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Equine veterinary journal2022; 55(2); 253-260; doi: 10.1111/evj.13583

Objective evaluation for analgesia of the distal interphalangeal joint, the navicular bursa and perineural analgesia in horses with naturally occurring forelimb lameness localised to the foot.

Abstract: The outcome and interpretation of intra-synovial diagnostic analgesia of the distal interphalangeal joint (DIPJ) and the navicular bursa (NB) remain in dispute, and no objective studies have been carried out to establish the percentage of improvement over time from these two analgesia techniques. Objective: To investigate the qualitative and time-dependent outcome of DIPJ-A and NB-A in naturally occurring forelimb lameness. Methods: Case series. Methods: Twenty-three clinical cases with forelimb lameness were evaluated objectively using a body mounted inertial sensor system (BMIS). Lameness was localised to the foot with a palmar digital nerve block and/or an abaxial sesamoidean nerve block on day 1, and analgesia of the DIPJ (DIPJ-A) and NB (NB-A) were performed on days 2 and 3. Improvement following perineural analgesia was measured after 10 min and intra-synovial blocks after 2-, 5- and 10-min. Horses with at least 70% improvement measured objectively after diagnostic analgesia were included in the study. Results: There was no significant association between improvement following perineural analgesia and the DIPJ-A and NB-A. The mean improvement in the lameness differed between DIPJ-A and NB-A at 2 min (p < 0.001) and at 5 min (p = 0.04), and it was no longer observed after 10 min (p = 0.06). A positive NB-A produced a high degree of improvement that remained stable, whereas the DIPJ-A improved over time. Conclusions: Perineural and intra-synovial analgesia were performed without contrast medium to assess the diffusion of mepivacaine. Conclusions: Our results suggest that perineural analgesia is not reliable enough to differentiate pain originating from DIPJ and NB. Early evaluation of the DIPJ-A and NB-A can determine the origin of the pain. An improvement following NB-A was constant over time, but an improvement following DIPJ-A varied by up to 10 min. Unassigned: Das Ergebnis und die Interpretation der intra-synovialen diagnostischen Analgesie des distalen Interphalangealgelenks (DIPJ) und des Strahlbein-Schleimbeutels (NB) sind nach wie vor umstritten, und es wurden bisher keine objektiven Studien an Pferden durchgeführt, um den Prozentsatz der Verbesserung im Laufe der Zeit durch diese beiden Analgesietechniken zu ermitteln. Unassigned: Untersuchung der qualitativen und zeitabhängigen Ergebnisse von DIPJ-A und NB-A bei natürlich auftretenden Lahmheiten der Vordergliedmaßen. Methods: Prospektive klinische Studie METHODEN: 23 klinische Fälle mit Lahmheiten der Vordergliedmaßen wurden objektiv mit einem am Körper montierten Inertialsensor-System (BMIS) bewertet. Die Lahmheit wurde am Tag 1 mit einer tiefen Palmarnervenanästhesie und/oder mittleren Palmarnervenanästhesie auf den Fuß beschränkt, und die Analgesie des DIPJ (DIPJ-A) und des NB (NB-A) wurden an Tag 2 und 3 durchgeführt. Die Verbesserung nach einer perineuralen Analgesie wurde nach 10 Minuten und nach intra-synovialen Blockaden nach 2, 5 und 10 Minuten gemessen. Pferde mit einer objektiv gemessenen Verbesserung von mindestens 70 % nach diagnostischer Analgesie wurden in die Studie aufgenommen. Unassigned: Es bestand kein signifikanter Zusammenhang zwischen der Verbesserung nach Perineuralanalgesie und dem DIPJ-A und NB-A. Die mittlere Verbesserung der Lahmheit war zwischen DIPJ-A und NB-A nach 2 Minuten (p<0,001) und nach 5 Minuten (p=0,04) unterschiedlich und wurde nach 10 Minuten (p=0,06) nicht mehr beobachtet. Eine positive NB-A zeigte einen hohen Grad der Verbesserung, die stabil blieb, während sich die DIPJ-A im Laufe der Zeit verbesserte. Unassigned: Die perineurale und intra-synoviale Analgesie wurde ohne Kontrastmittel durchgeführt, um die Diffusion von Mepivacain zu beurteilen. Unassigned: Unsere Ergebnisse deuten darauf hin, dass die perineurale Analgesie nicht zuverlässig genug ist, um Schmerzen zu unterscheiden, die von DIPJ und NB ausgehen. Durch eine frühzeitige Untersuchung des DIPJ-A und NB-A kann die Ursache des Schmerzes ermittelt werden. Die Verbesserung von NB-A war über die Zeit konstant, aber die Verbesserung von DIPJ-A variierte um bis zu 10 Minuten.
© 2022 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2022-06-06 PubMed ID: 35488427DOI: 10.1111/evj.13583Google Scholar: Lookup
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Summary

