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Objective pain assessment is important to guide and tailor therapy in clinical practice. This study describes the clinical applicability and validity of two pain scales, the Composite Pain Scale (CPS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) in horses with orthopaedic trauma or after orthopaedic surgery. A cohort follow-up study was performed using 77 adult horses (n = 43 with orthopaedic trauma or injury; n= 34 controls). Composite and facial expression-based pain scores were assessed by direct observations of pairs of two independent observers. All horses were assessed at arrival, and on the first and second day after arrival or after surgery. Both CPS and EQUUS-FAP scores demonstrated high inter-observer reliability (Crohnbach's alpha = 0.97 for CPS; Crohnbach's alpha = 0.93 for EQUUS-FAP; P< 0.001), with low bias (0.07 and -0.08 respectively) and limits of agreement of -1.9 to 1.9 for CPS and -1.9 to 1.9 for EQUUS-FAP. Both CPS and EQUUS-FAP scores showed significant differences between control horses and orthopaedic cases (P < 0.001). Trauma cases had significantly higher pain scores compared to postoperative cases for both CPS (P < 0.05) and for EQUUS-FAP (P < 0.01) and both pain scores significantly decreased after nonsteroidal anti-inflammatory drug (NSAID) administration. In accordance with the findings in other types of equine pain, the CPS and FAP proved useful and valid for objective and repeatable assessment of pain in horses with orthopaedic trauma or after orthopaedic surgery. This can further aid treatment of horses in clinical practice and might improve equine welfare. (C) 2019 Elsevier Ltd. All rights reserved.

Extracellular vesicle (EV) concentration, characteristics and function in equine synovial fluid (SF) during normal growth and development has not previously been studied. Isolation of EVs was performed in SF from three healthy foals and two adult horses by differential ultracentrifugation (10,000 g and 200,000 g); EVs were purified by sucrose density gradient floatation and analysed by high-resolution flow cytometry (FCM), buoyant density and western blotting. Additionally, repeated biomarker analysis of sulphated glycosaminoglycans (GAG), matrix metalloproteinase (MMP), C-terminal crosslinked telopeptide type II collagen (CTX-II), collagenase cleaved neopeptide type II collagen (C2C) was performed in SF from 10 foals and six adult horses. In contrast with the quantitative EV profile, the biomarker profile in SF from juvenile joints was substantially different from that in SF from adult animals. However, there were qualitative differences in the high-resolution FCM scatter plots. Future in-depth functional analyses may reveal differences between juvenile and mature EVs in SF.

In recent decades, much effort has been invested in scientific studies of objective and reliable assessment of pain in horses. Various types of pain assessment tools have been described and (partly) validated for different types of pain in horses. Currently, composite pain scales and facial expression-based pain scales seem to be the most promising tools for pain assessment in horses and numerous studies have recently been published on the use of these pain scales in horses. Therefore, this narrative review mainly focusses on these two types of pain scales and on the studies that have appeared describing these type of pain scales in horses. The extent to which these pain scales have been validated (sensitivity, specificity, inter observer reliability etc.) and their potential use for clinical pain states is discussed. Possible future directions for new studies and their possible aid in assessing pain in hospitalised and ridden horses are presented. In this way, improved pain scoring could improve criteria used to evaluate the clinical efficacy of new analgesic drugs and techniques, potentially benefiting equine welfare. (C) 2018 Elsevier Ltd. All rights reserved.

