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Haralambus R, Juri M, Mokry A, Jenner F. The impact of opioid administration on the incidence of postanaesthetic colic in horses. FRONTIERS IN PAIN RESEARCH 2024; 5:1347548. [PMID: 38440199 PMCID: PMC10910105 DOI: 10.3389/fpain.2024.1347548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/08/2024] [Indexed: 03/06/2024] Open
Abstract
Effective management of postoperative pain is essential to ensure patient welfare, reduce morbidity and optimize recovery. Opioids are effective in managing moderate to severe pain in horses but concerns over their adverse effects on gastrointestinal (GI) motility and associated increased colic risk limit their widespread use. Studies investigating the impact of systemic opioids on both GI motility and colic incidence in horses have yielded inconclusive outcomes. Therefore, this retrospective study aims to assess the influence of systemic administration of butorphanol, morphine, and methadone on post-anaesthetic colic (PAC) incidence. Horses undergoing general anaesthesia for non-gastrointestinal procedures that were hospitalized for at least 72 h post-anaesthesia were included in this study. Anaesthetised horses were stratified by procedure type into horses undergoing diagnostic imaging without surgical intervention, emergency or elective surgery. In addition, patients were grouped by opioid treatment regime into horses receiving no opioids, intraanaesthetic, short- (<24 h) or long-term (>24 h) postoperative opioids. Administered opioids encompassed butorphanol, morphine and methadone. The number of horses showing signs of colic in the 72 h after anaesthesia was assessed for each group. A total of 782 horses were included, comprising 659 undergoing surgical procedures and 123 undergoing diagnostic imaging. The overall PAC incidence was 15.1%. Notably, horses undergoing diagnostic imaging without surgery had a significantly lower PAC rate of 6.5% compared to those undergoing surgery (16.7%, p = 0.0146). Emergency surgeries had a significantly lower PAC rate of 5.8% compared to elective procedures (18%, p = 0.0113). Of the 782 horses, 740 received intraoperative opioids and 204 postoperative opioids, 102 of which long-term (≥24 h). Neither intraoperative (p = 0.4243) nor short-term postoperative opioids (p = 0.5744) increased PAC rates. Notably, only the long-term (≥24 h) administration of morphine significantly increased PAC incidence to 34% (p = 0.0038). In contrast, long-term butorphanol (5.3% PAC, p = 0.8482) and methadone (18.4% PAC, p = 0.6161) did not affect PAC rates. In summary, extended morphine administration was the only opioid treatment associated with a significantly increased risk of PAC.
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Affiliation(s)
- Rhea Haralambus
- Equine Surgery Unit, University Equine Hospital, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | | | | | - Florien Jenner
- Equine Surgery Unit, University Equine Hospital, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
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Castro-Cuellar G, Cremer J, Queiroz-Williams P, Knych HK, Leise BS. Pharmacokinetics of intra-articular buprenorphine in horses with lipopolysaccharide-induced synovitis. J Vet Pharmacol Ther 2023. [PMID: 36815620 DOI: 10.1111/jvp.13119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
The objective of this study was to describe the pharmacokinetics of intra-articular (IA) administered buprenorphine in horses with lipopolysaccharide (LPS)-induced synovitis. Radiocarpal synovitis was induced in six healthy adult horses with the IA injection of LPS (0.5 ng/joint) on two occasions in a randomized cross-over design. Treatments (IA buprenorphine (IAB) at 5 μg/kg plus intravenous saline; and intravenous buprenorphine (IVB) at 5 μg/kg plus IA saline) were administered 4 h following LPS injection. Concentrations of buprenorphine were assessed in plasma and synovial fluid (SF) at 0.5, 2, 6, 12, and 24 h after administration. Pharmacokinetic parameters after IVB and IAB in plasma and synovial fluid were calculated using a nonlinear mixed effects model. IAB was detectable in SF of all horses at 24 h [median concentration of 6.2 (3.46-22.6) ng/mL]. IAB resulted in a median plasma concentration of 0.59 (0.42-1.68) ng/mL at 0.5 h and was detectable in all subjects for up to 6 h and in two horses for up to 12 h. IVB resulted in SF concentrations detected up to 6 h in all horses [median concentration of 0.12 (0.07-0.82) ng/mL]. Results suggest that IA buprenorphine remains present in the inflamed joint for at least 24 h and systemic absorption occurs.
