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- Author or Editor: Randy B. Eggleston x
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Abstract
Objective—To compare the effects of 2 approaches and 2 injection volumes on diffusion of mepivacaine hydrochloride for local analgesia of the deep branch of the lateral plantar nerve (DBLPN) in horses.
Design—Experimental study.
Animals—16 adult horses.
Procedures—Either 2 mL (low volume) or 8 mL (high volume) of mepivacaine hydrochloride-iohexol (50:50 mixture) was injected by means of 1 of 2 techniques to produce analgesia of the DBLPN. For technique 1, the needle was inserted 15 mm distal to the head of the fourth metatarsal bone and directed perpendicular to the limb. For technique 2, the needle was inserted 20 mm distal to the head of the fourth metatarsal bone and was directed in a proximodorsal direction. Lateromedial radiographs were obtained before and 5, 15, 30, and 60 minutes after injection. Radiographs were evaluated to determine the proximal and distal extent of diffusion of the contrast solution and presumably anesthetic agent and whether contrast agent appeared to be present in the tarsal sheath or tarsometatarsal joint.
Results—A high degree of variability in contrast solution diffusion was noted among injections. High-volume injections diffused significantly further proximally and distally than did low-volume injections. Contrast agent was documented within the tarsal sheath in 5 of 32 (16%) injections and within the tarsometatarsal joint in 2 of 32 (6%) injections. No significant difference was found for risk of inadvertent tarsal sheath or tarsometatarsal joint injection between the 2 techniques or the 2 volumes of anesthetic used. Mepivacaine diffused significantly further distally with technique 1 than with technique 2 but diffused significantly further proximally with technique 2 than with technique 1. For both techniques, diffusion in the distal but not the proximal direction significantly increased over time.
Conclusions and Clinical Relevance—Results indicated that the proximal and distal diffusion of the mepivacaine-iohexol solution was quite variable following either DBLPN nerve block technique.
Abstract
Objective—To compare a double-layer inverting anastomosis with a single-layer appositional anastomosis, coated with either 1% sodium carboxymethylcellulose (SCMC) or 0.4% sodium hyaluronate (HA) solutions, in the small intestine of horses with respect to anastomotic healing and adhesion formation.
Animals—18 adult horses.
Procedure—Midline celiotomy and end-to-end jejunal anastomoses were performed. In control group horses (n = 6), a double-layer inverting anastomosis coated with sterile lactated Ringer's solution was performed. In treatment group horses, a single-layer appositional anastomosis was performed that was coated with 1% carboxymethylcellulose solution (SAA + SCMC group horses, 6) or 0.4% hyaluronate solution (SAA + HA group horses, 6). An additional 500 mL of the respective treatment solution was applied to the jejunal serosal surface, and 2 jejunal serosal abrasion sites were created. Horses were euthanatized 10 days after surgery. Anastomoses and abdominal adhesions were evaluated grossly. Anastomotic healing was evaluated on the basis of bursting wall tension.
Results—Bursting wall tension was significantly greater in SAA + SCMC group horses, compared with control group horses. All intestinal segments failed at a point distant to the anastomosis. Significantly fewer adhesions were found at the abrasion sites of SAA + HA group horses, compared with control group horses. No differences were found in adhesion formation at the anastomotic sites among groups.
Conclusions and Clinical Relevance—Coating a single- layer appositional jejunal anastomosis with SCMC or HA solutions does not adversely affect anastomotic healing. Application of 0.4% HA solution to the serosal surface of the jejunum significantly decreases the incidence of experimentally induced intra-abdominal adhesion formation in horses. ( Am J Vet Res 2004;65:637–643)
Abstract
Objective—To compare the outcomes of doublelayer inverting anastomosis (DIA), single-layer anastomosis (SLA), and single-layer anastomosis combined with a hyaluronate membrane (SLA+HA-membrane) with respect to stomal diameter, adhesion formation, surgery time, and anastomotic healing in horses.
Animals—18 adult horses.
Procedure—Midline celiotomy and end-to-end anastomoses were performed. In control horses (n = 6), DIA was performed; in treated horses, SLA was performed (6) or SLA+HA-membrane was performed (6). Horses were euthanatized 21 days after surgery. Abdominal adhesions were evaluated grossly and histologically. Stomal diameters were measured ultrasonographically and compared with adjacent luminal diameters. Anastomotic healing was evaluated histologically for fibrosis and inflammation, tissue alignment, and inversion. Surgery times were recorded for the anastomotic procedure and compared among groups.
Results—There were significantly more adhesions in the SLA group, compared with the DIA and SLA+HAmembrane groups. Reduction in stomal diameters in the DIA group was significantly greater than the SLA and SLA+HA-membrane groups. Surgery times for the DIA group were significantly greater than the SLA and SLA+HA-membrane groups. Histologic findings of fibrosis, inflammation, and mucosal healing were similar among groups. There was significant tissue inversion in the DIA group, compared with the 2 treatment groups. Tissue alignment was not different among groups.
Conclusions and Clinical Relevance—Use of a SLA+HA-membrane was an effective small intestinal anastomotic technique. This technique was faster to perform and resulted in a larger stomal diameter, compared with the DIA technique and significantly fewer perianastomotic adhesions, compared with the SLA technique. (Am J Vet Res 2001;62:1314–1319)
