Distal limb desensitisation following analgesia of the digital flexor tendon sheath in horses using four different techniques.
Abstract: Controversy exists about the desensitisation obtained after diagnostic analgesia of the digital flexor tendon sheath (DFTS) during lameness examinations. Objective: To determine whether DFTS analgesia results in inadvertent desensitisation of the palmar/plantar digital nerves and whether this depends on the injection technique used. Methods: Crossover experimental study. Methods: The DFTS of 9 horses were injected with local anaesthetic solution and radiodense contrast medium using one of the following techniques: Proximal (at lateral proximal recess of the DFTS), Axial (axial to the lateral proximal sesamoid bone), Base (at base of the lateral proximal sesamoid bone), and Distal (at palmar/plantar mid-pastern). In total, 72 injections were performed. Skin desensitisation at the heel bulbs was tested with a dynamometer before and at 15, 30, 90 and 120 min after injection. Results: Overall, complete desensitisation of a heel bulb at one or more time points after injection occurred in 22 limbs (30.6%). An additional 7 limbs were partially desensitised. Complete skin desensitisation occurred in 10, 3, 4 and 5 limbs using the Proximal, Axial, Base and Distal techniques respectively. Significant differences between techniques were only found at T30. The probability of skin desensitisation at the heel bulbs was 4 times higher when using the Proximal compared with the Axial and Base techniques in the forelimbs, and 3 times higher compared with the Axial and Distal techniques in the hindlimbs. Skin desensitisation nearly always occurred exclusively on the lateral heel bulb. Bilateral desensitisation only occurred in 5 limbs. Conclusions: Anaesthesia of the palmar/plantar digital nerves with distal limb desensitisation often occurs after DFTS analgesia. A higher chance of desensitisation exists when injecting the proximal DFTS recess. It is advisable to verify skin sensitivity at the heel bulbs after DFTS analgesia to avoid false interpretations about the origin of pain causing lameness.
© 2013 EVJ Ltd.
Publication Date: 2013-11-21 PubMed ID: 24033590DOI: 10.1111/evj.12186Google Scholar: Lookup
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- Journal Article
- Research Support
- Non-U.S. Gov't
Summary
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The research investigates the desensitisation that occurs in horses’ lower limbs after analgesic treatment of the digital flexor tendon sheath (DFTS), focusing on the impact of four different injection techniques.
Study Objective and Methodology
- The primary objective of this study was to figure out if injecting an analgesic into the DFTS of a horse causes unintentional desensitisation of the palmar/plantar digital nerves and whether the injection technique influences this outcome.
- A crossover experimental study was carried out for this research.
- Nine horses were selected for the experiment and their DFTSs were injected with a local anesthetic solution mixed with a radiodense contrast medium.
- Four different injection techniques were utilised: Proximal, Axial, Base, and Distal.
- The horses’ heel bulb skin sensitiveness was evaluated before and after the injection at 15, 30, 90, and 120 minutes.
Study Results
- Among the 72 injections, complete desensitisation of a heel bulb at one or various points after injection was observed in 22 limbs, constituting 30.6% of the cases. An extra 7 limbs were partially desensitised.
- Complete skin desensitisation occurred using the Proximal, Axial, Base, and Distal techniques in 10, 3, 4, and 5 limbs respectively.
- Significant differences among the techniques were only detected at T30, which is 30 minutes after the injection.
- The likelihood of skin desensitisation increased four times while using Proximal technique compared to the Axial and Base techniques in the forelimbs, and it was three times higher compared to the Axial and Distal techniques in the hindlimbs.
- Most instances of skin desensitisation occurred exclusively on the lateral heel bulb, and bilateral desensitisation was observed only in 5 limbs.
Conclusion
- Often, anaesthesia of the palmar/plantar digital nerves resulting in distal limb desensitisation occurs after DFTS analgesia.
- A greater risk of desensitisation was observed when injecting into the proximal DFTS recess.
- The study advises to check the skin sensitiveness at the heel bulbs after DFTS analgesia to avoid misinterpretations concerning the origin of pain causing lameness in horses.
Cite This Article
APA
Jordana M, Martens A, Duchateau L, Vanderperren K, Saunders J, Oosterlinck M, Pille F.
(2013).
Distal limb desensitisation following analgesia of the digital flexor tendon sheath in horses using four different techniques.
Equine Vet J, 46(4), 488-493.
https://doi.org/10.1111/evj.12186 Publication
Researcher Affiliations
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
MeSH Terms
- Analgesics
- Anesthesia, Local / methods
- Anesthesia, Local / veterinary
- Anesthetics, Local / administration & dosage
- Anesthetics, Local / pharmacology
- Animals
- Cross-Over Studies
- Female
- Horses
- Injections / methods
- Injections / veterinary
- Male
- Mepivacaine / administration & dosage
- Mepivacaine / pharmacology
- Tendons
- Triiodobenzoic Acids / administration & dosage
- Triiodobenzoic Acids / pharmacology
Citations
This article has been cited 5 times.- Cota LO, Malacarne BD, Dias LA, Neto ACP, Kneipp MLA, Cavalcante MA, Cunha MSLD, Paz CFR, Carvalho AM, Faleiros RR, Xavier ABDS. Mechanical nociceptive assessment of the equine hoof after navicular bursa anesthetic infiltration validated by bursography.. PLoS One 2022;17(6):e0269532.
- Haussler KK. Pressure Algometry for the Detection of Mechanical Nociceptive Thresholds in Horses.. Animals (Basel) 2020 Nov 24;10(12).
- Malacarne BD, Cota LO, Neto ACP, Paz CFR, Dias LA, Corrêa MG, Carvalho AM, Faleiros RR, Xavier ABS. Mechanical nociceptive assessment of the equine hoof following distal interphalangeal joint intra-articular anesthesia.. PeerJ 2020;8:e9469.
- Radtke A, Fortier LA, Regan S, Kraus S, Delco ML. Intra-articular anaesthesia of the equine stifle improves foot lameness.. Equine Vet J 2020 Mar;52(2):314-319.
- MacEoin F, Robinson P. Repetitive stress-related injury of the proximal metacarpus in a seven-year old Thoroughbred racehorse with emphasis on diagnostic analgesia of the proximopalmar metacarpus.. Ir Vet J 2014;67(1):26.
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