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Affiliation(s)
- Gabriel Castro-Cuellar
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Jeannette Cremer
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Patricia Queiroz-Williams
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Heather K Knych
- KL Maddy Equine Analytical Pharmacology Lab, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Britta S Leise
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
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Castro-Cuellar G, Cremer J, Liu CC, Queiroz-Williams P, Hampton C, Leise BS. Buprenorphine has a concentration-dependent cytotoxic effect on equine chondrocytes in vitro. Am J Vet Res 2023; 84:ajvr.22.08.0143. [PMID: 36662607 DOI: 10.2460/ajvr.22.08.0143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the cytotoxic effects of 2 different concentrations of buprenorphine and compare them with bupivacaine and morphine on healthy equine chondrocytes in vitro. SAMPLE Primary cultured equine articular chondrocytes from 3 healthy adult horses. PROCEDURES Chondrocytes were exposed for 0 and 2 hours to the following treatments: media (CON; negative control); bupivacaine at 2.2 mg/mL (BUPI; positive control); morphine at 2.85 mg/mL (MOR); buprenorphine at 0.12 mg/mL (HBUPRE); or buprenorphine at 0.05 mg/mL (LBUPRE). Chondrocyte viability was assessed using live/dead staining, water-soluble tetrazolium salt-8 (WST-8) cytotoxic assay, LDH assay, and flow cytometry. All continuous variables were evaluated with a mixed ANOVA with treatment, time, and their interactions as the fixed effects and each horse as the random effect. RESULTS Buprenorphine showed a concentration-dependent chondrotoxic effect. The viability of chondrocytes was significantly decreased with exposure to HBUPRE and BUPI compared to CON, MOR, and LBUPRE. CLINICAL RELEVANCE Negligible chondrotoxic effects were observed in healthy cultured equine chondrocytes exposed to 0.05 mg/mL of buprenorphine, whereas higher concentrations (0.12 mg/mL) showed a marked cytotoxic effect. Based on these results, low concentrations of buprenorphine appear to be safe for intra-articular administration. Further evaluation of this dose in vivo is needed before recommending its clinical use.
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Affiliation(s)
- Gabriel Castro-Cuellar
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
| | - Jeannette Cremer
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
| | - Chin-Chi Liu
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
| | - Patricia Queiroz-Williams
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
| | - Chiara Hampton
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN
| | - Britta Sigrid Leise
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
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Haunhorst FR, Hopster K, Schmicke M, Bienert-Zeit A, Kästner S. Clinical effect of buprenorphine or butorphanol, in combination with detomidine and diazepam, on sedation and postoperative pain after cheek tooth extraction in horses. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2022; 63:39-46. [PMID: 34975166 PMCID: PMC8682929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The objective of this study was to compare effects of butorphanol (BUT) or buprenorphine (BUP), in combination with detomidine and diazepam, on the sedation quality, surgical conditions, and postoperative pain control after cheek tooth extraction in horses, randomly allocated to 2 treatment groups (BUT: n = 20; BUP: n = 20). A bolus of detomidine (15 μg/kg, IV) was followed by either BUP (7.5 μg/kg, IV) or BUT (0.05 mg/kg, IV). After 20 min, diazepam (0.01 mg/kg, IV) was administered and sedation was maintained with a detomidine IV infusion (20 μg/kg/h), with rate adjusted based on scores to 5 variables. All horses received a nerve block (maxillary or mandibular), and gingival infiltration with mepivacaine. Sedation quality was assessed by the surgeon from 1 (excellent) to 10 (surgery not feasible). A pain scoring system (EQUUS-FAP) was used to assess postoperative pain. Serum cortisol concentrations and locomotor activity (pedometers) were measured. Horses in BUP and BUT required a median detomidine infusion rate of 30.2 μg/kg/h (20 to 74.4 μg/kg/h) and 32.2 μg/kg/h (20 to 48.1 μg/kg/h), respectively (P = 0.22). Horses in the BUP group had better sedation quality (P < 0.05) during surgery and higher step counts (P < 0.001) postoperatively. Buprenorphine combined with detomidine provided a more reliable sedation than butorphanol. However, the EQUUS-FAP pain scale became unreliable because of BUP-induced excitement behavior.