Objective The aim of this study was to compare different methods to determine venous admixture (Q_s=Q_t) in anaesthetized horses. The first objective was to estimate Q_s=Q_t using jugular venous blood oxygen content (Q_s=Q_t jugular), and a fixed value for the oxygen extraction (F-shunt). The second objective was to assess the influence of blood pressure and positioning on oxygen extraction. The third objective was to perform regression analysis between jugular and mixed venous blood oxygen tensions. Study design Prospective, experimental trial. Animals The study was performed with seven warmblood horses that were anaesthetized with detomidine, butorphanol, ketamine, diazepam and isoflurane in oxygen. Methods Multiple simultaneous arterial, jugular venous and pulmonary arterial blood samples were taken under normotensive and hypotensive conditions in lateral and dorsal recumbency. Arterial, mixed venous, and end-capillary oxygen content were calculated. Results A significant correlation between Q_s=Q_t and Q_s=Q_t jugular was found [intraclass correlation coefficient (ICC) ¼ 0.68, p < 0.001], and BlandeAltman analysis showed a bias of e11.5% and wide limits of agreement (e27.7% to 4.6%). Fshunt significantly correlated with Q_s=Q_t (ICC ¼ 0.88, p < 0.001), and BlandeAltman analysis showed a lower bias (e1.97) and narrower limits of agreement (e13.8% to 9.9%). Positioning and blood pressure significantly influenced oxygen extraction. The regression formula was Y ¼ 0.80X þ 2.61 (where Y is the calculated mixed venous oxygen tension and X is the jugular venous oxygen tension) when outliers were excluded (ICC¼0.82, p < 0.001). Conclusions and clinical relevance This study shows that F-shunt provides reasonable estimates of Q_s=Q_t but can possibly be improved by using simple algorithms without the need for pulmonary arterial catheterization. These algorithms use blood pressure- and positioning-dependent oxygen extraction and regression analysis between jugular venous and pulmonary arterial oxygen tension. Although promising, the validity of these algorithms needs to be determined in future studies

Objective To assess the clinical course of abdominal wall sensitivity after ventral midline coeliotomy in horses by determining mechanical nociceptive thresholds (MNTs) during hospitalization, and to determine the inter-observer reliability of pressure algometry on the abdominal wall. Study design Observational, cohort study. Sample population A total of 13 horses presenting with signs of abdominal pain/colic undergoing ventral midline coeliotomy and 10 healthy horses without an abdominal incision. Methods Measurements were performed on days 1, 3, 5, 7 and 9 postoperatively using a pressure algometer. Measurement sites were marked left and right, abaxial to the abdominal incision. Cranial to the incision, two control points were marked. Measurements were made by one observer, blinded to the recorded MNT values. To determine inter-observer reliability, five horses (surgical group n = 2; nonsurgical group n = 3) were measured by two observers in a randomized order. Results Mean MNT values on days 5 and 7 were 9.61 Ncm−2 and 10.14 Ncm−2 in the operated group (p = 0.009 ; p = 0.005) respectively versus 13.00 Ncm−2 on day 1. Wound-associated points showed lower values than control points (p = 0.002). The nonsurgical group did not show a difference between control points and wound-associated points (p = 0.06). No significant differences were found between the surgical and the nonsurgical groups at the wound-associated points on any days measured. The inter-observer reliability was low (intraclass correlation coefficient of 0.26; Cronbach’s alpha of 0.27). Conclusion Operated animals showed a reduction in MNT values on days 5 and 7 when compared with day 1 and lower values for the wound-associated points when compared with the control points. Inter-observer reliability was low. Pressure algometry could be a useful tool for assessing wound sensitivity after ventral midline coeliotomy in horses, which may improve pain management postoperatively.

The number of donkeys in the world may not be increasing but awareness of their use and concern for welfare and pain recognition and treatment are receiving increasing veterinary interest. Therefore, accurate information about anesthesia and analgesia in donkeys and mules is important to more equine practitioners. This review highlights the current knowledge on various anesthetic and analgesic approaches in donkey and mules. The authors emphasize that there is still much information that is not available about donkeys and mules; in many circumstances, the clinician must use available equine information to treat the patient, while monitoring for differences in response.

This case report details the unusual clinical course of a horse that had been hospitalised for recurrent colic prior to an acute colic episode requiring emergency laparotomy. Within the first 24 hours after surgery, the horse developed severe colic and postoperative ileus (POI) requiring repeat laparotomy. The horse suffered persistent ileus with copious reflux for 8 days thereafter, but its clinical condition permitted continued treatment. It was discharged after 4 weeks and returned to its previous performance level. The authors describe clinical decision-making regarding intravenous fluid therapy, prokinetic drug administration, enteral and parenteral nutrition, and institution of physical exercise in the treatment of persistent POI. Economic and welfare considerations allowing, equine POI may resolve even in protracted cases. Patients may benefit from strategies aimed at early enteral feeding and ambulation as have emerged in human POI management.

