Effect of emptying the vasculature before performing regional limb perfusion with amikacin in horses.
Authors: Sole A, Nieto J E, Aristizabal F A, Snyder J R
Journal: Equine veterinary journal
Summary
# Editorial Summary: Regional Limb Perfusion and Vascular Exsanguination in Horses Whilst exsanguination via Esmarch bandage is standard practice in human regional anaesthesia to minimise solution leakage under tourniquets, no evidence exists supporting its use during intravenous regional limb perfusion (IV-RLP) with antimicrobials in equine medicine. Sole and colleagues conducted a randomised crossover trial in eight healthy horses comparing IV-RLP with amikacin performed with and without prior limb exsanguination, measuring synovial fluid antibiotic concentrations in the radiocarpal and metacarpophalangeal joints at 5 minutes and 24 hours post-tourniquet release. Exsanguination significantly improved amikacin concentration in the metacarpophalangeal joint immediately after perfusion (257.4 ± 149.7 versus 49.7 ± 53.7 µg/ml; P = 0.04), though no benefit was observed in the radiocarpal joint or systemic plasma levels, and horse behaviour remained consistent between groups. For practitioners performing IV-RLP in distal limb infections, this suggests that exsanguination may provide superior antimicrobial delivery to the fetlock joint specifically, potentially improving clinical outcomes in metacarpophalangeal pathology, though the clinical significance of the fourfold increase warrants further investigation in naturally diseased joints.
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Practical Takeaways
- •Use Esmarch bandage exsanguination before IV-RLP with amikacin to maximize drug delivery to the metacarpophalangeal joint, which may improve therapeutic efficacy for distal interphalangeal joint infections
- •Exsanguination does not improve radiocarpal joint drug concentrations, so consider joint location when deciding whether to use this technique
- •The procedure is well-tolerated by horses with no increase in movement or stress response with exsanguination
Key Findings
- •Exsanguination with Esmarch bandage significantly increased amikacin concentration in metacarpophalangeal joint synovial fluid (257.4 vs 49.7 μg/ml, P=0.04)
- •No difference in amikacin concentration in radiocarpal joint synovial fluid between exsanguination and non-exsanguination groups
- •No difference in plasma amikacin concentrations between groups
- •Horse movement did not differ significantly between exsanguination and non-exsanguination procedures