Pain management in a horse with severe head trauma

This case report describes the pain management of an eleven year old, female warm blood horse after severe head trauma. The horse was anaesthetised using a balanced anaesthetic protocol to stabilise the mandibular fracture and for wound debridement. Postoperatively the horse received flunixine meglumine intravenously every 12 hours and methadone intramuscularly every 6 hours. Despite this pain management the horse showed obvious discomfort: box walking, pawing, head pressing and lack of appetite. Ketamine was administered subcutaneously and two 100 mcg/h fentanyl-patches were applied to the skin of the dorsal croup after clipping and cleaning of the site. A few hours later the horse was eating and showing decreased signs of discomfort. After the two patches were removed the horse was detoriating again. A further two patches reversed the behavioural signs again. Acupuncture was used in addition to the drugs. Ketamine was discontinued shortly after changing to fentanyl and starting acupuncture treatment. The pain management using fentanyl patches, flunixine and acupuncture was continued for six days postoperatively and the horse was comfortable throughout this time period. The case report reviews and discusses the multimodal analgesic approach for this horse