Analgesic, hemodynamic, and respiratory effects induced by caudal epidural administration of meperidine hydrochloride in mares

Comparative evaluation of sedative and anti-nociceptive effects of epidural romifidine, romifidine-lidocaine, and lidocaine in donkeys (Equus asinus)

Background

Local and regional anesthetic procedures are valuable tools in veterinary practice. Caudal epidural administration of local anesthetic agents is widely reported for surgical interventions of the tail, anus, rectum, vulva, vagina, urethra, and bladder in the standing horse. Epidural analgesia is also obtained using various drugs such as alpha-2 adrenoceptor agonists, dissociative anesthetics, and opioids. The present study evaluates the anti-nociceptive and sedative effects of epidural administration of romifidine, a romifidine-lidocaine combination, and lidocaine alone in donkeys.

Materials and methods

In a randomized prospective study, twenty-four healthy adult donkeys were assigned to four groups (three experimental and one control; n = 6) received either 50 μg/kg of romifidine, 0.30 mg/kg of lidocaine, combined romifidine (50 μg/kg) and lidocaine (0.30 mg/kg) diluted in 0.9% sterile normal saline solution to a total injection volume of 12 ml, or an equivalent volume of sterile saline epidurally. After epidural injection of each treatment, the onset, degree, and duration of sedation and anatomical extension of anti-nociception were documented. Observations began immediately (time 0) pre-administration and at 5, 15, 30, 45, 60, and 30-min intervals subsequently until 210 min after drug injection. Time to onset of perineal analgesia was documented every minute after the epidural injection by evaluating the animal's response to pinpricks.

Results

Only romifidine and romifidine-lidocaine induced mild to moderate sedation. Romifidine, romifidine-lidocaine, and lidocaine induced complete bilateral caudal epidural analgesia with loss of sensation in the perineum, tail, inguinal region, caudal aspect of the upper hind limb, chest areas, and extended distally to the dorsal metatarsal area. Sedation lasted longer (p < 0.05) with romifidine (160 ± 15.4 min) than with romifidine-lidocaine (141.6 ± 13.2 min). Longer-lasting analgesia (p < 0.05) was obtained with romifidine (158.3 ± 9.8 min) and romifidine-lidocaine (165 ± 9.4 min) than with lidocaine (75.8 ± 8 min).

Conclusions

Epidural administration of a single dose of romifidine or a combination of romifidine-lidocaine produced mild to moderate sedation and complete anti-nociception in the perineal and inguinal regions of donkeys. The clinical usefulness of epidural romifidine or romifidine-lidocaine combinations to perform obstetric procedures in donkeys needs to be assessed.

Meperidine pharmacokinetics and effects on physiologic parameters and thermal threshold following intravenous administration of three doses to horses

Background

Meperidine is a synthetic opioid that belongs to the phenylpiperidine class and is a weak mu receptor agonist. In horses there are a limited number of published studies describing the analgesic effects of systemically administered meperidine in horses. The objective of this study was to describe the pharmacokinetics, behavioral and physiologic effects and effect on thermal threshold of three doses of intravenously administered meperidine to horses. Eight University owned horses (four mares and four geldings, aged 3–8 years were studied using a randomized balanced 4-way cross-over design. Horses received a single intravenous dose of saline, 0.25, 0.5 and 1.0 mg/kg meperidine. Blood was collected before administration and at various time points until 96 hours post administration. Plasma and urine samples were analyzed for meperidine and normeperidine by liquid chromatography-mass spectrometry and plasma pharmacokinetics determined. Behavioral and physiologic data (continuous heart rate, step counts, packed cell volume, total plasma protein and gastrointestinal sounds) were collected at baseline through 6 hours post administration. The effect of meperidine administration on thermal nociception was determined and thermal excursion calculated.

Results

Meperidine was rapidly converted to the metabolite normeperidine. The volume of distribution at steady state and systemic clearance (mean ± SD) ranged from 0.829 ± 0.138–1.58 ± 0.280 L/kg and 18.0 ± 1.4–22.8 ± 3.60 mL/min/kg, respectively for 0.5–1.0 mg/kg doses. Adverse effects included increased dose-dependent central nervous excitation, heart rate and cutaneous reactions. Significant effects on thermal nociception were short lived (up to 45 minutes at 0.5 mg/kg and 15 minutes at 1.0 mg/kg).

