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Webster A, Pezzanite L, Hendrickson D, Griffenhagen G. Review of intra-articular local anaesthetic administration in horses: Clinical indications, cytotoxicity, and outcomes. Equine Vet J 2024; 56:870-883. [PMID: 37940372 DOI: 10.1111/evj.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
Equine practitioners frequently inject local anaesthetics (LA) intra-articularly in both diagnosis of lameness and for pain management intra- or post-operatively with synovial endoscopy. Recent reviews of the human and veterinary literature support the concept that chondrotoxicity of LA on joint tissues depends on the type of drug, dose administered, and duration of exposure. The purpose of this review is to summarise the current literature describing intra-articular local anaesthetic use, including both in vitro and in vivo studies, and to draw some comparisons to literature from other species where potential toxicity and duration of effect have been evaluated with the goal of advancing the field's understanding of intra-articular local anaesthetic use in horses, and indicating future directions for the field. The aggregate data available from all species, while generally sparse for horses, indicate that LA are rapidly cleared from the synovial fluid after injection, often within 30 min. In vitro data strongly suggest that lidocaine and bupivacaine are likely more chondrotoxic than other LA, although to what extent is still unknown, and cytotoxicity of LA may be mitigated through concurrent injection with HA, PRP, and drug combinations including nonsteroidal anti-inflammatories and opioids. The current body of in vitro research is not reflective of the in vivo environment, and further in vitro work, if performed, should focus on mimicking the native joint environment, utilising PK data and joint/injection volumes to replicate the native environment more accurately within the joint and the expected exposures to LA.
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Affiliation(s)
- Aaron Webster
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Lynn Pezzanite
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Dean Hendrickson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Gregg Griffenhagen
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Gruyaert M, Oosterlinck M, Haspeslagh M, Nagy A. Computed tomographic evaluation of the proximity of needles placed for perineural anesthesia of the palmar digital nerves to synovial structures in the foot: an ex vivo study. Front Vet Sci 2024; 11:1404331. [PMID: 38895719 PMCID: PMC11183268 DOI: 10.3389/fvets.2024.1404331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
Background Potential synovial penetration following palmar digital nerve blocks has not been investigated. Objectives To evaluate the proximity of needles placed for palmar digital nerve blocks to nearby synovial structures using computed tomography (CT). Study design Descriptive observational study. Methods In 18 cadaver forelimbs, sequential injection of the navicular bursa (NB), distal interphalangeal joint (DIPJ) and digital flexor tendon sheath (DFTS) was performed using 3, 5 and 10 mL diluted radiodense contrast medium, respectively. After each synovial injection, 25 gage needles were placed over the palmar digital nerves at the proximal aspect of the ungular cartilages (distal injections) and 1 cm further proximally (proximal injections), and CT examination was performed. Subsequently, needles were removed, and the synovial structures further distended with the same volume as for the first injection. Perineural needle placement and image acquisition were repeated. The distance between the needle tip and adjacent synovial structures was measured (mm) in reconstructed images. Results were analyzed in separate general linear mixed models, to determine the effect of needle position and synovial distension on the distance from the tip of the needle to the NB, DFTS and DIPJ. Results Synovial penetration was confirmed following 12/420 (3%) needle placements (NB n = 5, 1 after proximal and 4 after distal injections; DIPJ n = 2, DFTS n = 2, NB or DIPJ n = 3, all after distal injections). The mean distance from the needle tip to the NB and DIPJ was significantly smaller after the second distension (NB: p = 0.025; DIPJ: p < 0.001) and with the distal needle placements (NB: p < 0.001; DIPJ: p < 0.001). For the DFTS, the distance from the needle tip was significantly smaller with the proximal needle placements (p = 0.001). Main limitations Ex-vivo study. Conclusion There is a small risk of synovial penetration when performing palmar digital nerve blocks, especially when distension of adjacent synovial structures is present.
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Affiliation(s)
- Mounia Gruyaert
- Faculty of Veterinary Medicine, Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Ghent University, Merelbeke, Belgium
| | - Maarten Oosterlinck
- Faculty of Veterinary Medicine, Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Ghent University, Merelbeke, Belgium
| | - Maarten Haspeslagh
- Faculty of Veterinary Medicine, Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Ghent University, Merelbeke, Belgium
| | - Annamaria Nagy
- Equine Department and Clinic, University of Veterinary Medicine, Budapest, Hungary
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Katrinaki V, Estrada RJ, Mählmann K, Kolokythas P, Lischer CJ. Objective evaluation for analgesia of the distal interphalangeal joint, the navicular bursa and perineural analgesia in horses with naturally occurring forelimb lameness localised to the foot. Equine Vet J 2023; 55:253-260. [PMID: 35488427 DOI: 10.1111/evj.13583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/20/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The outcome and interpretation of intra-synovial diagnostic analgesia of the distal interphalangeal joint (DIPJ) and the navicular bursa (NB) remain in dispute, and no objective studies have been carried out to establish the percentage of improvement over time from these two analgesia techniques. OBJECTIVES To investigate the qualitative and time-dependent outcome of DIPJ-A and NB-A in naturally occurring forelimb lameness. STUDY DESIGN Case series. METHODS Twenty-three clinical cases with forelimb lameness were evaluated objectively using a body mounted inertial sensor system (BMIS). Lameness was localised to the foot with a palmar digital nerve block and/or an abaxial sesamoidean nerve block on day 1, and analgesia of the DIPJ (DIPJ-A) and NB (NB-A) were performed on days 2 and 3. Improvement following perineural analgesia was measured after 10 min and intra-synovial blocks after 2-, 5- and 10-min. Horses with at least 70% improvement measured objectively after diagnostic analgesia were included in the study. RESULTS There was no significant association between improvement following perineural analgesia and the DIPJ-A and NB-A. The mean improvement in the lameness differed between DIPJ-A and NB-A at 2 min (p < 0.001) and at 5 min (p = 0.04), and it was no longer observed after 10 min (p = 0.06). A positive NB-A produced a high degree of improvement that remained stable, whereas the DIPJ-A improved over time. MAIN LIMITATIONS Perineural and intra-synovial analgesia were performed without contrast medium to assess the diffusion of mepivacaine. CONCLUSIONS Our results suggest that perineural analgesia is not reliable enough to differentiate pain originating from DIPJ and NB. Early evaluation of the DIPJ-A and NB-A can determine the origin of the pain. An improvement following NB-A was constant over time, but an improvement following DIPJ-A varied by up to 10 min.
