Narcotic analgesics, their detection and pain measurement in the horse: a review

Pharmacokinetic Profiles of Metamizole Metabolites after Intramuscular and Intravenous Administration in Healthy Arabian Horses

Metamizole sodium (MT) is an analgesic and antipyretic drug molecule used in humans, horses, cattle, swine, and dogs. Metamizole rapidly hydrolyzes and turns into methylamino antipyrine (MAA), an active primary metabolite of MT. The present study aims to determine the pharmacokinetic (PK) profiles of MT metabolites after intravenous (IV) and intramuscular (IM) administration into sex of Arabian horses (Equus ferus caballus) using a cross-over study design. The plasma samples were extracted by solid-phase extraction (SPE) method, and plasma concentrations of MT metabolites were analyzed by high-performance liquid chromatography (HPLC). After administrations of MT, plasma concentrations of methylamino antipyrine (MAA), amino antipyrone (AA), and acetylamino antipyrone (AAA) were determined within range of 15 min-12 h. Plasma concentrations of AA and AAA were lower than the plasma concentrations of major metabolite MAA at each sampling point. The PK parameters were statistically evaluated for MT's metabolites between male and female horses and also between IM and IV administrations of PK parameters such as C_max , t_max , t_1/2λz , AUC_0-t , AUC_0-∞ , λz, Cl and V_ss (p < .05). The AUC_IM /AUC_IV ratio in female and male horses for MAA was 1.19 and 1.13, respectively. The AUC_IM /AUC_IV ratio for AA was lower than those found for MAA. AUC_IM /AUC_IV ratio was statistically significantly different between male and female horses for AA (p < .05). According to these results, some PK parameters such as Cmax, AUC, and MRT, MAA and AA concentrations have shown statistically significant differences by MT administrations.

Effect of fentanyl on thermal and mechanical nociceptive thresholds in horses and estimation of anti-nociceptive plasma concentration

There are few investigations relating anti-nociception to plasma concentrations of fentanyl in horses. The study objective was to evaluate analgesic efficacy and duration in horses and determine the minimum anti-nociceptive plasma concentrations. Eight horses were treated with saline (P) and fentanyl (F_2.5=2.5μg/kg; F₅=5μg/kg; F₁₀=10μg/kg) given IV over 5min, with a wash-out period of 10 days. To evaluate thermal (°C) and mechanical (N) nociceptive threshold single stimulations were applied prior to (baseline) and 10, 30, 60, 90, 120, 180, 240, 300, 360, 420, 540min and 22.5h after treatment. Plasma fentanyl concentrations were measured at specific time points. Locomotor activity, heart rate, respiratory rate and gastrointestinal sounds were recorded. Two-way repeated measures ANOVA and pairwise comparisons were used for data analysis (P<0.05). With treatment F₁₀, there was a significant increase in thermal threshold above baseline (47.2ö4.1°C) at t₁₀ (53.7ö4.2°C) and t₃₀ (52.1ö5.6°C), whereas mechanical threshold increased considerably above baseline (3.7ö1.3N) only at t₁₀ (6.6ö3.6N). Estimated mean minimum anti-nociceptive plasma concentration determined by thermal stimulation was 6.1-6.8ng/mL. Dose-dependent increased locomotion occurred, but no significant changes in heart rate, respiratory rate and gastrointestinal sounds were observed. Fentanyl IV at 10μg/kg produced anti-nociception for 10-30min and fentanyl plasma concentrations of ≥6.1-6.8ng/mL appear necessary to induce thermal anti-nociception. Dose-dependent increased locomotion was the main side effect observed.

Comparison of opioid receptor binding in horse, guinea pig, and rat cerebral cortex and cerebellum

OBJECTIVE

To compare the density and binding characteristics of opioid receptor subtypes in horse, rat, and guinea pig cerebral cortex and cerebellum.

STUDY DESIGN

Prospective receptor binding study.

