups were statistically insignificant, further research with larger sample size is required to conclusively determine the analgesic efficacy of tramadol in equine arthroscopy.
- The lack of chondrotoxicity at the selected concentration of tramadol is promising but warrants further examination.
Cite This Article
APA
Di Salvo A, Chiaradia E, Della Rocca G, Giorgi M, Mancini F, Marenzoni ML, Conti MB, Nannarone S.
(2019).
Efficacy, chondrotoxicity and plasma concentrations of tramadol following intra-articular administration in horses undergoing arthroscopy: preliminary findings.
Vet Q, 38(1), 129-137.
https://doi.org/10.1080/01652176.2018.1546963 Publication
Researcher Affiliations
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy.
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy.
- b CSCS-Centro di Studi del Cavallo Sportivo, University of Perugia , Perugia , Italy.
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy.
- c CeSDA-Centro di Studio sul Dolore Animale, University of Perugia , Perugia , Italy.
- d Department of Veterinary Sciences , University of Pisa , Pisa , Italy.
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy.
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy.
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy.
- c CeSDA-Centro di Studio sul Dolore Animale, University of Perugia , Perugia , Italy.
- a Department of Veterinary Medicine , University of Perugia , Perugia , Italy.
- b CSCS-Centro di Studi del Cavallo Sportivo, University of Perugia , Perugia , Italy.
- c CeSDA-Centro di Studio sul Dolore Animale, University of Perugia , Perugia , Italy.
MeSH Terms
- Analgesics, Opioid / adverse effects
- Analgesics, Opioid / therapeutic use
- Animals
- Arthroscopy / veterinary
- Horse Diseases / chemically induced
- Horses
- Injections, Intra-Articular / veterinary
- Joint Diseases / chemically induced
- Joint Diseases / diagnosis
- Joint Diseases / veterinary
- Pain / prevention & control
- Random Allocation
- Tramadol / adverse effects
- Tramadol / therapeutic use
References
This article includes 50 references
- Akinci SB, Saricaoğlu F, Atay OA, Doral MN, Kanbak M. Analgesic effect of intra-articular tramadol compared with morphine after arthroscopic knee surgery.. Arthroscopy 2005 Sep;21(9):1060-5.
- Alagöl A, Calpur OU, Kaya G, Pamukçu Z, Turan FN. The use of intraarticular tramadol for postoperative analgesia after arthroscopic knee surgery: a comparison of different intraarticular and intravenous doses.. Knee Surg Sports Traumatol Arthrosc 2004 May;12(3):184-8.
- Al-Metwalli RR, Mowafi HA, Ismail SA, Siddiqui AK, Al-Ghamdi AM, Shafi MA, El-Saleh AR. Effect of intra-articular dexmedetomidine on postoperative analgesia after arthroscopic knee surgery.. Br J Anaesth 2008 Sep;101(3):395-9.
- Altunkaya H, Ozer Y, Kargi E, Babuccu O. Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures.. Br J Anaesth 2003 Mar;90(3):320-2.
- Altunkaya H, Ozer Y, Kargi E, Ozkocak I, Hosnuter M, Demirel CB, Babuccu O. The postoperative analgesic effect of tramadol when used as subcutaneous local anesthetic.. Anesth Analg 2004 Nov;99(5):1461-1464.
- Arai YC, Ikeuchi M, Fukunaga K, Ueda W, Kimura T, Komatsu T. Intra-articular injection of warmed lidocaine improves intraoperative anaesthetic and postoperative analgesic conditions.. Br J Anaesth 2006 Feb;96(2):259-61.
- Bashandy MM, Ibrahim AK, El-Olemy KA, EL Ghoul WS, Morgan HM. Clinicopathological, radiological and synovial fluid evaluations in common musculoskeletal affections in horses.. Global Veterinaria 13889–897.
- Beyzadeoğlu T, Torun Köse G, Ekinci ID, Bekler H, Yilmaz C. Cytotoxicity of local anesthetics to rats' articular cartilage: an experimental study.. Acta Orthop Traumatol Turc 2012;46(3):201-7.
- Bussières G, Jacques C, Lainay O, Beauchamp G, Leblond A, Cadoré JL, Desmaizières LM, Cuvelliez SG, Troncy E. Development of a composite orthopaedic pain scale in horses.. Res Vet Sci 2008 Oct;85(2):294-306.
- Clark-Price SC. Recovery of horses from anesthesia.. Vet Clin North Am Equine Pract 2013 Apr;29(1):223-42.
