Meta-analysis of the effects of lidocaine on postoperative reflux in the horse.
Authors: Durket Elyse, Gillen Alexandra, Kottwitz Jack, Munsterman Amelia
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Lidocaine and Postoperative Reflux in Equine Colic Surgery A systematic meta-analysis of 12 peer-reviewed studies (drawn from 1933 initial publications between 2001–2017) examined whether lidocaine reduces postoperative reflux (POR) following exploratory celiotomy for small intestinal disease in horses. Counterintuitively, lidocaine administration was associated with a significantly *increased* incidence of diagnosed POR (odds ratio 6.3, 95% CI [1.4, 27.0]), yet horses receiving lidocaine demonstrated substantially improved survival to discharge (odds ratio 6.8, 95% CI [3.9, 11.7])—a clinically meaningful difference that suggests the medication may enhance overall recovery despite the higher reflux rates. These findings challenge the common perception that minimising POR should be the primary therapeutic goal during postoperative management; instead, the evidence indicates lidocaine's benefit lies in supporting systemic recovery and survival, with POR potentially being either a marker of severity in treated cases or a manageable complication rather than a contraindication to the drug's use. For practitioners managing post-colic patients, this meta-analysis supports lidocaine administration as part of postoperative protocol to improve outcomes, even when reflux does develop, and suggests that detecting reflux in a lidocaine-treated horse should not prompt discontinuation of the therapy.
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Practical Takeaways
- •Administer perioperative lidocaine in horses undergoing exploratory celiotomy for small intestinal disease to improve survival outcomes, despite the apparent increase in reflux diagnosis
- •The increased reflux detection in lidocaine-treated horses may reflect improved survival time allowing reflux to develop and be recognized, rather than lidocaine causing reflux
- •Lidocaine's survival benefit outweighs concerns about postoperative reflux and should be considered standard of care in this surgical population
Key Findings
- •Lidocaine administration was associated with significantly increased survival to discharge (OR 6.8, 95% CI [3.9, 11.7], P < 0.01) in horses undergoing celiotomy for small intestinal disease
- •Paradoxically, lidocaine was associated with increased incidence of diagnosed postoperative reflux (OR 6.3, 95% CI [1.4, 27.0], P = 0.01)
- •Meta-analysis included 12 relevant studies identified from 1933 initial publications screened between 2001-2017