Sedation and Analgesia in the Standing Horse
Authors: Grubb Tamara
Journal: Advances in Equine Laparoscopy
Summary
# Editorial Summary: Sedation and Analgesia in the Standing Horse Bilateral paranasal sinus disease remains uncommon in equine practice, and surgical management via bilateral frontonasal bone flap under standing sedation has not been documented in regular-sized adult horses until now. Grubb's 2024 case report details the successful treatment of a 13-year-old Thoroughbred presenting with bilateral mucopurulent nasal discharge secondary to ethmoid haematoma affecting the maxillary and frontal sinuses, employing standing sedation combined with local anaesthesia and performing a prophylactic tracheotomy to maintain airway patency throughout the procedure. Supplementary analgesia proved necessary during transection of the dorsal nasal septum, whilst the bilateral approach allowed simultaneous access to both paranasal sinuses and creation of patent drainage pathways; follow-up transendoscopic removal of sequestra was required at four weeks post-operatively, though the horse achieved complete functional and cosmetic recovery with histopathology confirming sinus cyst rather than neoplastic pathology. For practitioners managing equine sinus disease, this case demonstrates that carefully timed regional nerve blocks significantly enhance analgesia during standing procedures, and that prophylactic airway management via temporary tracheotomy substantially reduces perioperative risk. The bilateral bone flap technique should be considered a viable option for horses requiring simultaneous bilateral sinus access, particularly where general anaesthesia carries elevated risk or is contraindicated.
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Practical Takeaways
- •Bilateral sinus procedures can be performed standing in adult horses using proper sedation, local blocks, and airway management rather than general anesthesia
- •Temporary tracheotomy is essential for maintaining airway patency during bilateral sinus surgery and should be considered standard protocol
- •Regional nerve blocks significantly improve analgesia for invasive sinus procedures and should be incorporated into standing surgical protocols
Key Findings
- •Bilateral frontonasal bone flap approach successfully performed on standing adult horse under sedation and local anesthesia for bilateral sinus pathology
- •Temporary tracheotomy prevented airway obstruction during the surgical procedure
- •Regional nerve blocks provided adequate analgesia for dorsal nasal septum transection
- •Complete recovery achieved with excellent cosmetic outcome and histopathological diagnosis of sinus cyst