This study validates a recently described pain scale, the Equine Utrecht University scale for facial assessment of pain (EQUUS-FAP), in horses with acute or postoperative pain originating from the head, including dental pain, ocular pain, or trauma to the skull. This cohort study of 23 horses with head related pain and 23 normal, healthy controls revealed significant differences in EQUUS-FAP scores between control horses and horses with acute or postoperative pain (P < 0.001). Moreover, pain scores after surgery decreased significantly over time (P < 0.001). The scale showed good inter-observer reliability (intraclass correlation coefficient = 0.92), sensitivity (80%), specificity (78%), and positive (80%) and negative predictive values (78%). (C) 2017 Elsevier Ltd. All rights reserved.

REASONS FOR PERFORMING STUDY: Hypoventilation or apnoea, caused by the induction of general anaesthesia, may cause hypoxaemia. Pre-oxygenation may lengthen the period before this happens. No scientific studies are published on pre-oxygenation in equine anaesthesia. OBJECTIVES: To determine whether supplementation of oxygen at a flow rate of 15 litres per minute for 3 minutes via a nasal cannula before induction of general anaesthesia is effective in elevating the arterial partial pressure of oxygen (PaO2 ) directly after induction. STUDY DESIGN: Randomised, prospective clinical trial. METHODS: Eighteen adult horses, American Society of Anesthesiologists physical status 1 or 2, undergoing elective anaesthesia were randomly allocated to one of 2 groups. The first group (control group) received no oxygen supplementation before induction of general anaesthesia, whereas the second group (oxygen group) did. All horses were anaesthetised with intravenous detomidine, butorphanol, ketamine, midazolam and isoflurane. Directly after induction (T = 0) and 30 min later (T = 30) an arterial blood sample was taken for blood gas analysis. At T = 30 an estimate of intrapulmonary shunt fraction (Qs/Qt) was calculated. RESULTS: At T = 0 arterial partial pressure of oxygen (PaO2 ) was significantly higher in the oxygen group compared to the control group (11.0 ± 2.6 kPa versus 7.4 ± 1.6 kPa; mean ± s.d., p = 0.005), at T = 30 differences were not statistically significant. Partial pressure of carbon dioxide (PaCO2 ) and Qs/Qt did not differ between the groups. CONCLUSIONS: Supplementing oxygen by a nasal cannula before induction of general anaesthesia in horses is feasible and does effectively elevate the PaO2 immediately after induction. Future research is needed to determine whether supplementation of oxygen before induction of general anaesthesia in horses will affect outcomes. This article is protected by copyright. All rights reserved.

Summary Perineural nerve blocks are often used in equine practice, especially since the use of diagnostic and surgical procedures in the standing sedated horse have expanded over recent decades. The purpose of this review is to discuss the different perineural nerve blocks for the equine head. The review starts with the currently most used blind approaches as described in textbooks and scientific studies. In human medicine, the role of guided techniques, such as ultrasound guidance, advanced imaging guidance and nerve stimulator guided techniques, is very extensively described. These techniques are promising to use in equine medicine as well. The first studies that describe these techniques in equine cases are also discussed in this review, as well as the possibilities for neuromodulation in equine pain syndromes like equine trigeminus-mediated headshaking and the role of perineural nerve blocks in diagnosing this syndrome.

In this study, the intra-articular tolerability and suitability for local and sustained release of an in situ forming gel composed of an acetyl-capped poly(ε-caprolactone-co-lactide)-b-poly(ethylene glycol)-b-poly(ε-caprolactone-co-lactide) (PCLA-PEG-PCLA) copolymer loaded with celecoxib was investigated in horse joints. The systems were loaded with two dosages of celecoxib, 50 mg/g ('low CLB gel') and 260 mg/g ('high CLB gel'). Subsequently, they were injected into the joints of five healthy horses. For 72 h after intra-articular injection, they induced a transient inflammatory response, which was also observed after application of Hyonate(®), a commercial formulation containing hyaluronic acid for the intra-articular treatment of synovitis in horses. However, only after administration of the 'high CLB gel' the horses showed signs of discomfort (lameness score: 1.6 ± 1.3 on a 5-point scale) 1 day after injection, which completely disappeared 3 days after injection. Importantly, there was no indication of cartilage damage. Celecoxib Cmax in the joints was reached at 8 h and 24 h after administration of the 'low CLB gel' and 'high CLB gel', respectively. In the joints, concentrations of celecoxib were detected 4 weeks post administration. Celecoxib was also detected in plasma at concentrations of 150 ng/ml at day 3 post administration and thereafter its concentration dropped below the detection limit. These results show that the systems were well tolerated after intra-articular administration and showed local and sustained release of celecoxib for 4 weeks with low and short systemic exposure to the drug, demonstrating that these injectable in situ forming hydrogels are promising vehicles for intra-articular drug delivery.

