Diffusion of radiodense contrast medium after a mid‐pastern ring block

Diffusion of local anaesthetic solution after a mid‐pastern ring block has not previously been investigated. The aim of this study was to demonstrate potential distribution of local anaesthetic solution following injection of radiodense contrast medium as performed for a mid‐pastern ring block. Twelve mature horses were used and 1.5 ml radiodense contrast medium injected over the medial or lateral palmar digital nerve at the level of the proximal aspect of the ungular cartilages. A dorsal ring block was performed on the ipsilateral side, 1.5 cm proximal to the palpable palmar aspect of the proximal eminence of the middle phalanx, using 2 or 5 ml contrast medium. Both forelimbs were injected on 2 days (48 injections). Four standard radiographic views of the pastern were obtained immediately, 10 and 20 min after injections. Images were analysed subjectively and objectively. After dorsal injections, the contrast medium was distributed in a diffuse patch over the ipsilateral half of the proximal phalanx (P1), extending proximally over the half of the length of P1 in all limbs (greatest proximal extension: 89.0% of the length of P1 [from distal] after 2 ml, 94.2% after 5 ml). There was significant proximal diffusion in the first 10 min after injection and significant dorsal diffusion between all time points (P<0.01). There was significant positive association between injected volume and the proximal extension of the dorsal contrast patch (P = 0.01). The median dorsal diffusion was to the dorsal midline of P1; 5 ml contrast medium resulted in significantly greater dorsal diffusion than 2 ml (P<0.01). The dorsal and palmar contrast patches did not merge. In conclusion, diffusion to the proximal aspect of P1 following a mid‐pastern ring block may occur even if only 2 ml of local anaesthetic solution is used.     

Diffusion of radiodense contrast medium after perineural injection of the palmar digital nerves

Limited information exists on distribution of local anaesthetic solution following palmar digital nerve blocks. The aim of this study was to demonstrate potential distribution of local anaesthetic solution following perineural injection of the palmar digital nerves using 2 different volumes of contrast medium and 2 different injections sites. Twelve mature horses were used. Perineural injection of the palmar digital nerves were performed at the level of or 2 cm proximal to the proximal aspect of the ipsilateral ungular cartilage, using 1.5 or 2.5 ml radiopaque contrast medium. In total, 96 injections were performed. Four standard radiographic views of the pastern were obtained immediately after injections and 10 and 20 min later. Images were analysed subjectively and objectively. After distal injections, the contrast medium was more localised around the injection site; after proximal injections the contrast patch had greater proximal–distal length. The greatest proximal diffusion was to 31.7% of the length of the proximal phalanx (from the level of the proximal interphalangeal joint) after distal injections and to 70% after proximal injections. The larger volume resulted in significantly greater proximal diffusion than the smaller volume at the distal, but not at the proximal injection site (P<0.01). There was significant proximal diffusion with time after proximal and distal injections (P<0.01). In most limbs, numerous radiopaque lines of various thickness extended proximally from the contrast patches; subjectively, their number and thickness were greater at the distal injection site. In conclusion, palmar digital nerve blocks at the level of the ungular cartilage using ≤2.5 ml local anaesthetic solution may improve proximal interphalangeal joint and pastern region pain. If using a more proximal site, distal fetlock region pain may be improved. Due to diffusion into lymphatic vessels, too small a volume at the distal injection site may not provide sufficient analgesia.     

Anaesthesia and analgesia of the donkey and the mule

The number of donkeys and mules throughout the world is stable, and awareness of their use and concern for welfare, pain recognition and treatment are receiving increasing veterinary interest. Therefore, accurate information about anaesthesia and analgesia in donkeys and mules is important to ever more equine practitioners. Since donkeys are physiologically and pharmacologically different from horses, knowledge on species specific aspects of anaesthesia and analgesia are very important. Mules combine elements from both donkey and horse backgrounds, leading to great diversity in size, temperament and body type. Physiologically, they seem to resemble horses more than donkeys. This review highlights the current knowledge on various anaesthetic and analgesic approaches in donkeys and mules. There is still much information that is not available about donkeys; in many circumstances, the clinician must use available equine information to treat the patient, while monitoring carefully to observe for differences in response to therapy compared to the horse.     

A preventive multimodal analgesic strategy for bilateral rostral mandibulectomy in a horse

This case report describes the use of a wound soaker catheter as part of a preventive multimodal analgesic plan in a mare undergoing a bilateral rostral mandibulectomy. The administration of local anaesthetic into the surgical wound using a wound soaker catheter, together with systemic nonsteroidal anti‐inflammatory drugs (NSAIDs) and opioid therapy, controlled post operative pain satisfactorily.     