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Affiliation(s)
- Vasiliki Katrinaki
- Equine Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Roberto J Estrada
- Equine Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.,Large Animal Hospital, School of Veterinary Medicine, National University, Heredia, Costa Rica
| | - Kathrin Mählmann
- Equine Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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Adler DMT, Jørgensen E, Cornett C. The concentration of lidocaine and mepivacaine measured in synovial fluid of different joints of horses after single intra-articular injection. Front Vet Sci 2022; 9:1007399. [DOI: 10.3389/fvets.2022.1007399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectiveTo determine the synovial fluid (SF) concentrations of lidocaine and mepivacaine after intra-articular injection with clinically relevant doses to the distal interphalangeal (DIP), metacarpophalangeal (MCP), middle carpal (MC), and tarsocrural (TC) joint at two different time points after injection in order to be able to compare concentrations with previously established concentrations associated with cytotoxicity and antimicrobial activity.ProceduresIn the first of two experiments, 20 joints (5 MC, 5 MCP, 10 DIP joints) of five horses under general anesthesia were injected with clinically referenced doses of 2% lidocaine. Simultaneously, the horses had 19 joints (5 MC, 5 MCP, 9 DIP joints) injected with clinically referenced doses of 2% mepivacaine. Synovial fluid samples were collected ~7 min after injection. In experiment 2, 23 joints of seven horses under standing sedation were injected with clinically referenced doses of 2% lidocaine. Similarly, the horses had 21 joints injected with 2% mepivacaine. Synovial fluid samples were collected ~23 min after injection. The concentration of mepivacaine and lidocaine in the obtained SF samples was assessed using high-performance-liquid-chromatography with mass spectrometry detection (HPLC MS).ResultsSynovial fluid was obtained 6.8 ± 1.5 (experiment 1) and 23 ± 4.3 (experiment 2) min following intra-articular injection of mepivacaine and lidocaine. Synovial fluid concentrations of experiment 1 for lidocaine and mepivaciane were 6.46–19.62 mg/mL (mean 11.96 ± SD 3.89 mg/mL) and 5.01–13.38 mg/mL (mean 8.18 ± SD 1.76 mg/mL), respectively. In experiment 2, concentrations were 2.94–10.40 mg/mL (mean 6.31± SD 2.23 mg/mL) for lidocaine and 2.10–8.70 mg/mL (mean 4.97 ± SD 1.77 mg/mL) for mepivacaine.Conclusions and clinical relevanceIntra-articular LA injections in horses resulted in SF concentrations above those previously associated with cytotoxic effects in vitro but also above those associated with beneficial antimicrobial activities. Local anesthetic concentration was 33–60% lower after 23 min (experiment 2) than after 7 min (experiment 1).
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Mechanical nociceptive assessment of the equine hoof after navicular bursa anesthetic infiltration validated by bursography. PLoS One 2022; 17:e0269532. [PMID: 35671268 PMCID: PMC9173607 DOI: 10.1371/journal.pone.0269532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 05/23/2022] [Indexed: 12/03/2022] Open
Abstract
The analgesic specificity of navicular bursa (NB) anesthetic infiltration is still questionable. The study aimed to determine the mechanical nociceptive threshold of non-specific analgesia in the dorsal lamellar stratum, as well as in the sole, coronary band, and heel bulbs of the hoof, after navicular bursa anesthetic infiltration. Six healthy horses with no clinical or radiographic changes of the digits and no communication between the NB and the distal interphalangeal joint, were used. After random selection, the NB of one of the forelimbs was infiltrated with 2% lidocaine and the contralateral one with lactated ringer’s solution. Contrast was added to confirm radiographic infiltration. The mechanical nociceptive threshold was determined using a portable pressure dynamometer, before and at various times after the infiltration, in 10 points of the hoof. The effects of time and treatment were verified by ANOVA (P<0.05). There was no statistical difference in the values of the mechanical nociceptive threshold (P>0.05) in all regions evaluated. However, in one of the six hooves that receives lidocaine, complete absence of response to the painful stimulus (maximum force of 6 Kg over an area of 38.46 mm2, for a maximum of 4 seconds) was observed in the dorsal lamellae between 30 and 60 min after infiltration. In conclusion, lidocaine infiltration of NB did not promote significant increases in the nociceptive threshold of the sole, coronary band, bulbs of the heel and dorsal lamellae clinically healthy horses. However, the occurrence of analgesia in one of the six hooves subjected to NB anesthesia indicates that the technique may not be fully specific in few horses.
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6
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Istenič S, Cvetko E, Zabret J, Stopar Pintarič T, Umek N. Determination of bupivacaine tissue concentration in human biopsy samples using high-performance liquid chromatography with mass spectrometry. Biomed Chromatogr 2021; 35:e5198. [PMID: 34121212 DOI: 10.1002/bmc.5198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/13/2021] [Accepted: 06/09/2021] [Indexed: 11/05/2022]
Abstract
In the present study, we developed a simple and rapid analytical method for the quantification of bupivacaine hydrochloride in human biopsy samples of adipose, muscle, neural, connective and cartilage tissue using liquid chromatography-mass spectrometry. Anesthetics were extracted from the tissue samples using 0.1% formic acid in acetonitrile for protein denaturation and hexane for removal of lipophilic impurities. Analytes were separated adequately on Phenomenex Luna Omega polar C18 column using a gradient mobile phase 0.1% formic acid in water and 0.1% formic acid in acetonitrile. The lower limits of quantification were ≤ 97 ng g-1 tissue for all studied tissues. Intra-day recoveries were between 48.2% and 82.1% with relative standard deviations (RSDs) between 1.47% and 14.28%, whereas inter-day recoveries were between 52.2% and 77.6% with RSDs between 2.98% and 14.79%. The calibration curve showed a linear fit with R2 higher than 0.99 in the concentration range from 0.16 to 100 μg g-1 . Lidocaine hydrochloride was tested as internal standard because its recoveries and matrix effects were comparable to bupivacaine hydrochloride. Post-analytical corrections of measured bupivacaine tissue concentrations can accordingly be made based on recovery of lidocaine as internal standard, with recoveries between 51.2% and 86.9% and RSDs between 1.99% and 16.88%. The developed method could be used to study time-dependent spread of bupivacaine locally or to more distant locations across tissue barriers.
