Recumbency following diagnostic analgesia of the sacroiliac joint regions: 15 horses

Abstract

Sacroiliac (SI) joint region pain is relatively common in sports horses and diagnosis is ideally confirmed by diagnostic analgesia (SI joint region blocks). Anecdotal reports describe complications following SI joint region blocks, but there is no detailed published information. Our aim was to document a series of horses that became recumbent following SI joint region blocks. Clinicians were asked to participate via the email list of the American College of Veterinary Sports Medicine and Rehabilitation and by contacting clinicians known to the authors to investigate poor performance and lameness in sports horses. Horses (n = 15) were included if they became recumbent following SI joint region blocks, with or without using other substances in addition to local anaesthetic solution. Data on the clinicians' experience, injection technique, clinical findings before and while the horse was recumbent and the outcome were collected in an online questionnaire. The clinicians' experience and injection techniques varied. In three horses corticosteroids, with or without pitcher plant extract, were also injected with the local anaesthetic solution. In 14 horses, the injection(s) were performed at a clinic or hospital; 13 horses were injected in stocks. Seven horses were sedated for the procedure. Fourteen horses became recumbent within 10 min and one within 20 min. While recumbent, seven horses were sedated and six anaesthetised. Fourteen horses stood up at a mean time of 3.8 h after becoming recumbent; additional information was available for 13 horses, all of which made a complete recovery. Three horses suffered temporary complications (pneumonia related to intubation, abrasions from a sling and radial nerve dysfunction associated with slinging). One horse was euthanised after 3 days because of failure to regain hindlimb function. In conclusion, recumbency following diagnostic analgesia of the SI joint regions can occur, but in the majority of horses, it has no long-term consequences.

Ultrasonographic features associated with the lumbosacral or lumbar 5–6 symphyses in 64 horses with lumbosacral‐sacroiliac joint region pain (2012–2018)

“…Only horses in Group 1 underwent diagnostic anaesthesia of the sacroiliac joint regions, a technique which is not specific for either the sacroiliac joint or the caudal lumbar symphyses. However, we do advocate performing periarticular anaesthesia of the sacroiliac joints as a method of confirming the general region of pain and have demonstrated that it is relatively safe (Nagy and Dyson ). It is not possible to determine definitively the contribution to pain of the lesions identified, and this may have differed between Groups 1 and 2.…”

Complications following equine sacroiliac region analgesia are uncommon: A study in 118 horses

“…The complication rate of 0.70% per horse (2/284) correlates well with the prevalence identified in this study; however, the main difference between this study and the current data is that a different SIRA technique was used [ 1 ]. A recent study [ 10 ] reported a within-clinic recumbency rate of approximately 0.3% (3 out of approximately 1180) following SIRA, with the authors estimating 1–2% of horses showed mild ataxia that precluded ridden re-evaluation [ 10 ].…”

“…Ataxia and recumbency are the most frequently reported complications and are reported to be quick in onset following SIRA, with the majority of horses noted to be ataxic or become recumbent within 20 minutes [ 1 , 10 ]. The one horse that displayed a mild gait abnormality in this study was identified when re-evaluated ten minutes following the block, which correlates with the previous reports.…”

“…A variety of techniques, needle lengths, needle curvature and volumes of local anaesthetic for SIRA are reported, with no one method described as superior [ 11 , 22 ]. The medial contralateral approach used in this study is most similar to the cranial or medial contralateral approach previously described [ 1 , 10 , 14 ]. The cranial contralateral technique was used in the largest case series of sacroiliac region pain [ 1 ].…”

“…Due to anecdotal concerns regarding complications following SIRA there can be a reluctance to perform this block. A recent international survey with veterinary surgeons invited to participate reported 15 horses that became recumbent following SIRA, with 14 of these making a full recovery [ 10 ].…”