Advertisement

Comparison of hydromorphone and butorphanol for management of pain in equine patients undergoing elective arthroscopy: a randomized clinical trial

      Abstract

      Objective

      To compare the effects of hydromorphone and butorphanol in horses undergoing arthroscopy and describe the pharmacokinetics of hydromorphone in anesthetized horses.

      Study design

      Randomized controlled clinical trial.

      Animals

      A total of 40 adult horses admitted for elective arthroscopy.

      Methods

      Horses were randomly assigned to be administered intravenous hydromorphone (0.04 mg kg–1; group TxH; n = 19) or butorphanol (0.02 mg kg–1; group TxB; n = 21) prior to surgery as part of a standardized anesthetic protocol. Pain was scored by two observers unaware of group assignment using the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) and a composite pain scale (CPS) prior to surgery (baseline), 2 hours (P2) and 4 hours (P4) following recovery from anesthesia. Blood samples were collected at various time points for determination of plasma hydromorphone concentration using liquid chromatography–tandem mass spectrometry. Data were analyzed with a mixed-effect model.

      Results

      Median (range) baseline EQUUS-FAP was 1.2 (0.0–4.0) with no effect of group, time points or interaction. Baseline CPS was similar between groups. Group TxH baseline CPS was 2.5 (0.0–10.0), increased at P2 [4.5 (0–10.0); p = 0.046] and returned to baseline values at P4 [3.0 (0.0–11.0)]. Group TxB baseline CPS was 2.0 (0.0–8.0), increased at P2 [3.5 (0.0–11.0); p = 0.009] and P4 [5.0 (0.0–11.0); p < 0.001]. Pharmacokinetic terminal half-life was 774 ± 82.3 minutes, area under the curve was 1362 ± 314 ng minutes mL–1, clearance was 30.7 ± 7.23 mL minute–1 kg–1 and volume of distribution at steady state was 884 ± 740 mL kg–1.

      Conclusions

      Hydromorphone, but not butorphanol, decreased CPS back to baseline at P4 after recovery.

      Clinical relevance

      Hydromorphone may provide superior postoperative analgesia compared with butorphanol in horses undergoing arthroscopy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Veterinary Anaesthesia and Analgesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Andersen M.S.
        • Clark L.
        • Dyson S.J.
        • Newton J.R.
        Risk factors for colic in horses after general anaesthesia for MRI or nonabdominal surgery: absence of evidence of effect from perianaesthetic morphine.
        Equine Vet J. 2006; 38: 368-374
        • Ashley F.H.
        • Waterman-Pearson A.E.
        • Whay H.R.
        Behavioural assessment of pain in horses and donkeys: application to clinical practice and future studies.
        Equine Vet J. 2005; 37: 565-575
        • Boxenbaum H.
        Interspecies variation in liver weight, hepatic blood flow, and antipyrine intrinsic clearance: extrapolation of data to benzodiazepines and phenytoin.
        J Pharmacokinet Biopharm. 1980; 8: 165-176
        • Buisman M.
        • Wagner M.C.
        • Hasiuk M.M.
        • et al.
        Effects of ketamine and alfaxalone on application of a feline pain assessment scale.
        J Feline Med Surg. 2016; 18: 643-651
        • Bussières G.
        • Jacques C.
        • Lainay O.
        • et al.
        Development of a composite orthopaedic pain scale in horses.
        Res Vet Sci. 2008; 85: 294-306
        • Clark L.
        • Clutton R.E.
        • Blissitt K.J.
        • Chase-Topping M.E.
        The effects of morphine on the recovery of horses from halothane anaesthesia.
        Vet Anaesth Analg. 2008; 35: 22-29
        • Clark-Price S.C.
        • Lascola K.M.
        • Carter J.E.
        • et al.
        Assessment of agreement among diplomates of the American College of Veterinary Anesthesia and Analgesia for scoring the recovery of horses from anesthesia by use of subjective grading scales and development of a system for evaluation of the recovery of horses from anesthesia by use of accelerometry.
        Am J Vet Res. 2017; 78: 668-676
        • Dodds L.
        • Knight L.
        • Allen K.
        • Murrell J.
        The effect of postsurgical pain on attentional processing in horses.
        Vet Anaesth Analg. 2017; 44: 933-942
        • Dönselmann Im Sande P.
        • Hopster K.
        • Kästner S.
        Effects of morphine, butorphanol and levomethadone in different doses on thermal nociceptive thresholds in horses.
        Tierarztl Prax Ausg G Grosstiere Nutztiere. 2017; 45 (In German): 98-106
        • Dyke T.M.
        • Hubbell J.A.
        • Sams R.A.
        • Hinchcliff K.W.
        Hepatic blood flow in horses during the recuperative period from maximal exercise.
        Am J Vet Res. 1998; 59: 1476-1480
        • Ida K.K.
        • Fantoni D.T.
        • Ibiapina B.T.
        • et al.
        Effect of postoperative xylazine administration on cardiopulmonary function and recovery quality after isoflurane anesthesia in horses.
        Vet Surg. 2013; 42: 877-884
        • Love E.J.
        • Taylor P.M.
        • Clark C.
        • et al.
        Analgesic effect of butorphanol in ponies following castration.
        Equine Vet J. 2009; 41: 552-556
        • Martins F.C.
        • Keating S.C.
        • Clark-Price S.C.
        • et al.
        Pharmacokinetics and pharmacodynamics of hydromorphone hydrochloride in healthy horses.
        Vet Anaesth Analg. 2020; 47: 509-517
        • Reed R.
        • Barletta M.
        • Mitchell K.
        • et al.
        The pharmacokinetics and pharmacodynamics of intravenous hydromorphone in horses.
        Vet Anaesth Analg. 2019; 46: 395-404
        • Reed R.A.
        • Knych H.K.
        • Barletta M.
        • et al.
        Pharmacokinetics and pharmacodynamics of hydromorphone after intravenous and intramuscular administration in horses.
        Vet Anaesth Analg. 2020; 47: 210-218
        • Sanchez L.C.
        • Robertson S.A.
        Pain control in horses: what do we really know?.
        Equine Vet J. 2014; 46: 517-523
        • Santos M.
        • Fuente M.
        • Garcia-Iturralde R.
        • et al.
        Effects of alpha-2 adrenoceptor agonists during recovery from isoflurane anaesthesia in horses.
        Equine Vet J. 2003; 35: 170-175
        • Skrzypczak H.
        • Reed R.
        • Barletta M.
        • et al.
        A retrospective evaluation of the effect of perianesthetic hydromorphone administration on the incidence of postanesthetic signs of colic in horses.
        Vet Anaesth Analg. 2020; 47: 757-762
        • Steinbrook R.A.
        Epidural anesthesia and gastrointestinal motility.
        Anesth Analg. 1998; 86: 837-844
        • Taylor P.M.
        • Hoare H.R.
        • de Vries A.
        • et al.
        A multicentre, prospective, randomised, blinded clinical trial to compare some perioperative effects of buprenorphine or butorphanol premedication before equine elective general anaesthesia and surgery.
        Equine Vet J. 2016; 48: 442-450
        • van Loon J.P.
        • Van Dierendonck M.C.
        Pain assessment in horses after orthopaedic surgery and with orthopaedic trauma.
        Vet J. 2019; 246: 85-91