The Horse

MAR 2019

The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.

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YOUR GUIDE TO THE 2018 AAEP CONVENTION The Horse | AAEP Wrap-Up March 2019 A25 ALEXANDRA BECKSTETT ERICA LARSON Managing Laminitis Pain on the Farm L aminitis is extremely painful and requires aggressive treatment. With this disease, the tiny lamellae that attach the hoof to the coffin bone within fail, potentially causing the bone to sink or rotate. Lori Bidwell, DVM, Dipl. ACVAA, of East-West Equine Sports Medicine, described how practitioners can manage laminitic horses' pain levels during the acute and chronic phases of disease. Acute Treatment Bidwell said immedi- ate treatment of acute laminitis includes: ■ Icing the feet for the first 48 hours; ■ Administering non-steroidal anti- inflammatory drugs (NSAIDs) such as phenylbutazone (Bute) or flunixin meglumine (Banamine); ■ Removing the horse's shoes and pro- tecting the soles with pads; ■ Putting the horse on deep, soft footing, such as sand or deep shavings; and ■ Giving ¼ tube daily of omeprazole to protect the stomach lining from acid if the horse doesn't have much appetite. Bidwell might administer other pain-re- lieving drugs if a horse doesn't tolerate or respond to NSAIDs and is in severe pain. These include homeopathic Traumeel tablets (sold in most pharmacies) off- label; the sedative detomidine; the opioid butorphanol; or lidocaine patches. Another way to relieve pain in these horses, said Bidwell, is to place an abaxial nerve block (at the base of the proximal sesamoid bones, at the back of the fetlock) to numb everything below the fetlock. But she doesn't always recommend it because it can make the horse feel so good that he moves around. Rather, she recommends using sarapin, an extract distilled from the pitcher plant, to help relieve pain without numbing the nerve completely. For extremely painful horses, she said she might place a perineural catheter along the digital nerve branches and infuse lidocaine through it for 12 hours. Chronic Treatment Chronically laminitic horses have entered the recovery phase and deal with neuropathic (nerve) pain. "Treating chronic laminitis pain involves developing a balance between budget restraints placed by the owner, analgesic options, and patient drug toler- ance," said Bidwell. Along with NSAIDs, she said vets can reach for drugs such as the nerve pain medication gabapentin, the opioid metha- done, and the analgesic tramadol for long- term care. Drugs like gabapentin help quiet excitable nerves and allow other drugs, such as NSAIDs, to work better. She also recommended vets consider alternative ways to manage these horses' pain and anxiety, such as acupuncture and calming supplements. Take-Home Message "Every patient has a different response to pain," said Bidwell. "Be aggressive with treatment in the early phase … and find a balance with long- term care that is suited to each patient." If the horse is in uncontrollable pain or owner resources are limited, she said hu- mane euthanasia is often the best option. Epinephrine Prolongs, Intensifies Hoof Nerve Blocks Reasons to numb a horse's foot with a palmar digital nerve (PDN) block range from lameness diagnostics to standing surgical procedures. But blocks don't last forever, and vets can run into problems when working rapidly to finish before the horse regains feeling in the area. Physicians sometimes add small amounts of epinephrine to local anesthet- ic solutions to intensify and prolong their analgesic effects. So Ana Velloso Alvarez, LV, a resident at the Auburn University College of Veterinary Medicine, in Ala- bama, and colleagues tested three PDN blocks on lame limbs in six horses: ■ 2% lidocaine (a common local anes- thetic for performing nerve blocks); ■ 1% lidocaine; and ■ 1% lidocaine plus epinephrine. Next, the team used the objective Lameness Locator to evaluate the horses' gaits every five minutes for the first 30 minutes after PDN administration, then every 15 minutes for another 1.5 hours. They also measured skin sensation be- tween the horses' heel bulbs. Velloso Alvarez said treatment effects were no different for the first 30 minutes. Same goes for the two lidocaine-only treated groups for the longer duration; but horses treated with the combination remained sound significantly longer. The team noted normal skin sensation between the heel bulbs in the groups not receiving epinephrine, even though lame- ness improved. When they used the com- bo, the horses had decreased sensation. Velloso Alvarez said it isn't yet clear how long epinephrine prolongs analgesia, but because the combination of lidocaine and epinephrine increased the duration and potency of a PDN block, it might FRANK SORGE/WWW.ARND.NL Pain Management & Anesthesia

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