Local mepivacaine before castration of horses under medetomidine isoflurane balanced anaesthesia is effective to reduce perioperative nociception and cytokine release.
Abstract: In horses castration with primary intention healing is usually performed under balanced inhalation anaesthesia. To optimise analgesia, the use of local anaesthesia was tested. Objective: To investigate the effect of local mepivacaine before castration with first intention healing under balanced medetomidine-isoflurane anaesthesia and flunixin meglumine, morphine analgesia on perioperative cytokine levels and pain in horses. Methods: Prospective blinded clinical study. Methods: Twenty stallions were randomly assigned to control or mepivacaine groups. Flunixin meglumine was administered before sedation with medetomidine and followed by ketamine/diazepam intravenously (i.v.). Anaesthesia was maintained with isoflurane and 3.5 μg/kg per hour medetomidine. Mepivacaine horses were given mepivacaine 2% (3.5 mL SC, 1 mL/100 kg intrafunicularly, 2 mL/100 kg intratesticularly) on each side. For recovery, horses were given 2 μg/kg medetomidine i.v. and 0.1 mg/kg morphine i.m. and oral phenylbutazone (0.02 mg/kg q12h) for post-operative analgesia. One hour before premedication and 4, 8 and 24 h post-incision, pain was scored with three different pain scales (Equine Utrecht University Scale for Facial Assessment of Pain, Horse Grimace Scale, Equine Utrecht University Scale for Composite Pain Assessment) and plasma cytokines (interleukin-6 and tumour necrosis factor alpha) were measured. Data were analysed using repeated measures ANOVA, linear regression and unpaired t-test, significance level P≤0.05. Results: Horses in both groups showed a significant increase in pain scores and cytokines compared to baseline. Post-operatively the mepivacaine group exhibited significantly lower pain scores and cytokine levels. Mean heart rate during anaesthesia was significantly lower in the mepivacaine group compared to control group (28.8 ± 1 and 33.2 ± 1.7 respectively). Otherwise there were no differences between the groups. Conclusions: The decision to provide additional analgesia was based on the attending surgeon's assessment rather than a standardised rescue analgesia plan based on pain scores. The study was only conducted for 24 h post-castration and complications were not recorded. Conclusions: Local mepivacaine before castration with primary wound closure improved anaesthesia quality, attenuated post-operative increases in cytokines and reduced post-operative pain despite balanced anaesthesia with multimodal analgesia in control horses.
© 2018 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Publication Date: 2018-05-16 PubMed ID: 29660154PubMed Central: PMC6175468DOI: 10.1111/evj.12947Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Clinical Trial
- Veterinary
- Journal Article
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
This research investigates the effects of the local application of an anesthetic called mepivacaine prior to the castration of horses. The results indicate that using mepivacaine helps to reduce both pain and cytokine levels during and after the procedure.
Research Background and Objectives
- The research article is based on a study conducted on horses undergoing castration under a particular type of anaesthesia known as balanced inhalation anaesthesia.
- The main objective of the study was to investigate the effect of applying a local anaesthetic, mepivacaine, before the surgery on pain levels and cytokines during and after the procedure.
Research Methods
- The researchers conducted a clinical study involving 20 stallions, grouped into control and mepivacaine groups.
- Before the surgery, the horses were sedated and later given an intravenously administered anaesthetic combo of ketamine/diazepam.
- The horses in the mepivacaine group were given the anaesthetic on both sides of their testes, and all horses were given pain relief medication after the operation.
- Pain levels were regularly checked using three different pain scales, and plasma cytokines were measured at set intervals following the incision.
- Statistical methods used to analyse the data included repeated measures ANOVA, linear regression, and an unpaired t-test.
Research Findings
- Both groups of horses, those who had been given local mepivacaine, and those who had not, showed increased pain scores and cytokine levels after the procedure.
- However, horses that had been administered with mepivacaine exhibited considerably lower pain scores and cytokine levels post-operatively.
- The heart rate during anaesthesia was also found to be significantly lower in the mepivacaine group compared to the control group.
