Effects of Flunixin Meglumine, Firocoxib, and Meloxicam in Equines After Castration

Stress, lipid profile and inflammatory responses to flunixin meglumine administration in surgical and non-surgical castration in donkeys

Donkeys are in the Equidae family but have several differences from horses. There are many studies on the pathophysiology of pain and its clinical signs in horses, but data are limited for donkeys. Therefore, the present study aimed to investigate biochemical effects of flunixin meglumine in donkeys subjected to pain induced by bloodless and surgical castration. Twenty healthy male donkeys were randomly divided into four groups: 1- Surgical castration with flunixin injection, 2- Surgical castration without flunixin injection, 3- Non-surgical castration with flunixin injection, and 4- Non-surgical castration without flunixin injection. Blood samples were collected a day before surgical procedures; four hours, one day, and two days after castration. Serum levels of IL-6, TNF-α, CRP, fibrinogen, cortisol, triglyceride, and cholesterol significantly increased in non-surgical castrated group compared to the other groups. Moreover, the levels of the measured parameters were significantly higher in the non-surgically castrated group compared to the surgically castrated group. Furtheremore, flunixin meglumine administration reduced the levels of the mentioned parameters, and it was significant for TNF-α and fibrinogen in the surgically castrated donkeys. However, in the nonsurgically castrated animals, there was a significant reduction in the levels of all mentioned parameters except for fibrinogen. It was concluded that non-surgical method, compared to the surgical method, was accompanied by more inflammation, stress, and pain; therefore, the surgical method could be suggested as a preferred technique for the castration of donkeys. Furthermore, the injection of flunixin meglumine could be suggested in the castration of donkeys, particularly in the bloodless technique.

Assessing omeprazole and flunixin meglumine co-administration in treating equine gastric ulcer syndrome in Mongolian horses

BACKGROUND

Flunixin meglumine (FM) is commonly used in painful conditions in horses; however, it may contribute to equine gastric ulcer syndrome (EGUS). Some veterinarians combine omeprazole (OME) and FM to reduce EGUS risk. However, the efficacy and safety of this combination in Mongolian horses with chronic lameness remain unknown.

OBJECTIVES

To investigate the changes in lameness and EGUS scores in Mongolian horses through the comparison of three treatment strategies: FM, FM + OME and placebo treated control (CON) and to assess the effects of these treatments on gastric fluid pH, serum total protein, albumin and oxidative stress markers (MPO, SOD, CAT).

STUDY DESIGN

In vivo experiments.

METHODS

Eighteen Mongolian horses with initial American Association of Equine Practitioners lameness scores ≥3 of 5 were selected and equally divided into the placebo (CON), FM (1.1 mg/kg IV q. 24 h) and FM + OME (4 mg/kg PO q. 24 h) treatment groups in a randomised block design. During 15 days of treatment, weekly gastroscopy and physiological and biochemical tests were performed. Stomach tissues were harvested from two horses from each group for histopathological examination with haematoxylin and eosin, Masson's trichrome and periodic acid-Schiff (PAS) staining.

RESULTS

FM (median 1.0, interquartile range 0.0-1.0; p < 0.001) and FM + OME (1.0, 1.0-1.0; p < 0.001) significantly decreased lameness scores compared with CON (3.0, 3.0-4.0). Compared with CON (EGGD: 0.0, 0.0-1.0, p < 0.001; PG1: mean 231.9 ± standard deviation 25.2 ng/mL, p < 0.001) or FM + OME (EGGD: 0.8, 1.0-1.3, p = 0.003; PG1: 207.08 ± 34.85 ng/mL, p < 0.001), FM significantly increased equine gastric glandular disease (EGGD) grade (3.0, 2.0-3.3) and pepsinogen 1 (PG1) content (372.2 ± 33.2 ng/mL, p < 0.001). Compared with CON (total protein: 70.1 ± 2.9 g/L; albumin: 37.0 ± 3.0 g/L; Gastrin-17: 482.5 ± 48.1 pg/mL), FM significantly reduced total protein (62.8 ± 2.9 g/L, p = 0.003), albumin (31.5 ± 2.3 g/L, p = 0.01) and Gastrin-17 (GT-17) content (284.6 ± 57.2 pg/mL, p < 0.001). Compared with FM (EGGD: 3.0, 2.0-3.3; pH: 2.4 ± 0.3), FM + OME significantly decreased the EGGD grade (0.8, 1.0-1.3; p = 0.003) and significantly increased gastric fluid pH (7.4 ± 0.2; p < 0.001). FM + OME (207.1 ± 34.9 ng/mL) significantly decreased PG1 content compared with FM (372.24 ± 33.25 ng/mL; p < 0.001). Histopathology revealed that 15 days of FM treatment led to gastric lesions in horses, which were mitigated by combining with OME.

