title: Comparison of flunixin meglumine and meloxicam for post operative management of horses with strangulating small intestinal lesions.
abstract: BACKGROUND
  Ex vivo evidence suggests that cyclo-oxygenase (COX) 2-preferential inhibitor nonsteroidal anti-inflammatory drugs (NSAIDs), such as meloxicam, have a less detrimental effect on intestinal healing than flunixin meglumine (FM). Whether this translates to a beneficial effect in horses with naturally occurring strangulating small intestinal (SSI) lesions is unknown.
  
  
  OBJECTIVE
  To compare the clinical outcome of horses with naturally occurring SSI lesions treated with meloxicam or FM.
  
  
  METHODS
  Randomised prospective study.
  
  
  METHODS
  Cases presenting to the Royal Veterinary College Equine Referral Hospital and Bell Equine Veterinary Clinic during 2010 and 2011 in which an SSI lesion was identified at exploratory laparotomy were eligible for inclusion. Horses received either 1.1 mg/kg bwt FM or 0.6 mg/kg bwt meloxicam i.v. q. 12 h. Clinical outcomes and clinical and laboratory parameters associated with endotoxaemia were compared between groups.
  
  
  RESULTS
  Sixty cases were enrolled, 32 horses received FM and 28 received meloxicam. There was no difference in signalment, physical examination or surgical factors between groups. The overall survival to discharge was 81%; there was no difference in survival (P = 0.14) or incidence of post operative ileus (P = 0.25) between groups. There was no significant difference between the plasma lipopolysaccharide (LPS) concentrations at 0 h (P = 0.18) or 48 h (P = 0.60); however, there was a significant difference between neutrophil count at 48 h (P<0.05) and at 96 h (P<0.01) with significantly greater cell numbers in horses receiving meloxicam compared with FM. Blinded pain score evaluation showed that more horses receiving meloxicam showed gross signs of pain than those treated with FM (P = 0.04).
  
  
  CONCLUSIONS
  Nonsteroidal anti-inflammatory drug choice did not affect major clinical outcomes in horses with SSI lesions but had some effects on signs of pain. This study provides no evidence to recommend one NSAID treatment above another based on survival or the incidence of ileus; however, evaluation of a larger number of cases is required.
authors.affiliation: Equine Referral Hospital, Royal Veterinary College, Hatfield, Hertfordshire, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Naylor
authors.forename: A H
authors.initials: AH
authors.lastname: Taylor
authors.forename: E J
authors.initials: EJ
authors.lastname: Knowles
authors.forename: S
authors.initials: S
authors.lastname: Wilford
authors.forename: W
authors.initials: W
authors.lastname: Linnenkohl
authors.forename: T S
authors.initials: TS
authors.lastname: Mair
authors.forename: I C
authors.initials: IC
authors.lastname: Johns
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003002:Clonixin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004731:Endotoxins / Q000097:blood; D005260:Female; D006734:Horse Diseases / Q000188:drug therapy* / Q000209:etiology; D006736:Horses; D007249:Inflammation / Q000662:veterinary*; D007415:Intestinal Obstruction / Q000601:surgery / Q000662:veterinary; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery; D008297:Male; D000077239:Meloxicam; D011183:Postoperative Complications / Q000188:drug therapy / Q000662:veterinary*; D013843:Thiazines / Q000627:therapeutic use*; D013844:Thiazoles / Q000627:therapeutic use*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004731:Endotoxins; D013843:Thiazines; D013844:Thiazoles; C014558:flunixin meglumine; D003002:Clonixin; D000077239:Meloxicam
keywords: colic; endotoxaemia; flunixin; horse; nonsteroidal