Cervical Epidural Spinal Analgesia for Acute Management of Severe Unilateral Forelimb Lameness: Case Report.
Authors: Watkins Amanda R, Hopster Klaus, Levine David, Hurcombe Samuel D
Journal: Frontiers in veterinary science
Summary
# Editorial Summary: Cervical Epidural Analgesia for Severe Forelimb Lameness When a 20-year-old Quarter Horse presented with grade 5/5 lameness from a substantial superficial digital flexor tear confirmed via ultrasound, conventional systemic analgesia proved inadequate to manage pain or prevent the cascade risk of supporting limb laminitis. Rather than escalate systemic medications further, the clinical team employed cervical epidural catheterisation at C1-C2 under ultrasound guidance in the standing, sedated horse, delivering epidural morphine (initially 0.1 mg/kg daily, then 0.05 mg/kg twice daily) for three days. Pain scoring demonstrated significant improvement following each morphine administration, and critically, the gelding navigated the acute injury phase without developing contralateral laminitis, catheter-related complications, or adverse drug reactions—with the horse walking sound at two-month reassessment. This case demonstrates that cervical epidural analgesia represents a technically feasible and clinically effective bridge therapy for horses with severe unilateral soft tissue injuries when pain control becomes a genuine welfare and medical priority, expanding the analgesic toolkit beyond systemic approaches for acute management where supporting limb protection is essential.
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Practical Takeaways
- •Cervical epidural analgesia may be a viable option when severe forelimb lameness and risk of supporting limb laminitis make traditional systemic analgesia inadequate—consider referral for this technique
- •Ultrasound-guided C1-C2 epidural catheter placement appears technically safe in standing sedated horses and provides effective pain relief without catheter-related complications
- •This approach could potentially reduce the risk of laminitis in the contralateral limb during critical acute pain periods following severe soft tissue injuries
Key Findings
- •Cervical epidural catheter placement at C1-C2 under ultrasound guidance was technically successful in a standing, sedated horse
- •Epidural morphine (0.1 mg/kg every 24 h, then 0.05 mg/kg every 12 h) significantly decreased pain scores following each treatment over 3 days
- •No adverse effects were observed from catheter placement, epidural morphine administration, or supporting limb laminitis during acute pain management
- •Horse was walking sound at 2-month follow-up with no complications at catheter insertion site