Evaluation of 10-minute versus 30-minute tourniquet time for intravenous regional limb perfusion with amikacin sulfate in standing sedated horses.
Authors: Kilcoyne I, Dechant J E, Nieto J E
Journal: The Veterinary record
Summary
# Editorial Summary Intravenous regional limb perfusion (IVRLP) is a valuable technique for delivering high antibiotic concentrations to equine joints and soft tissues, but the optimal tourniquet duration remains unclear. Kilcoyne and colleagues conducted a randomised crossover study in seven healthy horses, administering 2 g amikacin sulfate via IVRLP to alternating forelimbs with tourniquet times of either 10 or 30 minutes, then measuring synovial fluid drug concentrations at five minutes and 24 hours post-perfusion. Synovial amikacin concentrations were equivalent between the two groups, whilst horses subjected to 30-minute tourniquet application exhibited significantly greater limb movement and discomfort; additionally, systemic venous amikacin concentrations were notably higher after 10-minute tourniquet release (P=0.001), suggesting greater drug leakage into systemic circulation with prolonged tourniquet time. These findings support reducing tourniquet application to 10 minutes in standing sedated horses, potentially improving animal welfare by minimising ischaemic discomfort without compromising synovial drug delivery—a meaningful consideration for practitioners balancing therapeutic efficacy with procedural stress in conscious patients.
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Practical Takeaways
- •Reducing tourniquet time from 30 to 10 minutes does not compromise therapeutic antibiotic delivery to radiocarpal and metacarpophalangeal joints, making procedures faster and less stressful for sedated horses
- •Shorter tourniquet application times reduce patient discomfort and movement, improving safety and procedure tolerability in standing horses
- •10-minute IVRLP protocols can be confidently adopted in clinical practice without sacrificing efficacy
Key Findings
- •No significant difference in synovial fluid amikacin concentrations between 10-minute and 30-minute tourniquet application times at 5 minutes and 24 hours post-IVRLP
- •Horses receiving 30-minute tourniquet application demonstrated significantly more movement than the 10-minute group
- •Systemic venous blood amikacin concentrations were significantly higher (P=0.001) in the 10-minute group one minute after tourniquet release
- •10-minute tourniquet application with wide elastic tourniquet appears sufficient for effective IVRLP in standing sedated horses