Meta‐analysis of the effects of lidocaine on postoperative reflux in the horse

Abstract

ObjectiveTo determine the efficacy of lidocaine at reducing incidence of postoperative reflux (POR) in horses by using quantitative statistical analysis.Study designSystematic meta‐analytical review.Sample populationStudies on horses undergoing gastrointestinal surgery for small intestinal lesions, identified by systematic search between 2001 and 2017.MethodsA search with PubMed/MEDLINE, Web of Science, and Google Scholar was performed, followed by secondary searches of veterinary trade journals and bibliographies of relevant articles. The primary outcome measure for this study was the effect of lidocaine therapy on the odds of POR. Subgroup analysis assessed included the timing of lidocaine therapy, incidence of mortality, and incidence of repeat celiotomy. A meta‐analysis was performed with a random effects model, with the effect size calculated as an odds ratio (OR) with 95% confidence intervals (CI). Statistical significance was set at P < .05.ResultsAmong 1933 peer reviewed publications that met the initial search criteria, 12 relevant studies were available for analysis. Lidocaine was associated with an increased incidence of diagnosis of POR (OR 6.3, 95% CI [1.4, 27.0], P = .01). Horses treated with lidocaine were more likely to survive to discharge (OR 6.8, 95% CI [3.9, 11.7], P < .01).ConclusionLidocaine was associated with an increased survival rate in horses undergoing exploratory celiotomy for small intestinal disease according to this meta‐analysis of the recent literature.Clinical significanceThis body of published evidence provides support to administer lidocaine in horses to improve survival rather than preventing POR.

Therapeutic options for COVID-19: a quick review

“…Letters to the editor, review articles, computer docking and simulation works were excluded from this study. 11,12 Results Thirty-nine articles were retrieved, excluding repetitions, among which 26 (66.67%) were based on clinical trials, 12 (30.77%) were based on in vitro studies, and only one (2.56%) was categorized as an experimental animal study ( Figure 2 and Table 1). Of the agents evaluated for COVID-19 therapeutics, fifteen (38.46%) were antiviral, four studies (10.26%) each for antimalarial, and immunotherapy (10.26%), two (5.13%) for antibacterial, one (2.56%) each as antiparasitic, anticoagulant, combinations of antiviral/antimalarial and antiviral/ herbal, while eightstudies (20.51%) were antibiotic/ antimalarial combinations (Table 1 and Figure 3).…”

The effects of bit chewing on borborygmi, duodenal motility, and gastrointestinal transit time in clinically normal horses

“…1,2 The reported prevalence of POI following exploratory celiotomy varies from 6%-61.7%, 2 with the percentage increasing substantially if a small intestinal lesion is present. [2][3][4][5] Persistent POI has been demonstrated to lead to an increased likelihood of repeat laparotomy, development of laminitis, and increased cost, due to medications and increased hospital stay. 2,6,7,8 The mortality rate of horses that develop POI has been reported to be as high as 86%.…”

“…Causes of POI include general anesthesia, opioids, inflammation due to intestinal manipulation and distention, and endotoxemia 1,2 . The reported prevalence of POI following exploratory celiotomy varies from 6%‐61.7%, 2 with the percentage increasing substantially if a small intestinal lesion is present 2–5 . Persistent POI has been demonstrated to lead to an increased likelihood of repeat laparotomy, development of laminitis, and increased cost, due to medications and increased hospital stay 2,6,7,8 .…”

Retrospective study on the use of lidocaine constant rate infusions for the treatment of ileus in ruminants and camelids

“…Typically, in equids, the prokinetic properties of lidocaine are used to treat postoperative ileus (POI) 2,5 . However, despite routine use for POI, there is conflicting evidence to support its efficacy in improving motility and survival rates 1,2,6–10 . Additionally, the mechanism of action for treating POI is not well understood and might include a combination of anti‐inflammatory or analgesic effects, and ability to stimulate or block intestinal muscular contraction 6 .…”

“… 2 , 5 However, despite routine use for POI, there is conflicting evidence to support its efficacy in improving motility and survival rates. 1 , 2 , 6 , 7 , 8 , 9 , 10 Additionally, the mechanism of action for treating POI is not well understood and might include a combination of anti‐inflammatory or analgesic effects, and ability to stimulate or block intestinal muscular contraction. 6 Other reports suggest the role in mitigating POI is through reducing gastric reflux and decreasing intraluminal jejunal and peritoneal fluid accumulation.…”