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Equine veterinary journal2020; 52(5); 743-751; doi: 10.1111/evj.13236

Systemic and local effects of lidocaine or mepivacaine when used for intravenous regional anaesthesia of the distal limb in standing sedated horses.

Abstract: Local anaesthetics are being combined clinically with amikacin in intravenous regional limb perfusion (IVRLP), with limited knowledge on the analgesia provided and its onset and duration of action after tourniquet application and release. Objective: To evaluate the systemic clinical effect, limb withdrawal to nociceptive stimulation, and plasma and synovial fluid concentrations after IVRLP with lidocaine or mepivacaine in standing sedated horses. Methods: Prospective, controlled, randomised, cross-over study. Methods: Six healthy adult horses were sedated and received IVRLP with lidocaine, mepivacaine or saline (negative control), or perineural anaesthesia of the medial and lateral palmar and palmar metacarpal nerves (positive control) in one forelimb with a 3-week washout period between trials. Electrical and mechanical stimuli were used to test nociceptive threshold of the limb before and after IVRLP/perineural anaesthesia. For lidocaine and mepivacaine trials, blood was collected from the jugular vein and synovial fluid from the radiocarpal joint before, during and out to 24 hours after IVRLP. Drug concentrations were measured using high-performance liquid chromatography. Results: Nociceptive thresholds for lidocaine, mepivacaine and perineural anaesthesia trials were significantly increased compared with saline and baseline values at 10, 20 and 30 minutes, with no differences between anaesthetic trials. During this time, horses had lower heart rates than IVRLP with saline. After tourniquet release at 30 minutes, nociceptive thresholds for lidocaine and mepivacaine trials gradually returned to baselines, whereas perineural anaesthesia trial remained unchanged out to an hour. Plasma lidocaine and mepivacaine concentrations were ≤50 ng/mL while the tourniquet was in place, significantly increasing 10 minutes after tourniquet release. Maximal lidocaine and mepivacaine concentrations in synovial fluid were reached 25 minutes after IVRLP injection. Conclusions: Amikacin was not included in the perfusate. Conclusions: Similar to perineural anaesthesia, IVRLP with lidocaine or mepivacaine provides anti-nociception to the distal limb in standing sedated horses while a tourniquet is applied with concentrations remaining below toxic levels in plasma and synovial fluid.
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Publication Date: 2020-02-21 PubMed ID: 31972065DOI: 10.1111/evj.13236Google 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 study investigates the systemic and local effects of using lidocaine or mepivacaine for intravenous regional anaesthesia in horses. It finds that both drugs provide similar levels of anti-nociception to the distal limb in horses, similar to perineural anaesthesia, while maintaining safe levels of concentration in plasma and synovial fluid.

Research Context

  • The focus of the research is to explore the implications of using lidocaine or mepivacaine in intravenous regional limb perfusion (IVRLP) in horses, with a special emphasis on understanding the measure of analgesia provided.
  • There’s limited knowledge on how these anaesthetics work in terms of onset and duration of action particularly after the application and release of a tourniquet during the process.

Research Methodology

  • The methodology involved a prospective, controlled, randomized, cross-over study which involved six healthy adult horses.
  • Each horse was sedated and received IVRLP with either lidocaine, mepivacaine or saline (as a negative control), or were given perineural anaesthesia.
  • A 3-week washout period was observed between trials to avoid any interference or overlaps in results.
  • Electrical and mechanical stimuli were used to measure the nociceptive threshold of the limb before and after IVRLP or perineural anaesthesia.
  • Blood and synovial fluid samples were collected at different stages for drug concentration analysis done through high-performance liquid chromatography.

Research Findings

  • The nociceptive thresholds for both lidocaine and mepivacaine were significantly increased compared with saline and initial values at 10, 20, and 30 minutes.
  • There were no significant differences between the various anaesthetic trials themself.
  • Lower heart rates were observed in horses during IVRLP with these anaesthetics compared with saline.
  • After tourniquet release at 30 minutes, nociceptive thresholds gradually returned to baseline levels for lidocaine and mepivacaine trials, while the perineural anaesthesia trial showed unaltered effects up to an hour.
  • Both lidocaine and mepivacaine showed a significant increase in plasma concentrations 10 minutes post-tourniquet release, but remained at safe levels.
  • Maximal lidocaine and mepivacaine concentrations in synovial fluid were observed at around 25 minutes post-IVRLP injection.

Conclusion

  • The study concludes that both lidocaine and mepivacaine exert similar anaesthetic effects to perineural anaesthesia when used in IVRLP.
  • Both anaesthetics provide sufficient anti-nociception to the distal limb in sedated horses while the tourniquet is applied.
  • These effects and the drug concentrations remain safely below toxic levels in plasma and synovial fluid.

Cite This Article

APA
Mendez-Angulo JL, Granados MM, Modesto R, Serrano-Rodriguez JM, Funes FJ, Quiros S, Gomez-Villamandos RJ, Zaldívar S, Trumble TN. (2020). Systemic and local effects of lidocaine or mepivacaine when used for intravenous regional anaesthesia of the distal limb in standing sedated horses. Equine Vet J, 52(5), 743-751. https://doi.org/10.1111/evj.13236

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 52
Issue: 5
Pages: 743-751

Researcher Affiliations

Mendez-Angulo, Jose L
  • Department of Animal Medicine and Surgery, University of Córdoba, Córdoba, Spain.
Granados, Maria M
  • Department of Animal Medicine and Surgery, University of Córdoba, Córdoba, Spain.
Modesto, Rolf
  • Veterinary Population Medicine Department, University of Minnesota, St. Paul, MN, USA.
Serrano-Rodriguez, Juan M
  • Department of Pharmacology, Toxicology and Legal and Forensic Medicine, University of Córdoba, Córdoba, Spain.
Funes, Francisco J
  • Department of Animal Medicine and Surgery, University of Córdoba, Córdoba, Spain.
Quiros, Setefilla
  • Department of Animal Medicine and Surgery, University of Córdoba, Córdoba, Spain.
Gomez-Villamandos, Rafael J
  • Department of Animal Medicine and Surgery, University of Córdoba, Córdoba, Spain.
Zaldívar, Sara
  • Department of Genetics, University of Córdoba, Córdoba, Spain.
Trumble, Troy N
  • Veterinary Population Medicine Department, University of Minnesota, St. Paul, MN, USA.

MeSH Terms

  • Anesthesia, Conduction / veterinary
  • Anesthetics, Local
  • Animals
  • Anti-Bacterial Agents
  • Cross-Over Studies
  • Forelimb
  • Horses
  • Lidocaine
  • Mepivacaine
  • Prospective Studies
  • Synovial Fluid

Grant Funding

  • University of Cu00f3rdoba

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Citations

This article has been cited 1 times.
  1. Loppnow Z, Kersh K, Wang C, Spaethe S, Troy J. Clinical use of antimicrobial regional limb perfusion in adult horses diagnosed with synovial sepsis or penetrating synovial wounds at a single equine referral hospital in the Midwest United States-163 cases (2010-2020). Front Vet Sci 2025;12:1504486.
    doi: 10.3389/fvets.2025.1504486pubmed: 40206250google scholar: lookup
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