BEVA primary care clinical guidelines: Analgesia.
Authors: Bowen I M, Redpath A, Dugdale A, Burford J H, Lloyd D, Watson T, Hallowell G D
Journal: Equine veterinary journal
Summary
# BEVA Primary Care Clinical Guidelines: Analgesia The British Equine Veterinary Association convened an expert panel to synthesise evidence on analgesic use across common equine primary care scenarios, applying a modified GRADE framework (vetGRADE) to evaluate research quality and generate recommendations for practitioners. For routine castration, the guidelines emphasise that intratesticular local anaesthesia is essential regardless of surgical technique, preoperative NSAIDs are mandatory, and analgesia should continue for three days postoperatively; opioids such as butorphanol and buprenorphine are explicitly contraindicated as sole agents. Phenylbutazone emerged as the superior NSAID for hoof pain and laminitis, whilst firocoxib and flunixin provide better analgesia than phenylbutazone or meloxicam in colic cases, though NSAIDs show no enhanced efficacy in joint pain management. Critically, the panel stress that all analgesic classes carry adverse event risks—including right dorsal colitis with NSAIDs and ileus or aberrant behaviour with opioids—necessitating individualised pain management plans with rigorous veterinary oversight and ongoing monitoring. The guidance highlights a significant evidence gap: the lack of a validated composite equine pain scale limits robust medication comparisons and represents a priority for future research, with implications for both clinical decision-making and the development of improved analgesic protocols across equine practice.
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Practical Takeaways
- •Always combine local anaesthesia with systemic NSAIDs for castration cases and continue pain relief for 3 days post-op; opioids alone are inadequate for this procedure
- •Use phenylbutazone preferentially for laminitis and hoof pain management, but choose flunixin or firocoxib when treating colic-associated pain
- •Monitor all horses on NSAIDs for right dorsal colitis and those on opioids for reduced locomotor activity and potential ileus
Key Findings
- •Horses undergoing castration should receive intratesticular local anaesthesia and NSAIDs preoperatively, with analgesia continued for 3 days postoperatively (high certainty)
- •Butorphanol and buprenorphine are not appropriate as sole analgesics for castration procedures (high certainty)
- •Phenylbutazone provides superior analgesia compared to meloxicam and firocoxib for hoof pain and laminitis (moderate certainty)
- •In colic cases, flunixin and firocoxib provide more effective analgesia than meloxicam or phenylbutazone (moderate certainty)