Effect of Regional Intravenous Limb Perfusate Volume on Synovial Fluid Concentration of Amikacin and Local Venous Blood Pressure in the Horse.
Authors: Moser Darla K, Schoonover Mike J, Holbrook Todd C, Payton Mark E
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Regional intravenous limb perfusion (IVRLP) via the cephalic vein is a valuable technique for delivering high antibiotic concentrations directly to equine distal limb structures, but optimal perfusate volumes remain poorly defined; Moser and colleagues investigated how varying the volume of amikacin solution affects both synovial fluid drug concentrations and regional venous pressures in standing, sedated horses. Using radiocarpal and distal interphalangeal joint synovial samples alongside systemic blood analysis, the researchers assessed whether larger perfusate volumes enhanced intra-articular antibiotic delivery or compromised the regional vascular seal by elevating venous back-pressure. Key findings demonstrated that increasing perfusate volume significantly elevated intra-articular amikacin concentrations in both joints whilst also raising regional venous pressures—a trade-off that practitioners must consider when balancing therapeutic efficacy against risks of excessive tissue pressure and potential leakage into systemic circulation. These results have direct clinical relevance for farriers and veterinarians selecting IVRLP protocols in cases of septic arthritis or osteomyelitis: larger volumes may enhance local drug delivery to infected joints but require careful monitoring to prevent vascular compromise, meaning volume selection should be individualised based on the specific anatomical location and clinical urgency of each case.
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Practical Takeaways
- •Perfusate volume selection for cephalic vein IVRLP influences how much antibiotic reaches joint structures—choose volumes based on your target joint and desired concentration
- •Monitor regional venous pressure during IVRLP procedures; excessive pressure may compromise tissue perfusion or increase systemic drug leakage
- •Standing sedated IVRLP via cephalic vein is practical for treating radiocarpal and distal interphalangeal joint infections in field or clinic settings
Key Findings
- •Intravenous regional limb perfusion via cephalic vein successfully delivered amikacin to synovial fluid of radiocarpal and distal interphalangeal joints in standing sedated horses
- •Perfusate volume affected both synovial fluid antibiotic concentrations and regional venous pressure during IVRLP
- •Study provided evidence for optimizing IVRLP technique parameters to maximize local therapeutic drug delivery while managing systemic absorption