The effect of intra-articular mepivacaine administration prior to carpal arthroscopy on anesthesia management and recovery characteristics in horses.
Authors: Gaesser Angela M, Varner Kelley M, Douglas Hope F, Barr Ciara A, Hopster Klaus, Levine David G
Journal: Veterinary surgery : VS
Summary
# Editorial Summary This 2020 study examined whether injecting mepivacaine directly into the carpus before arthroscopy could reduce the anaesthetic burden during equine joint surgery. Twenty-two horses received identical general anaesthetic protocols, with one group receiving intra-articular mepivacaine and the control group receiving saline prior to carpal arthroscopy; researchers then tracked end-tidal isoflurane concentrations, heart rate, mean arterial pressure, and recovery quality throughout the procedure. The mepivacaine group demonstrated clinically meaningful reductions in cardiovascular responses to surgical stimulation—mean arterial pressure remained 7–10% higher in controls during joint distension, heart rate was 8–11% elevated during the most noxious procedures, and only control horses required supplemental ketamine (two cases versus none). Despite these haemodynamic advantages, recovery quality scores were equivalent between groups, suggesting the local anaesthetic provided effective nociception blockade without compromising post-operative outcomes. For equine practitioners, intra-articular mepivacaine offers a straightforward method to refine balanced anaesthesia protocols, potentially reducing systemic drug requirements and physiological stress during carpal procedures—a particularly valuable consideration in geriatric or systemically compromised patients where minimising volatile anaesthetic exposure is desirable.
Read the full abstract on PubMed
Practical Takeaways
- •Adding intra-articular mepivacaine before carpal arthroscopy reduces the anesthetic response to surgical stimulation, potentially decreasing general anesthetic drug requirements and improving hemodynamic stability during the procedure
- •This balanced anesthesia technique is safe and practical to implement in routine carpal arthroscopy cases, requiring only a single IA injection before surgery begins
- •Consider IA mepivacaine injection as part of your standard anesthetic protocol for carpal procedures to minimize anesthetic depth needs and support more stable vital signs without compromising recovery quality
Key Findings
- •Intra-articular mepivacaine reduced mean arterial pressure increase during joint distension by 10% compared to saline control (P = 0.04)
- •Heart rate was 8-11% lower in the mepivacaine group during joint distension and chip removal procedures (P = 0.04 and P = 0.03)
- •Only 2 control horses required additional ketamine for anesthetic supplementation versus none in the mepivacaine-treated group
- •Recovery quality scores were similar between groups, indicating IA mepivacaine does not negatively impact recovery characteristics