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Equine veterinary journal2023; 56(5); 870-883; doi: 10.1111/evj.14027

Review of intra-articular local anaesthetic administration in horses: Clinical indications, cytotoxicity, and outcomes.

Abstract: Equine practitioners frequently inject local anaesthetics (LA) intra-articularly in both diagnosis of lameness and for pain management intra- or post-operatively with synovial endoscopy. Recent reviews of the human and veterinary literature support the concept that chondrotoxicity of LA on joint tissues depends on the type of drug, dose administered, and duration of exposure. The purpose of this review is to summarise the current literature describing intra-articular local anaesthetic use, including both in vitro and in vivo studies, and to draw some comparisons to literature from other species where potential toxicity and duration of effect have been evaluated with the goal of advancing the field's understanding of intra-articular local anaesthetic use in horses, and indicating future directions for the field. The aggregate data available from all species, while generally sparse for horses, indicate that LA are rapidly cleared from the synovial fluid after injection, often within 30 min. In vitro data strongly suggest that lidocaine and bupivacaine are likely more chondrotoxic than other LA, although to what extent is still unknown, and cytotoxicity of LA may be mitigated through concurrent injection with HA, PRP, and drug combinations including nonsteroidal anti-inflammatories and opioids. The current body of in vitro research is not reflective of the in vivo environment, and further in vitro work, if performed, should focus on mimicking the native joint environment, utilising PK data and joint/injection volumes to replicate the native environment more accurately within the joint and the expected exposures to LA.
© 2023 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2023-11-08 PubMed ID: 37940372DOI: 10.1111/evj.14027Google Scholar: Lookup
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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.

The research paper reviews the current understanding of local anesthetic (LA) use in horses, with a particular focus on the issues of diagnosis, pain management, cytotoxicity, and outcomes.

Clinical Indications

Local anesthetics are often administered intra-articularly by equine practitioners for both diagnosing lameness and managing pain intra- or post-operatively with synovial endoscopy. In terms of clinical applications, the LA substances are seen as crucial tools.

  • They can reveal the source of lameness when used in diagnostic nerve blocks.
  • They serve as an essential part of pain management strategies for horses undergoing invasive procedures, such as synovial endoscopy.

Cytotoxicity

A significant part of the research focused on the potential cytotoxic effects of LA on joint tissues, an issue termed chondrotoxicity. It seems that several factors influence such cytotoxic effects.

  • The type of drug used is seen as an important determinant of the level of cytotoxicity.
  • The dose administered and the duration of exposure are other substantial factors.

The paper suggests that lidocaine and bupivacaine might be particularly chondrotoxic compared to other local anesthetics. However, the exact extent of this cytotoxicity is not yet fully known.

Potential Mitigation of Cytotoxicity

The research also delved into various methods to potentially mitigate the cytotoxic effects of LA. Some of these include the concurrent use of hyaluronic acid (HA), platelet-rich plasma (PRP), non-steroidal anti-inflammatories, and opioids with LA.

Comparison with Other Species

The study drew comparisons between horses and other species, especially regarding the potential toxicity, duration of effect, and effectiveness of local anesthetics. The researchers found out that these anesthetic substances are rapidly cleared from the synovial fluid after injection, typically within 30 minutes.

Future Direction

The authors identify areas of future study to help improve the understanding of LA use in horses. They call for more in vitro work that closely mimics the native joint environment to provide more accurate data. Their ultimate goal is to make the use of local anesthetic in horses safer and more effective.

Cite This Article

APA
Webster A, Pezzanite L, Hendrickson D, Griffenhagen G. (2023). Review of intra-articular local anaesthetic administration in horses: Clinical indications, cytotoxicity, and outcomes. Equine Vet J, 56(5), 870-883. https://doi.org/10.1111/evj.14027

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 56
Issue: 5
Pages: 870-883

Researcher Affiliations

Webster, Aaron
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Pezzanite, Lynn
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Hendrickson, Dean
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Griffenhagen, Gregg
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.

MeSH Terms

  • Horses
  • Animals
  • Anesthetics, Local / administration & dosage
  • Injections, Intra-Articular / veterinary
  • Horse Diseases / chemically induced
  • Horse Diseases / drug therapy

Grant Funding

  • Carolyn Quan and Porter Bennett
  • Colorado State University Department of Clinical Sciences
  • Colorado State University Veterinary Summer Scholars Program
  • Colorado State University Young Investigator Program in Companion Animal Studies

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