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Affiliation(s)
- Franziska R Haunhorst
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany (Haunhorst, Bienert-Zeit); Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Road, Kennett Square, Philadelphia, Pennsylvania 19348, USA (Hopster); Institute of Agricultural and Nutritional Sciences, Martin-Luther University Halle-Wittenberg, Theodor-Lieser-Str. 11, 06120 Halle, Germany (Schmicke); Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany (Kästner)
| | - Klaus Hopster
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany (Haunhorst, Bienert-Zeit); Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Road, Kennett Square, Philadelphia, Pennsylvania 19348, USA (Hopster); Institute of Agricultural and Nutritional Sciences, Martin-Luther University Halle-Wittenberg, Theodor-Lieser-Str. 11, 06120 Halle, Germany (Schmicke); Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany (Kästner)
| | - Marion Schmicke
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany (Haunhorst, Bienert-Zeit); Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Road, Kennett Square, Philadelphia, Pennsylvania 19348, USA (Hopster); Institute of Agricultural and Nutritional Sciences, Martin-Luther University Halle-Wittenberg, Theodor-Lieser-Str. 11, 06120 Halle, Germany (Schmicke); Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany (Kästner)
| | - Astrid Bienert-Zeit
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany (Haunhorst, Bienert-Zeit); Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Road, Kennett Square, Philadelphia, Pennsylvania 19348, USA (Hopster); Institute of Agricultural and Nutritional Sciences, Martin-Luther University Halle-Wittenberg, Theodor-Lieser-Str. 11, 06120 Halle, Germany (Schmicke); Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany (Kästner)
| | - Sabine Kästner
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany (Haunhorst, Bienert-Zeit); Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Road, Kennett Square, Philadelphia, Pennsylvania 19348, USA (Hopster); Institute of Agricultural and Nutritional Sciences, Martin-Luther University Halle-Wittenberg, Theodor-Lieser-Str. 11, 06120 Halle, Germany (Schmicke); Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany (Kästner)
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Straticò P, Carluccio A, Varasano V, Guerri G, Suriano R, Robbe D, Cerasoli I, Petrizzi L. Analgesic Effect of Butorphanol during Castration in Donkeys under Total Intravenous Anaesthesia. Animals (Basel) 2021; 11:2346. [PMID: 34438803 PMCID: PMC8388773 DOI: 10.3390/ani11082346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/04/2022] Open
Abstract
Pain management is necessary for all surgical procedures. Little scientific evidence about drug efficacy in donkeys is available. The aim of this study was to evaluate the analgesic effect of butorphanol in donkeys undergoing orchiectomy under total intravenous anaesthesia with guaifenesin-ketamine-detomidine. A randomized blinded prospective clinical trial (Protocol n. 2021/0000338), was carried out on 18 clinically healthy donkeys undergoing bilateral orchiectomy. Patients were assigned to Group D (n = 8) or Group DB (n = 10) if receiving intravenous detomidine or detomidine-butorphanol respectively, before induction of general anaesthesia with ketamine-diazepam. Intraoperative muscle relaxation, nystagmus, palpebral reflex, heart and respiratory rate, and non-invasive blood pressure were evaluated every 2 min; time to prepare the patient, duration of surgery and anaesthesia and recovery score were recorded. Group D had significantly longer surgical time, higher heart rate, higher systolic and mean blood pressure (p < 0.05; repeated measure ANOVA), increased muscle rigidity and expression of palpebral reflex (p < 0.05; Mann-Whitney U test) than group DB. Top-ups with thiopental were statistically higher in Group D. Butorphanol and detomidine together produced a more stable anaesthetic plan. The low dosage of opioid and alpha-2-agonists and reduced rescue anaesthesia are responsible for a safer and more superficial anaesthesia, which is mandatory under field conditions.