MAIN LIMITATIONS

Individual differences among horses were large, but the sample size was small and sampling was infrequent.

CONCLUSIONS

Compared with FM alone, use of FM + OME did not impact the reduction in lameness scores with therapy, but reduced the occurrence of EGGD in Mongolian horses. When used to manage chronic lameness, FM + OME might protect against FM-induced EGGD by increasing the gastric pH and decreasing serum PG1 content.

A scoping review on intraoperative and postoperative surgical castration complications in domesticated equids

BACKGROUND

Castration is the most common surgical procedure in domesticated equids; surgical techniques used and perioperative management vary considerably.

OBJECTIVES

To identify and chart the current evidence on perioperative complications associated with different methods of surgical castration in domesticated equids.

STUDY DESIGN

Joanna Briggs Institute systematic scoping review.

METHOD

CAB Abstracts, Medline and Embase databases were searched using terms related to equine castration complications. Two authors independently and blindly screened publications against eligibility criteria. Data on study methods, perioperative management, surgical techniques, and perioperative complications were extracted. Surgical techniques were grouped into categories depending on technique; open, closed or half-closed, and whether the parietal tunic was open or closed at the end of surgery.

RESULTS

The search identified 1871 publications; 71 studies met the final inclusion criteria. The data reported 76 734 castrations, most of which were open or closed, with the vaginal tunic remaining open at the end of surgery. Twenty-five studies reported information regarding surgical techniques and perioperative management, allowing detailed charting and comparisons, of which analgesia and antimicrobial usage varied notably. Eighteen different complications were reported, with swelling or oedema being the most common. Evisceration was most commonly reported in draught breeds and Standardbreds, and the risk appeared low if the parietal tunic was closed at the end of surgery.

MAIN LIMITATIONS

Grey literature and studies not available in English were not included. Existing studies varied greatly in perioperative management, surgical techniques and reporting of outcomes, making evidence consolidation problematic.

CONCLUSION

A lack of consensus regarding complication definitions creates uncertainty and discrepancies between complication rates associated with different surgical techniques and perioperative management. The implementation of standardised systems for describing surgical techniques and complications is recommended for future studies. A number of studies did not follow current recommendations for perioperative analgesia and use of antimicrobials.

The effect of Traumeel LT ad us. vet. on the perioperative inflammatory response after castration of stallions: a prospective, randomized, double-blinded study

Introduction

Stallion castration is a standard procedure with a risk of post-surgical complications. Castration induces an acute phase response (APR). Serum Amyloid-A (SAA) is a well-studied major acute phase protein (APP), that has been shown to be a good marker for the development of post-surgical complications. The current gold standard for reducing the APR after castration is Flunixin-Meglumin, which is a non-steroidal anti-inflammatory drug (NSAID) inhibiting COX1/2. In contrast, Traumeel LT ad us. vet. can modulate the APR by induction of the inflammation resolution. The aim of this study was to compare the effect of Flunixin-Meglumin and Traumeel LT ad us. vet. on the acute phase response.

Material and methods

A total of 60 stallions were recruited and 54 stallions entered the study with 27 stallions in each treatment group. The stallions were treated pre- and postoperatively with either Flunixin-Meglumin (FL) or with Traumeel LT ad us. vet. (TR). Blood was taken before and 24 h, 48 h and 72 h after castration. The following main parameters were assessed: SAA, fibrinogen, iron, white blood cells, neutrophils, Interleukin1ß, and cortisol. Wound healing and pain were assessed at 8 time points.