ANIMALS

Whole brains were obtained from four neurologically normal adult horses during necropsy. Rat and guinea pig brains were obtained commercially.

METHODS

The cerebellum and cerebral cortex were dissected from each brain, and tissue homogenates prepared. A radioligand binding technique with the highly selective ligands [(3)H]-DAMGO, [(3)H]-U69593, and [(3)H]-DPDPE was used to identify the mu- (mu), kappa- (kappa) and delta- (delta) opioid receptors, respectively. Competitive binding assays were performed with these ligands and varying concentrations of one of multiple unlabeled ligands.

RESULTS

While there were marked species differences in relative densities of opioid receptors, all radioligands interacted with their binding sites with high, nanomolar affinity in both the cerebral cortex and cerebellum. In the horse cerebral cortex, the percentages of total opioid binding sites for the mu-, kappa- and delta-receptors were 71%, 14% and 15%, respectively. In the rat and guinea pig cerebral cortex, the corresponding values were 56% mu-, 4% kappa- and 40% delta-receptors, and 25% mu-, 37% kappa- and 38% delta-receptors, respectively. In horse and guinea pig cerebellum, the binding was 37% mu-, 59% kappa- and 4% delta-receptors, and 15% mu-, 76% kappa- and 10% delta-receptors, respectively. For competitive analysis, all competitors of the mu-, kappa- and delta-receptors completely displaced [(3)H]-DAMGO, [(3)H]-U69593, and [(3)H]-DPDPE and had inhibitory constants in the nanomolar range.

CONCLUSION AND CLINICAL RELEVANCE

Horses used in this study had a greater density of mu-receptors in the cerebral cortex compared with rats and guinea pigs but without further characterization of the functional role of these receptors it is impossible to determine the clinical significance of these data.

Effects of butorphanol on the withdrawal reflex using threshold, suprathreshold and repeated subthreshold electrical stimuli in conscious horses

OBJECTIVE

To assess the effects of a single intravenous dose of butorphanol (0.1 mg kg(-1)) on the nociceptive withdrawal reflex (NWR) using threshold, suprathreshold and repeated subthreshold electrical stimuli in conscious horses.

STUDY DESIGN

'Unblinded', prospective experimental study.

ANIMALS

Ten adult horses, five geldings and five mares, mean body mass 517 kg (range 487-569 kg).

METHODS

The NWR was elicited using single transcutaneous electrical stimulation of the palmar digital nerve. Repeated stimulations were applied to evoke temporal summation. Surface electromyography was performed to record and quantify the responses of the common digital extensor muscle to stimulation and behavioural reactions were scored. Before butorphanol administration and at fixed time points up to 2 hours after injection, baseline threshold intensities for NWR and temporal summation were defined and single suprathreshold stimulations applied. Friedman repeated-measures analysis of variance on ranks and Wilcoxon signed-rank test were used with the Student-Newman-Keul's method applied post-hoc. The level of significance (alpha) was set at 0.05.

RESULTS

Butorphanol did not modify either the thresholds for NWR and temporal summation or the reaction scores, but the difference between suprathreshold and threshold reflex amplitudes was reduced when single stimulation was applied. Upon repeated stimulation after butorphanol administration, a significant decrease in the relative amplitude was calculated for both the 30-80 and the 80-200 millisecond intervals after each stimulus, and for the whole post-stimulation interval in the right thoracic limb. In the left thoracic limb a decrease in the relative amplitude was found only in the 30-80 millisecond epoch.

CONCLUSION

Butorphanol at 0.1 mg kg(-1) has no direct action on spinal Adelta nociceptive activity but may have some supraspinal effects that reduce the gain of the nociceptive system.

CLINICAL RELEVANCE

Butorphanol has minimal effect on sharp immediate Adelta-mediated pain but may alter spinal processing and decrease the delayed sensations of pain.

Pharmacokinetics and pharmacodynamics of morphine in llamas

OBJECTIVE

To assess the pharmacokinetics and pharmacodynamics of morphine in llamas.

