The effect of intra‐articular mepivacaine administration prior to carpal arthroscopy on anesthesia management and recovery characteristics in horses

Abstract

Objective: To evaluate the effects of intra-articular (IA) mepivacaine administration prior to carpal arthroscopy on anesthetic drug requirements, blood pressure support, hemodynamic variables, and quality of recovery in horses. Study design: Experimental, analytical, cohort study. Sample population: Twenty-two horses (n = 11 horses/group). Methods: Horses were anesthetized by using the same protocol, but an IA injection of mepivacaine or saline was performed before carpal arthroscopy. End-tidal isoflurane concentration, heart rate, and mean arterial pressure were recorded at specific time points. Quality of recovery was scored by the anesthetist, who was unaware of group assignment. Data were analyzed by using two-way repeated-measures analysis of variance. Results: Mean arterial pressure was higher during joint distension in the control group compared with baseline (7% higher, P = .02) and with the treatment group (10% higher, P = .04). Heart rate was higher in the control group compared with the treatment group during joint distension (8% higher, P = .04) and chip removal (11% higher, P = .03). Heart rate was higher in the control group compared with baseline during chip removal (5.5% higher, P = .04). Two horses in the control group required additional ketamine vs none in the treatment group. Quality of recovery was not different between groups. Conclusion: Intra-articular mepivacaine resulted in fewer detectable reactions to surgical stimulation, with similar recovery scores and blood pressure support requirements. Clinical significance: Intra-articular anesthesia prior to arthroscopy can be used safely in the horse and should be considered as a part of balanced anesthetic protocols.

Recovery of horses from general anaesthesia: A systematic review (2000–2020) of the influence of anaesthetic protocol on recovery quality

“…Other authors failed to identify a benefit in terms of QR when peripheral nerve blocks were performed prior to recovery 26,125 . Similarly, a group of researchers found no difference in QR in horses receiving either an intra‐articular injection of mepivacaine or saline performed before carpal arthroscopy 126 Although, in three of these studies, 125,126,128 the sample size was small which may hinder the ability to detect a difference between groups.…”

“…A total of five studies were identified that assessed the effect of locoregional anaesthesia on QR (Table 8). The evidence presented regarding the impact of peripheral nerve blocks and intra‐articular opioid or local anaesthetic administration on QR is inconsistent 26,126,134 …”

Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature

“…(1) The effect of epidural xylazine on halothane minimum alveolar concentration in ponies [272] (2) Epidural morphine and detomidine decreases postoperative hindlimb lameness in horses after bilateral stifle arthroscopy [273] (3) Castration of horses under total intravenous anaesthesia: Analgesic effects of lidocaine [274] (4) Local mepivacaine before castration of horses under medetomidine isoflurane balanced anaesthesia is effective to reduce perioperative nociception and cytokine release [275] (5) Intratesticular mepivacaine versus lidocaine in anaesthetised horses undergoing Henderson castration [276] (6) The effect of intra-articular mepivacaine administration prior to carpal arthroscopy on anesthesia management and recovery characteristics in horses [277] 2 / 3 (7) Epidural administration of opioid analgesics improves quality of recovery in horses anaesthetised for treatment of hindlimb synovial sepsis [278] (8) Clinical assessment of an ipsilateral cervical spinal nerve block for prosthetic laryngoplasty in anesthetized horses [279] 4 (9) The outcome of epidural anaesthesia in horses with perineal and tail melanomas: Complications associated with ataxia and the risks of rope recovery [280] 5 / Total loco-regional publications = 9…”

“…Nine publications focused on different loco-regional techniques [272][273][274][275][276][277][278][279][280]. In the last few years, a renaissance of loco-regional techniques on standing horses has occurred with the advent of ultrasound guided technology [469,470].…”

“…Local anaesthetics can be used in castrations without implications on the recovery [274][275][276]. Gaesser et al, (2020) reported the safe use of intraarticular mepivacaine for carpal arthroscopy [277]. Epidural xylazine produced halothane sparing effects, suggesting analgesic properties [272], whereas detomidine and morphine, via the same route, provided analgesia after bilateral stifle arthroscopy [273].…”