A preventive multimodal analgesic strategy for bilateral rostral mandibulectomy in a horse

Abstract

Summary This case report describes the use of a wound soaker catheter as part of a preventive multimodal analgesic plan in a mare undergoing a bilateral rostral mandibulectomy. The administration of local anaesthetic into the surgical wound using a wound soaker catheter, together with systemic nonsteroidal anti‐inflammatory drugs (NSAIDs) and opioid therapy, controlled post operative pain satisfactorily.

Systematic pain assessment in horses

“…Aspects of behaviour that may be altered by pain include elements of demeanour, posture and gait, as well as interactive behaviour. However, a horse's behaviour is influenced by factors other than pain, including breed, temperament, sex, age and (familiarity with) environment (Wagner, 2010;Minghella and Auckburally, 2014). The amount of time needed to carefully observe and assess a horse's behaviour may be a limiting factor in clinical practice (Ashley et al, 2005).…”

Multiple mandibular ossifying fibromas in a yearlingBelgianDraught horse filly

“…; Sponseller et al . ; Minghella and Auckburally ) and in a single case, a segmental mandibulectomy has been described in an attempt to remove an undifferentiated sarcoma in a horse (Carmalt and Linn ). Beside complete removal of the lesion, radiotherapy after debulking of the lesion has also been described as adjunctive treatment (Orsini et al .…”

Multimodal strategies for equine analgesia, one step beyond…

“…The techniques described in the current case report by Minghella and Auckburally () and the abundant amount of literature on the positive effects of continuous peripheral nerve blocks in humans shows the potential benefit of multimodal analgesic strategies for horses with specific painful conditions. Although knowledge on equine analgesia has improved significantly in recent decades, the most important steps towards improved analgesic strategies in the horse may still lie ahead of us.…”

“…The case report by Minghella and Auckburally () in the current issue of Equine Veterinary Education presents an equine case that was scheduled for bilateral rostral mandibulectomy because of the presence of an ameloblastoma. Because of the extended surgical procedure and the expected amount of post operative pain, a multimodal pain protocol was developed that incorporated α 2 ‐agonists (medetomidine in premedication and constant rate infusions during maintenance), opioids (morphine in premedication), NSAIDs (flunixine in premedication) and a bilateral inferior alveolar nerve block with local anaesthetics (bupivacaine) for perioperative pain control.…”