Conclusions

Results of the current study do not support routine clinical use of IV meperidine at a dose of 1 mg/kg to horses. Administration of 0.5 mg/kg may provide short-term analgesia, however, the associated inconsistent and/or short-term adverse effects suggest that its use as a sole agent at this dose, at best, must be cautiously considered.

Meperidine prolongs lidocaine caudal epidural anaesthesia in the horse

The aim of the study was to evaluate and compare the effects of caudal epidural administration of meperidine (MP), lidocaine (LD), and a combination of the two (MPLD) in six mature saddle horses. Horses were randomly assigned to receive three treatments (MP 0.3 mg/kg; LD 0.2 mg/kg; and MPLD: MP 0.3 mg/kg and LD 0.2 mg/kg), with at least 1 week between treatments. Drugs were injected into the epidural space between the first and second coccygeal areas in conscious standing horses. Analgesia, ataxia, sedation, cardiovascular and respiratory effects, and rectal temperature were recorded at different intervals before (baseline) and after administration. Epidural administration of MPLD resulted in a longer duration of analgesia of the tail, perineum, and upper hind limb regions than did administration of MP or LD alone.

Comparison of electroacupuncture and butorphanol on respiratory and cardiovascular effects and rectal pain threshold after controlled rectal distention in mares

OBJECTIVE

To compare effects of electroacupuncture and butorphanol on hemodynamic and respiratory variables and rectal analgesia in mares after controlled rectal distention.

ANIMALS

8 healthy mares.

PROCEDURE

Each horse received saline (0.9% NaCl) solution (0.01 mL/kg, IV; control treatment), butorphanol tartrate (0.1 mg/kg, IV), or 2 hours of electroacupuncture (EA) at acupoints Bladder 21, 25, and 27 on both sides of the vertebral column, Bai hui, and Stomach 36 (right side only). Order of treatments in each mare was randomized. At least 7 days elapsed between treatments. A balloon was inserted in the rectum of each mare, and controlled distention of the balloon (pressures of < or = 220 mm Hg) was used to measure nociceptive rectal pain threshold. Rectal temperature and cardiovascular and respiratory variables were measured before (baseline) and 5,15, 30, 60, 90, and 120 minutes after onset of each treatment.

RESULTS

Butorphanol produced greater increases in rectal pain threshold, compared with EA (mean +/- SD, 214 +/- 24 vs 174 +/- 35 mm Hg of balloon pressure). Electroacupuncture produced minimal cardiovascular and respiratory changes. Although clinically not important, butorphanol produced moderate significant increases in heart and respiratory rates, arterial blood pressure, and rectal temperature and decreases in arterial oxygen tension. Arterial pH, carbon dioxide tension, bicarbonate concentrations, base excess, Hct, and concentration of total solids were not significantly different from baseline values after EA, butorphanol, and control treatments.

CONCLUSIONS AND CLINICAL RELEVANCE

Electroacupuncture and butorphanol (0.1 mg/kg, IV) may provide useful rectal analgesia in horses.

Analgesic, behavioral, and hemodynamic and respiratory effects of midsacral subarachnoidally administered ropivacaine hydrochloride in mares

OBJECTIVE

To determine the analgesic, behavioral, hemodynamic and respiratory effects of midsacral subarachnoid administration of ropivacaine hydrochloride solution in mares.

STUDY DESIGN

Randomized, blinded study.

ANIMALS

Ten healthy mares, weighing from 470 to 560 kg.

METHODS

Intravascular and subarachnoid catheters were placed after infiltration of the skin and subcutaneous tissues with 2% lidocaine. Ropivacaine (0.2%, 5 mL) or 0.9% NaCl was then administered subarachnoidally at the midsacral (S2-S3) vertebrae. Analgesia was determined by lack of sensory perception to electrical stimulation (>40 mA) and absence of response to needle pricks extending from coccygeal to S1 dermatomes. Numerical scores of sedation, change in pelvic limb position, sweating in analgesic zones, urination, behavior, response to noise, and compliance with restraint were determined. Two-way ANOVA with repeated measures and Dunnett's t-tests were used to evaluate differences between the listed numerical scores, and cardiovascular and respiratory variables before and during a 5-hour testing period.