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Affiliation(s)
- Simon Istenič
- Core Facility, Helios TBLUS, Domžale, Slovenia.,Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Erika Cvetko
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Joži Zabret
- Core Facility, Helios TBLUS, Domžale, Slovenia
| | - Tatjana Stopar Pintarič
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nejc Umek
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Bergstrom T, Bass L, Daglish J, Moorman V, Griffin J, Barrett M. Complex pastern injuries involving the scutum medium in ten horses. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T. Bergstrom
- Department of Clinical Sciences Colorado State University Fort Collins Colorado USA
| | - L. Bass
- Department of Clinical Sciences Colorado State University Fort Collins Colorado USA
| | - J. Daglish
- Department of Clinical Sciences Colorado State University Fort Collins Colorado USA
| | - V. Moorman
- Department of Clinical Sciences Colorado State University Fort Collins Colorado USA
| | - J. Griffin
- Department of Large Animal Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Texas A&M University College Station Texas USA
| | - M. Barrett
- Environmental and Radiological Health Science Colorado State University Fort Collins Colorado USA
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8
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Nagy A. Clinical insights: Lameness diagnosis in sports horses. Equine Vet J 2020; 52:775-778. [PMID: 33017491 DOI: 10.1111/evj.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 05/30/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Annamaria Nagy
- Equine Department and Clinic, University of Veterinary Medicine, Dóra Major, Üllő, Hungary
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9
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Malacarne BD, Cota LO, Neto ACP, Paz CFR, Dias LA, Corrêa MG, Carvalho AM, Faleiros RR, Xavier ABS. Mechanical nociceptive assessment of the equine hoof following distal interphalangeal joint intra-articular anesthesia. PeerJ 2020; 8:e9469. [PMID: 32864201 PMCID: PMC7427544 DOI: 10.7717/peerj.9469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/11/2020] [Indexed: 11/26/2022] Open
Abstract
Background With the hypothesis that equine dorsal lamellar tissue can be desensitized by anesthesia injection into distal interphalangeal joint (DIPJ), the objective was to assess the mechanical nociceptive threshold of hoof dorsal lamellae following intra-articular (IA) administration of lidocaine into this joint. Methods The DIPJ of the forelimbs of six adult healthy horses were injected with either 5 mL of lidocaine, or 5 mL of lactated Ringer’s solution. Treatments were randomly distributed, with each forelimb undergoing a single treatment. The hooves were evaluated pre- and post-injection at pre-selected times over 4 h, using a pressure algometry model. Mechanical nociceptive thresholds (MNTs) were recorded for the sole (dorsal, palmarolateral, and palmaromedial regions), coronary band (medial, lateral, and dorsal regions), heel bulbs (medial and lateral), and dorsal lamellar region (2 cm and 4 cm distal to the coronary band). The MNT means were compared over time using the Friedman test and between treatments using the Wilcoxon signed-rank test, with values of P < 0.05 considered statistically significant. Results There were no differences between treatments for any region of the hoof during the evaluation period. However, MNT values indicating analgesia were recorded in the dorsal lamellar region in 50% of hooves following adminstration of lidocaine into the DIPJ. Conclusion The administration of 5 mL of lidocaine into the DIPJ does not significantly increase the mechanical nociceptive threshold of the equine hoof.
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Affiliation(s)
- Bruno D Malacarne
- Equinova Research Group -Department of Veterinary Clinics and Surgery, School of Veterinary, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leticia O Cota
- Equinova Research Group -Department of Veterinary Clinics and Surgery, School of Veterinary, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Antônio C P Neto
- Equinova Research Group -Department of Veterinary Clinics and Surgery, School of Veterinary, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cahuê F R Paz
- Centro Universitário INTA-Uninta, Sobral, Ceará, Brazil
| | - Lucas A Dias
- Equinova Research Group -Department of Veterinary Clinics and Surgery, School of Veterinary, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mayara G Corrêa
- Equinova Research Group -Department of Veterinary Clinics and Surgery, School of Veterinary, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Armando M Carvalho
- Equinova Research Group -Department of Veterinary Clinics and Surgery, School of Veterinary, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rafael R Faleiros
- Equinova Research Group -Department of Veterinary Clinics and Surgery, School of Veterinary, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Conselho Nacional de Desenvolvimento Cientìfico e Tecnològico -CNPq, Brasília, Brazil
| | - Andressa B S Xavier
- Equinova Research Group -Department of Veterinary Clinics and Surgery, School of Veterinary, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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10
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Koch DW, Barrett MF, Jackman BR, MacDonald D, Goodrich LR. Comparison of lameness outcomes in horses with acute or chronic digital lameness that underwent magnetic resonance imaging. N Z Vet J 2020; 68:283-288. [PMID: 32248754 DOI: 10.1080/00480169.2020.1750499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: To compare the outcome, in terms of lameness score or return to athletic function, of horses with acute vs. chronic digital lameness that underwent magnetic resonance imaging (MRI) of the distal limb and to compare the proportion of horses that received intra-articular therapy of the distal interphalangeal (DIP) joint and pattern of diagnostic analgesia in these groups. Methods: This is a retrospective study of horses (n = 95) with acute (≤12 weeks; n = 46) or chronic (>12 weeks; n = 49) digital lameness that underwent MRI of the distal limb from 2009-2016, at two equine referral centres in the USA. Criteria for inclusion in the study were that a majority of lameness localised distal to the fetlock, and that lameness assessments for ≥12 months following MRI could be obtained from the medical record or the owner could be interviewed regarding their horse's athletic function. Outcome was characterised by an improvement score where 2 = return to work at a previous or higher level or lameness improved by one grade or more, 1 = return to work at a lower level or lameness improved by less than one grade, and 0 = did not return to work or lameness grade worsened. Whether horses had received intra-articular therapy of the DIP joint and the pattern of diagnostic analgesia prior to MRI was also obtained from medical records or by interviewing the owner. Results: There was a difference (p = 0.004) in the proportion of horses assigned to improvement scores of 0, 1 and 2 between horses with acute or chronic lameness. There was no evidence of a difference in the likelihood of having received intra-articular therapy of the DIP joint prior to MRI between horses with chronic or acute lameness (p = 0.085). Similarly, there was no evidence of a difference in the pattern of diagnostic analgesia prior to MRI between the two groups (p = 0.94). Eighty-two percent of owners of horses with acute and 62% of those with horses with chronic lameness had a positive opinion of the utility of MRI as a diagnostic modality. Conclusion: In a population of horses with digital lameness undergoing MRI, a difference in the outcome, in terms of lameness score or return to athletic function was identified between horses with acute lameness compared to those with chronic lameness. Clinical relevance: Horses with digital lameness that undergo MRI when the lameness is acute may have an improved prognosis due to accurate diagnosis and earlier application of appropriate therapy.