Results

The main variable SAA was increased after surgery reaching a mean value of 122 µg/ml in the FL group and a mean SAA of 226 µg/ml in the TR group 48 h after surgery, reaching a significant difference only at the 24 h timepoint (p = 0.03). All stallions had the highest pain summary score 8 hours after surgery, with decreasing values thereafter. The pain scores were not statistically different at any time point. In the FL group five stallions developed a suture dehiscence compared to only one stallion in the TR group (p = 0.001).

Discussion

Within the limitations of this study, Traumeel LT ad us. vet. seems to have proresolving effects on the inflammation induced by surgery making it a valuable treatment to reduce the APR induced by castration. Due to its different mode of action, Traumeel LT ad us. vet. might be an alternative treatment option if gastrointestinal side effects or renal side effects of NSAIDs should be avoided. Further studies are needed combining Traumeel LT ad us. vet. and Flunixin.

A Multicomponent Microneedle Patch for the Delivery of Meloxicam for Veterinary Applications

This study evaluates the use of poly(vinyl alcohol), collagen, and chitosan blends for developing a microneedle patch for the delivery of meloxicam (MEL). Results confirm successful MEL encapsulation, structural integrity, and chemical stability even after ethylene oxide sterilization. Mechanical testing indicates the patch has the required properties for effective skin penetration and drug delivery, as demonstrated by load-displacement curves showing successful penetration of pig ear surfaces at 3N of normal load. In vitro imaging confirms the microneedle patch penetrates the pig's ear cadaver skin effectively and uniformly, with histological evaluation revealing the sustained presence and gradual degradation of microneedles within the skin. Additionally, in vitro drug diffusion experiments utilizing ballistic gel suggest that microneedles commence dissolution almost immediately upon insertion into the gel, steadily releasing the drug over 24 h. Furthermore, the microneedle patch demonstrates ideal drug release capabilities, achieving nearly 100% release of meloxicam content from a single patch within 18 h. Finally, in vivo studies using pigs demonstrate the successful dissolution and transdermal drug delivery efficacy of biodegradable microneedle patches delivering meloxicam in a porcine model, with over 70% of microneedles undergoing dissolution after 3 days. While low detectable meloxicam concentrations were observed in the bloodstream, high levels were detected in the ear tissue, confirming the release and diffusion of the drug from microneedles. This work highlights the potential of microneedle patches for controlled drug release in veterinary applications.

Analgesic Efficacy of Non-Steroidal Anti-Inflammatory Drug Therapy in Horses with Abdominal Pain: A Systematic Review

This systematic review aimed to identify the evidence concerning the analgesic efficacy of non-steroidal anti-inflammatory drugs to treat abdominal pain in horses, and to establish whether one non-steroidal anti-inflammatory drug could provide better analgesia compared to others. This systematic review was conducted following the "Systematic Review Protocol for Animal Intervention Studies". Research published between 1985 and the end of May 2023 was searched, using three databases, namely, PubMed, Embase, and Scopus, using the words equine OR horse AND colic OR abdominal pain AND non-steroidal anti-inflammatory drug AND meloxicam OR flunixin meglumine OR phenylbutazone OR firocoxib OR ketoprofen. Risk of bias was assessed with the SYRCLE risk of bias tool, and level of evidence scored according to the Oxford Centre for Evidence-based Medicine. A total of 10 studies met the inclusion criteria. From those only one study judged pain with a validated pain score, and a high risk of bias was identified due to the presence of selection, performance, and "other" types of bias. Therefore, caution is required in the interpretation of results from individual studies. To date, the evidence on analgesic efficacy to determine whether one drug is more potent than another regarding the treatment of abdominal pain in horses is sparse.

