Administration of Epidural Ropivacaine for the Treatment of Hindlimb Pain
Principal Investigator: Jordyn Boesch
Co-PI: Aimee Colbath
DESCRIPTION (provided by applicant):
Horses often present to equine veterinarians with acute, severe hindlimb pain that may ultimately result in euthanasia. Epidural injection is a well-established means of relieving pain when systemic analgesics fail and typically includes the full mu agonist opioid morphine. Epidural morphine is effective and spares neurological (proprioceptive and motor) function, but often causes ileus that may lead to colic. An alternative to morphine that is at least equally effective but spares both neurological function and gastrointestinal (GI) motility is needed. The local anesthetic ropivacaine, used at low concentrations (≤ 0.125%), relieves pain without producing neurological abnormalities (ataxia or paresis) in people and is therefore a promising candidate in horses. However, it has not been evaluated in conscious horses with hindlimb pain and lameness. In this blinded, controlled, crossover, randomized, pre-clinical study, eight systemically healthy, sound research horses will undergo epidural catheterization and tibiotarsal injection (one joint per study phase) of recombinant equine interleukin-1beta (IL-1β) to induce temporary inflammatory pain and lameness. Approximately 12 hours later, baseline data will be collected by blinded investigators, including 1) lameness examination – both subjective (using the American Association of Equine Practitioners Lameness Scale) and objective (using the Equinosis Q Lameness Locator), 2) neurological examination (using a modified Mayhew scale), 3) evaluation of GI motility (by auscultating cecal borborygmi, counting fecal piles, and monitoring for colic), and 4) measurement of heart and respiratory rates. Next, a total volume of 0.04 mL/kg of either preservative-free (PF) 0.9% saline (control phase) or PF 0.125% ropivacaine (epidural phase) will be injected through the epidural catheter [time = 0 hours (t0)]. Evaluation of lameness, neurological function, GI motility, and heart and respiratory rates will be repeated at intervals thereafter (t0.5, 1, 2, 3, 4, 5, and 6). The primary outcome is displacement in mm between hindlimbs generated by the Lameness Locator and will be analyzed using repeated measures ANOVA with evaluation of the time*treatment interaction term. We hypothesize that epidural 0.125% ropivacaine will decrease mean difference in displacement between hindlimbs for 6 hours without producing ataxia, paresis, or ileus.