Study Limitations and Conclusions
- The research had a few limitations, including that it did not record complications in the 24 hours after the procedure. Furthermore, the decision to give additional pain relief was dependent on the surgeon’s assessment, not a standardised plan based on pain scores.
- In conclusion, administering local mepivacaine before castration helped improve anaesthesia quality, post-operative cytokines levels, and reduced pain even after providing balanced anaesthesia with multimodal analgesia in control horses.
Cite This Article
APA
Abass M, Picek S, Garzón JFG, Kühnle C, Zaghlou A, Bettschart-Wolfensberger R.
(2018).
Local mepivacaine before castration of horses under medetomidine isoflurane balanced anaesthesia is effective to reduce perioperative nociception and cytokine release.
Equine Vet J, 50(6), 733-738.
https://doi.org/10.1111/evj.12947 Publication
Researcher Affiliations
- Equine Department, Division of Anaesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.
- Department of Surgery, Anaesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt.
- Equine Department, Division of Anaesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.
- Institute of Physiology, University of Zurich, Zurich, Switzerland.
- Equine Department, Division of Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.
- Department of Surgery, Anaesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt.
- Equine Department, Division of Anaesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.
MeSH Terms
- Analgesics / administration & dosage
- Anesthesia / methods
- Anesthesia / veterinary
- Anesthetics, Local / administration & dosage
- Animals
- Arterial Pressure / drug effects
- Cardiotonic Agents / administration & dosage
- Clonixin / administration & dosage
- Clonixin / analogs & derivatives
- Cytokines / blood
- Cytokines / metabolism
- Diazepam / administration & dosage
- Dobutamine / administration & dosage
- Double-Blind Method
- Horses / physiology
- Horses / surgery
- Hypnotics and Sedatives / administration & dosage
- Isoflurane / administration & dosage
- Ketamine / administration & dosage
- Male
- Medetomidine / administration & dosage
- Mepivacaine / administration & dosage
- Nociceptive Pain / prevention & control
- Orchiectomy / veterinary
- Pain, Postoperative / prevention & control
- Pain, Postoperative / veterinary
- Prospective Studies
- Random Allocation
Grant Funding
- Egyptian Ministry of Higher Education and Scientific Research (MHESR)
References
This article includes 38 references
- Shoemaker R, Bailey J, Janzen E, Wilson DG. Routine castration in 568 draught colts: incidence of evisceration and omental herniation.. Equine Vet J 2004 May;36(4):336-40.
- Robert MP, Chapuis RJJ, de Fourmestraux C, Geffroy OJ. Complications and risk factors of castration with primary wound closure: Retrospective study in 159 horses.. Can Vet J 2017 May;58(5):466-471.
- Kummer M, Gygax D, Jackson M, Bettschart-Wolfensberger R, Fürst A. Results and complications of a novel technique for primary castration with an inguinal approach in horses.. Equine Vet J 2009 Jul;41(6):547-51.
- Price J, Eager RA, Welsh EM, Waran NK. Current practice relating to equine castration in the UK.. Res Vet Sci 2005 Jun;78(3):277-80.
- Green P. Castration techniques in the horse.. In Pract. 23, 250–261.
- Green P. Castration of horses and analgesia – reply.. Vet. Rec. 149, 160–160.
- Maxwell JA. Challenging the current paradigm of equine castration.. Vet Surg 2009 Oct;38(7):902-3.
- Love EJ, Taylor PM, Clark C, Whay HR, Murrell J. Analgesic effect of butorphanol in ponies following castration.. Equine Vet J 2009 Jul;41(6):552-6.
- Dalla Costa E, Minero M, Lebelt D, Stucke D, Canali E, Leach MC. Development of the Horse Grimace Scale (HGS) as a pain assessment tool in horses undergoing routine castration.. PLoS One 2014;9(3):e92281.
- Love EJ, Taylor PM, Whay HR, Murrell J. Postcastration analgesia in ponies using buprenorphine hydrochloride.. Vet Rec 2013 Jun 15;172(24):635.
- McGuire L, Heffner K, Glaser R, Needleman B, Malarkey W, Dickinson S, Lemeshow S, Cook C, Muscarella P, Melvin WS, Ellison EC, Kiecolt-Glaser JK. Pain and wound healing in surgical patients.. Ann Behav Med 2006 Apr;31(2):165-72.
