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TDK conference 2017

Ocular pain scoring and comparison of the effects of intravenous administration of flunixin meglumine, phenylbutazon, and electroacupuncture on ocular pain relief in the horse: a pilot study
Csereklye Nóra - year 6
University of Veterinary Medicine, Department and Clinic of Equine Medicine
Supervisor: Dr. Zita Makra


This pilot study was carried out in equine ophthalmology, in which 2 different NSAID’s, flunixin and phenylbutazon, as well as electroacupuncture were evaluated using a multifactorial pain scale in order to assess corneal pain. Accurately established dosages of flunixin or phenylbutazon to relieve ocular pain were not available in the literature. Neither was electroacupuncture studied for this purpose in equine ophthalmology.

Our objectives were to evaluate how flunixin (1,1 mg/bwkg), phenylbutazon (4,4 mg/bwkg), used in their common doses intravenously, and electroacupuncture can ameliorate ocular pain, furthermore to construct a multifactorial ocular pain scale that can be used in the clinical work, and to develop a pain model of acute ocular pain such as corneal wounding.

Four Hungarian warm-blood horses underwent epithelial debridement under clinical circumstances in four sessions alternating the eyes 1 month in between the procedures and treated by four different methods. In the 4 different sessions after the manual epithelial debridement either flunixin, phenylbutazon, electroacupunture or placebo were used. Four hours after the debridement all horses were pain scored and then at 6, 8, 10 hours postop and every 4hs within the first 2 days and then twice daily until complete wound heling (106 h time point). Pain scores were allocated in 11 parameters in 18 different time points. The pain scores were completed with three more observers’ points masked to the treatment. Corneal wounds were defined as healed when flourescein dye was no longer retained. Average values of the pain scores were used for statistical analysis. Differences in pain scores in treatment groups were analyzed using Student’s t-test. Interobserver reliability was analysed using Bhapkar-test.

Results of this pilot study suggest that the evaluated 5 ocular symptoms (blepharospasm, tearing, eyelid swelling, corneal opacity, conjunctival hyperaemia, chemosis) showed significant difference in treatment time and proved to be good indicators of ocular pain. The other parameters (heart rate, corneal touch threshold, respond to palpation, 3 behavioural parameters) were not relevant in evaluating the pain degree.

There were significantly lower pain scores (p<0,05) in flunixin group when were compared to placebo values in the first 46 hours, so in the case of ocular pain flunixin at 1,1 mg/bwkg iv. dose can be used as an effective analgesic drug. At later time points and in other treatment groups (phenylbutazon, electroacupuncture) we got remarkable clinical differences, so that further studies needed with larger sample sizes to fully validate the effectiveness other drugs or methods.

The masked observers gave significantly different pain scores, so in the future to validate this pain score we have to reduce the number of parameters, standardize photos and modify their evaluation.

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