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Affiliation(s)
- D W Koch
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - M F Barrett
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | | | | | - L R Goodrich
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
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Hontoir F, Rejas E, Falticeanu A, Nisolle JF, Simon V, Nicaise C, Clegg PD, Vandeweerd JME. Communication between the distal interphalangeal joint and the navicular bursa in the horse at Computed Tomography Arthrography. Anat Histol Embryol 2019; 48:133-141. [DOI: 10.1111/ahe.12421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Fanny Hontoir
- Faculty of Sciences, Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) - Namur Research Institute for Life Sciences (NARILIS); University of Namur; Namur Belgium
| | - Erika Rejas
- Faculty of Sciences, Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) - Namur Research Institute for Life Sciences (NARILIS); University of Namur; Namur Belgium
| | - Ana Falticeanu
- Centre Hospitalier Universitaire (CHU) UCL Namur-Mont Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - Jean-François Nisolle
- Centre Hospitalier Universitaire (CHU) UCL Namur-Mont Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - Vincent Simon
- Faculty of Sciences, Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) - Namur Research Institute for Life Sciences (NARILIS); University of Namur; Namur Belgium
| | - Charles Nicaise
- LabCeTi - Laboratoire des Cellules et Tissus - Faculty of Medicine; University of Namur; Namur Belgium
| | - Peter D. Clegg
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic disease; University of Liverpool; Liverpool UK
| | - Jean-Michel E. Vandeweerd
- Faculty of Sciences, Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) - Namur Research Institute for Life Sciences (NARILIS); University of Namur; Namur Belgium
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12
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Dau S, Azevedo M, Corte FDL, Brass K, Gallio M, Ceni F, Lubini B. Response of three digital anesthetic technics in horses with forelimb hoof lameness. ARQ BRAS MED VET ZOO 2017. [DOI: 10.1590/1678-4162-9155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The presented study aimed to assess objectively the response of distal interphalangeal joint (DIJ), navicular bursa (NB) and deep digital flexor tendon sheath (DDFTS) anesthesia in horses with forelimb hoof lameness; and evaluate if the presence of radiographic abnormalities on navicular bone could interfere on blocks’ results. Fifteen horses with lameness improvement above 70% after palmar digital nerve (PDN) block were selected for this study. Blocks were assessed separately on five consecutive trials at seven different time-points. The fifth trial was performed to evaluate the influence of exercise on preexisting lameness. Most of horses (73.33%) presented pain related to the podotrochlear apparatus based on clinical and lameness exam and blocks’ responses. NB and DIJ anesthesia differed on the frequency of horses with lameness improvement above 70% only at 10min (p=0.03), and both differed from DDFTS block until 30’(p<0.05). The blocks’ response was variable along the time and the highest means for NB, DIJ and DDFTS were observed at 5-10 minutes (’), 15-20’ and 10-15’ respectively.Exercise had low interference on lameness intensity since no improvement above 50% was observed and an increase on lameness intensity over time was identified in seven horses. Variable grades of navicular bone radiographic lesions were observed in 14 horses, although these lesions had no interference on blocks’ response (p>0.05). The NB and DIJ blocks had similar responses and both were superior to DDFTS anesthesia, coincident with a major prevalence of podotroclear apparatus abnormalities in this equine population.
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Affiliation(s)
- S.L. Dau
- Universidade Federal de Santa Maria, Brazil
| | | | | | - K.E. Brass
- Universidade Federal de Santa Maria, Brazil
| | - M. Gallio
- Universidade Federal de Santa Maria, Brazil
| | - F. Ceni
- Universidade Federal de Santa Maria, Brazil
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13
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Janvier V, Olive J, Rossier Y. Magnetic Resonance Assessment of the Equine Distal Phalanx Facies Flexoria. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nottrott K, De Guio C, Khairoun A, Schramme M. An ultrasound-guided, tendon-sparing, lateral approach to injection of the navicular bursa. Equine Vet J 2017; 49:655-661. [PMID: 28128875 DOI: 10.1111/evj.12673] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Navicular disease in the horse often requires injection of the navicular bursa. We have developed an ultrasound-guided, lateral needle approach to navicular bursocentesis, which avoids penetration of the deep digital flexor tendon (DDFT) and the need for radiographic control. OBJECTIVES To describe and evaluate the feasibility and efficacy of an ultrasound-guided, lateral bursocentesis technique. STUDY DESIGN Cadaveric and in vivo experiments. METHODS The navicular bursa in 62 cadaveric forelimbs of 31 horses and in both forelimbs of 26 live horses, positioned with the foot flexed in a navicular block, were submitted to lateral, ultrasound-guided injection of 1.5 ml radiocontrast agent. Lateromedial radiographs were taken to locate the contrast. A second injection of 0.5 ml methylene blue was administered during needle withdrawal in cadaveric limbs to investigate the needle pathway during dissection. RESULTS Contrast agent was successfully deposited in the navicular bursa in 104 of 114 (91%) limbs and in the navicular bursa alone in 89 of 114 (78%) limbs. Dissection showed no evidence of penetration of the DDFT in cadaver limbs. Failure to inject the navicular bursa was significantly associated with poor quality of the ultrasound image (P = 0.04) and resulted in aberrant injection of the distal interphalangeal joint in five of 114 (4%) limbs, the peribursal soft tissues in four of 114 (4%) limbs and the digital flexor tendon sheath in one of 114 (0.9%) limbs. Synovial fluid was observed at the needle hub in 58% of live horses. MAIN LIMITATIONS It is unknown whether injection results obtained in the limbs of horses without disease can be extrapolated to horses with clinical disease of the podotrochlear apparatus. The localisation of contrast medium on radiographs may not accurately reflect the behaviour of local anaesthetic solution or therapeutic medications injected in the navicular bursa. CONCLUSIONS This lateral, ultrasound-guided technique for injecting the navicular bursa is effective, does not penetrate the DDFT and avoids exposure of personnel to radiation.
