Objective—To compare pain responses in stallions undergoing standing laparoscopic cryptorchidectomy following intratesticular or mesorchial infiltration of lidocaine.
Animals—20 stallions with 1 or 2 undescended testes.
Procedures—Standing horses were administered a nonsteroidal anti-inflammatory drug and a caudal epidural injection of detomidine hydrochloride and underwent laparoscopic cryptorchidectomy. The undescended testis (1/horse) was grasped to determine the preoperative pain response (present vs absent) and assess severity of pain (by use of a visual analog scale [VAS]). The undescended testis or its mesorchium was injected with 2% lidocaine (10 mL); saline (0.9% NaCl) solution (10 mL) was injected in the untreated structure. Presence and severity of pain was determined by 2 individuals as the testis was grasped following infiltration and at the times of ligature placement and transection of the spermatic cord. Serum cortisol concentration was analyzed preoperatively, after ligation, and after transection. Presence or absence of signs of pain, severity of pain, and serum cortisol concentrations were compared within and between treatment groups.
Results—Detection of signs of pain and VAS pain scores did not differ between observers at any time point. Perceived pain responses associated with ligature placement differed significantly from preoperative responses. Pain responses and serum cortisol concentrations after intratesticular and mesorchial infiltration of lidocaine did not differ.
Conclusions and Clinical Relevance—Results suggested that intratesticular or mesorchial infiltration of lidocaine combined with administration of a nonsteroidal anti-inflammatory drug and caudal epidural injection of detomidine provides adequate analgesia in standing stallions undergoing laparoscopic cryptorchidectomy.
Objective—To compare intraoperative pain responses
following intraovarian versus mesovarian injection of lidocaine
in mares undergoing laparoscopic ovariectomy.
Design—Randomized controlled trial.
Animals—15 mares between 4 and 20 years old.
Procedure—Standard bilateral laparoscopic ovariectomy
was performed. Prior to manipulation of the ovary,
2% lidocaine (10 mL) was injected into the ovary and
saline (0.9% NaCl) solution (10 mL) was injected into
the mesovarium on 1 side, with saline solution (10 mL)
injected into the ovary and 2% lidocaine (10 mL) injected
into the mesovarium on the other side. Presence
(yes vs no) and severity (visual analogue scale) of pain
were scored at 5 times (grasping of the ovary, dissection
of the mesosalpinx, tightening of the first loop ligature,
tightening of the second loop ligature, and transection
of the ovarian pedicle) by 2 individuals blinded
to treatment and each other's observations.
Results—During 4 of the 5 observation periods, significantly
fewer mares had signs of pain following
mesovarian injection of lidocaine, and during 2 of the
5 observation periods, visual analogue scale score
was significantly lower.
Conclusions and Clinical Relevance—Results suggest
that mesovarian injection of lidocaine is associated
with significantly lower pain responses, compared
with intraovarian injection, in horses undergoing
laparoscopic ovariectomy. (J Am Vet Med Assoc
Case Description—A 7-year-old mixed-breed stallion was admitted because of colic.
Clinical Findings—Entrapment of the left colon in the renosplenic space was diagnosed via rectal palpation and ultrasonographic examination, despite a renosplenic space ablation 6.5 years earlier.
Treatment and Outcome—The renosplenic entrapment was corrected with a combination of phenylephrine administration, rolling, and ballottement of the horse's abdomen during general anesthesia. The following week, left flank laparoscopic renosplenic space ablation was performed with the horse standing. On examination of the previous surgical site, only 4 bands of fibrous adhesion remained of the original space ablation. The renosplenic space was again closed by suturing the perirenal fascia and renosplenic ligament to the splenic capsule. The horse was discharged from the hospital and recovered at home. No complications or recurrence of entrapment was reported following the procedure.
Clinical Relevance—There have been no previous reports of recurrence of renosplenic entrapment following procedures to permanently ablate the renosplenic space. Recurrence in this patient may be attributed to the horse's young age at the time of initial surgery or inadequate size or spacing of the sutures through the perirenal fascia and splenic capsule.
