• 1. Hoerdemann M, Smith RL, Hosgood G. Duration of action of mepivacaine and lidocaine in equine palmar digital perineural blocks in an experimental lameness model. Vet Surg 2017;46:986993.

    • Search Google Scholar
    • Export Citation
  • 2. Silva GB, De La Côrte FD, Brass KE, et al. Duration and efficacy of different local anesthetics on the palmar digital nerve block in horses. J Equine Vet Sci 2015;35:749755.

    • Search Google Scholar
    • Export Citation
  • 3. Salinas FV, Malik K, Benzon HT. Local anesthetics for regional anesthesia and pain management. In: Benzon H, Rathmell JP, Wu CL, et al. eds. Raj's practical management of pain. 4th ed. Philadelphia: Mosby Elsevier, 2008;811838.

    • Search Google Scholar
    • Export Citation
  • 4. Day TK, Skarda RT. The pharmacology of local anesthetics. Vet Clin North Am Equine Pract 1991;7:489500.

  • 5. Skarda RT, Muir WW III, Hubbell JA. Local anesthetic drugs and techniques. In: Muir WW III, Hubbell JA, eds. Equine anesthesia: monitoring and emergency therapy. 2nd ed. St Louis: Saunders Elsevier, 2009;210242.

    • Search Google Scholar
    • Export Citation
  • 6. Sinnott CJ, Cogswell LP III, Johnson A, et al. On the mechanism by which epinephrine potentiates lidocaine's peripheral nerve block. Anesthesiology 2003;98:181188.

    • Search Google Scholar
    • Export Citation
  • 7. Schoenmakers KP, Fenten MG, Louwerens JW, et al. The effects of adding epinephrine to ropivacaine for popliteal nerve block on the duration of postoperative analgesia: a randomized controlled trial. BMC Anesthesiol 2015;15:100.

    • Search Google Scholar
    • Export Citation
  • 8. MacDonald M, Kannegieter N, Peroni J, et al. The musculoskeletal system. In: Higgins A, Snyder J, eds. The equine manual. 2nd ed. Philadelphia: Saunders Elsevier, 2006;8691058.

    • Search Google Scholar
    • Export Citation
  • 9. Fürst AE. Diagnostic anesthesia. In: Auer JA, Stick JA, eds. Equine surgery. 4th ed. St Louis: Elsevier, 2012;9981015.

  • 10. Keegan KG, Yonezawa Y, Pai PF, et al. Evaluation of a sensor-based system of motion analysis for detection and quantification of forelimb and hind limb lameness in horses. Am J Vet Res 2004;65:665670.

    • Search Google Scholar
    • Export Citation
  • 11. Keegan KG, MacAllister CG, Wilson DA, et al. Comparison of an inertial sensor system with a stationary force plate for evaluation of horses with bilateral forelimb lameness. Am J Vet Res 2012;73:368374.

    • Search Google Scholar
    • Export Citation
  • 12. Keegan KG, Kramer J, Yonezawa Y, et al. Assessment of repeatability of a wireless, inertial sensor-based lameness evaluation system for horses. Am J Vet Res 2011;72:11561163.

    • Search Google Scholar
    • Export Citation
  • 13. Jordana M, Martens A, Duchateau L, et al. Distal limb desensitisation following analgesia of the digital flexor tendon sheath in horses using four different techniques. Equine Vet J 2014;46:488493.

    • Search Google Scholar
    • Export Citation
  • 14. Littell RC, Henry PR, Ammerman CB. Statistical analysis of repeated measures data using SAS procedures. J Anim Sci 1998;76:12161231.

  • 15. Littell RC, Milliken GA, Stroup WW, et al. SAS for mixed models. 2nd ed. Cary, NC: SAS Institute Inc, 2006;160203.

  • 16. Littell RC, Pendergast J, Natarajan R. Modelling covariance structure in the analysis of repeated measures data. Stat Med 2000;19:17931819.

    • Search Google Scholar
    • Export Citation
  • 17. Westfall PH, Hochberg Y, Rom D, et al. Multiple comparisons and multiple tests using the SAS system. Cary, NC: SAS Institute Inc, 1999;213225.

    • Search Google Scholar
    • Export Citation
  • 18. Datta S, Kodali BS, Segal S. Local anesthetic pharmacology. In: Obstetric anesthesia handbook. 5th ed. New York: Springer, 2010;1526.

  • 19. Björn H, Huldt S. The efficiency of xylocaine as a dental terminal anesthetic compared to that of procaine. Sven Tandlak Tidskr 1947;40:831851.

    • Search Google Scholar
    • Export Citation
  • 20. Krunic AL, Wang LC, Soltani K, et al. Digital anesthesia with epinephrine: an old myth revisited. J Am Acad Dermatol 2004;51:755759.

  • 21. Stashak TS. Examination for lameness. In: Adams' lameness in horses. 5th ed. Philadelphia: Lippincott Williams and Wilkins, 2001;113183.

    • Search Google Scholar
    • Export Citation
  • 22. Owen D. Excerpts from AAEP meeting report: local nerve blocks. J Am Vet Med Assoc 1974;164:364.

  • 23. Mueller E, Hay W. Ancillary diagnostic aids. In: Colahan PT, Merritt AN, Moore JN, et al, eds. Equine medicine and surgery. 5th ed. St Louis: Mosby, 1999;12921344.

    • Search Google Scholar
    • Export Citation
  • 24. Barr A. Musculoskeletal diseases. In: Taylor FGR, Hillyer MH, eds. Diagnostic techniques in equine medicine. London: WB Saunders, 1997;231270.

