Haralambus Rhea, Juri Michaela, Mokry Anna, Jenner Florien
Equine Surgery Unit, University Equine Hospital, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria.
Front Pain Res (Lausanne). 2024 Feb 19;5:1347548. doi: 10.3389/fpain.2024.1347548. eCollection 2024.
Effective management of postoperative pain is essential to ensure patient welfare, reduce morbidity and optimize recovery. Opioids are effective in managing moderate to severe pain in horses but concerns over their adverse effects on gastrointestinal (GI) motility and associated increased colic risk limit their widespread use. Studies investigating the impact of systemic opioids on both GI motility and colic incidence in horses have yielded inconclusive outcomes. Therefore, this retrospective study aims to assess the influence of systemic administration of butorphanol, morphine, and methadone on post-anaesthetic colic (PAC) incidence. Horses undergoing general anaesthesia for non-gastrointestinal procedures that were hospitalized for at least 72 h post-anaesthesia were included in this study. Anaesthetised horses were stratified by procedure type into horses undergoing diagnostic imaging without surgical intervention, emergency or elective surgery. In addition, patients were grouped by opioid treatment regime into horses receiving no opioids, intraanaesthetic, short- (<24 h) or long-term (>24 h) postoperative opioids. Administered opioids encompassed butorphanol, morphine and methadone. The number of horses showing signs of colic in the 72 h after anaesthesia was assessed for each group. A total of 782 horses were included, comprising 659 undergoing surgical procedures and 123 undergoing diagnostic imaging. The overall PAC incidence was 15.1%. Notably, horses undergoing diagnostic imaging without surgery had a significantly lower PAC rate of 6.5% compared to those undergoing surgery (16.7%, = 0.0146). Emergency surgeries had a significantly lower PAC rate of 5.8% compared to elective procedures (18%, = 0.0113). Of the 782 horses, 740 received intraoperative opioids and 204 postoperative opioids, 102 of which long-term (≥24 h). Neither intraoperative ( = 0.4243) nor short-term postoperative opioids ( = 0.5744) increased PAC rates. Notably, only the long-term (≥24 h) administration of morphine significantly increased PAC incidence to 34% ( = 0.0038). In contrast, long-term butorphanol (5.3% PAC, = 0.8482) and methadone (18.4% PAC, = 0.6161) did not affect PAC rates. In summary, extended morphine administration was the only opioid treatment associated with a significantly increased risk of PAC.
有效的术后疼痛管理对于确保患者福祉、降低发病率和优化恢复至关重要。阿片类药物在控制马匹中度至重度疼痛方面有效，但对其对胃肠（GI）蠕动的不良影响以及相关的结肠绞痛风险增加的担忧限制了它们的广泛使用。研究全身性阿片类药物对马匹胃肠蠕动和结肠绞痛发生率的影响得出了不确定的结果。因此，这项回顾性研究旨在评估全身性给予布托啡诺、吗啡和美沙酮对麻醉后结肠绞痛（PAC）发生率的影响。本研究纳入了因非胃肠道手术接受全身麻醉且麻醉后住院至少72小时的马匹。麻醉后的马匹按手术类型分层为接受无手术干预的诊断性成像、急诊或择期手术的马匹。此外，患者按阿片类药物治疗方案分组为未接受阿片类药物、麻醉期间、短期（<24小时）或长期（>24小时）术后使用阿片类药物的马匹。给予的阿片类药物包括布托啡诺、吗啡和美沙酮。评估每组在麻醉后72小时内出现结肠绞痛迹象的马匹数量。总共纳入了782匹马，其中659匹接受手术，123匹接受诊断性成像。总体PAC发生率为15.1%。值得注意的是，未接受手术的诊断性成像马匹的PAC发生率显著低于接受手术的马匹（6.5%对16.7%，P = 0.0146）。急诊手术的PAC发生率显著低于择期手术（5.8%对18%，P = 0.0113）。在782匹马中，740匹在术中接受阿片类药物，204匹在术后接受阿片类药物，其中102匹接受长期（≥24小时）阿片类药物。术中（P = 0.4243）和短期术后阿片类药物（P = 0.5744）均未增加PAC发生率。值得注意的是，只有长期（≥24小时）给予吗啡会使PAC发生率显著增加至34%（P = 0.0038）。相比之下，长期给予布托啡诺（PAC发生率5.3%，P = 0.8482）和美沙酮（PAC发生率18.4%，P = 0.6161）并不影响PAC发生率。总之，延长吗啡给药是唯一与PAC风险显著增加相关的阿片类药物治疗。
