Effects of tourniquet number and exsanguination on amikacin concentrations in the radiocarpal and distal interphalangeal joints after low volume intravenous regional limb perfusion in horses.
Authors: Schoonover Mike J, Moser Darla K, Young Jenna M, Payton Mark E, Holbrook Todd C
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Optimising Antibiotic Delivery to Equine Joint Synovial Fluid When treating septic arthritis in horses with intravenous regional limb perfusion (IVRLP), achieving adequate antibiotic concentrations at the site of infection is critical, yet the optimal technique for delivering antibiotics to distal joints remains unclear. Researchers compared four tourniquet configurations during low-volume cephalic IVRLP in six horses, measuring amikacin concentrations in synovial fluid from both the radiocarpal joint (knee) and distal interphalangeal joint (coffin joint) at 15 and 30 minutes post-perfusion. Dual tourniquet placement—one proximal and one distal to the carpus—achieved significantly higher amikacin concentrations in the radiocarpal joint than single-tourniquet techniques (P < 0.0001), whilst the proximal-only approach paradoxically produced better distal interphalangeal joint penetration. Interestingly, pre-perfusion exsanguination made no meaningful difference to final synovial concentrations with either single or dual tourniquet methods. For practitioners treating radiocarpal sepsis, this evidence supports the addition of a distal Esmarch tourniquet to standard proximal pneumatic technique, though the trade-off between proximal and distal joint penetration suggests treatment strategy should be tailored to the primary site of infection.
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Practical Takeaways
- •For treating radiocarpal joint infections or disease with intravenous regional limb perfusion, use dual tourniquets (proximal and distal to the carpus) with 10 mL low-volume amikacin infusion to maximize drug concentration at the target site
- •Exsanguination is unnecessary when performing low-volume cephalic IVRLP—skip this step to reduce procedure time and complexity without compromising therapeutic drug delivery
- •Single tourniquet technique preferentially delivers higher drug concentrations to the distal interphalangeal joint, so select your tourniquet strategy based on which joint requires treatment
Key Findings
- •Dual tourniquet placement (proximal and distal to carpus) achieved significantly higher amikacin concentrations in radiocarpal joint synovial fluid compared to single tourniquet technique at 15 and 30 minutes post-perfusion (P <0.0001)
- •Single tourniquet technique achieved higher amikacin concentrations in distal interphalangeal joint at 15 minutes (P=0.0002) and at 30 minutes compared to dual tourniquet with exsanguination (P <0.0001)
- •Limb exsanguination prior to low-volume intravenous regional limb perfusion did not significantly alter synovial fluid amikacin concentrations in either joint