ANIMALS

6 healthy adult llamas.

PROCEDURES

Llamas received morphine sulfate in a randomized crossover design. In phase 1, they received IV or IM administration of morphine at 0.05 or 0.5 mg/kg, respectively; in phase 2, they received IV administration of morphine at 0.05, 0.25, or 0.5 mg/kg. Plasma morphine and morphine-6-glucuronide concentrations were determined by validated methods. Body temperature, heart rate, respiratory rate, sedation, and analgesia were assessed and compared with plasma concentrations by regression analysis.

RESULTS

Total body clearance was similar between IV administration of morphine sulfate at 0.25 and 0.5 mg/kg (mean +/- SD, 25.3 +/- 6.9 mL/min/kg and 27.3 +/- 5.9 mL/min/kg, respectively), and linearity was demonstrated between these doses. Bioavailability of morphine following IM administration at 0.5 mg/kg was 120 +/- 30%. Body temperature and sedation increased as the dose of morphine administered increased. Heart rate was unaffected by varying doses. Respiratory rate decreased as dose increased. Analgesia was difficult to assess as a result of high individual variability. Intravenous administration of morphine at 0.25 mg/kg provided the most consistent increase in tolerance to electric stimulation. Pharmacodynamic modeling revealed a sigmoidal relationship between plasma concentration and sedation score.

CONCLUSIONS AND CLINICAL RELEVANCE

Morphine was characterized by a large apparent volume of distribution and high systemic clearance in llamas. A prolonged half-life was observed with IM injection. Intravenous administration of morphine sulfate at 0.25 mg/kg every 4 hours is suggested for further study.

Morphine administration in horses anaesthetized for upper respiratory tract surgery

OBJECTIVE

To determine the effect of morphine administration on commonly monitored cardio-respiratory variables and recovery quality in horses undergoing anaesthesia and surgery.

STUDY DESIGN

Prospective, randomized clinical study.

ANIMALS

Thirty-eight thoroughbred horses, 32 geldings and six mares, 3-13 years old, weighing 411-600 kg.

MATERIALS AND METHODS

A standard anaesthetic technique was used. Twenty minutes after induction of anaesthesia horses received 0.1 mg kg(-1) (0.1 m) or 0.2 mg kg(-1) (0.2 m) morphine by intravenous injection. A control group did not receive morphine. Heart rate, respiratory rate (fr), mean arterial pressure (MAP) and blood gases were measured before morphine administration and every 10 minutes thereafter. Horses were positioned for 35 minutes in right lateral recumbency for tension palatoplasty by cautery and were then moved into dorsal recumbency for additional intraluminal surgery comprising one or more of aryepiglottic fold resection, sub-epiglottal mucosal resection, ventriculectomy and cordectomy. A subjective recovery score from 0 (worst) to 5 (best) was assigned by a single observer who was unaware of treatment group. Two-way repeated measures anova, one-way anova, Kruskal-Wallis test, Mann-Whitney test, Pearson and Spearman correlation coefficients, and chi-squared tests were used to analyse the data where appropriate.

RESULTS

Arterial partial pressure of oxygen (PaO(2)) decreased significantly over time and was significantly lower in horses that received morphine. One horse in the control group and two horses in each of the morphine groups had a PaO(2) <13 kPa. No other significant cardiopulmonary effects were detected. Recovery scores [median (range)] were higher in morphine recipients: 4 (2-5) in 0.1 m, 4 (3-5) in 0.2 m compared with 3 (2-4) in the control group.

CONCLUSIONS AND CLINICAL RELEVANCE

The lower PaO(2) in morphine recipients did not appear to be of clinical significance in healthy horses because the number of horses with a low PaO(2) was similar between groups. The quality of recovery was significantly better in morphine recipients. These results indicate that morphine may be considered for use in clinical cases although further work is required to assess the analgesic properties of the drug in this species.