- Clark-Price SC, Posner LP, Gleed RD. Recovery of horses from general anesthesia in a darkened or illuminated recovery stall.. Vet Anaesth Analg 2008 Nov;35(6):473-9.
- 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(3):e92281.
- Di Salvo A, Bufalari A, De Monte V, Cagnardi P, Marenzoni ML, Catanzaro A, Vigorito V, Della Rocca G. Intra-articular administration of lidocaine in anaesthetized dogs: pharmacokinetic profile and safety on cardiovascular and nervous systems.. J Vet Pharmacol Ther 2015 Aug;38(4):350-6.
- Di Salvo A, Chiaradia E, della Rocca G, Mancini F, Galarini R, Giusepponi D, De Monte V, Cagnardi P, Marenzoni ML, Bufalari A. Intra-articular administration of lidocaine plus adrenaline in dogs: Pharmacokinetic profile and evaluation of toxicity in vivo and in vitro.. Vet J 2016 Feb;208:70-5.
- Di Salvo A, Della Rocca G, Bazzica C, Giontella A, Cagnardi P, Nannarone S. A pharmacokinetic/clinical approach to postulate a local action of intra-articular xylazine administration in the horse: a preliminary study.. J Vet Pharmacol Ther 2014 Oct;37(5):464-71.
- Faisal H, Lamichhane A, Mahara D. Analgesic effect of intraarticular tramadol with morphine after arthroscopic knee surgery.. NOAJ 314–18.
- Fatahian Dehkordi RA, Bigham-Sadegh A, Vajdi N. The effects of intra-articular tramadol administration on histopathological indices in rat knee joints.. Vet Arhiv 84667–676.
- Giorgi M, Soldani G, Manera C, Ferrarini PL, Sgorbini M, Saccomanni G. Pharmacokinetics of tramadol and its metabolites M1, M2 and M5 in horses following intravenous, immediate release (Fasted/Fed) and sustained release single dose administration.. J Equine Vet Sci 27(11):481–488.
- Gleerup KB, Forkman B, Lindegaard C, Andersen PH. An equine pain face.. Vet Anaesth Analg 2015 Jan;42(1):103-14.
- Gleerup KB, Lindegaard C. Recognition and quantification of pain in horses: A tutorial review.. Equine Vet Educ 28(1):47–57.
- Grond S, Meuser T, Uragg H, Stahlberg HJ, Lehmann KA. Serum concentrations of tramadol enantiomers during patient-controlled analgesia.. Br J Clin Pharmacol 1999 Aug;48(2):254-7.
- Grond S, Sablotzki A. Clinical pharmacology of tramadol.. Clin Pharmacokinet 2004;43(13):879-923.
- Hassan AA, Khalil MM. Intra-articular analgesia with ketamine and tramadol; the effect of the type of surgery.. AJAIC 861–67.
- Hofmeister EH, King J, Read MR, Budsberg SC. Sample size and statistical power in the small-animal analgesia literature.. J Small Anim Pract 2007 Feb;48(2):76-9.
- ICRS Clinical Cartilage Injury Evaluation system-2000 n2000. nhttps://cartilage.org/society/publications/icrs-score/ (accessed 13 March 2018). International Cartilage Repair Society, Switzerland,
- Jacobs TF, Vansintjan PS, Roels N, Herregods SS, Verbruggen G, Herregods LL, Almqvist KF. The effect of Lidocaine on the viability of cultivated mature human cartilage cells: an in vitro study.. Knee Surg Sports Traumatol Arthrosc 2011 Jul;19(7):1206-13.
- Jahromi AR, Lischer C, Ehrle A. Assessment of analgesic efficacy of intra-articular tramadol administration following arthroscopic surgery in horses - a pilot study.. IJVS 11:1–7.
- Jahromi AR, Naeini AT, Nazifi S. Effects of intraarticular tramadol administration on biochemical and cytological properties of equine synovial fluid: comparison with lidocaine.. Am J Pharmacol Toxicol 6:20–26.
- Jazayeri SM, Mosaffa F, Abbasian M, Hosseinzadeh HR. Comparing the efficacy of intra-articular application of morphine and tramadol on postoperative pain after arthroscopic knee surgery.. Anesth Pain Med 2012 Summer;2(1):28-31.
- Joshi W, Reuben SS, Kilaru PR, Sklar J, Maciolek H. Postoperative analgesia for outpatient arthroscopic knee surgery with intraarticular clonidine and/or morphine.. Anesth Analg 2000 May;90(5):1102-6.