Although phenylbutazone (PBZ) is commonly used in equine orthopaedic practice, little is known about its in vivo effects on joint inflammation and cartilage turnover. This study investigates the effects of PBZ on inflammatory parameters, matrix metalloproteinase (MMP) activity and cartilage biomarkers in equine joints with acute synovitis. In a two-period cross-over study, transient synovitis was induced at T = 0 h in the middle carpal joint of seven ponies by lipopolysaccharide (LPS) injection. Ponies received PBZ (2 mg/kg PO twice daily) or placebo for 1 week, starting at T = 2 h. Arthroscopic assessment of the middle carpal joint was performed at T = -504, 48 and 672 h. Synovial fluid (SF) was sampled at T = -504, 0, 8, 24, 48, 168, 336 and 672 h and analysed for leukocytes and total protein, substance P, general MMP activity, glycosaminoglycans (GAG), collagen II cleavage marker C2C and synthesis marker CPII. Markers in PBZ- vs. placebo-treated joints were compared over time using a linear mixed model. LPS injection caused marked transient synovitis without visible cartilage changes. Substance P and general MMP activity were not significantly reduced by PBZ treatment, nor were SF GAG or C2C concentrations at any time point. Concentration of CPII was significantly lower at T = 24 and 168 h in PBZ treated joints compared to placebo. Although PBZ is clinically effective in treating acute synovitis, it does not limit inflammation-induced cartilage catabolism and may transiently reduce collagen anabolism as evidenced by SF markers.

Recognition and management of equine pain have been studied extensively in recent decades and this has led to significant advances. However, there is still room for improvement in the ability to identify and treat pain in horses that have undergone emergency gastrointestinal surgery. This study assessed the validity and clinical application of the composite pain scale (CPS) in horses after emergency gastrointestinal surgery. Composite pain scores were determined every 4h over 3 days following emergency gastrointestinal surgery in 48 horses. Inter-observer reliability was determined and another composite visceral pain score (numerical rating scale, NRS) was determined simultaneously with CPS scores. CPS scores had higher inter-observer reliability (r=0.87, K=0.84, P

REASONS FOR PERFORMING STUDY: Intra-articular (IA) injection of corticosteroids with or without hyaluronate (HA) has been used for decades in equine practice for treatment of noninfectious synovitis and osteoarthritis. However, to date, no large-scale randomised equine field trials have been reported that address the supposed superior clinical efficacy of the combination of corticosteroid + HA compared with IA injection of corticosteroid alone.\n\nOBJECTIVES: To compare the clinical efficacy of IA triamcinolone acetonide (TA, 12 mg) compared with IA TA (12 mg) + high molecular weight HA (20 mg) in horses with clinical joint disease.\n\nSTUDY DESIGN: Prospective, randomised, parallel, open label, multicentre clinical trial.\n\nMETHODS: Eighty client-owned horses from 13 clinics were included. Lameness and effusion scores were assessed at baseline and 3 weeks after IA treatment. A standardised telephone questionnaire was completed between the owner and consulting veterinarian at 3 months. The primary outcome parameter was clinical success rate, defined as ≥2 grades lameness reduction (on a 0-5 scale) at 3 weeks. Chi-square statistics and binary logistic regression were used to analyse data on an intention-to-treat basis for the 3 week outcome.\n\nRESULTS: The success rate of IA TA 3 weeks after treatment was 87.8%, while that of TA+HA was 64.1% (P = 0.01). Age >13 years was associated with a reduced success rate for the combination treatment (P = 0.004) at 3 weeks. At 3 months, half the horses in each group had returned to their previous level of performance.\n\nCONCLUSIONS: The combination of TA with HA was associated with a lower short-term clinical success rate and a similar medium-term outcome compared with IA TA, with only half of the horses performing at their previous level of exercise after 3 months regardless of treatment group allocation.

