Continuous caudal epidural analgesia for perioperative pain control after bilateral mastectomy in a mare

Rodrigo-Mocholí, Diego; Steblaj, Barbara; Vlaminck, Lieven; Gasthuys, Frank; Schauvliege, Stijn

doi:10.1136/vetreccr-2015-000275

Cited by 4 publications

(3 citation statements)

References 81 publications

(69 reference statements)

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“…However, it has recently been shown that a single dose of epidural morphine (up to 0.1 mg/kg) does not delay gastrointestinal transit time [5]. Moreover, repeated epidural administration of morphine (0.1 mg/kg every 8 h for 4 days) did not provoke any neurological or behavioural abnormalities [3]. Finally, no changes in rectal temperature, heart rate, respiratory rate, and gastrointestinal motility were observed during prolonged epidural administration over a period of 14 days (0.2 mg/kg of morphine every 12 h) [6].…”

Section: Introductionmentioning

confidence: 98%

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Morphine plasmatic concentration in a pregnant mare and its foal after long term epidural administration

et al. 2020

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Background Epidural administration of morphine has been shown to be an effective analgesic strategy in horses; however, the possible occurrence of side effects limits its usage. In order to decrease their frequency, it is important to target the minimal effective plasma concentration and avoid overdosing. As to date species-specific pharmacokinetics data are not available for epidural morphine, the dosing regimen is usually established on the basis of clinical reports and personal experience. In certain physiological conditions, like gestation, the outcome of an empirical dosing scheme can be unpredictable. The aim of this case report is to describe the pharmacological profile of morphine and its metabolites after prolonged epidural administration in a pregnant mare and her foal. Case presentation A 20 years old pregnant mare was presented to our hospital because of severe lameness, 2 months before delivery. Following an ineffective systemic pain treatment, an epidural catheter was inserted and morphine administered (initial dose 0.1 mg/kg every 8 h). Due to its efficacy in controlling pain, it was continued until end of gestation. Plasmatic concentration of morphine and its metabolites were assessed in the mare 6 weeks after starting the treatment, and in both the mare and foal during the first days after delivery. Plasmatic values similar to those previously reported in the literature following morphine short term administration through various routes and not accompanied by side effects were found in the mare, except during an excitatory period. Moreover, no evidence of dangerous drug accumulation or significant milk passage was noticed in the foal. Mild reduction of feces production with no signs of colic and two self-limiting episodes of excitement occurred during treatment in the mare. No side effects occurred during gestation and first phases of life in the foal. Conclusion Prolonged epidural administration of morphine in a pregnant mare allowed good pain control in absence of clinically relevant side effects, in both the mare and her foal. Sudden increase in morphine plasmatic concentration can occur and side effects appear; careful treatment to the lowest effective dose and continuous monitoring of the clinical condition of the treated horse should be performed.

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Section: Introductionmentioning

confidence: 98%

“…Epidural injection of morphine has been used to treat various painful conditions in horses [1][2][3]. Despite good clinical outcomes after both single and repeated injections, the risk of side effects, especially on the gastrointestinal system, limit its usage [4].…”

Section: Introductionmentioning

confidence: 99%

Morphine plasmatic concentration in a pregnant mare and its foal after long term epidural administration

et al. 2020

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“…Cervical epidural catheter placement and analgesia has recently been described as an alternative neuraxial technique for thoracic limb conditions ( 35 – 37 ). It is important to consider, however, that caudal epidural analgesia can also be an effective strategy for non-orthopedic conditions including abdominal and urogenital conditions ( 18 , 20 , 25 ). The epidural catheters in this study were maintained for a median of 4 days, with a maximum duration of 33 days.…”

Section: Discussionmentioning

confidence: 99%

Caudal epidural catheterization for pain management in 48 hospitalized horses: A descriptive study of demographics, complications, and outcomes

et al. 2022

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The placement of caudal epidural catheters in horses has become more frequent as a multi-modal analgesic strategy. Despite its integration into clinical practice, there are limited reports describing the use of caudal epidural catheterization for prolonged use in horses. The purpose of this study was to characterize the hospitalized caseload undergoing epidural catheterization for long-term epidural analgesic administration, to report the response to epidural therapy and observed complications, and to describe patient outcomes. Medical records of hospitalized equine patients that underwent placement of a caudal epidural catheter for analgesic management between 2017 and 2021 were analyzed retrospectively. For the 62 catheters placed in the 48 cases, the most frequent diagnosis category prompting epidural analgesia was orthopedic (43/48, 89.6%). Synovial sepsis was the most frequent specific diagnosis prompting epidural catheter placement (11/48, 22.9%). The initial response to epidural therapy was characterized as positive for 37/62 (59.7%) catheters. Complications were documented for 46/62 (74.2%) catheters. However, most of these complications were classified as mild (51.6%) or moderate (14.5%), and exaggerated physiologic responses were observed most frequently. Of the horses studied, 52.1% survived to be discharged from the hospital. With awareness of potential complications and vigilant monitoring, caudal epidural catheters should be considered for equine patients as an analgesic strategy.

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Equine Pain Management

Love¹

2019

Equine Surgery

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Continuous caudal epidural analgesia for perioperative pain control after bilateral mastectomy in a mare

Cited by 4 publications

References 81 publications

Morphine plasmatic concentration in a pregnant mare and its foal after long term epidural administration

Morphine plasmatic concentration in a pregnant mare and its foal after long term epidural administration

Caudal epidural catheterization for pain management in 48 hospitalized horses: A descriptive study of demographics, complications, and outcomes

Equine Pain Management

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