The Effect of Lidocaine on Postoperative Jejunal Motility in Normal Horses

Milligan, Melissa; Beard, Warren L.; KuKanich, Butch; Sobering, Timothy J.; Waxman, Sarah J

doi:10.1111/j.1532-950x.2007.00255.x

Cited by 46 publications

(47 citation statements)

References 21 publications

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“…Lidocaine administration following exploratory laparotomy has been associated with reduced small intestinal diameter and peritoneal fluid accumulation [8], decreased duration of gastric reflux and hospital stay [7], and reduced incidence of post-operative ileus and improved survival [21]. However, in normal horses lidocaine causes decreased jejunal motility [6] and delayed gastrointestinal transit time after prolonged administration [22]. In this study, we observed no effects of a prolonged lidocaine CRI on gastrointestinal transit, except when combined with butorphanol.…”

Section: Discussionmentioning

confidence: 99%

Systemic and anti-nociceptive effects of prolonged lidocaine, ketamine, and butorphanol infusions alone and in combination in healthy horses

et al. 2014

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BackgroundProlonged drug infusions are used to treat horses with severe signs of pain, but can be associated with altered gastrointestinal transit. The purpose of this study was to determine the effects of prolonged constant rate infusions (CRI) of lidocaine (L), butorphanol (B), and ketamine (K) alone and in combination on gastrointestinal transit, behavior, and thermal nociceptive threshold in healthy horses.MethodsEight healthy adult horses were used in a randomized, cross-over, blinded, prospective experimental trial. Interventions were saline, L, K, B, LK, LB, BK, and LBK as an intravenous CRI for 96 hours. Drugs were mixed or diluted in saline; following a bolus, CRI rate was 0.15mL/kg/hr with drug doses as follows: L – 1.3 mg/kg then 3 mg/kg/hr; B – 0.018 mg/kg then 0.013 mg/kg/hr; K – 0.55 mg/kg then 0.5 mg/kg/hr. Two-hundred plastic beads were administered intragastrically by nasogastric tube immediately prior to the bolus. Feces were collected every 2 hours, weighed, and beads manually retrieved. Behavior was scored every 2 hours, vital parameters every 6 hours, and thermal nociceptive threshold every 12 hours for 96 hours. Drug concentrations in the LBK solution were tested every 6 hours for 72 hours.ResultsFour of 64 trials (3 LBK, 1 BK) were discontinued early due to signs of abdominal discomfort. There were no apparent differences between groups in vital parameters or thermal threshold. Transit time was delayed for LB and LBK with a corresponding decrease in fecal weight that was most severe in the final 24 hours of infusion. Significant changes in behavior scores, vital parameters, or thermal threshold were not observed. The concentration of each drug in the combined solution declined by less than 31% over the sampling period.ConclusionsDrug combinations containing butorphanol cause an apparent delay in gastrointestinal transit in healthy horses without substantially affecting somatic nociception at the doses studied. Combinations of lidocaine and ketamine may have less impact on gastrointestinal transit than infusions combined with butorphanol. Further work is needed to determine the effects of these drugs in painful or critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Systemic and anti-nociceptive effects of prolonged lidocaine, ketamine, and butorphanol infusions alone and in combination in healthy horses

et al. 2014

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“…Traut et al (2008) reviewed the evidence for the clinical efficacy of various prokinetics in man and concluded that there was no evidence of efficacy of erythromycin, cholecystokinin, cisapride, dopamine-antagonists, propranolol or vasopressin and inconclusive evidence for lidocaine and neostigmine [148]. Evidence of the prokinetic properties of lidocaine is contradictory; some studies demonstrate an increase in contractile activity [149,150], others fail to report any change [151] and one study reported an increase in faecal transit time following a continuous lidocaine infusion [152]. Evidence of the prokinetic properties of lidocaine is contradictory; some studies demonstrate an increase in contractile activity [149,150], others fail to report any change [151] and one study reported an increase in faecal transit time following a continuous lidocaine infusion [152].…”

Section: Prokineticsmentioning

confidence: 99%

An update on equine post‐operative ileus: Definitions, pathophysiology and management

Lisowski

Pirie

Blikslager

et al. 2018

Equine Veterinary Journal

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Post-operative ileus (POI) is a serious condition which any horse undergoing abdominal surgery is at risk of developing, leading to increased hospitalisation time and resulting costs. Advances in the understanding of the development of equine POI are mainly based on human and rodent literature, where manipulation-induced inflammation has been identified as a trigger, with activation of resident muscularis externa macrophages playing a crucial role in the pathophysiology. Despite many pharmacological trials in all species, there is no single completely successful treatment for POI, highlighting that the condition is multifactorial in cause and requires a multimodal approach to minimise its incidence.

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“…Phase II has intermittently occurring spike bursts, and finally Phase III has spike bursts associated with each slow wave. (Milligan et al 2007) Spike bursts are action potentials superimposed on the slow waves which result in contraction of the intestinal muscular layer. (Davies and Gerring 1983) The individual components of the MMC, i.e.…”

Section: Clinical Application Of Lidocaine Proposed Mechanism Of Actionmentioning

confidence: 99%

Serum concentrations of lidocaine and its metabolites after prolonged infusion in healthy horses

Dickey

McKenzie

Brown

et al. 2008

Equine Veterinary Journal

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Summary Reasons for performing study: Continuous‐rate infusions (CRI) of lidocaine are often used for prolonged duration but, to date, only limited time/concentration relationships administered as a short term (24 h) CRI have been reported. Objective: To determine the time/concentration profile of lidocaine and its active metabolites glycinexylidide (GX) and monoethylglycinexylidide (MEGX) during a 96 h lidocaine infusion. Methods: Lidocaine was administered to 8 mature healthy horses as a continuous rate infusion (0.05 mg/kg bwt/min) for 96 h. Blood concentrations of lidocaine, GX and MEGX were determined using high performance liquid chromatography during and after discontinuation of the infusion. Results: Serum lidocaine concentrations reached steady state by 3 h and did not accumulate thereafter. Concentrations were above the target therapeutic concentration (980 ng/ml) only at 6 and 48 h, and did not reach the range described as potentially causing toxicity (>1850 ng/ml) at any time. MEGX did not accumulate over time, while the GX accumulated significantly up to 48 h and then remained constant. The serum concentrations of lidocaine, MEGX and GX were below the limit of detection within 24 h of discontinuation of the infusion. None of the horses developed any signs of lidocaine toxicity during the study. Conclusions: The metabolism of lidocaine was not significantly impaired by prolonged infusion and no adverse effects were observed. Prolonged infusions appear to be safe in normal horses but the accumulation of GX, a potentially toxic active metabolite, is cause for concern. Clinical relevance: Although the toxic level of GX has not yet been determined, such accumulation could lead potentially to adverse side effects and it is important to consider this potential for accumulation when utilising prolonged lidocaine infusions.

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The Effect of Lidocaine on Postoperative Jejunal Motility in Normal Horses

Abstract: Use of lidocaine as a prokinetic agent cannot be supported by this study in normal horses; however, results may differ in clinically affected horses.

Cited by 46 publications

References 21 publications

Systemic and anti-nociceptive effects of prolonged lidocaine, ketamine, and butorphanol infusions alone and in combination in healthy horses

Systemic and anti-nociceptive effects of prolonged lidocaine, ketamine, and butorphanol infusions alone and in combination in healthy horses

An update on equine post‐operative ileus: Definitions, pathophysiology and management

Serum concentrations of lidocaine and its metabolites after prolonged infusion in healthy horses

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