SPORTS MEDICINE AND REHABILITATION


Table 2. Analgesic Options for the Laminitic Horse Drug Name


Phenylbutazone Flunixin


Ketoprofen Firocoxib


Diclofenac ointment Pentoxifylline Lidocaine


Bupivacaine Detomidine


Morphine Butorphanol Buprenorphine


Methadone Fentanyl


Tramadol


Ketamine Epidurals


Dosage/Route of Administration


2.2–4.4 mg/kg IV or PO q12h 0.5–1.1 mg/kg IV or PO q8–12h 2.2–3.6 mg/kg IV q6–12h 0.1 mg/kg PO q24h Topical q12–24h 4.4 mg/kg PO q8h


1.3 mg/kg IV loading dose, 0.05 mg/kg/ min CRI


3 mL of 0.5% solution perineurally q12– 24h


10–40 g/kg IM or IV q2–4h


Bolus 5–10 g/kg IV, 24–36 g/kg/hr CRI 0.1–0.2 mg/kg IV/IM q4–6h


0.1 mg/kg qs to 50 mL with saline via IVRP


0.01–0.4 mg/kg IV/IM q2–4h


5–20 g/kg IV/IM q8h 6 g/kg sublingual q12h 0.1–0.2 mg/kg IV/IM q4–6h


2–3 10 mg (100 g/hr) patches changed q2–3d


5 mg/kg PO q12h Combine with ketamine CRI at 0.6 mg/kg/hr for first 3 days


100–150 g/kg bolus, 60–120 ug/kg/hr CRI


Morphine 0.1–0.2 mg/kg, xylazine 0.17 mg/kg OR detomidine 20–30 g/kg)  bupivacaine (0.125–0.25%), bolus 15–30 mL or infuse at 0.5–3.0 mL/hr


Morphine 0.2 mg/kg, xylazine 0.2 mg/kg diluted with 0.9% NaCl to 0.2 ml/kg


Gabapentin


Acepromazine Isoxsuprine Resveratrol


Acetaminophen TENS


Morphine 0.2 mg/kg, detomidine 30 g/kg 5–20 mg/kg PO q8–12h 0.06 mg/kg IV q12h 1.2 mg/kg PO q12h


2000 mg resveratrol  200 mg sodium hyaluronic acid q24h for minimum 28 days


No controlled studies have been performed


Acute pain settings: Frequency 100 Hz, pulse duration 50 s


Chronic pain settings: Frequency 20 Hz, pulse duration 200 s


CRI, constant rate infusion; GI, gastrointestinal; IM, intramuscular; IV, intravenous; IVRP, intravenous regional limb perfusion; TENS, transcutaneous electrical nerve stimulation.


Must wean off slowly when discontinuing No known direct analgesic effect No known direct analgesic effect


Precautions/Notes


Possible renal, GI Possible renal, GI Possible renal, GI


0.3 mg/kg often given on first day


Skin irritation can occur; must clip hair No known direct analgesic effect Neurologic side effects can occur


Can consider placing percutaneous catheter Consider coadministration with opioid


GI, behavioral side effects can occur; Consider coadministration with alpha-2


GI, behavioral side effects can occur Consider coadministration with alpha-2 GI, behavioral side effects can occur Consider coadministration with alpha-2


Consider combining with detomidine at 0.1 mg/kg IV fentanyl ineffective


Increased risk GI side effects at 10 mg/kg PO q12h


Consider combining with tramadol


References 2


2


2, 11, 21 21, 23 29 94 2


38 21


21 21 21


21, 51 20, 47


48, 49, 50


19, 21, 50 21


3


43, 82 3 2


94 129 131


effective. Horses with naturally occurring forelimb or hindlimb lameness were exercised on a treadmill. Horses were given either phenylbutazone (2.2 mg/kg PO q12h) or phenylbutazone plus flunixin (1.1 mg/kg IV q12h) for 5 days. No significant clinical improvement was seen with phenylbutazone alone; however, greater effect was seen with stacking of the NSAIDs at 12 and 24 hours.19 Gastrointestinal and renal side effects must be taken into consider- ation if multiple NSAIDs are administered.


Flunixin Meglumine (Flunixin)


While anecdotally phenylbutazone has been consid- ered superior to other NSAIDs for musculoskeletal pain, flunixin may also be effective. While not spe- cifically evaluated in the laminitic horse, analgesic effects of flunixin (1.1mg/kg IV) and phenylbutazone (4.4 mg/kg IV) were comparable in horses with nat-


urally occurring navicular syndrome evaluated us- ing both objective (force platforms) and subjective lameness methods.20


Ketoprofen


One study evaluating horses with bilateral chronic laminitis demonstrated that when administered at an equivalent dose, ketoprofen was more effective than phenylbutazone for controlling pain in horses with naturally occurring chronic laminitis.21 A dose of 3.63 mg/kg (equimolar to 4.4 mg/kg phenyl- butazone dose) was more effective than the 2.2 mg/kg ketoprofen or the 4.4 mg/kg phenylbutazone doses at reducing lameness and hoof pain.21


Firocoxib


Firocoxib has not been specifically evaluated in the laminitic horse; however, firocoxib has been effective


AAEP PROCEEDINGS  Vol. 66  2020 245


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