Case Description—An 11-year-old Quarter Horse stallion was admitted for intermittent hemospermia of 4 years' duration.
Clinical Findings—A linear vertical defect had been detected endoscopically following multiple episodes of hemospermia on the caudodorsal convex surface of the urethra at the level of the ischial arch.
Treatment and Outcome—When sexual rest alone did not result in complete healing of the urethral defect, a subischial urethrotomy and buccal mucosal urethroplasty were performed. The surgical site healed without complication. Four months of sexual rest was recommended after surgery. Repeat endoscopy at 4 months allowed inspection of the urethral graft site. Following endoscopic examination, resumption of semen collection was recommended on the basis of the apparent healing at the urethral defect site. Hemospermia did not reoccur following surgical repair.
Clinical Relevance—Buccal mucosal urethroplasty resulted in a favorable outcome in a stallion with recurrent hemospermia. Buccal mucosal urethroplasty may be a useful surgical option in stallions that have hemospermia secondary to a urethral defect and do not heal with sexual rest alone.
Case Description—An 18-year-old Paint stallion (horse 1) and a 17-year-old Morgan gelding (horse 2) were evaluated because of an acute onset of severe unilateral forelimb lameness.
Clinical Findings—Both horses were unable to bear weight on the affected forelimb and had a dropped elbow appearance. Radial nerve paralysis, triceps myopathy, and fractures of the humerus and ulna were ruled out. The caudal aspect of the affected antebrachium of each horse was very firm to palpation and became firmer when weight was shifted onto the limb. Ultrasonographic examination revealed swelling and suspected intramuscular hemorrhage of the caudal antebrachial muscles. On the basis of clinical examination and diagnostic imaging findings, both horses had antebrachial compartment syndrome diagnosed. Lameness did not substantially improve with medical treatment in either horse.
Treatment and Outcome—Caudal antebrachial fasciotomy was performed in each horse. Following sedation and local anesthetic administration, a bistoury knife was inserted through small incisions to perform fasciotomy. Horses remained standing throughout the procedure and were immediately able to bear weight on the affected limb without signs of discomfort. Horse 1 developed colitis and horse 2 developed a mild incisional infection, but both fully recovered and returned to their previous activities.
Clinical Relevance—Antebrachial compartment syndrome is a rare cause of severe unilateral forelimb lameness and should be considered as a differential diagnosis in horses with a dropped elbow appearance. Both horses of this report had a successful outcome following antebrachial fasciotomy.
A 6-year-old Quarter Horse gelding used for barrel racing was evaluated for acute onset of non–weight-bearing lameness of the left hind limb following strenuous exercise.
Nuclear scintigraphic imaging revealed focal increased radiopharmaceutical uptake centrally within the left talus. Subsequent standard radiographic and ultrasonographic examinations of the tarsus failed to identify the cause of the increased radiopharmaceutical uptake; however, the lameness was definitively localized to the tarsocrural joint by intra-articular anesthesia. Subsequent MRI sequences of the left tarsus revealed an incomplete fracture of the talus that extended distally from the trochlear groove and evidence of maladaptive stress remodeling of the trochlear groove of the talus and distal intermediate ridge of the tibia.
TREATMENT AND OUTCOME
The horse was treated conservatively, with management consisting of stall confinement, physical rehabilitation, therapeutic laser therapy, and intra-articular autologous conditioned serum administration. The lameness resolved, and the horse was competing at its previous level within 15 months after lameness onset.
Although rare, incomplete fracture of the talus should be considered as a differential diagnosis for horses that develop acute hind limb lameness following strenuous exercise, especially when that exercise involves abrupt changes in direction while the horse is traveling at maximal speed. Acquisition of additional oblique projections during radiographic evaluation of the tarsus might be useful for identification of such fractures, but definitive diagnosis may require advanced diagnostic imaging modalities such as CT and MRI. Horses with incomplete fractures of the talus can be successfully treated with conservative management.