RESULTS

Subarachnoidally administered ropivacaine-induced variable analgesia extending bilaterally from the coccyx to S1, with minimal sedation and change in pelvic limb position in standing mares. Perineal analgesia was attained at 7.5 +/- 2.6 minutes and lasted for 218 +/- 44 minutes (mean +/- SD). Subarachnoid ropivacaine significantly reduced respiratory rates and did not change heart rate, rectal temperature, arterial blood pressure, PCV, arterial gas tensions (PaO2 and PaCO2), pH, and arterial standard bicarbonate and base excess from baseline.

CONCLUSION AND CLINICAL RELEVANCE

Ropivacaine (0.2% solution, 5 mL 500 kg(-1)) can be administered subarachnoidally at midsacral (S2-S3) vertebrae to produce prolonged (>3 hours) bilateral perineal analgesia with minimal changes of behavior, and circulatory and respiratory disturbances in standing mares.

Cutaneous analgesia, hemodynamic and respiratory effects, and beta-endorphin concentration in spinal fluid and plasma of horses after acupuncture and electroacupuncture

OBJECTIVE

To determine cutaneous analgesia, hemodynamic and respiratory effects, and beta-endorphin concentration in spinal fluid and plasma of horses after acupuncture and electroacupuncture (EA).

ANIMALS

8 healthy 10- to 20-year-old mares that weighed between 470 and 600 kg.

PROCEDURE

Each horse received 2 hours of acupuncture and 2 hours of PAES at acupoints Bladder 18, 23, 25, and 28 on both sides of the vertebral column as well as sham needle placement (control treatment). Each treatment was administered in a random order. At least 7 days elapsed between treatments. Nociceptive cutaneous pain threshold was measured by use of skin twitch reflex latency (STRL) and avoidance to radiant heat (< or = 50 degrees C) in the lumbar area. Skin temperature, cardiovascular and respiratory variables, and beta-endorphin concentration in spinal fluid (CSF-EN) and plasma (plasma-EN) were measured.

RESULTS

Acupuncture and PAES significantly increased STRL and skin temperature. The CSF-EN was significantly increased from baseline values 30 to 120 minutes after onset of PAES, but it did not change after acupuncture and control treatments. Heart and respiratory rates, rectal temperature, arterial blood pressure, Hct, total solids and bicarbonate concentrations, base excess, plasma-EN, and results of blood gas analyses were not significantly different from baseline values after acupuncture, PAES, and control treatments.

CONCLUSIONS AND CLINICAL RELEVANCE

Administration of PAES was more effective than acupuncture for activating the spinal cord to release beta-endorphins into the CSF of horses. Acupuncture and PAES provided cutaneous analgesia in horses without adverse cardiovascular and respiratory effects.

Use of opioids for pain and anesthetic management in horses

REGIONAL ADMINISTRATION: There is limited, but convincing, evidence that epidural administration of morphine and some other mu-agonist opioids consistently relieves regional pain in horses. In addition, this effect is not accompanied by notable undesirable effects. On the other hand, a clinically important analgesic action has not been demonstrated for similarly administered kappa-agonist opioids. There has been little objective data presented to support the analgesic effectiveness of intra-articularly administered opioids in horses. However, the evidence of local opioid receptors legitimately encourages work to substantiate the value of intra-articular opioid administration to relieve joint-associated pain in horses. SYSTEMIC ADMINISTRATION: So far, study results do not provide convincing, objective evidence to support the opinion that systemically administered opioids consistently and effectively relieve pain in horses. Given this lack of evidence, and considering that opioids stimulate locomotor and other forms of unwanted excitant behavior, reduce propulsive gastrointestinal motility, decrease alveolar ventilation (especially in association with general anesthesia), and require regulatory and practical considerations for abuse potential in both humans and horses, we conclude that routine, indiscriminate administration of opioids for pain relief in horses is not justified. Identification and focused, objective study of selective beneficial opioid actions to provide guidance for appropriate clinical use is long overdue.

Epidural anesthesia and analgesia in horses

Intercoccygeal, or caudal, epidural injection of local anesthetics is a convenient method of producing analgesia and local anesthesia of the tail and perineal structures in conscious standing horses. This technique has been further developed to provide long duration analgesia and anesthesia by placement of catheters into the epidural space of horses. More recently, opioid, alpha-2 adrenergic agonists, ketamine and other analgesic agents have been administered by caudal epidural injection, providing pain relief in both conscious, standing and anesthetized, recumbent horses. This chapter describes the development of different anesthetic and analgesic epidural techniques in horses, methods for epidural injection and catheterization, and reviews the current literature related to epidural analgesia and pain control in horses.