Accurate recognition and quantification of pain in horses is imperative for adequate pain management. The past decade has seen a much needed surge in formal development of systematic pain assessment tools for the objective monitoring of pain in equine patients. This narrative review describes parameters that can be used to detect pain in horses, provides an overview of the various pain scales developed (visual analogue scales, simple descriptive scales, numerical rating scales, time budget analysis, composite pain scales and grimace scales), and highlights their strengths and weaknesses for potential clinical implementation. The available literature on the use of each pain assessment tool in specific equine pain states (laminitis, lameness, acute synovitis, post-castration, acute colic and post-abdominal surgery) is discussed, including any problems with sensitivity, reliability or scale validation as well as translation of results to other clinical pain states. The review considers future development and further refinement of currently available equine pain scoring systems.

Articular cartilage defects are common after joint injuries. When left untreated, the biomechanical protective function of cartilage is gradually lost, making the joint more susceptible to further damage, causing progressive loss of joint function and eventually osteoarthritis (OA). In the process of translating promising tissue-engineering cartilage repair approaches from bench to bedside, pre-clinical animal models including mice, rabbits, goats, and horses, are widely used. The equine species is becoming an increasingly popular model for the in vivo evaluation of regenerative orthopaedic approaches. As there is also an increasing body of evidence suggesting that successful lasting tissue reconstruction requires an implant that mimics natural tissue organization, it is imperative that depth-dependent characteristics of equine osteochondral tissue are known, to assess to what extent they resemble those in humans. Therefore, osteochondral cores (4-8 mm) were obtained from the medial and lateral femoral condyles of equine and human donors. Cores were processed for histology and for biochemical quantification of DNA, glycosaminoglycan (GAG) and collagen content. Equine and human osteochondral tissues possess similar geometrical (thickness) and organizational (GAG, collagen and DNA distribution with depth) features. These comparable trends further underscore the validity of the equine model for the evaluation of regenerative approaches for articular cartilage.

Frozen-thawed ovarian cortical fragments (1 mm(3)) were autotransplanted to the uterus of completely ovariectomized goats. The grafts developed preovulatory follicles, accompanied by estrous behavior and a rise in plasma E(2) levels, demonstrating successful cryopreservation and transplantation.

REASONS FOR PERFORMING STUDY: Multiple in vitro studies assessing articular tissues have indicated that glucosamine and chondroitin sulphate may possess anti-inflammatory effects, but little is known of their clinical effects in vivo. Many old horses have stiff joints, which is likely to be attributable to inflammation and therapy with these nutraceutical compounds could improve joint function. OBJECTIVES: To assess the clinical effects of a mixed supplement on the improvement of stiff gait in aged horses. STUDY DESIGN: Randomised, blinded, placebo-controlled study. METHODS: A group of 24 geriatric equids (age 29 ± 4 years; mean ± s.d.) received either 3 months oral supplementation with a test compound (containing glucosamine, chondroitin sulfate and methyl sulfonyl methane), or a placebo. Kinematic outcome criteria (primary: stride length; secondary: carpal flexion, fore fetlock extension and tarsal range of motion) were objectively quantified on a treadmill at a walk and trot before and after treatment. RESULTS: Stride length did not change significantly in the treated horses at the end of the trial. In the control group, carpal flexion and fore fetlock extension were significantly increased (P

Although recognition of equine pain has been studied extensively over the past decades there is still need for improvement in objective identification of pain in horses with acute colic. This study describes scale construction and clinical applicability of the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) in horses with acute colic. A cohort follow-up study was performed using 50 adult horses (n = 25 with acute colic, n = 25 controls). Composite pain scores were assessed by direct observations, Visual Analog Scale (VAS) scores were assessed from video clips. Colic patients were assessed at arrival, and on the first and second mornings after arrival. Both the EQUUS-COMPASS and EQUUS-FAP scores showed high inter-observer reliability (ICC = 0.98 for EQUUS-COMPASS, ICC = 0.93 for EQUUS-FAP, P