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Affiliation(s)
- K Nottrott
- Pole Equin, VetAgro Sup, Marcy L'Étoile, France
| | - C De Guio
- Pole Equin, VetAgro Sup, Marcy L'Étoile, France
| | - A Khairoun
- Pole Equin, VetAgro Sup, Marcy L'Étoile, France
| | - M Schramme
- Pole Equin, VetAgro Sup, Marcy L'Étoile, France
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Dyson S. Evaluation of poor performance in competition horses: A musculoskeletal perspective. Part 2: Further investigation. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12498] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S. Dyson
- Centre for Equine Studies; Animal Health Trust; Newmarket Suffolk UK
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Mählmann K, Koch C, Bodó G. Diagnostic endoscopy of the navicular bursa using a needle endoscope by direct or transthecal approach: A comparative cadaver study. Vet Surg 2015; 44:816-24. [DOI: 10.1111/vsu.12369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kathrin Mählmann
- Department of Clinical Veterinary Science; Swiss Institute for Equine Medicine, Vetsuisse Faculty University of Berne and ALP-Haras Avenches; Germany
| | - Christoph Koch
- Department of Clinical Veterinary Science; Swiss Institute for Equine Medicine, Vetsuisse Faculty University of Berne and ALP-Haras Avenches; Germany
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Pilsworth R, Dyson S. Where does it hurt? Problems with interpretation of regional and intra-synovial diagnostic analgesia. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12392] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - S. Dyson
- Centre for Equine Studies; Animal Health Trust; Newmarket Suffolk UK
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18
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Jordana M, Martens A, Duchateau L, Haspeslagh M, Vanderperren K, Oosterlinck M, Pille F. Diffusion of mepivacaine to adjacent synovial structures after intrasynovial analgesia of the digital flexor tendon sheath. Equine Vet J 2015; 48:326-30. [PMID: 25827158 DOI: 10.1111/evj.12447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/22/2015] [Indexed: 11/26/2022]
Abstract
REASONS FOR PERFORMING STUDY Controversy exists about the specificity of diagnostic analgesia of the digital flexor tendon sheath (DFTS) in horses. OBJECTIVES To evaluate the degree of diffusion of mepivacaine from the equine DFTS to adjacent synovial structures. STUDY DESIGN Crossover experiment. METHODS Under general anaesthesia, the DFTS of one front and one hindlimb of 8 horses were injected simultaneously with mepivacaine. Synovial fluid samples of the injected DFTS, the adjacent metacarpo-/metatarsophalangeal (MCP/MTP) joint, proximal interphalangeal joint, distal interphalangeal joint, navicular bursa and contralateral MCP/MTP joint were collected 15 min post injection (T15) from one of the injected limbs and 60 min post injection (T60) from the other limb. Venous blood samples were obtained at T0, T15 and T60 to evaluate systemic distribution of mepivacaine. After a 2-week washout period, the procedure was repeated using the same limbs but reversing the time of sampling (front vs. hindlimbs). The concentration of mepivacaine in samples was measured with a commercial ELISA kit. RESULTS Mepivacaine concentrations in the DFTS samples, at both T15 (5077 mg/l) and T60 (3503 mg/l), exceeded those estimated sufficient to produce synovial analgesia (100 mg/l or 300 mg/l). Mepivacaine was found in all synovial structures adjacent to the injected DFTS and in the contralateral MCP/MTP joints, but concentrations were low, with a maximum value of only 3.2 mg/l. With the exception of the navicular bursa samples, the mepivacaine concentrations in the adjacent synovial structures were significantly higher at T60 than at T15 (P<0.03). Significantly higher mepivacaine concentrations were found in the ipsilateral than the contralateral MCP/MTP joints at T60 (P<0.001). Blood samples had significantly higher mepivacaine concentrations at T15 and T60 than at T0 (P<0.001). CONCLUSIONS Mepivacaine injected into the DFTS of horses diffuses towards adjacent synovial structures without achieving clinically relevant concentrations.
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Affiliation(s)
- M Jordana
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - A Martens
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - L Duchateau
- Department of Comparative Physiology and Biometrics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - M Haspeslagh
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - K Vanderperren
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - M Oosterlinck
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - F Pille
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Is there an association between clinical features, response to diagnostic analgesia and radiological findings in horses with a magnetic resonance imaging diagnosis of navicular disease or other injuries of the podotrochlear apparatus? Vet J 2015; 204:40-6. [PMID: 25724857 DOI: 10.1016/j.tvjl.2014.12.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 11/20/2022]
Abstract
Previous descriptions of the clinical features of navicular disease occurred before the widespread use of magnetic resonance imaging (MRI) allowed a more definitive diagnosis of foot pain. The objective of this study was to compare the clinical features of horses with lesions of the podotrochlear apparatus with those with other causes of foot pain. It was hypothesised that primary navicular bone disease would be associated with more advanced radiological findings than other diagnoses. A retrospective study was performed of all horses examined at a referral centre with a definitive diagnosis of foot pain based on MRI ± post-mortem examination. Clinical examination findings, response to diagnostic analgesia and radiological grading of the navicular bone were compared among five diagnosis groups: (1) primary navicular bone pathology (NB); (2) lesions of the collateral sesamoidean ligament and/or distal sesamoidean impar ligament (CSL + DSIL); (3) primary deep digital flexor tendon injury (DDFT); (4) navicular bone pathology and other lesions of the podotrochlear apparatus ± DDFT (PTA) and (5) Other. There were 702 horses (NB, 62; CSL + DSIL, 180; DDFT, 69; PTA, 92; Other, 299). Horses with PTA injuries were more frequently unilaterally lame than other groups (P = 0.04). Horses with DDFT injury were more likely to exhibit pain on turning than other groups (P <0.01). There were no associations between response to diagnostic analgesia and diagnostic group, and no association between radiological grade and diagnostic group. Clinical examination findings generally did not discriminate between diseases of the PTA and other causes of foot pain. Overall radiological scores of the navicular bone did not accurately predict navicular bone pathology.
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20
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Claunch KM, Eggleston RB, Baxter GM. Effects of approach and injection volume on diffusion of mepivacaine hydrochloride during local analgesia of the deep branch of the lateral plantar nerve in horses. J Am Vet Med Assoc 2014; 245:1153-9. [DOI: 10.2460/javma.245.10.1153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Is anaesthesia of the deep branch of the lateral plantar nerve specific for the diagnosis of proximal metatarsal pain in the horse? Vet Comp Orthop Traumatol 2014; 27:351-7. [PMID: 25213031 DOI: 10.3415/vcot-13-12-0146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 06/13/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the specificity of anaesthesia of the deep branch of the lateral plantar nerve (DB-LPN). METHODS Twenty horses had DB-LPN anaesthesia performed by a single injection technique as part of a lameness investigation. The mechanical nociceptive threshold (NT) was measured using a handheld force meter at six points on the lateral aspect of the limb: before diagnostic anaesthesia (T0), and at 15 (T15) and 30 (T30) minutes post anaesthesia. Paired t-tests were performed and significance was set at p <0.05. In addition, ten cadaveric limbs were injected with 2.5 ml new methylene blue solution using a single injection technique to evaluate the extent of dye diffusion within the proximal metatarsal region. RESULTS Compared with T0, there was a significant decrease in NT for all points combined at T15 (p = 0.008) and also at T30 (p = 0.007). There was a significant decrease in NT at T15 on the lateral third metatarsal bone (p = 0.012). At T30 there was a significant decrease in NT at the lateral sesamoid (p = 0.007), lateral third metatarsal bone (p = 0.031), and mid metatarsus (p = 0.033). Four out of 20 horses had a NT greater than 10 N at the lateral heel bulb at T30. In the cadaveric limbs, the total diffusion distance for all limbs (mean ± SD) was 70.4 ± 20.5 mm. Dye surrounded the DB-LPN in all limbs and the lateral plantar nerve (LPN) in nine out of 10 limbs. CLINICAL SIGNIFICANCE Concurrent anaesthesia of the LPN is likely to occur when DB-LPN anaesthesia is performed using a single injection technique.
