Caudal epidural catheterization for pain management in 48 hospitalized horses: A descriptive study of demographics, complications, and outcomes.
Authors: Douglas Hope, Midon Monica, Shroff Kavita, Floriano Dario, Driessen Bernd, Hopster Klaus
Journal: Frontiers in veterinary science
Summary
# Caudal epidural catheterization for pain management in hospitalized horses Prolonged epidural analgesia via caudal catheterization is increasingly used in equine practice as part of multimodal pain control, yet clinical experience remains poorly characterised in the literature. This retrospective analysis examined 48 hospitalised horses (62 catheters placed) between 2017 and 2021, predominantly with orthopaedic conditions (89.6%), most commonly synovial sepsis (22.9%), to document response rates, complications, and survival outcomes. Initial positive response to epidural therapy occurred in 59.7% of cases, though complications developed in 74.2%—the majority mild (51.6%) or moderate (14.5%), with exaggerated physiologic responses being most prevalent. Despite this complication rate, 52.1% of horses were discharged, supporting caudal epidural catheterisation as a viable analgesic strategy when practitioners implement rigorous monitoring protocols. For equine professionals managing cases with severe or prolonged pain, particularly where systemic analgesia is limited, this evidence suggests epidural catheters warrant consideration alongside careful patient selection and vigilant post-operative surveillance.
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Practical Takeaways
- •Caudal epidural catheters are a viable multi-modal pain management option for hospitalized horses with orthopedic disease or synovial sepsis, with most complications being manageable if monitored closely
- •Expect initial positive analgesic response in about 60% of cases, but plan for vigilant post-placement monitoring as complications occur in roughly 3 of 4 placements
- •Exaggerated physiologic responses (likely hypotension, bradycardia, or ataxia) are the most common complication type—educate owners and be prepared to manage hemodynamic changes
Key Findings
- •Caudal epidural catheterization was used in 48 hospitalized horses (62 catheters placed) with 89.6% having orthopedic diagnoses
- •Initial positive response to epidural therapy occurred in 59.7% of catheters, though 74.2% experienced some complication
- •Most complications were mild (51.6%) or moderate (14.5%), with exaggerated physiologic responses being most frequent
- •Hospital discharge rate was 52.1%, indicating epidural analgesia may be part of successful pain management in complex cases