Abstract
Analgesia for critical patients: Where internal medicine and anesthesiology meet
Despite increasing research efforts over the past decade, clinical analgesia for equine critical care patients tends to remain more art than science. For many of the drugs and treatment regimens routinely used in equine referral practice, we still lack adequately sized clinical trials targeting their efficacy and safety at commonly used dosages in terms of patient-relevant outcomes (pain relief, decreased morbidity or mortality, reduced time to discharge) and incidence of adverse effects. The drug classes that are typically used in horses with moderate to severe acute pain include non-steroidal anti-inflammatory drugs, α-2 agonists, opioids, and local anesthetic agents; of note, all of these affect the digestive system, and gastro-intestinal side-effects associated with long-term systemic NSAID or opioid administration are a major concern limiting their clinical use. Multimodal analgesia, i.e. the practice of administering a combination of analgesic drugs with different modes of action via one or more routes of administration, is preferred as this may alleviate pain more effectively and at lower doses of each individual agent, limiting the potential for adverse effects. Routes of administration to consider include loco-regional techniques (perineural blocks, epidural analgesia) as well as systemic (PO, IM or IV) use. Chronic pain states may require different treatment strategies as well as different pharmacological approaches. This lecture will briefly discuss clinical analgesic strategies for two equine pain states that concern anesthesiologists and internal medicine specialists alike: acute colic (pre-, peri- and post-operative) and laminitis.
Despite increasing research efforts over the past decade, clinical analgesia for equine critical care patients tends to remain more art than science. For many of the drugs and treatment regimens routinely used in equine referral practice, we still lack adequately sized clinical trials targeting their efficacy and safety at commonly used dosages in terms of patient-relevant outcomes (pain relief, decreased morbidity or mortality, reduced time to discharge) and incidence of adverse effects. The drug classes that are typically used in horses with moderate to severe acute pain include non-steroidal anti-inflammatory drugs, α-2 agonists, opioids, and local anesthetic agents; of note, all of these affect the digestive system, and gastro-intestinal side-effects associated with long-term systemic NSAID or opioid administration are a major concern limiting their clinical use. Multimodal analgesia, i.e. the practice of administering a combination of analgesic drugs with different modes of action via one or more routes of administration, is preferred as this may alleviate pain more effectively and at lower doses of each individual agent, limiting the potential for adverse effects. Routes of administration to consider include loco-regional techniques (perineural blocks, epidural analgesia) as well as systemic (PO, IM or IV) use. Chronic pain states may require different treatment strategies as well as different pharmacological approaches. This lecture will briefly discuss clinical analgesic strategies for two equine pain states that concern anesthesiologists and internal medicine specialists alike: acute colic (pre-, peri- and post-operative) and laminitis.
| Original language | English |
|---|---|
| Title of host publication | ECEIM annual conference |
| Place of Publication | Utrecht |
| Publication status | Published - 6 Nov 2015 |
| Event | ECEIM congress 2015 - Equine University Clinic , Utrecht, Netherlands Duration: 5 Nov 2015 → 7 Nov 2015 |
Conference
| Conference | ECEIM congress 2015 |
|---|---|
| Country/Territory | Netherlands |
| City | Utrecht |
| Period | 5/11/15 → 7/11/15 |