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22
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Contino EK, King MR, Valdés-Martínez A, McIlwraith CW. In vivodiffusion characteristics following perineural injection of the deep branch of the lateral plantar nerve with mepivacaine or iohexol in horses. Equine Vet J 2014; 47:230-4. [DOI: 10.1111/evj.12261] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- E. K. Contino
- Gail Holmes Equine Orthopaedic Research Center; Department of Clinical Sciences; Colorado State University; Fort Collins Colorado USA
| | - M. R. King
- Gail Holmes Equine Orthopaedic Research Center; Department of Clinical Sciences; Colorado State University; Fort Collins Colorado USA
| | - A. Valdés-Martínez
- Department of Environmental and Radiological Health Sciences; Colorado State University; Fort Collins Colorado USA
| | - C. W. McIlwraith
- Gail Holmes Equine Orthopaedic Research Center; Department of Clinical Sciences; Colorado State University; Fort Collins Colorado USA
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23
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MacEoin F, Robinson P. Repetitive stress-related injury of the proximal metacarpus in a seven-year old Thoroughbred racehorse with emphasis on diagnostic analgesia of the proximopalmar metacarpus. Ir Vet J 2014; 67:26. [PMID: 25937918 PMCID: PMC4417533 DOI: 10.1186/2046-0481-67-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/20/2014] [Indexed: 11/30/2022] Open
Abstract
This report describes the diagnosis and management of repetitive stress-related injury (RSRI) of the proximal metacarpus in a seven-year old Thoroughbred racehorse. Intra-articular analgesia of the middle carpal joint (MCJ) as well as perineural analgesia of the lateral palmar nerve (LPN) abolished lameness and a diagnosis of RSRI of the proximopalmar metacarpus was made after nuclear scintigraphic examination. Given the response to intra-articular analgesia, the authors undertook a cadaver study in order to better describe the relationship between the medial and lateral palmar pouches of carpo-metacarpal joint (CMCJ), the LPN and the deep branch of the lateral palmar nerve (DBLPaN).
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Affiliation(s)
- Felim MacEoin
- Department of Veterinary Clinical Services, The Hong Kong Jockey Club, Sha Tin Racecourse, New Territories, Hong Kong, China SAR
| | - Paul Robinson
- Department of Veterinary Clinical Services, The Hong Kong Jockey Club, Sha Tin Racecourse, New Territories, Hong Kong, China SAR
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Schumacher J, Schramme MC, Schumacher J, DeGraves FJ. Diagnostic analgesia of the equine digit. EQUINE VET EDUC 2013. [DOI: 10.1111/eve.12001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Schumacher
- Sports Medicine; College of Veterinary Medicine; Auburn University; Alabama; USA
| | - M. C. Schramme
- Equine Clinic; National Veterinary School of Lyon; Marcy l'Etoile; France
| | - J. Schumacher
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Tennessee; USA
| | - F. J. DeGraves
- Ogden College of Science and Engineering; Western Kentucky University; Kentucky; USA
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Nagy A, Bodò G, Dyson SJ, Compostella F, Barr ARS. Distribution of radiodense contrast medium after perineural injection of the palmar and palmar metacarpal nerves (low 4-point nerve block): an in vivo and ex vivo study in horses. Equine Vet J 2010; 42:512-8. [PMID: 20716191 DOI: 10.1111/j.2042-3306.2010.00076.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING STUDY Evidence-based information is limited on distribution of local anaesthetic solution following perineural analgesia of the palmar (Pa) and palmar metacarpal (PaM) nerves in the distal aspect of the metacarpal (Mc) region ('low 4-point nerve block'). OBJECTIVES To demonstrate the potential distribution of local anaesthetic solution after a low 4-point nerve block using a radiographic contrast model. METHODS A radiodense contrast medium was injected subcutaneously over the medial or the lateral Pa nerve at the junction of the proximal three-quarters and distal quarter of the Mc region (Pa injection) and over the ipsilateral PaM nerve immediately distal to the distal aspect of the second or fourth Mc bones (PaM injection) in both forelimbs of 10 mature horses free from lameness. Radiographs were obtained 0, 10 and 20 min after injection and analysed subjectively and objectively. Methylene blue and a radiodense contrast medium were injected in 20 cadaver limbs using the same techniques. Radiographs were obtained and the limbs dissected. RESULTS After 31/40 (77.5%) Pa injections, the pattern of the contrast medium suggested distribution in the neurovascular bundle. There was significant proximal diffusion with time, but the main contrast medium patch never progressed proximal to the mid-Mc region. The radiological appearance of 2 limbs suggested that contrast medium was present in the digital flexor tendon sheath (DFTS). After PaM injections, the contrast medium was distributed diffusely around the injection site in the majority of the limbs. In cadaver limbs, after Pa injections, the contrast medium and the dye were distributed in the neurovascular bundle in 8/20 (40%) limbs and in the DFTS in 6/20 (30%) of limbs. After PaM injections, the contrast and dye were distributed diffusely around the injection site in 9/20 (45%) limbs and showed diffuse and tubular distribution in 11/20 (55%) limbs. CONCLUSIONS AND POTENTIAL RELEVANCE Proximal diffusion of local anaesthetic solution after a low 4-point nerve block is unlikely to be responsible for decreasing lameness caused by pain in the proximal Mc region. The DFTS may be penetrated inadvertently when performing a low 4-point nerve block.
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Affiliation(s)
- A Nagy
- Equine Diagnostic Centre, University of Bristol, UK.
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Kristiansen KK, Kold SE. Multivariable analysis of factors influencing outcome of 2 treatment protocols in 128 cases of horses responding positively to intra-articular analgesia of the distal interphalangeal joint. Equine Vet J 2010; 39:150-6. [PMID: 17378444 DOI: 10.2746/042516407x170094] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY There is limited knowledge available of factors influencing response to treatments of the DIP-joint in horses with lameness responding to diagnostic analgesia of the DIP-joint. For this reason a multivariable statistical analysis was performed. HYPOTHESIS Horses with lameness reduced by > or = 75% 10 min after intra-articular analgesia of the DIP-joint, can be treated successfully by intra-articular medication of the joint. Multiple factors influence the response to treatment. METHODS The study was performed retrospectively based on clinical records of horses treated with either polysulphated glycosaminoglycan (PSGAG) or methylprednisolone acetate (MPA) in the DIP-joint between January 1996 and January 2003. Information was collected from clinical records and from the owners of the horses via a detailed questionnaire, in which they described their perception of the outcome a minimum of one year after treatment. Allocation of the horses to the 2 treatment groups was done mainly because of a change in treatment policy. In Regime A all horses received 3 intra-articular injections of PSGAG approximately 8 days apart, whereas in Regime B all horses received a single intra-articular injection of MPA as a first treatment. If the horse did not improve sufficiently to return to work by 4 weeks, a series of 3 intra-articular PSGAG injections was administered. RESULTS Of the horses receiving Regime A, 67% had a successful outcome, compared with 46% of the group receiving Regime B. A significantly better result was obtained in dressage horses than in jumping horses (eventing and showjumping). Other variables such as age, duration of lameness, distribution of lameness, degree of lameness, response to DIP-joint analgesia and radiographic observations were also associated with success of treatment. CONCLUSIONS AND POTENTIAL RELEVANCE There is a rationale for using either PSGAG or MPA intra-articularly in the treatment of lameness, reduced > or = 75% within 10 min of analgesia of the DIP-joint.
