The analgesic effects of intrathecal xylazine and detomidine in sheep and their antagonism with systemic atipamezole

Adverse Reaction Following the Subarachnoid Injection of Xylazine in a Sheep

Simple Summary

To maintain high standards of veterinary care, it is crucial adverse events are reported. This case report describes the adverse cardiovascular and respiratory responses to xylazine—a veterinary sedative and pain relief drug. While adverse effects are known to occur following vascular injection of xylazine during anaesthesia in sheep, this is the first report to detail the adverse responses following the injection of xylazine into the subarachnoid space. Injecting xylazine into the subarachnoid space (the space around the spinal cord containing spinal fluid) is commonly performed for the management of pain in sheep; as most clinicians believe this method carries significantly less risks for the patient than vascular routes of administration. The profound cardiovascular and respiratory depression detailed here is therefore of interest to veterinary professionals and scientists involved in the anaesthesia and/or pain management of sheep.

Abstract

Alpha₂ receptor agonists are frequently used to provide sedation and analgesia in sheep. There are numerous reports of adverse pulmonary effects following intravenous (IV) injection; however, adverse effects following subarachnoid injection (SAI) are underreported. An adult Merino wether was one of eighteen animals anaesthetised during an experimental trial modelling intervertebral disc injury. The animal was premedicated with methadone 0.1 mg/kg and midazolam 0.3 mg/kg IV. Anaesthesia was induced using alfaxalone IV and it was maintained using isoflurane, delivered in 100% oxygen by controlled mechanical ventilation. An SAI of xylazine 0.05 mg/kg diluted to 1 mL with 0.9% saline was performed at the lumbosacral site prior to recovery. This resulted in rapid narcosis, oxygen dependency and ventilatory compromise. Treatment with frusemide 1 mg/kg IV and salbutamol 0.2 mg inhaled did not attenuate the adverse cardiopulmonary effects. A rapid improvement in all physiological variables was seen following high dose atipamezole 0.05 mg/kg IV. This case report adds to the current knowledge regarding the risk for potential side effects when using alpha₂ receptor agonists, such as xylazine, for the sedation or regional analgesia in sheep.

Intrathecal adenosine enhances the antinociception of Xylazine in goats

Background

The role of adenosine (AD) in neuromodulation of nociceptive signaling at the level of the spinal cord has been established in both preclinical and clinical models. Recently, the signaling pathway that involves adenosine 5-monophosphate activated protein kinase has been reported to mediate the antinociceptive effects of xylazine (XYL). The objective of this study was to investigate the antinociceptive, cardiorespiratory and hematological effects of intrathecal administration of combined XYL-AD in goats as compared to XYL alone. Six clinically healthy adult goats weighing 25 ± 2 kg were randomly assigned to one of three groups in a cross-over design. Goats were sedated with XYL (0.05 mg/kg, IM) in all groups. Ten min later, 0.9% saline solution [SAL group], XYL (0.05 mg/kg) [XYL group] or a combination of XYL (0.05 mg/kg) and AD (2000 µg) [XYL-AD group] was injected intrathecally. Antinociception scores and both cardiorespiratory and hematological parameters were measured before XYL sedation and intrathecal injection (baseline), and at 5, 10, 15, 30, 60, 90, 120 and 150 min thereafter.

Results

The XYL-AD group showed significantly earlier onset of antinociception [5 (5–7) min] than XYL [13 (12–14.25] min (P = 0.031). The duration of complete antinociception in goats that received XYL-AD was significantly longer (P = 0.031) than that received XYL alone [65 (58.75–66.25) and 47.5 (43.75–51.25) min, respectively]. In both XYL and XYL-AD groups, heart rate (HR), arterial blood pressure (SAP, MAP and DAP) were significantly decreased (P < 0.05) compared to the baseline. Compared to the SAL group, a statistically significant reduction in HR from 10 to 150 min (P < 0.05) was detected in the XYL group contrary to the XYL-AD group. Differences in the hematological parameters among different groups were insignificant.

Conclusions

AD injected intrathecally interacts synergistically with XYL to promote antinociception in goats. This discovery supports the use of AD in combination with XYL in clinical trials.

Analgesia for Sheep in Commercial Production: Where to Next?

Simple Summary

Increasing societal and customer pressure to provide animals with ‘a life worth living’ continues to apply pressure on industry to alleviate pain associated with husbandry practices, injury and illness. Although a number of analgesic solutions are now available for sheep, providing some amelioration of the acute pain responses, this review has highlighted a number of potential areas for further research.

Abstract

Increasing societal and customer pressure to provide animals with ‘a life worth living’ continues to apply pressure on livestock production industries to alleviate pain associated with husbandry practices, injury and illness. Over the past 15–20 years, there has been considerable research effort to understand and develop mitigation strategies for painful husbandry procedures in sheep, leading to the successful launch of analgesic approaches specific to sheep in a number of countries. However, even with multi-modal approaches to analgesia, using both local anaesthetic and non-steroidal anti-inflammatory drugs (NSAID), pain is not obliterated, and the challenge of pain mitigation and phasing out of painful husbandry practices remains. It is timely to review and reflect on progress to date in order to strategically focus on the most important challenges, and the avenues which offer the greatest potential to be incorporated into industry practice in a process of continuous improvement. A structured, systematic literature search was carried out, incorporating peer-reviewed scientific literature in the period 2000–2019. An enormous volume of research is underway, testament to the fact that we have not solved the pain and analgesia challenge for any species, including our own. This review has highlighted a number of potential areas for further research.

Use and Efficacy of Analgesic Agents in Sheep (Ovis aries) Used in Biomedical Research

Sheep (Ovis aries) are widely used as large animal models in biomedical research. However, current literature on the use of analgesics in sheep generally focuses on an industry or farm level of use. This structured review evaluates use and efficacy of analgesics administered to sheep in a biomedical research setting. Electronic databases were searched with terms related to analgesia in research sheep. After application of exclusion criteria, 29 peer-reviewed publications were evaluated from 1995 to 2018. Drugs used for analgesia in sheep include opioids, α₂ agonists, NSAID, local anesthetics, NMDA receptor antagonists, and calcium channel blockers. Opioid agonists have previously been considered short acting and of questionable efficacy in sheep, but newer modalities may provide effective analgesia. NSAID may exhibit an analgesic effect only when inflammatory pain is present and may not be beneficial for use in acute pain models. α₂ agonists provide effective yet short-lived analgesia; however, side effects are of concern. Local anesthetics were previously widely used as stand-alone agents, as alternatives to the use of general anesthetics in sheep. These agents have since fallen out of favor as sole agents. Despite this, they provide a valuable analgesic effect when used as adjuncts to general anesthetic regimes. The NMDA antagonist ketamine provided good analgesia and is likely underutilized as an analgesic agent in sheep. Future controlled studies should further evaluate the analgesic properties of ketamine in sheep.