Effect of Procaine Penicillin G and Flunixin Meglumine on Serum Amyloid A Response in Healthy Adult Horses

This study was designed to determine the effect of PPG and/or flunixin meglumine on SAA response when used at clinical dosing regimens in healthy adult horses. Six healthy adult horses were enrolled in a crossover study design including one control and three treatment groups: no treatment (control); PPG alone (intramuscularly q12h for 72h); flunixin meglumine alone (intravenously q24h for 72h); and PPG (intramuscularly q12h for 72h) and flunixin meglumine (intravenously q24h for 72h). Whole blood was collected at 0, 24, 48, 72, 96 and 120 hours post-initial drug administration to measure SAA using a commercial lateral-flow immunoassay. The washout period was 30 days. Individual SAA values were within the reference range (≤ 20 µg/mL) for almost all horses in the control group. One control horse displayed a SAA value of 28 µg/mL at 72 hours. All horses from the PPG group showed normal SAA values throughout the study. Apart from one horse (SAA of 24 µg/mL at 96 hours) from the flunixin meglumine group, all horses showed normal SAA values. For the PPG and flunixin meglumine group, 5 horses had SAA values within reference range. One horse displayed increased SAA values (32-45 µg/mL) between 48 to 96 hours post-drug administration. There was no difference in area under the SAA time curve amongst control and treatment groups (P > 0.05). The administration of intramuscular PPG and/or intravenous flunixin meglumine does not trigger an inflammatory response that induces a SAA value above reference range in most adult healthy horses.

The Clinical Pharmacology and Therapeutic Evaluation of Non-Steroidal Anti-Inflammatory Drugs in Adult Horses

This review firstly examines the underlying pathophysiology of pain and inflammation associated with orthopedic disease and endotoxemia. Then, it reviews the clinical pharmacology (pharmacokinetics and pharmacodynamics) of both conventional and non-conventional NSAIDs in the adult horse, and finally provides an overview of different modalities to evaluate the therapeutic efficacy of NSAIDs in research.

Updates on Diagnosis and Management of Colic in the Field and Criteria for Referral

Gastrointestinal colic is the most common primary care equine emergency and affects nearly one of four horses per year. Colic is a significant welfare concern for equine patients and a financial and emotional burden for owners. The primary care practitioner is instrumental in identifying critical cases quickly and making appropriate management recommendations to improve patient outcomes.

Early castration in foals: Consequences on physical and behavioural development

BACKGROUND

The impact of very early castration of foals has not yet been studied despite the many positive effects observed in dogs and cats.

OBJECTIVES

The objective of the study was to compare castration at 3 days and 18 months and assess their subsequent morphological and behavioural development.

STUDY DESIGN

This was a randomised, blinded clinical study.

METHODS

Twenty-two Welsh ponies underwent either early (3-day old, EC group, n = 11) or traditional (18-month old, TC group, n = 11) castration. Animals were followed up to 3 years of age. All ponies were castrated using a primary closure technique under general anaesthesia. Weight and morphometric measurements were monitored monthly from birth until 8 months of age in both groups. Then, measurements were taken every 3 months until 2 years of age and then every 6 months until 3 years of age. Temperament tests were performed on all animals when they were 1- and 3-years old.

RESULTS

No differences were observed between the EC and TC groups in terms of physical development from birth until 40 months of age or in terms of temperament and behaviour at either 1 or 3 years of age.

MAIN LIMITATIONS

The study included only one breed (Welsh ponies) and only 22 animals that were castrated before 2 years of age, precluding comparison with castration performed at older ages.

CONCLUSIONS

We demonstrate that early castration at 3 days does not interfere with morphological or behavioural development.

