Opioid‐free anaesthesia protocol for standing spinal surgery in a horse
Authors: Perez Bartolome Rico, Hawkins Alexander, Fiske‐Jackson Andrew, Jimenez Carolina Palacios
Journal: Veterinary Record Case Reports
Summary
# Editorial Summary: Opioid-Free Standing Spinal Surgery in Equines Recognising that opioid administration in horses frequently precipitates undesirable effects—including excitement, ataxia and post-operative ileus—this 2023 case report examined whether effective analgesia could be achieved without opioids during standing spinal surgery. A single horse undergoing multiple subtotal spinous process ostectomies (a procedure commonly performed for kissing spines) received analgesia via continuous detomidine infusion combined with bilateral ultrasound-guided erector spinae blocks, demonstrating that opioid-free protocols can provide adequate surgical conditions and pain management for this procedure. The significance lies in expanding clinicians' options for horses where opioid avoidance is desirable—whether due to pre-existing conditions, concerns about gastrointestinal function, or individual patient sensitivities—though the evidence base remains limited to a single case. For equine veterinarians and allied professionals managing horses with thoracolumbar pathology, this represents a useful proof-of-concept that regional anaesthetic techniques combined with alpha-2 agonists warrant further investigation as a viable alternative to traditional opioid-based protocols.
Read the full abstract on the publisher's site
Practical Takeaways
- •Consider opioid-free protocols as an alternative when traditional opioid use is contraindicated or to avoid opioid side effects like ataxia and GI stasis in standing surgical cases
- •Detomidine CRI combined with regional nerve blocks (erector spinae block) can provide adequate analgesia for standing spinal surgery
- •This represents an emerging approach — gather more data and experience before routine implementation, but worth exploring as an option in your practice
Key Findings
- •Opioid-free anaesthesia using detomidine CRI and bilateral ultrasound-guided erector spinae block successfully provided analgesia during standing spinal surgery in one horse
- •The protocol avoided known opioid adverse effects in horses including excitement, ataxia, and gastrointestinal stasis
- •Opioid-free surgical anaesthesia appears feasible for equine subtotal spinous process ostectomies