- Bettschart‐Wolfensberger R, Larenza MP. Balanced anesthesia in the equine.. Clin. Tech. Equine Pract. 6, 104–110.
- Viñuela-Fernández I, Jones E, Chase-Topping ME, Price J. Comparison of subjective scoring systems used to evaluate equine laminitis.. Vet J 2011 May;188(2):171-7.
- Myrna KE, Bentley E, Smith LJ. Effectiveness of injection of local anesthetic into the retrobulbar space for postoperative analgesia following eye enucleation in dogs.. J Am Vet Med Assoc 2010 Jul 15;237(2):174-7.
- Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A, Murthy Y. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials.. Anesthesiology 2010 Nov;113(5):1144-62.
- Portier KG, Jaillardon L, Leece EA, Walsh CM. Castration of horses under total intravenous anaesthesia: analgesic effects of lidocaine.. Vet Anaesth Analg 2009 Mar;36(2):173-9.
- Haga HA, Lykkjen S, Revold T, Ranheim B. Effect of intratesticular injection of lidocaine on cardiovascular responses to castration in isoflurane-anesthetized stallions.. Am J Vet Res 2006 Mar;67(3):403-8.
- Stevens BJ, Posner LP, Jones CA, Lascelles BD. Comparison of the effect of intratesticular lidocaine/bupivacaine vs. saline placebo on pain scores and incision site reactions in dogs undergoing routine castration.. Vet J 2013 Jun;196(3):499-503.
- Perez TE, Grubb TL, Greene SA, Meyer S, Valdez N, Bingman J, Farnsworth R. Effects of intratesticular injection of bupivacaine and epidural administration of morphine in dogs undergoing castration.. J Am Vet Med Assoc 2013 Mar 1;242(5):631-42.
- De Jongh RF, Vissers KC, Meert TF, Booij LHDJ, De Deyne CS, Heylen RJ. The role of interleukin-6 in nociception and pain.. Anesth Analg 2003 Apr;96(4):1096-1103.
- Sharma B, Bhattacharya A, Kumra VP. Cytokines‐clinical applications in pain, anaesthesia and critical care.. J. Anaesthesiol. Clin. Pharmacol. 19, 3–14.
- Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication?. Anesthesiology 2000 Sep;93(3):858-75.
- Bettschart-Wolfensberger R, Dicht S, Vullo C, Frotzler A, Kuemmerle JM, Ringer SK. A clinical study on the effect in horses during medetomidine-isoflurane anaesthesia, of butorphanol constant rate infusion on isoflurane requirements, on cardiopulmonary function and on recovery characteristics.. Vet Anaesth Analg 2011 May;38(3):186-94.
- van Loon JP, Van Dierendonck MC. Monitoring acute equine visceral pain with the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP): A scale-construction study.. Vet J 2015 Dec;206(3):356-64.
- Ringer SK, Kalchofner K, Boller J, Fürst A, Bettschart-Wolfensberger R. A clinical comparison of two anaesthetic protocols using lidocaine or medetomidine in horses.. Vet Anaesth Analg 2007 Jul;34(4):257-68.
- Menzies MP, Ringer SK, Conrot A, Theurillat R, Kluge K, Kutter AP, Jackson M, Thormann W, Bettschart-Wolfensberger R. Cardiopulmonary effects and anaesthesia recovery quality in horses anaesthetized with isoflurane and low-dose S-ketamine or medetomidine infusions.. Vet Anaesth Analg 2016 Nov;43(6):623-634.
- Kalchofner KS, Ringer SK, Boller J, Kastner SBR, Lischer C, Bettschart‐Wolfensberger R. Clinical assessment of anesthesia with isoflurane and medetomidine in 300 equidae.. Pferdeheilkunde 22, 301–308.
- Joyce J, Hendrickson DA. Comparison of intraoperative pain responses following intratesticular or mesorchial injection of lidocaine in standing horses undergoing laparoscopic cryptorchidectomy.. J Am Vet Med Assoc 2006 Dec 1;229(11):1779-83.