Oral Administration of Meloxicam and Flunixin Meglumine Have Similar Analgesic Effects After Lipopolysaccharide-Induced Inflammatory Response in Thoroughbred Horses

Flunixin meglumine (FM), a nonselective cyclooxygenase (COX) inhibitor, is most frequently selected for the treatment of equine systemic inflammatory response syndrome (SIRS)/endotoxemia. However, FM has considerable adverse effects on gastrointestinal function. The aims of this study were to compare the effect of meloxicam (MX), a COX-2 selective inhibitor commonly used in equine clinical practice, with FM, and to investigate the potential for clinical application in horses with SIRS/endotoxemia. Fifteen horses were divided into three groups of five and orally administered MX (0.6 mg/kg), FM (1.1 mg/kg), or saline as placebo at 30 minutes after LPS challenge. Clinical parameters, including behavioral pain scores, were recorded and blood for clinical pathological data was collected at various times from 60 minutes before to 420 minutes after LPS infusion. The pain score were significantly lower in both the MX and FM groups than in the placebo group, with no significant difference between them. Body temperature was significantly lower in the MX and FM groups than in the placebo group. Heart rates and respiratory rates, hoof wall surface temperature, and leukocyte counts changed similarly between the MX and FM groups. TNF-α and cortisol were lower in the FM group than in the MX group. The results suggest that MX suppresses the inflammatory response after LPS infusion and has an analgesic effect similar to that of FM. Given the adverse effects of nonselective COX inhibitors, clinical application of MX may be beneficial in horses with SIRS/endotoxemia.

Comparison of Flunixin Meglumine, Meloxicam and Ketoprofen on Mild Visceral Post-Operative Pain in Horses

Simple Summary

Pain management following surgical intervention is key. In horses, several anti-inflammatories (flunixin meglumine, meloxicam and ketoprofen) are available for the management of pain following castration. However, their analgesic efficacy remains unclear for mild visceral pain. The aim of this study was to compare the analgesic efficacy of the above-mentioned anti-inflammatory drugs, following a simple surgery (inguinal castration). Horses were administered a randomly assigned anti-inflammatory drug before and after surgery. A pain score was recorded using a previously described pain assessment scale (PASPAS) before administration, and after the first and second administrations by a senior clinician and a veterinary student. Thirty horses were evaluated, and there was no significant effect of the drug administered on the pain score. Horse welfare was not compromised regardless of drug assigned. Horses showed mild pain post-operatively, which decreased significantly within 24 h. Pain scores were significantly different when assessed by a veterinary student and a senior clinician. The authors found that the anti-inflammatory drug studied provided a similar level of analgesia for the management of mild visceral pain in horses, but that the pain scale used is not suitable for junior evaluators or, by extension, owners.

Abstract

The analgesic efficacy of meloxicam and ketoprofen against equine visceral pain is unclear. The aim of this study was to compare the analgesic efficacy of meloxicam (M) and ketoprofen (K) to flunixin meglumine (F) following inguinal castration. Horses undergoing inguinal castration under general anesthesia were randomly assigned F (1.1 mg/kg), M (0.6 mg/kg) or K (2.2 mg/kg) intravenously two hours pre-operatively and 24 h later. A pain score (out of 31) was recorded blindly by a senior clinician and veterinary student before NSAIDs administration (T₀), and after the first (T₁) and second (T₂) administrations, using a modified post-abdominal surgery pain assessment scale (PASPAS). Pain was classified as mild (score ≤ 7), moderate (score = 8–14) or severe (score > 14). Thirty horses (12 F, 10 M, 8 K) aged 6.2 ± 4.9 years, mostly warmbloods, were included. Horse welfare was not compromised regardless of the drug assigned. There was no statistically significant effect of NSAIDs on pain score. Mean pain scores were significantly higher at T₁ than T₀ for each NSAID (F: 5.08 ± 2.50 vs. 1.58 ± 1.38 (p < 0.001); M: 4.60 ± 2.32 vs. 1.10 ± 1.20 (p < 0.001); K: 5.25 ± 1.39 vs. 1.50 ± 1.51 (p < 0.0001)) and lower at T₂ than T₁ for F (2.92 ± 2.423 vs. 5.08 ± 2.50 (p < 0.001)) and M (2.90 ± 1.37 vs. 4.60 ± 2.32 (p < 0.0325)). At T₁, senior pain scores were significantly different than for junior (5.56 ± 0.54 vs. 3.22 ± 0.62, p = 0.005). This study indicates that meloxicam and ketoprofen provide a similar level of analgesia to flunixin meglumine for the management of mild visceral pain in horses. PASPAS is not reliable for junior evaluators.