Intravenous continuous infusion of lidocaine for treatment of equine ileus.
Authors: Malone Erin, Ensink Jos, Turner Tracy, Wilson Julie, Andrews Frank, Keegan Kevin, Lumsden Jonathan
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Intravenous Lidocaine for Equine Ileus This double-blinded, placebo-controlled trial evaluated whether continuous intravenous lidocaine infusion could effectively resolve postoperative ileus and enteritis-related reflux in 32 horses, using a bolus of 1.3 mg/kg followed by 0.05 mg/kg/min maintenance dosing over 24 hours. Markedly superior outcomes emerged in the lidocaine group, with 65% of treated horses ceasing reflux within 30 hours (mean 15.2 hours) compared to just 27% in the saline control group, and importantly, lidocaine-treated responders passed faeces within 16 hours of commencing infusion. Beyond reflux resolution, lidocaine recipients experienced shorter hospitalisation periods without compromising survival rates or triggering adverse complications such as increased infection, thrombosis, laminitis or diarrhoea, though muscle fasciculations were noted in 18% of treated horses. For equine practitioners managing postoperative colic or refluxing cases, these findings suggest lidocaine offers a clinically meaningful, well-tolerated option to accelerate gastro-intestinal recovery and reduce hospital time, though fasciculation monitoring remains prudent during administration.
Read the full abstract on PubMed
Practical Takeaways
- •IV lidocaine infusion (1.3 mg/kg bolus + 0.05 mg/kg/min) should be considered as a first-line treatment for horses with significant gastric reflux (>20 L or >24 hours duration) as it reduces reflux duration and hospital stay by approximately 50%
- •Early fecal passage (within 16 hours) is a reliable indicator that the horse will respond well to lidocaine treatment; lack of fecal passage by this timepoint may suggest need for alternative management
- •The treatment is safe with minimal side effects at recommended doses—monitor for occasional muscle fasciculations but expect no increase in complications like laminitis, infection, or thrombosis
Key Findings
- •65% of lidocaine-treated horses stopped refluxing within 30 hours compared to 27% in saline-treated controls
- •Lidocaine-treated horses that responded passed feces within 16 hours of infusion start
- •Hospitalization time was significantly shorter in lidocaine-treated survivors with equivalent survival rates
- •Muscle fasciculations occurred in 18% of lidocaine-treated horses with no other clinically significant adverse effects