The impact of opioid administration on the incidence of postanaesthetic colic in horses.

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%, p = 0.0146). Emergency surgeries had a significantly lower PAC rate of 5.8% compared to elective procedures (18%, p = 0.0113). Of the 782 horses, 740 received intraoperative opioids and 204 postoperative opioids, 102 of which long-term (≥24 h). Neither intraoperative (p = 0.4243) nor short-term postoperative opioids (p = 0.5744) increased PAC rates. Notably, only the long-term (≥24 h) administration of morphine significantly increased PAC incidence to 34% (p = 0.0038). In contrast, long-term butorphanol (5.3% PAC, p = 0.8482) and methadone (18.4% PAC, p = 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.

Clinical and imaging findings, treatment details and outcomes in foals with extensor tendon rupture-A multicentre retrospective study.

BACKGROUND: Forelimb extensor tendon rupture (ETR) in foals is sparsely documented. OBJECTIVES: To describe clinical and imaging findings, treatment details, and long-term outcome in foals with ETR. STUDY DESIGN: Multicentre retrospective case-series. METHODS: Clinical record review of foals with ETR, presented to Faculty of Veterinary Medicine at Ghent University (Belgium), the Clinic for Horses at the University of Veterinary Medicine Hannover (Germany), and Rossdales Equine Hospital (UK) between 2009-2021. Long-term outcome based on structured telephone interview with the owner at the university hospitals and on future ratings from a public racing results archive at Rossdales Equine Hospital. RESULTS: Eight foals (28%; 95%CI: 11.7%-44.3%) presented with ETR only, whereas 21 foals (72%; 95%CI: 55.7%-88.3%) presented with ETR and concurrent flexural limb deformity foals with ETR only were older (median 20 days; Interquartile range [IQR] 13-22) than foals with ETR and flexural limb deformity (median five days; IQR 3-11; p = 0.001). Treatment included medical support, immobilization, and box rest. Hospitalisation time was longer for foals with ETR and flexural limb deformity (median 26 days; IQR 16-44) than for ETR-only foals (median 11 days; IQR 6-16; p = 0.03). Total rehabilitation time was longer for foals with ETR and flexural limb deformity (median 58 days; IQR 42-91) than for foals without flexural limb deformity (median 32 days; IQR 12-39; p = 0.03). Six foals (21%; 95%CI: 6.3%-35.7%) were euthanased within seven months: three because of problems with limb protraction and progressive flexural limb deformity. Long-term follow-up (>18 months) was available for two cases with ETR only, and seven cases with ETR and flexural limb deformity. Both ETR-only foals had a positive cosmetic outcome but only one a positive functional outcome. Foals with ETR and concurrent flexural limb deformity suffered limitations regarding cosmetic appearance (5/7 negative) and limb function (7/7 negative). MAIN LIMITATIONS: Small sample size, retrospective study, and no clinical follow-up. CONCLUSIONS: ETR is a rare condition in this sample of foals treated under hospital conditions often requiring prolonged care, especially with concurrent flexural limb deformity. Further research should investigate potential associations with future athletic performance.

Evaluation of a novel, patient-mounted system for CT-guided needle navigation-an ex vivo study.

PURPOSE: To describe the features of a novel patient-mounted system for CT-guided needle navigation, the Puncture Cube System (PCS), and to evaluate the accuracy and efficiency of the PCS by (a) applying numerical simulations and (b) by conducting punctures using the system in comparison to punctures using the free-hand method (FHM). METHODS: The PCS consists of a self-adhesive cube that is attached to the patient, with multiple through-holes in the upper and lower template plate and dedicated software that, using a computer vision algorithm, recognizes the cube in a planning scan. The target in the image dataset is connected by a line, here "virtual needle," which passes through the cube. For any chosen path of the virtual needle, the entry points for the needle into the cube are displayed by the software for the upper and lower template on-the-fly. The possible exactness of the system was investigated by using numerical simulations. Next, 72 punctures were performed by 6 interventionists using a phantom to compare for accuracy, time requirement, and number of CT scans for punctures with the system to the FHM ex vivo (phantom study). RESULTS: The theoretical precision to arrive at targets increased with the distance of the target but remained low. The mean error for targets up to 20 cm below the lower plate was computed to be well below 0.5 mm, and the worst-case error stayed below 1.3 mm. Compared to a conventional free-hand procedure, the use of the navigation system resulted in a statistically significantly improved accuracy (3.4 mm ± 2.3 mm versus FHM 4.9 mm ± 3.2 mm) and overall lower intervention time (168 s ± 28.5 s versus FHM 200 s ± 44.8 s). Furthermore, the number of CT scans was reduced to 2.3 versus FHM 2.8). CONCLUSION: The PCS is a promising technique to improve accuracy and reduce intervention time in CT-guided needle navigations compared to the FHM.