Comparison of two tourniquets and determination of amikacin sulfate concentrations after metacarpophalangeal joint lavage performed simultaneously with intravenous regional limb perfusion in horses.

The research investigates whether the joint lavage procedure, performed alongside intravenous regional limb perfusion (IVRLP), impacts the effectiveness of IVRLP in horses, and which tourniquet type — pneumatic or Esmarch — is more effective in this regard. The study reveals that performing joint lavage and IVRLP together doesn’t significantly impact amikacin loss while Esmarch tourniquet was found to be more effective, easier to implement, and cost-effective than the pneumatic tourniquet.

Research Methodology

• Eleven adult horses were divided into two groups of six, testing each type of tourniquet once. One horse was used twice to test both tourniquet types.
• An IVRLP procedure was performed in a standing position using a 500mg dose of amikacin for 30 minutes. At the same time, the horse’s metacarpophalangeal joint was flushed with 2 liters of lactated Ringer’s solution and the outflow fluids were collected.
• The synovial fluid from the distal interphalangeal joint and blood from the digital and jugular veins were gathered at fixed intervals.
• All fluid samples were then assessed for their amikacin concentrations using fluorescence polarization immunoassay.

Key Findings

• It was found that the systemic circulation contained less amikacin when the Esmarch tourniquet was used, as compared to the pneumatic tourniquet.
• Amikacin concentrations in the distal interphalangeal joint’s synovial fluid ranged between 45.1 to 1,968 μg/mL in the Esmarch tourniquet group, and 1.7 to 92.3 μg/mL in the pneumatic tourniquet group after 30 minutes of IVRLP.
• The total amount of amikacin lost in the egress fluids from the joint lavage was between 1.36 to 7.72 mg in the Esmarch tourniquet group and 1.20 to 1.75 mg in the pneumatic tourniquet group.

Conclusions

• Performing a joint lavage simultaneously with IVRLP in horses standing position results in negligible loss of amikacin in the outflow lavage fluids.
• The Esmarch tourniquet was more effective in minimizing the loss of amikacin from the limb’s distal part. It was also easier to use and less expensive compared to its pneumatic counterpart.