The Effect of Perfusate Volume on Amikacin Concentration in the Metacarpophalangeal Joint Following Cephalic Regional Limb Perfusion in Standing Horses.
Authors: Oreff Gil L, Dahan Roee, Tatz Amos J, Raz Tal, Britzi Malka, Kelmer Gal
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Perfusate Volume and Amikacin Delivery to the Fetlock Regional limb perfusion (RLP) via the cephalic vein offers a practical way to achieve high antibiotic concentrations in distal forelimb joints without general anaesthesia, but optimal dosing parameters remain incompletely defined. Gil and colleagues investigated whether reducing perfusate volume—a potentially cost-saving measure—would compromise drug delivery to the metacarpophalangeal joint in seven standing horses receiving 2 grams of amikacin in volumes of 30, 60, or 100 mL. At 30 minutes post-perfusion, the 100 mL volume produced mean synovial concentrations of 579 μg/mL, substantially exceeding the 227 μg/mL achieved with 60 mL and the 282 μg/mL with 30 mL; moreover, all horses perfused with 100 mL reached the proposed therapeutic threshold of 160 μg/mL, compared to only 43% of those receiving 60 mL. For practitioners performing RLP at the cephalic site in standing cases, these findings suggest that maintaining the full 100 mL perfusate volume is worthwhile to maximise early joint penetration and therapeutic efficacy, particularly when treating acute septic arthritis where rapid antibiotic delivery is clinically critical.
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Practical Takeaways
- •Use 100 mL perfusate volume when performing cephalic regional limb perfusion with amikacin in standing horses to ensure therapeutic drug concentrations reach the metacarpophalangeal joint
- •Smaller perfusate volumes (30-60 mL) result in subtherapeutic synovial drug concentrations in many cases, reducing treatment efficacy
- •This protocol allows effective antibiotic delivery to metacarpophalangeal joints without general anesthesia, beneficial for standing surgical or therapeutic procedures
Key Findings
- •100 mL perfusate volume achieved mean amikacin concentration of 579 μg/mL in synovial fluid at 30 minutes, significantly higher than 60 mL (227 μg/mL) or 30 mL (282 μg/mL)
- •100% of horses receiving 100 mL perfusate volume reached the therapeutic threshold of 160 μg/mL at 30 minutes post-perfusion, compared to 43% with 60 mL and 57% with 30 mL
- •Optimal amikacin delivery to metacarpophalangeal joint via cephalic regional limb perfusion in standing horses requires 100 mL perfusate volume