Many, if not most of equine dental procedures are performed today on the standing horse. With an appropriate multi-modal analgesia, general anesthesia can almost always be avoided. An adequate combination of physical and chemical restraint of the equine patient is essential for its welfare and for conducting the potentially painful intervention with success.

Before sedatives are given to the horse, it is considerate that the horse should be administered anti-inflammatory drugs (NSAIDs) and if necessary anti-microbial drugs. The administration of intravenous sedatives can be done via an intravenous catheter previously placed, through repetitive injections or a constant rate infusion, or via repetitive needle injections as and when required. The mainstay and the most frequently used molecules are alpha 2 adrenoreceptor agonists (e.g. Detomidine, Romifidine, Xylazine). These can be used in combination with other analgesic drugs (Buthorphanol, Morphine, Levo-methadone or Ketamine), as well as anxiolytics (e.g. Diazepam) to deepen the sedative effect and the compliance of the horse. Side effects, such as bradycardia, respiratory depression and ataxia should be monitored and anticipated at all times. Counter measurements to oppose exaggerated adverse effects should be available. Nerve blocks and intraoral and intraligamentous analgesia are additional methods to desensitise painful areas of the head and to augment patient compliance. Four major sites for nerve block analgesia are frequently targeted, all are derived from the trigeminal nerve (Cn 5) : The maxillary and intraorbital nerve for the upper jaw and the mandibular and mental nerve for the lower jaw. Clipping and aseptic preparation of the injection site should be standard to reduce the risk of infection and consequent complications.