Evaluation of skin sensitivity after shock wave treatment in horses

OBJECTIVE

To evaluate the effects of shock wave treatment on cutaneous nerve function, compared with the effects of local nerve block and sedation.

ANIMALS

18 clinically sound Swiss Warmbloods.

PROCEDURE

Horses were randomly allocated to 3 groups and received different amounts and types of shock waves (extracorporeal shock wave treatment [ESWT] or radial pressure wave treatment [RPWT]). Horses were sedated with xylazine and levomethadone. Shock waves were applied to the lateral palmar digital nerve at the level of the proximal sesamoid bones on 1 forelimb. Skin sensitivity was evaluated by means of an electrical stimulus at the coronary band before and 5 minutes after sedation and at 4, 24, and 48 hours after application of ESWT or RPWT. On the contralateral forelimb, skin sensitivity was tested before and 10 minutes after an abaxial sesamoid nerve block.

RESULTS

No significant changes in skin sensitivity were detected, regardless of the shock wave protocol applied. Mean reaction thresholds after sedation were more than twice the baseline thresholds. After the abaxial sesamoid block, no reaction was recorded in any of the horses.

CONCLUSIONS AND CLINICAL RELEVANCE

Application of ESWT or RPWT to the palmar digital nerve had no effect on cutaneous sensation distal to the treated region for at least 2 days after application. The analgesic effect of sedation on reaction to electrical stimuli was distinct but varied among horses.

Problems associated with perioperative morphine in horses: a retrospective case analysis

OBJECTIVE

To identify the incidence of adverse effects caused by morphine 100-170 micro g kg-1 administration during surgery in horses.

DESIGN

Retrospective case record analysis (1996-2000).

ANIMALS

Eighty-four healthy (ASA 1 or 2) horses, mean age 5.5 +/- 3.1 (SD) years (2 months to 16 years), mean weight 524 +/- 14 kg (100-950).

METHODS

Physiological data and evidence of complications were collected from the anaesthetic records of all animals anaesthetized with romifidine, ketamine, diazepam and halothane and undergoing laryngeal surgery or orchiectomy at the Royal (Dick) School of Veterinary Studies. Cases were divided into those receiving (group M+; n = 18) and those not receiving morphine (M-; n = 29), and the data compared. Values for heart and respiratory rate and mean arterial pressure were compared at 15-minute intervals between 30 and 120 minutes after induction using anova for repeated measures. The incidence of intraoperative problems was compared using Fisher's exact test. Recovery scores were compared using Student's unpaired t-test. The records of a further 37 horses undergoing umbilical herniorrhaphy (n = 5), arthroscopy (n = 29) or tarsal arthrodesis (n = 3) were also studied but not analysed statistically due to disparate treatment distribution.

RESULTS

There were no significant differences between the M+ and M- groups. The incidence of post-operative complications such as box-walking and colic were similar in each group.

CONCLUSIONS

Morphine doses of 100-170 micro g kg-1 do not increase the risk of problems when used to provide perioperative analgesia in horses anaesthetized with romifidine, ketamine, diazepam and halothane.

CLINICAL RELEVANCE

Morphine provides an acceptable and relatively inexpensive way to provide perioperative analgesia in horses.

Interactions of morphine and isoflurane in horses

OBJECTIVE

To quantitate dose- and time-related magnitudes of interactive effects of morphine (MOR) and isoflurane (ISO) in horses and to characterize pharmacokinetics of MOR in plasma and the ventilatory response to MOR during administration of ISO.

ANIMALS

6 adult horses.

PROCEDURE

Horses were anesthetized 3 times to determine the minimum alveolar concentration (MAC) of ISO in O2 and then to characterize the change in anesthetic requirement as defined by the alteration in ISO MAC following IV administration of saline (0.9% NaCl) solution and 2 doses of MOR (low dose, 0.25 mg/kg; high dose, 2.0 mg/kg). Arterial blood samples were obtained before and after MOR and analyzed.

RESULTS

Mean +/- SD baseline ISO MAC was 1.43 +/- 0.06%. The ISO MAC did not change with time after administration of saline solution. Effects of MOR on ISO MAC varied. Maximal change in MAC ranged from -20.2 to +28.3% and -18.9 to +56.2% after low and high doses of MOR, respectively. Typical half-life of MOR in plasma was 40 to 60 minutes and related to dose. Mean PaCO2 increased from 70 mm Hg before MOR to 88 to 102 mm Hg for 30 to 240 minutes after the high dose of MOR. Recovery from anesthesia after administration of the high dose of MOR was considered undesirable and dangerous.

CONCLUSIONS AND CLINICAL RELEVANCE

Our results do not support routine clinical use of MOR administered IV at dosages of 0.25 or 2.0 mg/kg as an adjuvant to anesthesia in horses administered ISO.

Pilot epidemiological study of attitudes towards pain in horses

This preliminary study investigated the attitudes, and evaluated the current practice of a sample of the veterinary profession in the UK in relation to the management of pain in horses. In June 2001, a questionnaire was posted to 260 veterinarians in specialised equine practice, and 140 veterinarians in general practice with a significant equine caseload. There was a 25 per cent response rate to the questionnaire, which recorded information about the availability and prescription of analgesic drugs, the factors influencing the selection of analgesics and their administration, and estimates of the severity of pain associated with selected clinical conditions. There were considerable variations in the practices applied to manage pain in horses, implying that there are similar attitudinal barriers to the optimal management of pain in horses as have been identified in other domestic spedes.

Quantitative assessment of nociception in horses by use of the nociceptive withdrawal reflex evoked by transcutaneous electrical stimulation

OBJECTIVES

To evoke and measure the nociceptive withdrawal reflex (NWR) by use of electromyographic recordings and to score the behavioral nociceptive responses to electrical pulses in standing nonsedated horses.

ANIMALS

10 adult horses.

PROCEDURE

The lateral palmar digital nerve of the forelimb was transcutaneously stimulated, and surface electromyographic responses were recorded from the ulnaris lateralis, extensor carpi radialis, and common digital extensor muscles. Stimuli consisted of a 25-millisecond train of 5 constant-current pulses delivered by a computer-controlled stimulator. The 80- to 250-milliseconds poststimulation interval was analyzed to detect the NWR. The current intensity was increased in steps of 0.5 mA until the NWR threshold intensity (lt) was reached. The stimulus at It was repeated twice. Latency and amplitude of the NWR, together with the behavioral reaction of horses, were analyzed. The latter was scored according to a scale from 0 (no reaction) to 5 (vigorous reaction). Finally, 3 suprathreshold stimuli at 1.2 X It were analyzed.

RESULTS

The median It to elicit NWR was 2.5 mA. Median onset latency of the NWR was 96.0 milliseconds at It and 89.6 milliseconds for suprathreshold stimuli. The amplitude of the reflexes was higher for suprathreshold stimulations, and behavioral reactions were slightly stronger when stimulus intensity increased.

CONCLUSIONS AND CLINICAL RELEVANCE

Results of our study indicate that it is possible to record NWR in conscious standing horses, to define a reflex threshold, and to measure reflexes in response to increasing stimulus intensity.

Management of gastrointestinal pain

Choice of an analgesic for gastrointestinal pain requires consideration of the cause of the pain, desired duration of pain relief, need for sedation, and potential side effects and toxicity, particularly in light of other drugs being used and effects on the gastrointestinal tract. It is imperative that close monitoring be continued to ensure that surgical lesions or worsening conditions are detected. Recent research in the field may lead to new drugs, drug combinations, and avenues of treatment that minimize the side effects of these drugs while maximizing their efficacy.