- Kazak Bengisun Z, Aysu Salviz E, Darcin K, Suer H, Ates Y. Intraarticular levobupivacaine or bupivacaine administration decreases pain scores and provides a better recovery after total knee arthroplasty.. J Anesth 2010 Oct;24(5):694-9.
- Kola M, Uzun S, Zeybek ND, Saricaoğlu F, Akinci SB, Aypar Ü, Asan E. Effects of intra articular tramadol on articular cartilage and synovium of rats.. J Clin Exp Invest 6:337–342.
- Lehmann KA, Kratzenberg U, Schroeder-Bark B, Horrichs-Haermeyer G. Postoperative patient-controlled analgesia with tramadol: analgesic efficacy and minimum effective concentrations.. Clin J Pain 1990 Sep;6(3):212-20.
- Lindegaard C, Thomsen MH, Larsen S, Andersen PH. Analgesic efficacy of intra-articular morphine in experimentally induced radiocarpal synovitis in horses.. Vet Anaesth Analg 2010 Mar;37(2):171-85.
- Mancini F, Nannarone S, Buratta S, Ferrara G, Stabile AM, Vuerich M, Santinelli I, Pistilli A, Chiaradia E. Effects of xylazine and dexmedetomidine on equine articular chondrocytes in vitro.. Vet Anaesth Analg 2017 Mar;44(2):295-308.
- McIlwraith CW. Experiences in diagnostic and surgical arthroscopy in the horse.. Equine Vet J 1984 Jan;16(1):11-9.
- Miyazaki T, Kobayashi S, Takeno K, Yayama T, Meir A, Baba H. Lidocaine cytotoxicity to the bovine articular chondrocytes in vitro: changes in cell viability and proteoglycan metabolism.. Knee Surg Sports Traumatol Arthrosc 2011 Jul;19(7):1198-205.
- Naccache F, Metzger J, Distl O. Genetic risk factors for osteochondrosis in various horse breeds.. Equine Vet J 2018 Sep;50(5):556-563.
- Park J, Sutradhar BC, Hong G, Choi SH, Kim G. Comparison of the cytotoxic effects of bupivacaine, lidocaine, and mepivacaine in equine articular chondrocytes.. Vet Anaesth Analg 2011 Mar;38(2):127-33.
- Piat P, Richard H, Beauchamp G, Laverty S. In vivo effects of a single intra-articular injection of 2% lidocaine or 0.5% bupivacaine on articular cartilage of normal horses.. Vet Surg 2012 Nov;41(8):1002-10.
- Santos LC, de Moraes AN, Saito ME. Effects of intraarticular ropivacaine and morphine on lipopolysaccharide-induced synovitis in horses.. Vet Anaesth Analg 2009 May;36(3):280-6.
- Santos M, Fuente M, Garcia-Iturralde R, Herran R, Lopez-Sanroman J, Tendillo FJ. Effects of alpha-2 adrenoceptor agonists during recovery from isoflurane anaesthesia in horses.. Equine Vet J 2003 Mar;35(2):170-5.
- Savoia G, Loreto M, Scibelli G. [Systemic review of trials on the use of tramadol in the treatment of acute and chronic pain].. Minerva Anestesiol 2000 Oct;66(10):713-31.
- Sheehy JG, Hellyer PW, Sammonds GE, Mama KR, Powers BE, Hendrickson DA, Magnusson KR. Evaluation of opioid receptors in synovial membranes of horses.. Am J Vet Res 2001 Sep;62(9):1408-12.
- Stein C, Clark JD, Oh U, Vasko MR, Wilcox GL, Overland AC, Vanderah TW, Spencer RH. Peripheral mechanisms of pain and analgesia.. Brain Res Rev 2009 Apr;60(1):90-113.
- Van Vynckt D, Polis I, Verschooten F, Van Ryssen B. A review of the human and veterinary literature on local anaesthetics and their intra-articular use. Relevant information for lameness diagnosis in the dog.. Vet Comp Orthop Traumatol 2010;23(4):225-30.
- van Weeren PR, de Grauw JC. Pain in osteoarthritis.. Vet Clin North Am Equine Pract 2010 Dec;26(3):619-42.
- van Weeren PR, Jeffcott LB. Problems and pointers in osteochondrosis: Twenty years on.. Vet J 2013 Jul;197(1):96-102.
- Webb ST, Ghosh S. Intra-articular bupivacaine: potentially chondrotoxic?. Br J Anaesth 2009 Apr;102(4):439-41.
- Wernecke C, Braun HJ, Dragoo JL. The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review.. Orthop J Sports Med 2015 May;3(5):2325967115581163.
Citations
This article has been cited 0 times.Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists