Comparison of hydromorphone and butorphanol for management of pain in equine patients undergoing elective arthroscopy: a randomized clinical trial

Reed, Rachel; Trenholme, H. Nicole; Skrzypczak, Heather; Chang, Ke‐Vin; Ishikawa, Yushun; Barletta, Michele; Quandt, Jane; Knych, Heather K.; Sakai, Daniel M.

doi:10.1016/j.vaa.2022.05.006

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…In a study comparing hydromorphone and butorphanol for analgesia in horses undergoing elective arthroscopy, it was found that horses receiving hydromorphone had CPS scores significantly higher than baseline at 2 h post-anesthetic recovery but returned to baseline at 4 h. Meanwhile, horses receiving butorphanol scored significantly higher than baseline at both 2 and 4 h post anesthetic recovery ( 12 ). However, this increase was not observed with the EQUUS-FAP system and the authors speculated that the residual effects of general anesthesia affected the CPS scores at the 2 h timepoint.…”

Section: Discussionmentioning

confidence: 99%

“…A priori sample size calculation was performed using G*Power 3.1 (Heinrich-Heine-Universität Dusseldorf, Germany). Pain scoring data from a previous clinical study were utilized for the calculation ( 12 ). For the CPS, to detect a difference of 1.7 between baseline pain scores and post anesthetic recovery, with an alpha of 5% and power of 95%, a sample size of 40 horses would be required.…”

Section: Methodsmentioning

confidence: 99%

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Post-anesthetic CPS and EQUUS-FAP scores in surgical and non-surgical equine patients: an observational study

Reed,

Krikorian,

Reynolds

et al. 2023

Front. Pain Res.

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BackgroundEquine pain scoring may be affected by the residual effect of anesthetic drugs.ObjectivesTo compare pain scores in the hours immediately following anesthetic recovery to baseline pre-anesthetic scores in equine patients undergoing surgical and non-surgical procedures.Study designClinical observational study.MethodsFifty adult horses undergoing anesthesia for surgical or non-surgical procedures were enrolled. Horses underwent pain scoring using the Composite Pain Score (CPS) and Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) prior to anesthesia (T0) and following anesthetic recovery to standing, every hour for 5 h (T1-T5). Data were analyzed using a generalized linear mixed effects model. A post-hoc Dunnett's test for multiple comparisons was performed for variables where an effect was detected.ResultsMean (95% confidence interval) CPS scores for T0-T5 were 1.6 (1.2–2.0), 6.8 (6.0–7.6), 5.1 (4.3–5.9), 4.3 (3.4–5.2), 3.7 (2.8–4.6), and 2.8 (2.0–3.6) and EQUUS-FAP scores were 0.6 (0.3–0.9), 3.0 (2.5–3.5), 1.9 (1.6–2.2), 1.1 (0.8–1.4), 0.6 (0.4–0.8), and 0.7 (0.4–1.0), respectively. For the CPS, scores greater than 5, and for the EQUUS-FAP scores greater than 3, are consistent with minor pain. There was no effect of type of procedure (surgical vs non-surgical) on CPS or EQUUS-FAP scores. There was an effect of time with CPS scores significantly greater than baseline at T1-T5 and EQUUS-FAP scores significantly greater than baseline at T1 and T2.Main limitationsDiscomfort caused by hoisting was not quantified and it was difficult to ascertain if this affected the results.ConclusionsPost-anesthetic pain scores may be influenced by the residual effect of anesthetic agents for as long as 5 h and 2 h for the CPS and EQUUS-FAP, respectively.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Post-anesthetic CPS and EQUUS-FAP scores in surgical and non-surgical equine patients: an observational study

Reed,

Krikorian,

Reynolds

et al. 2023

Front. Pain Res.

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“…Post-anaesthetic colic (PAC) represents a common complication in equine patients, with reported incidence rates reaching up to 21.1% ( 5 , 6 , 25 – 28 ). Research into risk factors for the development of PAC and the influence of systemic opioids on gastrointestinal (GI) motility has produced equivocal results, ranging from decreased risk ( 25 ), no elevated risk ( 6 , 26 , 27 , 29 – 32 ) to a fourfold rise in colic cases following perioperative opioid administration ( 5 ). The inconsistency in these outcomes could be attributed to differences in the GI side effects associated with various opioid agonists and variations in the dosage, frequency, administration method, and duration of opioid use across these studies.…”

Section: Introductionmentioning

confidence: 99%

“…Butorphanol, morphine, methadone and hydromorphone are commonly used in equine analgesia and their pharmacokinetics and pharmacodynamics have been thoroughly investigated ( 2 , 24 , 29 , 30 , 32 , 33 ). Butorphanol, a synthetic strong κ -opioid receptor agonist and weak μ -opioid receptor antagonist ( 2 , 34 – 38 ), has been observed to induce a transient reduction in gastrointestinal motility in anesthetized horses when used as CRI at a dosage of 13 μg/kg/h ( 34 ).…”

Section: Introductionmentioning

confidence: 99%

The impact of opioid administration on the incidence of postanaesthetic colic in horses

Haralambus,

Juri,

Mokry

et al. 2024

Front. Pain Res.

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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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Opioids

Simon,

Lizarraga

2024

Veterinary Anesthesia and Analgesia

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Comparison of hydromorphone and butorphanol for management of pain in equine patients undergoing elective arthroscopy: a randomized clinical trial

Cited by 5 publications

References 19 publications

Post-anesthetic CPS and EQUUS-FAP scores in surgical and non-surgical equine patients: an observational study

Post-anesthetic CPS and EQUUS-FAP scores in surgical and non-surgical equine patients: an observational study

The impact of opioid administration on the incidence of postanaesthetic colic in horses

Opioids

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