The Effects of Mepivacaine Hydrochloride on Antimicrobial Activity and Mechanical Nociceptive Threshold During Amikacin Sulfate Regional Limb Perfusion in the Horse

Abstract

Addition of mepivacaine to amikacin for IVRLP in the horse as a means of providing analgesia without decreasing antimicrobial activity.

Meropenem synovial fluid concentrations after intravenous regional limb perfusion in standing horses

“…Meropenem concentrations did not rise above 6 µg/mL in the RC joint of 3 horses in this study. Similar failure rates have been reported after IVRLP in standing sedated horses and horses under general anesthesia . These failures could result from tourniquet failure or excessive movement during the procedure.…”

Synovial butorphanol concentrations and mechanical nociceptive thresholds after intravenous regional limb perfusion in standing sedated horses

“…When considering a novel drug for IVRLP, an objective method for assessing its efficacy is required. With respect to antimicrobial IVRLP, this is relatively straightforward with known minimal inhibitory concentrations or evaluating the effect on microbial growth . With respect to an analgesic IVRLP, however, there is no clear target concentration.…”

“…Among the various analgesic testing techniques, mechanical nociceptive testing was chosen because it has been reported as the most reliable and appropriate, with the argument being that most nociceptive stimuli experienced by equine patients are mechanical (eg, weight bearing, blunt trauma, lacerations) . Similar testing has been used to evaluate systemically administered analgesics, including butorphanol, as well as the efficacy of local anesthetic IVRLP …”

“…A further consideration prior to clinical use is whether there is a reduction in either antimicrobial or analgesic efficacy when opioids are combined with an antimicrobial IVRLP. This has been evaluated with respect to local anesthetics, and the same should be pursued for opioids . Finally, no investigation into the effect of butorphanol on articular cartilage was made in the present study.…”

“…7,8 While typically used to deliver antimicrobials, IVRLP has also been used to deliver anti-inflammatory drugs, local anesthetics, and analgesics. [7][8][9][10][11] Intravenous regional limb perfusion relies on both concentration and pressure gradients to achieve local drug diffusion and higher drug concentrations than could be achieved with routine systemic doses. 8 Intravenous regional limb perfusion is also associated with a presumed improved safety profile because of the reduced dosages of the drug administered and the shorter duration of therapy.…”