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Affiliation(s)
- K K Kristiansen
- Willesley Equine Clinic Ltd., Tetbury, Gloucestershire, GL8 8QU UK
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Bidwell LA, Brown KE, Cordier A, Mullineaux DR, Clayton HM. Mepivacaine local anaesthetic duration in equine palmar digital nerve blocks. Equine Vet J 2010; 36:723-6. [PMID: 15656504 DOI: 10.2746/0425164044848154] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Perineural analgesics are used for lameness diagnosis but the duration of effect, knowledge of which would provide valuable information when performing subsequent blocks, is unknown. OBJECTIVE To evaluate the duration of a palmar digital nerve block using force plate measurements. METHODS Ten horses diagnosed with unilateral navicular syndrome were trotted at range of 3 +/- 0.15 m/sec over a force plate to record ground reaction forces for 5 trials of each forelimb. Data were recorded before nerve block, and then at 15 mins, 1, 2 and 24 h post nerve block. RESULTS Before nerve block, peak vertical force (mean +/- s.e.) was significantly higher in the contralateral forelimb (CL = 5345 +/- 188 N) than in the lame forelimb (L = 4256 +/- 204 N; P<0.05). At 15 mins post nerve block there was no significant difference between the 2 forelimbs (CL = 5140 +/- 184 N; L = 5126 +/- 129 N), and this remained the case for 1 h. By 2 h, the mean score for the lame leg had decreased (L = 4642 +/- 182 N) but was still greater than preblock. By 24 h, vertical forces had returned to preblock values. CONCLUSIONS The palmar digital nerve block was fully effective between 15 mins and 1 h. The analgesic effect began to subside between 1 and 2 h but sufficient analgesia persisted to affect gait characteristics beyond 2 h. POTENTIAL RELEVANCE When using a palmar digital nerve block, it is important to perform lameness evaluations between 15 mins and 1 h to be sure of effective nerve blockade.
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Affiliation(s)
- L A Bidwell
- Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan 48824, USA
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Dyson SJ, Murray R, Schramme MC. Lameness associated with foot pain: results of magnetic resonance imaging in 199 horses (January 2001-December 2003) and response to treatment. Equine Vet J 2010; 37:113-21. [PMID: 15779622 DOI: 10.2746/0425164054223804] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY The diagnosis of foot-related lameness often remains elusive and it can be difficult to offer rational treatment, or to predict outcome. OBJECTIVES To describe the spectrum of injuries of the foot identified using magnetic resonance imaging (MRI), to determine their relative prevalence among MRI diagnoses and to establish the long-term results of treatment. METHODS The MR images of horses examined from January 2001--December 2003 were reviewed. Horses were selected for MRI if the pain causing lameness was localised to the foot using perineural analgesia but any clinical, radiological or ultrasonographic abnormalities were insufficient to explain the degree of lameness. The clinical significance of lesions identified using MRI was determined with reference to the results of local analgesia, radiography, ultrasonography and nuclear scintigraphy. Follow-up information was obtained in January 2004 for horses which had been examined 6-36 months previously and the outcome classified as excellent (horse returned to full athletic function without recurrent lameness), moderate (sound, but only in light work), or poor (persistent or recurrent lameness). RESULTS One hundred and ninety-nine horses underwent MRI examinations. Deep digital flexor (DDF) tendonitis was the most common injury (59%) with primary injury in 65 horses (33%) and a further 27 horses (14%) having lesions of the DDF tendon and navicular bone. Seventeen percent of horses had injuries to multiple structures, including 24 with DDF tendonitis. Desmitis of a collateral ligament (CL) of the distal interphalangeal (DIP) joint was the second most common injury (62 horses, 31%), with primary injuries in 30 horses (15%) and a further 32 horses (16%) that had CL desmitis in conjunction with other injuries. Prognosis was best for horses with traumatic injuries of the middle or distal phalanges, with 5 of 7 horses (71%) having an excellent outcome. Horses with primary lesions of the DDF tendon or CL of the DIP joint had excellent results in only 13 of 47 (28%) and 5 of 17 horses (29%), respectively. Horses with combined injuries of the DDF tendon and navicular bone, or primary navicular bone abnormalities, had a poor outcome, with the majority of horses suffering persistent lameness. CONCLUSIONS A wide variety of lesions associated with foot pain were identified using MRI, a high proportion of which were primary soft tissue injuries with a guarded prognosis for return to full athletic function. POTENTIAL RELEVANCE It is now possible to propose more rational treatment strategies for the variety of foot injuries identified using MRI than had previously been possible; however, further information concerning aetiopathogenesis of these injuries is needed to improve their management.
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Affiliation(s)
- S J Dyson
- Centre for Equine Studies, Animal Health Trust, Kentford, Newmarket, Suffolk CB8 7UU, UK
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30
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Schumacher J, Schumacher J, Schramme MC, DeGraves FJ, Smith R, Coker M. Diagnostic analgesia of the equine forefoot. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2004.tb00288.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Diffusion of contrast medium after perineural injection of the palmar nerves: An in vivo and in vitro study. Equine Vet J 2010; 41:379-83. [DOI: 10.2746/042516409x372502] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Accuracy of ultrasound-guided injections of thoracolumbar articular process joints in horses: A cadaveric study. Equine Vet J 2009; 42:18-22. [DOI: 10.2746/042516409x454565] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sardari K, Kazemi H. Evaluation of clinical examination for differential diagnosis of lameness by navicular apparatus or heel pain in horses. Pak J Biol Sci 2008; 11:1754-6. [PMID: 18819633 DOI: 10.3923/pjbs.2008.1754.1756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To evaluation of clinical examination for differential diagnosis of navicular region pain from other forms of palmar heel pain in the forelimb in horses the present study was undertaken. Thirty four horses with lameness referable to the palmar aspect of the hoof based on their response to the palmar digital nerves analgesia were divided into 2 groups based on their response to both distal interphalangeal joint and navicular bursa analgesia. Horses that were profoundly improved by both analgesic blocks (distal interphalangeal joint and navicular bursa) were considered to have navicular region pain whereas, all other horses were considered to have other cause of palmar heel pain. The responses to various diagnostic tests such as hoof tester, distal limb flexion and toe wedge tests were compared between the groups. For all diagnostic tests, sensitivity, specificity and positive predictive values for navicular pain were calculated. According to the present study the single most accurate diagnostic test was analgesia of the distal interphalangeal joint for navicular region pain.
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Affiliation(s)
- Kamran Sardari
- Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, P.O. Box 91775-1793, Mashhad, Iran
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Dabareiner RM, Carter GK, Honnas CM. Injection of corticosteroids, hyaluronate, and amikacin into the navicular bursa in horses with signs of navicular area pain unresponsive to other treatments: 25 cases (1999-2002). J Am Vet Med Assoc 2003; 223:1469-74. [PMID: 14627099 DOI: 10.2460/javma.2003.223.1469] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine history, clinical and radiographic abnormalities, and outcome in horses with signs of navicular area pain unresponsive to corrective shoeing and systemic nonsteroidal anti-inflammatory drug administration that were treated with an injection of corticosteroids, sodium hyaluronate, and amikacin into the navicular bursa. DESIGN Retrospective study. ANIMALS 25 horses. PROCEDURE Data collected from the medical records included signalment, history, horse use, severity and duration of lameness, shoeing regimen, results of diagnostic anesthesia, radiographic abnormalities, and outcome. RESULTS 17 horses had bilateral forelimb lameness, 7 had unilateral forelimb lameness, and 1 had unilateral hind limb lameness. Mean duration of lameness was 9.2 months. All horses had been treated with corrective shoeing and nonsteroidal anti-inflammatory drugs for at least 6 months; 18 had previously been treated by injection of corticosteroids and sodium hyaluronate into the distal interphalangeal joint. Fourteen horses had mismatched front feet, and 21 horses had signs of pain in response to application of pressure over the central aspect of the frog. Palmar digital nerve anesthesia resulted in substantial improvement in or resolution of the lameness in all horses. Twenty horses (80%) were sound and returned to intended activities 2 weeks after navicular bursa treatment; mean duration of soundness was 4.6 months. Two horses that received numerous navicular bursa injections had a rupture of the deep digital flexor tendon at the level of the pastern region. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that navicular bursa treatment may provide temporary improvement in horses with signs of chronic navicular area pain that fail to respond to other treatments.
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Affiliation(s)
- Robin M Dabareiner
- Department of Large Animal Medicine and Surgery, College of Veterinary Medicine, Texas A&M University, College Station, TX 77843, USA
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Schumacher J, Schumacher J, Gillette R, DeGraves F, Schramme M, Smith R, Perkins J, Coker M. The effects of local anaesthetic solution in the navicular bursa of horses with lameness caused by distal interphalangeal joint pain. Equine Vet J 2003; 35:502-5. [PMID: 12875330 DOI: 10.2746/042516403775600460] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Analgesia of the palmar digital (PD) nerves has been demonstrated to cause analgesia of the distal interphalangeal (DIP) joint as well as the sole. Because the PD nerves lie in close proximity to the navicular bursa, we suspected that that analgesia of the navicular bursa would anaesthetise the PD nerves, which would result in analgesia of the DIP joint. OBJECTIVES To determine the response of horses with pain in the DIP joint to instillation of local anaesthetic solution into the navicular bursa. METHODS Lameness was induced in 6 horses by creating painful synovitis in the DIP joint of one forefoot by administering endotoxin into the joint. Horses were videorecorded while trotting, before and after induction of lameness, at three 10 min intervals after instilling 3.5 ml local anaesthetic solution into the navicular bursa and, finally, after instilling 6 ml solution into the DIP joint. Lameness scores were assigned by grading the videorecorded gaits subjectively. RESULTS At the 10 and -20 min observations, median lameness scores were not significantly different from those before administration of local anaesthetic solution into the navicular bursa (P > or = 0.05), although lameness scores of 3 of 6 horses improved during this period, and the 20 min observation scores tended toward significance (P = 0.07). At the 30 min observation, and after analgesia of the DIP joint, median lameness scores were significantly improved (P < or = 0.05). CONCLUSIONS These results indicate that pain arising from the DIP joint can probably be excluded as a cause of lameness, when lameness is attenuated within 10 mins by analgesia of the navicular bursa. POTENTIAL RELEVANCE Pain arising from the DIP joint cannot be excluded as a cause of lameness when lameness is attenuated after 20 mins after analgesia of the navicular bursa.
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Affiliation(s)
- John Schumacher
- Department of Large Animal Surgery and Medicine, College of Veterinary Medicine, Auburn University, Alabama, USA
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Gough MR, Munroe GA, Mayhew G. Diffusion of mepivacaine between adjacent synovial structures in the horse. Part 2: tarsus and stifle. Equine Vet J 2002; 34:85-90. [PMID: 11817557 DOI: 10.2746/042516402776181088] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This paper tests the hypothesis that the local analgesic agent mepivacaine diffuses between adjacent equine synovial structures in the hindlimb and with greater frequency than latex, gelatine dye or contrast media. We report the incidence of diffusion of mepivacaine between the tarsometatarsal, centrodistal and tarsocrural joints, and the 3 synovial compartments of the stifle in 33 fresh equine cadavers. The tarsometatarsal joint and one synovial compartment of the stifle in the left limb and the centrodistal joint and a different synovial compartment of the stifle in the right limbs were injected with mepivacaine. Following flexion and extension of the limb, synovial fluid was aspirated from the noninjected centrodistal and tarsometatarsal joints and the tarsocrural joints of the hock and the noninjected compartments of the stifle. Concentrations of mepivacaine in these samples were assayed using an enzyme linked immunosorbent assay. For samples obtained by dilution of synovial fluid the concentration of mepivacaine was determined by comparing the concentration of urea in the diluted synovial fluid and the concentrations of the serum urea. Mepivacaine was detected in 25/25 (100%) adjacent tarsometatarsal and centrodistal joints after diffusion in both directions, in 23/25 (92%) of tarsocrural joints after diffusion from tarsometatarsal joints and in 22/25 (88%) tarsocrural joints after diffusion from centrodistal joints in the hocks. Diffusion from the femoropatellar to medial and lateral femorotibial joints and between the medial and lateral femorotibial joints in both directions were 20/20 (100%). Diffusion from the lateral femorotibial to the femoropatellar joint was 18/20 (90%) and from the medial femorotibial to femoropatellar joints 17/20 (85%). Mepivacaine was detected at concentrations >0.3 mg/l in a proportion of samples ranging from 15/25 (60%) in the tarsocrural joint following tarsometatarsal joint injection to 18/20 (90%) in the lateral femorotibial joint after femoropatellar joint injection. At mepivacaine concentrations >100 mg/l, detection ranged from 3/20 (15%) in the lateral femorotibial joint from the medial femorotibial joint to 19/25 (76%) in the centrodistal joint from the tarsometatarsal joint. At mepivacaine concentrations >300 mg/l, detection ranged from 1/25 (4%) in the tarsocrural joint from the tarsometatarsal joint to 16/25 (64%) in the from centrodistal joint the tarsometatarsal joint. The results show greater diffusion of mepivacaine between these adjacent synovial structures than assumed from previous anatomical, latex injection and contrast arthrographic studies. Therefore, commonly performed intrasynovial local analgesic techniques in the hindlimb of the horse are not as specific as first thought.
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Affiliation(s)
- M R Gough
- Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Veterinary Centre, Midlothian, Scotland, UK
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