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EQUINE VETERINARY EDUCATION


Equine vet. Educ. (2018) 30 (2) 58-59 doi: 10.1111/eve.12883


Highlights of recent clinically relevant papers


Castration complications This retrospective cohort study by Sarah Rosanowski and colleagues in the UK, Ireland and Hong Kong investigated the prevalence of post-operative complications following routine open, standing castration in a closed population of Thoroughbreds in Hong Kong. Data from 250 horses castrated over a 5-year period were


analysed in order to determine the prevalence of complications in the 30-day post-operative period. Sixty percent of horses (n = 150) experienced complications, which is up to three times higher than previously reported. Of these complications, 56.7% (n = 85) were classified as


mild (e.g. seroma formation, mild infection, mild colic), 38% (n = 57) were classified as moderate (e.g. seroma formation requiring digital opening of the wound, funiculitis, loose faeces or moderately painful colic) and 5.3% (n = 8) were classified as severe (e.g. pyrexia, excessive and prolonged haemorrhage, peritonitis). There was a significant difference between complication severity and time to return to galloping and racing. Despite variations in technique such as ligating the testicular


vessels, performing scrotal ablation etc., post-operative care was reportedly within standard practices and the veterinarians performing the procedures were experienced clinicians. There was also no association between rate of complication and month or season. From these findings it appears that open standing castration may have a far higher complication rate than previously thought.


Septic peritonitis treatment


In this knowledge summary Sarah Scott Smith examines the published evidence to answer the question ‘in adult horses with septic peritonitis, does peritoneal lavage combined with antibiotic therapy compared to antibiotic therapy alone improve survival rates?’. A small quantity of evidence is available and the quality


of the evidence is low, with comparison of the two treatment modalities in equids only performed in case series. One study performed the most robust analysis possible of a retrospective case series by using multivariate analysis to examine the effect of multiple variables on survival. Inherent to case series is the risk that case selection will have introduced significant bias into the results; peritoneal lavage may be used more commonly in more severely affected cases or where the abdomen has been contaminated with intestinal or uterine contents. There have been no randomised trials to compare the efficacy of the treatment options discussed. When examining the method of peritoneal lavage chosen


there is a single experimental, randomised control trial comparing the use of sterile saline, saline containing potassium penicillin and neomycin, 3% or 10% povidone iodine solution for abdominal lavage in horses. The quality of evidence describing types of antibiotics used is low (case series) and there is no direct comparison of antibiotics used. The conclusion of this summary was that there is no


evidence in equids that there is a difference in survival when the use of antibiotics is compared to the use of antibiotics combined with peritoneal lavage. However, the quality of


© 2017 EVJ Ltd


data available is insufficient to direct clinical practice apart from two areas; in peritonitis caused by Actinobacillus equuli, treatment with antibiotics alone is sufficient, and the use of antiseptic solutions such as povidone iodine to lavage the abdomen causes inflammation and is detrimental to the patient. More definitive conclusions cannot be drawn until higher quality evidence on this topic is available.


Duration of action of local anaesthetics


The aim of this trial by Mona Hoerdemann and colleagues in Australia was to establish and compare the onset and duration of action of mepivacaine and lidocaine in equine palmar digital perineural blocks in an experimental lamenessmodel. Reversible forelimb lameness was induced in eight horses


and a palmar digital nerve block (PDNB) was applied with mepivacaine or lidocaine (both 2%). Quantitative lameness and skin sensitivity data were collected with an inertial sensor system and a force gauge, respectively. The times to lameness resolution/skin desensitisation (T1), consistent lameness detection/partial return of skin sensitivity (T2), and complete return of lameness/skin sensitivity (T3) were determined and compared between treatments and assessment methods. Mepivacaine blocks resolved lameness in 8/8 horses,


compared to 3/8 horses with lidocaine blocks. Both agents led to skin desensitisation in 8/8 horses. Skin desensitisation occurred sooner than lameness resolution after mepivacaine. Duration of action was longer with mepivacaine than lidocaine (mean T3_lameness mepivacaine 366 min, lidocaine 113 min; T3_skin mepivacaine 195 min, lidocaine 63 min). Skin sensitivity returned sooner than lameness after lidocaine block at T3. The authors concluded that the use of lidocaine in PDNBs


for the diagnosis of lameness should be reassessed, as it may not resolve lameness despite loss of skin sensation. Mepivacaine is superior, with a reliable onset and longer duration of action. Skin desensitisation as an indicator for the onset of action or effectiveness of PDNBs for mepivacaine and lidocaine, or as a measure of the duration of action of lidocaine PDNBs should be interpreted with caution.


PRP and corneal healing


This prospective cohort study by James Rushton and colleagues in Austria aimed to evaluate the potential use of platelet rich plasma (PRP) and plasma rich in growth factors (PRGF) for the treatment of corneal disease in horses. Whole blood was collected from 35 healthy horses and


processed to yield serum, PRGF (using the Endoret PRGF system) and PRP (using the E-PETTM


system). The corneas from


six horses deemed to have no corneal abnormalities were removed within 1 h of euthanasia and processed to allow for culture of corneal limbal and stromal cells. Cells were then treated with a medium containing 20% of one of the three blood-derived products. Cell proliferation and migration were then compared amongst treatment groups in both single cell and co-culture systems. After 48 h of the treatment protocol, cell proliferation was


seen to increase in the PRP group, remain relatively constant in the PRGF group, and decrease upon serum treatment.


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