    • Search Google Scholar
    • Export Citation
  • 25. Dagher FB, Yared GM, Machtou P. An evaluation of 2% lidocaine with different concentrations of epinephrine for inferior alveolar nerve block. J Endod 1997;23:178180.

    • Search Google Scholar
    • Export Citation
  • 26. Becker DE, Reed KL. Essentials of local anesthetic pharmacology. Anesth Prog 2006;53:98108.

  • 27. Bidwell LA, Brown KE, Cordier A, et al. Mepivacaine local anesthetic duration in equine palmar digital nerve blocks. Equine Vet J 2004;36:723726.

    • Search Google Scholar
    • Export Citation
  • 28. Spoormakers TJ, Donker SH, Ensink JM. Diagnostic anaesthesia of the equine lower limb: a comparison of lidocaine and lidocaine with epinephrine. Tijdschr Diergeneeskd 2004;129:548551.

    • Search Google Scholar
    • Export Citation
  • 29. Bassage LH II, Ross MW. Diagnostic analgesia. In: Ross MW, Dyson SJ, eds. Diagnosis and management of lameness in horses. 2nd ed. St Louis: Elsevier Saunders, 2011;100135.

    • Search Google Scholar
    • Export Citation
  • 30. Lamont L. Local anesthetics. In: Doherty T, Valverde A, eds. Manual of equine anesthesia and analgesia. Ames, Iowa: Blackwell Publishing, 2006;154165.

    • Search Google Scholar
    • Export Citation
  • 31. Wyn-Jones G. Equine lameness. Boston: Wiley-Blackwell, 1988:1011.

  • 32. da Silva Azevedo M, De La Côrte FD, Brass KE, et al. The use of xylazine or acepromazine does not interfere in the lameness evaluation by inertial sensors. J Equine Vet Sci 2015;35:2730.

    • Search Google Scholar
    • Export Citation
  • 33. Bernards CM, Kopacz DJ. Effect of epinephrine on lidocaine clearance in vivo: a microdialysis study in humans. Anesthesiology 1999;91:962968.

    • Search Google Scholar
    • Export Citation
  • 34. Curatolo M, Petersen-Felix S, Arendt-Nielsen L, et al. Epidural epinephrine and clonidine: segmental analgesia and effects on different pain modalities. Anesthesiology 1997;87:785794.

    • Search Google Scholar
    • Export Citation
  • 35. Thompson G, Moore GE. Celiac plexus, intercostal, and minor peripheral blockade. In: Cousins MJ, Bridenbaugh PO, eds. Neural blockade in clinical anesthesia and management of pain. 2nd ed. Philadelphia: JB Lippencott Co, 1988;503530.

    • Search Google Scholar
    • Export Citation
  • 36. Bader JD, Bonito AJ, Shugars DA. Cardiovascular effects of epinephrine in hypertensive dental patients. Evid Rep Technol Assess (Summ) 2002;48:13.

    • Search Google Scholar
    • Export Citation
  • 37. Laragnoit AB, Neves RS, Neves IL, et al. Locoregional anesthesia for dental treatment in cardiac patients: a comparative study of 2% plain lidocaine and 2% lidocaine with epinephrine (1:100,000). Clinics (Sao Paulo) 2009;64:177182.

    • Search Google Scholar
    • Export Citation
  • 38. Ketabi M, Shamami MS, Alaie M, et al. Influence of local anesthetics with or without epinephrine 1/80000 on blood pressure and heart rate: a randomized double-blind experimental clinical trial. Dent Res J (Isfahan) 2012;9:437440.

    • Search Google Scholar
    • Export Citation

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Effect of the addition of epinephrine to a lidocaine solution on the efficacy and duration of palmar digital nerve blocks in horses with naturally occurring forefoot lameness

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  • 1 Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849.
  • | 2 Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849.
  • | 3 Department of Agriculture, Ogden College of Science and Engineering, Western Kentucky University, Bowling Green, KY 42101.

Abstract

OBJECTIVE To determine whether addition of epinephrine to a lidocaine solution would prolong and potentiate the efficacy of a palmar digital nerve block (PDNB) in horses.

ANIMALS 6 adult horses with naturally occurring forefoot lameness.

PROCEDURES Initially, a PDNB with a 2% lidocaine solution was performed on the affected foot of each horse. Three days later, the PDNB was repeated with a 1% lidocaine solution or a 1% lidocaine solution containing epinephrine (dilution, 1:200,000). After another 3-day washout period, the PDNB was repeated with the treatment opposite that administered for the second PDNB. Gait was analyzed with a computerized lameness analysis system and heart rate and extent of skin sensation between the heel bulbs of the blocked foot were evaluated at predetermined times for 2 hours after each PDNB.

RESULTS Efficacy and duration of the PDNB did not differ significantly between the 2% and 1% lidocaine treatments. The addition of epinephrine to the 1% lidocaine solution improved the efficacy and prolonged the duration of the PDNB. It also resulted in a positive correlation between skin desensitization and amelioration of lameness. Median heart rate remained unchanged throughout the observation period for all 3 treatments. No adverse effects associated with the PDNBs were observed.

CONCLUSIONS AND CLINICAL RELEVANCE Addition of epinephrine (dilution, 1:200,000) to a 1% lidocaine solution improved the efficacy and prolonged the duration of a PDNB in horses with naturally occurring lameness and might be clinically useful for lameness evaluations and standing surgery of the forefoot of horses.

Contributor Notes

Address correspondence to Dr. Velloso Alvarez (azv0023@auburn.edu).