Effect of acepromazine and butorphanol on halothane minimum alveolar concentration in ponies

The effect of i.v. acepromazine (0.05 mg/kg bwt), butorphanol (0.05 mg/kg bwt) and a combination of acepromazine and butorphanol on halothane minimum alveolar concentration (MAC) was determined in 7 mixed-breed ponies. Ventilation was controlled, and blood pressure and temperature were maintained within normal limits. Following the determination of baseline MAC, treatments were administered to each pony in a random manner. The control treatment was normal saline. The baseline halothane dMAC for the control group was 0.91 +/- 0.04%, and no significant change occurred after saline administration. Acepromazine decreased (P = 0.0001) the halothane MAC from mean +/- s.e. 0.92 +/- 0.02% to 0.58 +/- 0.04%, and the combination of acepromazine and butorphanol, decreased (P = 0.003) halothane MAC, from mean +/- s.e. 0.95 +/- 0.04% to 0.59 +/- 0.06%. This represents a decrease of 36.9 and 37.8%, respectively. However, the difference between these 2 treatments was not significant. Butorphanol did not significantly change the mean group value for MAC; nevertheless, 3 ponies had an increase, one a decrease, while the MAC did not change in the remaining 3 ponies following butorphanol treatment.

Effects of intracerebroventricularly administered mu-, delta- and kappa-opioid agonists on locomotor activity of the guinea pig and the pharmacology of the locomotor response to U50,488H

The effects of intracerebroventricular administration of morphine, the selective mu-agonist DAMGO, the delta-agonist DPDPE, the kappa-preferring peptide dynorphin A(1-13) and the kappa-agonist U50,488H on locomotor behaviour in the guinea pig were investigated. Morphine (total dose = 0.01, 0.1, 1, 10, 200 nmol), DAMGO and DPDPE (total dose = 0.1, 1, 10, 100 nmol of each) produced piloerection and sedation, indicating that the responses of guinea pigs to mu- and delta-opioid agonists differed from those of rats and mice. In contrast, U50,488H (total dose = 10, 100 nmol) and dynorphin A(1-13) (total dose = 100 nmol) produced increased locomotor activity which was attenuated by pretreatment with naloxone and norbinaltorphimine, thus confirming the involvement of kappa-opioid receptors. Furthermore, pretreatment with spantide, baclofen, muscimol, bicuculline, MK-801, raclopride and atropine also inhibited the U50,488H-induced locomotor activity, suggesting the involvement of GABA, dopamine, excitatory amino acids, substance P and acetylcholine in this response.

The influence of surgery and anaesthesia on the pharmacokinetics of pethidine in the horse

The plasma concentration of pethidine was measured in 16 horses, after its administration intravenously (i.v.) at a dose rate of 1 mg/kg bodyweight (bwt). In eight animals studied before surgery, the plasma levels of the drug decreased in a bi-exponential manner with a distributive half life of 3 mins and an elimination half life of 57.7 mins. Total body clearance was 17.7 ml/kg bwt/min. The remaining horses were investigated immediately after a period of anaesthesia and surgery and in these animals the drug exhibited smaller volumes of distribution (V1 cand Vdarea) and a significantly lower clearance rate of 12.8 ml/kg bwt/min in these animals. Correlation between the plasma concentration of pethidine and information published previously on the duration of action of the agent in the horses suggests that plasma levels of approximately 0.4 microgram/ml are required to produce analgesia in this species.

Effect of low-dose butorphanol on halothane minimum alveolar concentration in ponies

Minimum alveolar concentration (MAC) for halothane was measured before and after administration of intravenous butorphanol (0.022 and 0.044 mg/kg in bodyweight in nine yearling Shetland ponies. Arterial blood pressure, heart rate, respiratory rate, expired CO2 and rectal temperature was also measured. Even though mean MAC values decreased 10 and 9 per cent after the low and high doses respectively, they were not statistically different from those measured prior to butorphanol. Halothane MAC values increased after butorphanol in two ponies, both animals increasing locomotor activity and demonstrating apparent central nervous system stimulation. No significant differences were seen in any variable measured after butorphanol administration.