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This study investigates the effectiveness and time-dependent outcome of analgesia techniques, specifically the distal interphalangeal joint (DIPJ) and navicular bursa (NB) in naturally occurring forelimb lameness in horses.

Research Methodology

  • The study involved a case series method where 23 clinical cases with forelimb lameness were assessed using a body mounted inertial sensor system (BMIS).
  • Initially, lameness was localized to the foot using a palmar digital nerve block and/or an abaxial sesamoidean nerve block on the first day. On the second and third day, analgesia of the DIPJ (DIPJ-A) and NB (NB-A) were carried out.
  • The improvement was measured after 10 minutes in case of perineural analgesia and at intervals of 2, 5 and 10 minutes for intra-synovial blocks. Only horses with at least 70% improvement measured objectively after diagnostic analgesia were included in the study.

Findings

  • There was no substantial relationship identified between improvement following perineural analgesia and the DIPJ-A and NB-A analgesia.
  • The mean improvement in lameness was observed to differ between DIPJ-A and NB-A at 2 minutes (p < 0.001) and at 5 minutes (p = 0.04). This difference was no longer observed after 10 minutes (p = 0.06).
  • A substantial level of improvement remained stable in horses that reacted positively to NB-A analgesia, while improvement in cases of DIPJ-A increased over time.

Conclusions

  • Both perineural and intra-synovial analgesia were performed without contrast medium in order to assess the diffusion of mepivacaine, an anesthetic.
  • The study concluded perineural analgesia as a standalone may not be reliable to differentiate pain originating from DIPJ and NB. Hence, early evaluation of DIPJ-A and NB-A is crucial to determine the pain origin.
  • Improvement in lameness following NB-A analgesia remained constant over time, whereas improvement following DIPJ-A differed by up to 10 minutes.

Cite This Article

APA
Katrinaki V, Estrada RJ, Mählmann K, Kolokythas P, Lischer CJ. (2022). Objective evaluation for analgesia of the distal interphalangeal joint, the navicular bursa and perineural analgesia in horses with naturally occurring forelimb lameness localised to the foot. Equine Vet J, 55(2), 253-260. https://doi.org/10.1111/evj.13583

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 55
Issue: 2
Pages: 253-260

Researcher Affiliations

Katrinaki, Vasiliki
  • Equine Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.
Estrada, Roberto J
  • Equine Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.
  • Large Animal Hospital, School of Veterinary Medicine, National University, Heredia, Costa Rica.
Mählmann, Kathrin
  • Equine Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.
Kolokythas, Panagiotis
  • Service of Statistic AD HOC Studies, Chalkis, Greece.
Lischer, Christophorus J
  • Equine Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.

MeSH Terms

  • Animals
  • Horses
  • Lameness, Animal / diagnosis
  • Lameness, Animal / drug therapy
  • Injections, Intra-Articular / veterinary
  • Pain / veterinary
  • Analgesia / veterinary
  • Forelimb
  • Horse Diseases / diagnosis
  • Horse Diseases / drug therapy

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