Evaluation of poor performance in competition horses: A musculoskeletal perspective. Part 2: Further investigation

There is not a right and a wrong way of investigating musculoskeletal causes of poor performance in sports horses and the methods of investigation are, in part, determined by the clinical signs. Measurement of serum muscle enzyme concentrations before and after exercise is essential for recognition of primary muscle pathology. Many horses with multilimb lameness have a secondary reduced range of motion of the thoracolumbosacral region mimicking primary thoracolumbar pain. Radiographic examination of the thoracolumbar vertebrae may be confusing unless combined with diagnostic analgesia because many clinically normal horses have radiological abnormalities. Nuclear scintigraphy offers a method of evaluating a large proportion of the horse, but there are many false positive and false negative results. Diagnostic analgesia is the most reliable method of investigation but requires experience and skill in interpretation and is time consuming in a horse with multilimb lameness.     

Comparison of morphological changes and tactile sensitivity of the pharynx and larynx between four standing sedative and analgesic protocols in eight adult healthy horses

Objective

To compare the topographic modifications and tactile sensitivity of the pharynx and larynx after administration of four sedative and analgesic protocols in standing horses.

The pharmacokinetics and pharmacodynamics of the injectable anaesthetic alfaxalone in the horse

ObjectiveTo determine the pharmacokinetics and pharmacodynamics of the neurosteroidal anaesthetic, alfaxalone, in horses after a single intravenous (IV) injection of alfaxalone, following premedication with acepromazine, xylazine and guaiphenesin.Study designProspective experimental study.AnimalsTen (five male and five female), adult, healthy, Standardbred horses.MethodsHorses were premedicated with acepromazine (0.03 mg kg^?1 IV). Twenty minutes later they received xylazine (1 mg kg^?1 IV), then after 5 minutes, guaiphenesin (35 mg kg^?1 IV) followed immediately by IV induction of anaesthesia with alfaxalone (1 mg kg^?1). Cardiorespiratory variables (pulse rate, respiratory rate, pulse oximetry) and clinical signs of anaesthetic depth were evaluated throughout anaesthesia. Venous blood samples were collected at strategic time points and plasma concentrations of alfaxalone were assayed using liquid chromatography-mass spectrometry (LC/MS) and analysed by noncompartmental pharmacokinetic analysis. The quality of anaesthetic induction and recovery was scored on a scale of 1–5 (1 very poor, 5 excellent).ResultsThe median (range) induction and recovery scores were 4 (3–5) (good: horse slowly and moderately gently attained recumbency with minimal or no rigidity or paddling) and 4 (1–5) (good: horse stood on first attempt with some knuckling and ataxia) respectively. The monitored cardiopulmonary variables were within the range expected for clinical equine anaesthesia. The mean ± SD durations of anaesthesia from induction to sternal recumbency and from induction to standing were 42.7 ± 8.4 and 47 ± 9.6 minutes, respectively. The mean ± SD plasma elimination half life (t_1/2), plasma clearance (Clp) and volume of distribution (V_d) for alfaxalone were 33.4 minutes, 37.1 ± 11.1 mL minute^?1 kg^?1 and 1.6 ± 0.4 L kg^?1, respectively.Conclusions and clinical relevanceAlfaxalone, in a 2-hydroxypropyl-beta-cyclodextrin formulation, provides anaesthesia with a short duration of recumbency that is characterised by a smooth induction and satisfactory recovery in the horse. As in other species, alfaxalone is rapidly cleared from the plasma in the horse.     

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

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.     

Acute cortisol responses of lambs to ring castration and docking after the injection of lignocaine into the scrotal neck or testes at the time of ring application

OBJECTIVE: To test whether injecting lignocaine into the scrotal neck 5 to 10 s before or into both testes immediately after ring castration and docking wound significantly reduce the plasma cortisol response to castration and docking. DESIGN: A physiological study with controls. PROCEDURE: Lambs were given one of six treatments: control handling, injection of lignocaine into scrotal neck, injection of lignocaine into both testes, ring castration and docking, ring castration and docking after lignocaine was injected into the scrotal neck, and ring castration and docking before lignocaine was injected into both testes. Blood samples were taken before and regularly after treatment and analysed for plasma cortisol concentrations. RESULTS: The plasma cortisol concentrations of lambs castrated and docked after lignocaine had been injected into the scrotal neck were significantly lower between 20 and 60 min after treatment than in lambs castrated and docked without local anaesthesia. Injecting lignocaine into the testes after ring application did not significantly reduce the cortisol response to ring castration and docking. CONCLUSIONS: Lignocaine injected into the scrotal neck 5 to 10 s before ring castration will reduce the cortisol response and by inference the pain associated with ring castration.