- McGuirk S, Fahy C, Costi D, Cyna AM. Use of invasive placebos in research on local anaesthetic interventions.. Anaesthesia 2011 Feb;66(2):84-91.
- Wagner AE. Effects of stress on pain in horses and incorporating pain scales for equine practice.. Vet Clin North Am Equine Pract 2010 Dec;26(3):481-92.
- van Loon JPAM, Back W, Hellebrekers LJ, van Weeren PR. Application of a composite pain scale to objectively monitor horses with somatic and visceral pain under hospital conditions.. J. Equine. Vet. Sci. 30, 641–649.
- Reid J, Nolan AM, Hughes JML, Lascelles D, Pawson P, Scott EM. Development of the short‐form Glasgow Composite Measure Pain Scale (CMPS‐SF) and derivation of an analgesic intervention score.. Anim Welf. 16, 97–104.
- Sanz MG, Sellon DC, Cary JA, Hines MT, Farnsworth KD. Analgesic effects of butorphanol tartrate and phenylbutazone administered alone and in combination in young horses undergoing routine castration.. J Am Vet Med Assoc 2009 Nov 15;235(10):1194-203.
- Bidwell LA, Brown KE, Cordier A, Mullineaux DR, Clayton HM. Mepivacaine local anaesthetic duration in equine palmar digital nerve blocks.. Equine Vet J 2004 Dec;36(8):723-6.
- Li S, Yang Y, Yu C, Yao Y, Wu Y, Qian L, Cheung CW. Dexmedetomidine Analgesia Effects in Patients Undergoing Dental Implant Surgery and Its Impact on Postoperative Inflammatory and Oxidative Stress.. Oxid Med Cell Longev 2015;2015:186736.
- Liu C, Tang J. Expression levels of tumor necrosis factor-α and the corresponding receptors are correlated with trauma severity.. Oncol Lett 2014 Dec;8(6):2747-2751.
- Gebhard F, Pfetsch H, Steinbach G, Strecker W, Kinzl L, Brückner UB. Is interleukin 6 an early marker of injury severity following major trauma in humans?. Arch Surg 2000 Mar;135(3):291-5.
- Bradley JR. TNF-mediated inflammatory disease.. J Pathol 2008 Jan;214(2):149-60.
Citations
This article has been cited 6 times.- Vullo C, Crupi R, Di Paola R, Cuzzocrea S, Gugliandolo E, Biondi V, Catone G. Intratesticular Versus Intrafunicular Lidocaine to Reduce Perioperative Nociception and Immunological Response in Ponies Undergoing Field Castration.. Vet Sci 2022 Nov 28;9(12).
- Lemonnier LC, Thorin C, Meurice A, Dubus A, Touzot-Jourde G, Couroucé A, Leroux AA. Comparison of Flunixin Meglumine, Meloxicam and Ketoprofen on Mild Visceral Post-Operative Pain in Horses.. Animals (Basel) 2022 Feb 21;12(4).
- Cunneen A, Pratt S, Perkins N, McEwen M, Truchetti G, Rainger J, Farry T, Kidd L, Goodwin W. Total Intravenous Anaesthesia with Ketamine, Medetomidine and Midazolam as Part of a Balanced Anaesthesia Technique in Horses Undergoing Castration.. Vet Sci 2021 Jul 26;8(8).
- Gozalo-Marcilla M, Ringer SK. Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature.. Animals (Basel) 2021 Jun 14;11(6).
- Straticò P, Varasano V, Guerri G, Celani G, Palozzo A, Petrizzi L. A Retrospective Study of Cryptorchidectomy in Horses: Diagnosis, Treatment, Outcome and Complications in 70 Cases.. Animals (Basel) 2020 Dec 21;10(12).
- van Dierendonck MC, Burden FA, Rickards K, van Loon JPAM. Monitoring Acute Pain in Donkeys with the Equine Utrecht University Scale for Donkeys Composite Pain Assessment (EQUUS-DONKEY-COMPASS) and the Equine Utrecht University Scale for Donkey Facial Assessment of Pain (EQUUS-DONKEY-FAP).. Animals (Basel) 2020 Feb 22;10(2).
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists