BEVA primary care clinical guidelines: Analgesia

Abstract

Summary 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.

Clinical care of the geriatric horse

“…Meloxicam is a preferential COX‐2 inhibitor (Knych 2017), implying an enhanced safety profile compared to phenylbutazone, although long‐term, large‐scale comparative studies do not exist at this time. The BEVA primary care guidelines suggest meloxicam may not provide as effective analgesia as phenylbutazone for sole use in severe musculoskeletal hoof pain such as laminitis, but may be useful in the management of chronic OA cases and acute inflammatory OA (Bowen and others 2020).…”

“…The British Equine Veterinary Association's primary care guidelines on analgesia (Bowen and others 2020) has recently been published and provides a review of the evidence and recommendations for each NSAID and is valuable for further information.…”

“…Phenylbutazone is the most commonly prescribed NSAID for musculoskeletal conditions in the UK (Duz and others 2019), followed by suxibuzone, flunixin and meloxicam, respectively. Phenylbutazone is a non‐selective NSAID and therefore may be more likely to induce side effects (Bowen and others 2020); however, it remains popular as it provides effective analgesia, is inexpensive and the oral sachets are generally well accepted by horses. Flavoured phenylbutazone products, such as apple or vanilla flavour, are also available in the UK.…”

BEVA primary care clinical guidelines: Wound management in the horse

“…The majority of literature around wound management is expert opinion or case series, and there are currently no evidence summaries to inform clinical decision‐making. The primary care clinical guidelines have been developed for analgesia in the horse using the GRADE framework, 2 and this study was initiated to develop these for wounds in the horse.…”

Erratum

“…In article, published in the January 2020 issue of Equine Veterinary Journal, the authors’ names were incorrectly ordered. The correct order is as follows:…”