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Affiliation(s)
- Paola Straticò
- Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy; (P.S.); (A.C.); (V.V.); (R.S.); (D.R.); (L.P.)
| | - Augusto Carluccio
- Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy; (P.S.); (A.C.); (V.V.); (R.S.); (D.R.); (L.P.)
| | - Vincenzo Varasano
- Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy; (P.S.); (A.C.); (V.V.); (R.S.); (D.R.); (L.P.)
| | - Giulia Guerri
- Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy; (P.S.); (A.C.); (V.V.); (R.S.); (D.R.); (L.P.)
| | - Riccardo Suriano
- Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy; (P.S.); (A.C.); (V.V.); (R.S.); (D.R.); (L.P.)
| | - Domenico Robbe
- Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy; (P.S.); (A.C.); (V.V.); (R.S.); (D.R.); (L.P.)
| | - Ilaria Cerasoli
- Clinica Veterinaria Borghesiana, Via di Vermicino 96, 00133 Roma, Italy;
| | - Lucio Petrizzi
- Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy; (P.S.); (A.C.); (V.V.); (R.S.); (D.R.); (L.P.)
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Flynn H, Cenani A, Brosnan RJ, DiMaio Knych HK, de Araujo Aguiar AJ. Pharmacokinetics and pharmacodynamics of a high concentration of buprenorphine (Simbadol) in conscious horses after subcutaneous administration. Vet Anaesth Analg 2021; 48:585-595. [PMID: 33934992 DOI: 10.1016/j.vaa.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/27/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the pharmacokinetics and pharmacodynamics of high-concentration formulation of buprenorphine (1.8 mg mL-1; Simbadol) following subcutaneous (SC) administration in horses. STUDY DESIGN Prospective, randomized, crossover trial. ANIMALS A group of six healthy adult horses weighing 521-602 kg. METHODS On three occasions, Simbadol (0.005 mg kg-1; treatment S5), (0.0025 mg kg-1; treatment S2.5) or saline (treatment SAL) were administered SC at least 7 days apart in random order. Electrical nociceptive threshold (ENT) measured on the neck region, physiologic variables, locomotor activity, degree of restlessness and presence of excitatory signs were measured at baseline and for up to 48 hours after injection. Blood was collected for pharmacokinetic analysis at the same time intervals and plasma buprenorphine concentration (Cp) measured using liquid chromatography-tandem mass spectrometry. RESULTS Buprenorphine was quantifiable in all horses from 15 minutes after administration up to 8-12 hours. ENT was significantly increased in treatment S2.5 compared with treatment SAL at 0.75-6 hours after treatment. Increase in locomotor activity and compulsive behavior were recorded in all horses after Simbadol, and degree of restlessness was significantly higher in treatment S5 than SAL for a sustained time. Gastrointestinal motility significantly decreased in all horses after Simbadol and returned to baseline by 16 hours after treatment. CONCLUSIONS AND CLINICAL RELEVANCE In horses, SC Simbadol was rapidly absorbed and Cp decreased rapidly. Side effects commonly seen in horses after opioids were observed in both Simbadol treatments, but degree of opioid-induced excitement lasted significantly longer in treatment S5. Simbadol (0.0025 mg kg-1) SC has the potential to be used clinically to treat pain in horses. However, at this dose, duration of antinociceptive effects was not longer than that reported for conventional buprenorphine, and side effects, including reduction in gastrointestinal motility and increased locomotor activity, were documented.
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Affiliation(s)
- Harriet Flynn
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Alessia Cenani
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA.
| | - Robert J Brosnan
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Heather K DiMaio Knych
- KL Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Antonio J de Araujo Aguiar
- Department of Veterinary Surgery and Anesthesiology, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista - UNESP, Botucatu, SP, Brazil
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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. [PMID: 31657050 DOI: 10.1111/evj.13198] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/18/2019] [Indexed: 02/07/2023]
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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Affiliation(s)
- I M Bowen
- Oakham Veterinary Hospital/University of Nottingham, Sutton Bonington, Loughborough, UK
| | - A Redpath
- Oakham Veterinary Hospital/University of Nottingham, Sutton Bonington, Loughborough, UK
| | - A Dugdale
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, UK
| | - J H Burford
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, UK
| | - D Lloyd
- ChesterGates Veterinary Specialists, Chester, UK
| | - T Watson
- Waterlane Equine Vets, Stroud, UK
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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. [PMID: 29660154 PMCID: PMC6175468 DOI: 10.1111/evj.12947] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 03/30/2018] [Indexed: 02/07/2023]
Abstract
Background In horses castration with primary intention healing is usually performed under balanced inhalation anaesthesia. To optimise analgesia, the use of local anaesthesia was tested. Objectives To investigate the effect of local mepivacaine before castration with first intention healing under balanced medetomidine‐isoflurane anaesthesia and flunixin meglumine, morphine analgesia on perioperative cytokine levels and pain in horses. Study design Prospective blinded clinical study. Methods Twenty stallions were randomly assigned to control or mepivacaine groups. Flunixin meglumine was administered before sedation with medetomidine and followed by ketamine/diazepam intravenously (i.v.). Anaesthesia was maintained with isoflurane and 3.5 μg/kg per hour medetomidine. Mepivacaine horses were given mepivacaine 2% (3.5 mL SC, 1 mL/100 kg intrafunicularly, 2 mL/100 kg intratesticularly) on each side. For recovery, horses were given 2 μg/kg medetomidine i.v. and 0.1 mg/kg morphine i.m. and oral phenylbutazone (0.02 mg/kg q12h) for post‐operative analgesia. One hour before premedication and 4, 8 and 24 h post‐incision, pain was scored with three different pain scales (Equine Utrecht University Scale for Facial Assessment of Pain, Horse Grimace Scale, Equine Utrecht University Scale for Composite Pain Assessment) and plasma cytokines (interleukin‐6 and tumour necrosis factor alpha) were measured. Data were analysed using repeated measures ANOVA, linear regression and unpaired t‐test, significance level P≤0.05. Results Horses in both groups showed a significant increase in pain scores and cytokines compared to baseline. Post‐operatively the mepivacaine group exhibited significantly lower pain scores and cytokine levels. Mean heart rate during anaesthesia was significantly lower in the mepivacaine group compared to control group (28.8 ± 1 and 33.2 ± 1.7 respectively). Otherwise there were no differences between the groups. Main limitations The decision to provide additional analgesia was based on the attending surgeon's assessment rather than a standardised rescue analgesia plan based on pain scores. The study was only conducted for 24 h post‐castration and complications were not recorded. Conclusion Local mepivacaine before castration with primary wound closure improved anaesthesia quality, attenuated post‐operative increases in cytokines and reduced post‐operative pain despite balanced anaesthesia with multimodal analgesia in control horses.
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Affiliation(s)
- M Abass
- Equine Department, Division of Anaesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.,Department of Surgery, Anaesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
| | - S Picek
- Equine Department, Division of Anaesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - J F G Garzón
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - C Kühnle
- Equine Department, Division of Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - A Zaghlou
- Department of Surgery, Anaesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
| | - R Bettschart-Wolfensberger
- Equine Department, Division of Anaesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
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Affiliation(s)
| | - E. J. Love
- School of Veterinary Sciences University of Bristol Bristol UK
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10
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Abstract
There has been great progress in the understanding of basic neurobiologic mechanisms of pain, but this body of knowledge has not yet translated into new and improved analgesics. Progress has been made regarding pain assessment in horses, but more work is needed until sensitive and accurate pain assessment tools are available for use in clinical practice. This review summarizes and updates the knowledge concerning the cornerstones of pain medicine (understand, assess, prevent, and treat). It highlights the importance of understanding pain mechanisms and expressions to enable a rational approach to pain assessment, prevention, and management in the equine patient.
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The effect of postsurgical pain on attentional processing in horses. Vet Anaesth Analg 2017; 44:933-942. [PMID: 28821424 DOI: 10.1016/j.vaa.2016.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/28/2016] [Accepted: 07/07/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the effect of postsurgical pain on the performance of horses in a novel object and auditory startle task. STUDY DESIGN Prospective clinical study. ANIMALS Twenty horses undergoing different types of surgery and 16 control horses that did not undergo surgery. METHODS The interaction of 36 horses with novel objects and a response to an auditory stimulus were measured at two time points; the day before surgery (T1) and the day after surgery (T2) for surgical horses (G1), and at a similar time interval for control horses (G2). Pain and sedation were measured using simple descriptive scales at the time the tests were carried out. Total time or score attributed to each of the behavioural categories was compared between groups (G1 and G2) for each test and between tests (T1 and T2) for each group. RESULTS The median (range) time spent interacting with novel objects was reduced in G1 from 58 (6-367) seconds in T1 to 12 (0-495) seconds in T2 (p=0.0005). In G2 the change in interaction time between T1 and T2 was not statistically significant. Median (range) total auditory score was 7 (3-12) and 10 (1-12) in G1 and G2, respectively, at T1, decreasing to 6 (0-10) in G1 after surgery and 9.5 (1-12) in G2 (p=0.0003 and p=0.94, respectively). There was a difference in total auditory score between G1 and G2 at T2 (p=0.0169), with the score being lower in G1 than G2. CONCLUSIONS AND CLINICAL RELEVANCE Postsurgical pain negatively impacts attention towards novel objects and causes a decreased responsiveness to an auditory startle test. In horses, tasks demanding attention may be useful as a biomarker of pain.
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Potter JJ, MacFarlane PD, Love EJ, Tremaine H, Taylor PM, Murrell JC. Preliminary investigation comparing a detomidine continuous rate infusion combined with either morphine or buprenorphine for standing sedation in horses. Vet Anaesth Analg 2016; 43:189-94. [DOI: 10.1111/vaa.12316] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/19/2015] [Indexed: 01/18/2023]
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13
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Olson ME, Fierheller E, Burwash L, Ralston B, Schatz C, Matheson-Bird H. The Efficacy of Meloxicam Oral Suspension for Controlling Pain and Inflammation After Castration in Horses. J Equine Vet Sci 2015. [DOI: 10.1016/j.jevs.2015.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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de Grauw JC, van Loon JPAM. Systematic pain assessment in horses. Vet J 2015; 209:14-22. [PMID: 26831169 DOI: 10.1016/j.tvjl.2015.07.030] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 05/30/2015] [Accepted: 07/26/2015] [Indexed: 12/23/2022]
Abstract
Accurate recognition and quantification of pain in horses is imperative for adequate pain management. The past decade has seen a much needed surge in formal development of systematic pain assessment tools for the objective monitoring of pain in equine patients. This narrative review describes parameters that can be used to detect pain in horses, provides an overview of the various pain scales developed (visual analogue scales, simple descriptive scales, numerical rating scales, time budget analysis, composite pain scales and grimace scales), and highlights their strengths and weaknesses for potential clinical implementation. The available literature on the use of each pain assessment tool in specific equine pain states (laminitis, lameness, acute synovitis, post-castration, acute colic and post-abdominal surgery) is discussed, including any problems with sensitivity, reliability or scale validation as well as translation of results to other clinical pain states. The review considers future development and further refinement of currently available equine pain scoring systems.
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Affiliation(s)
- J C de Grauw
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 112, 3584 CM Utrecht, The Netherlands.
| | - J P A M van Loon
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 112, 3584 CM Utrecht, The Netherlands
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15
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Gleerup KB, Lindegaard C. Recognition and quantification of pain in horses: A tutorial review. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12383] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. B. Gleerup
- Department of Large Animal Sciences; University of Copenhagen; Frederiksberg Denmark
| | - C. Lindegaard
- Evidensia Equine Specialist Hospital Helsingborg; Helsingborg Sweden
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16
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Taylor PM, Hoare HR, de Vries A, Love EJ, Coumbe KM, White KL, Murrell JC. A multicentre, prospective, randomised, blinded clinical trial to compare some perioperative effects of buprenorphine or butorphanol premedication before equine elective general anaesthesia and surgery. Equine Vet J 2015; 48:442-50. [PMID: 25772950 PMCID: PMC5033022 DOI: 10.1111/evj.12442] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/08/2015] [Indexed: 12/22/2022]
Abstract
Reasons for performing study Buprenorphine, a μ‐agonist opioid, has recently been licensed for equine use, but butorphanol, a κ‐agonist opioid, is more commonly used in horses. The effect of the 2 opioids has not previously been compared in a large clinical study. Objectives To compare post operative analgesia and physiological variables in horses undergoing elective surgery following premedication with either buprenorphine or butorphanol in a conventional clinical setting. Study design Multicentre, prospective, randomised, blinded clinical investigation. Methods Eighty‐nine healthy horses admitted for elective surgery to one of 6 UK equine veterinary clinics were premedicated with acepromazine, a nonsteroidal anti‐inflammatory drug, and romifidine followed by intravenous (i.v.) buprenorphine or butorphanol. Anaesthesia was induced with diazepam/ketamine and maintained with isoflurane in oxygen. A range of surgical procedures were performed and supplementary anaesthetic agents given as required. Physiological variables were monitored during anaesthesia and pain, ataxia, sedation and vital function were assessed post operatively. Data were analysed using t‐tests, ANOVA, Mann–Whitney U‐test and Chi‐squared test as appropriate and P<0.05 was regarded as significant, except for multiple comparisons, when P<0.01 was used. Results Surgery was carried out successfully in all cases and no mortality or serious morbidity occurred. Physiological variables remained within normal limits and all horses recovered successfully, most standing within 1 h of ceasing anaesthesia. There were no significant differences between groups in any variable except post operative pain when scores (simple descriptive scale) between 3 and 6 h were significantly lower after buprenorphine than after butorphanol. Conclusions Horses experienced less post operative pain after buprenorphine than after butorphanol premedication. Compared with butorphanol, buprenorphine did not cause any different effects on vital function.
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Affiliation(s)
- P M Taylor
- Taylor Monroe, Little Downham, Cambridgeshire, UK
| | - H R Hoare
- School of Veterinary Medicine and Science, Nottingham University, Sutton Bonington, Leicestershire, UK
| | - A de Vries
- Animal Health Trust, Newmarket, Suffolk, UK
| | - E J Love
- Equine First Opinion and Referral Clinic, University of Bristol, Langford, Bristol, UK
| | | | - K L White
- School of Veterinary Medicine and Science, Nottingham University, Sutton Bonington, Leicestershire, UK
| | - J C Murrell
- School of Veterinary Science, University of Bristol, Langford, Bristol, UK
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17
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Risberg ÅI, Spadavecchia C, Ranheim B, Hendrickson EHS, Lervik A, Haga HA. Antinociceptive effect of buprenorphine and evaluation of the nociceptive withdrawal reflex in foals. Vet Anaesth Analg 2015; 42:329-38. [DOI: 10.1111/vaa.12205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/02/2014] [Indexed: 11/30/2022]
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18
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Affiliation(s)
- S. Schauvliege
- Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
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19
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Rigotti C, De Vries A, Taylor PM. Buprenorphine provides better anaesthetic conditions than butorphanol for field castration in ponies: results of a randomised clinical trial. Vet Rec 2014; 175:623. [PMID: 25262056 DOI: 10.1136/vr.102729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A prospective, randomised, blinded, clinical trial in 47 ponies compared butorphanol and buprenorphine administered intravenously with detomidine prior to castration under anaesthesia. Detomidine 12 μg/kg intravenously was followed by butorphanol 25 μg/kg (BUT) or buprenorphine 5 μg/kg (BUP) before induction of anaesthesia with intravenous ketamine and diazepam. Quality of sedation, induction and recovery from anaesthesia, response to tactile stimulation, and surgical conditions were scored. If anaesthesia was inadequate 'rescue' was given with intravenous ketamine (maximum three doses) followed by intravenous thiopental and detomidine. Time from induction to first rescue, total ketamine dose and number of rescues were recorded. Postoperative locomotor activity was scored and abnormal behaviour noted. Simple descriptive scales were used for all scoring. Data were analysed using two-way analysis of variance, t tests, Mann-Whitney or Fisher's exact tests as appropriate; P<0.05 was considered statistically significant. Cryptorchid animals did not undergo surgery, but castration was successfully completed in 18 BUT and 20 BUP. More incremental ketamine (P=0.0310) and more rescue drugs (P=0.0165) were required in BUT and more postoperative locomotor activity occurred in BUP (P=0.0001). There were no other differences between groups. Both opioids were suitable for premedication prior to castration but buprenorphine appeared to provide better intraoperative analgesia.
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Affiliation(s)
- C Rigotti
- School of Veterinary Science University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - A De Vries
- Davies Veterinary Specialists, Higham Gobion, UK
| | - P M Taylor
- Taylor Monroe, Gravel Head Farm, Downham Common, Ely CB6 2TY, UK
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20
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Sanchez LC, Robertson SA. Pain control in horses: What do we really know? Equine Vet J 2014; 46:517-23. [DOI: 10.1111/evj.12265] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 03/07/2014] [Indexed: 01/15/2023]
Affiliation(s)
- L. C. Sanchez
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville USA
| | - S. A. Robertson
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; Michigan State University; East Lansing USA
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Love EJ, Pelligand L, Taylor PM, Murrell JC, Sear JW. Pharmacokinetic-pharmacodynamic modelling of intravenous buprenorphine in conscious horses. Vet Anaesth Analg 2014; 42:17-29. [PMID: 24735059 DOI: 10.1111/vaa.12165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 10/08/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Describe the pharmacokinetics of buprenorphine and norbuprenorphine in horses and to relate the plasma buprenorphine concentration to the pharmacodynamic effects. STUDY DESIGN Single phase non-blinded study. ANIMALS Six dedicated research horses, aged 3-10 years and weighing 480-515 kg. METHODS Thermal and mechanical nociceptive thresholds, heart and respiratory rates and locomotor activity were measured before and 15, 30, 45 & 60 minutes and 2, 4, 6, 8, 12 & 24 hours post-administration of 10 μg kg(-1) buprenorphine IV. Intestinal motility was measured 1, 6, 12 & 24 hours after buprenorphine administration. Venous blood samples were obtained before administration of buprenorphine 10 μg kg(-1) IV and 1, 2, 4, 6, 10, 15, 30, 45 & 60 minutes, and 2, 4, 6, 8, 12 & 24 hours afterwards. Plasma buprenorphine and norbuprenorphine concentrations were measured using a liquid chromatography-tandem mass spectroscopy (LC-MS/MS) assay with solid-phase extraction. A non-compartmental method was used for analysis of the plasma concentration-time data and plasma buprenorphine concentrations were modelled against two dynamic effects (change in thermal threshold and mechanical threshold) using a simple Emax model. RESULTS Plasma buprenorphine concentrations were detectable to 480 minutes in all horses and to 720 minutes in two out of six horses. Norbuprenorphine was not detected. Thermal thresholds increased from 15 minutes post-buprenorphine administration until the 8-12 hour time points. The increase in mechanical threshold ranged from 3.5 to 6.0 Newtons (median: 4.4 N); and was associated with plasma buprenorphine concentrations in the range 0.34-2.45 ng mL(-1) . CONCLUSIONS AND CLINICAL RELEVANCE The suitability of the use of buprenorphine for peri-operative analgesia in the horse is supported by the present study.
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Affiliation(s)
- Emma J Love
- School of Veterinary Sciences, University of Bristol, Langford, UK
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