Epidural Administration Of Opioid Analgesics Improves Quality Of Recovery In Horses Anaesthetised For Treatment Of Hindlimb Synovial Sepsis

Background Opioid epidural analgesia has been shown to provide effective analgesia in horses. There is a lack of evidence regarding the effect of opioid epidural analgesia on quality of recovery in horses. Objectives Identify whether opioid epidural analgesia influences quality of recovery in horses undergoing general anaesthesia required for management of hindlimb synovial sepsis. Study design Single-centre retrospective cross-sectional study. Methods Data were obtained from the clinical records of horses which had undergone arthroscopic or tenoscopic surgery for management of hindlimb synovial sepsis over a 9-year period in a referral hospital population. Multivariable logistic regression analysis was used to identify the perioperative factors that impact on quality of recovery. Results Records from 149 horses, undergoing 170 general anaesthetics were included. Multivariable logistic regression analysis showed that opioid epidural analgesia (OR 3.0, 95% CI 1.2 to 7.2,P = .02) was associated with good quality of recovery, whereas Cob breeds (OR 0.16, 95% CI 0.06 to 0.46,P = .001), age (in years) (OR 0.90, 95% CI 0.83 to 0.97,P = .004) increasing intraoperative dosages (in mg/kg) of thiopental (OR 0.64, 95% CI 0.46 to 0.90,P = .01) or ketamine (OR 0.42, 95% CI 0.18 to 0.98,P = .04) were associated with poor quality of recovery. Main limitations Certain variables that may influence quality of recovery, such as patient temperament and hindlimb orthopaedic co-morbidities were not recorded. The clinical prediction model obtained is only applicable to the specific facilities, population and perianaesthetic management practiced at our institution. Conclusions Opioid epidural analgesia is significantly associated with good quality of recovery in horses undergoing general anaesthesia required for management of hindlimb synovial sepsis. Other risk factors, such as increasing age, cob breed, use of higher intraoperative dosages (in mg/kg) of ketamine and/or thiopental, were associated with poor quality of recovery.