Cargando…

Has intravenous lidocaine improved the outcome in horses following surgical management of small intestinal lesions in a UK hospital population?

BACKGROUND: Perioperative lidocaine treatment is commonly used in horses that undergo surgical treatment of colic, to prevent or treat postoperative ileus and reduce the effects of intestinal ischaemia-reperfusion injury. However, its clinical efficacy has not been evaluated in a large population of...

Descripción completa

Detalles Bibliográficos
Autores principales: Salem, Shebl E., Proudman, Chris J., Archer, Debra C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962447/
https://www.ncbi.nlm.nih.gov/pubmed/27459996
http://dx.doi.org/10.1186/s12917-016-0784-7
_version_ 1782444837555929088
author Salem, Shebl E.
Proudman, Chris J.
Archer, Debra C.
author_facet Salem, Shebl E.
Proudman, Chris J.
Archer, Debra C.
author_sort Salem, Shebl E.
collection PubMed
description BACKGROUND: Perioperative lidocaine treatment is commonly used in horses that undergo surgical treatment of colic, to prevent or treat postoperative ileus and reduce the effects of intestinal ischaemia-reperfusion injury. However, its clinical efficacy has not been evaluated in a large population of horses undergoing small intestinal surgery. The aim of the current study was to evaluate whether systemic lidocaine administration reduced the prevalence, volume and duration of postoperative reflux and improved rates of survival following surgical treatment of small intestinal lesions. Data were collected as a part of two prospective studies investigating postoperative survival of surgical colic patients admitted to a UK equine referral hospital during the periods 2004–2006 and 2012–2014. Kaplan-Meier plots of cumulative probability of survival and the log-rank test were used to compare survival between horses that did or did not receive lidocaine. The Wilcoxon rank-sum test was used to compare the total reflux volume and duration of reflux between the groups. A multivariable Cox proportional hazards model was used to identify pre- and intraoperative risk factors for non-survival. RESULTS: Data from 318 horses were included in the final analysis. The overall prevalence of postoperative reflux was 24.5 %. This was significantly higher (34.8 %) in horses admitted in 2012–2014 compared to the 2004–2006 cohort (16.7). Perioperative lidocaine treatment had no effect on total reflux volume, duration of reflux or rates of postoperative survival nor was it a risk factor associated with altered postoperative survival. Variables identified to be associated with increased risk of postoperative mortality included packed cell volume on admission (hazard ratio [HR] 1.03 95 %, 95 % confidence interval [CI] 1.004–1.06, p = 0.024), heart rate on admission (HR 1.014, 95 % CI 1.004–1.024, p =0.008) and duration of surgery (HR 1.007, 95 % CI 1.002–1.01, p = 0.008). CONCLUSIONS: Lidocaine therapy had no effect on the prevalence of postoperative reflux, total reflux volume and duration of reflux nor did it have any effect on postoperative survival in horses undergoing surgical management of small intestinal disease for treatment of colic. There is a need for a well-designed multicentre, prospective randomised controlled trial to fully investigate the efficacy of lidocaine across different hospital populations. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12917-016-0784-7) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-4962447
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-49624472016-07-28 Has intravenous lidocaine improved the outcome in horses following surgical management of small intestinal lesions in a UK hospital population? Salem, Shebl E. Proudman, Chris J. Archer, Debra C. BMC Vet Res Research Article BACKGROUND: Perioperative lidocaine treatment is commonly used in horses that undergo surgical treatment of colic, to prevent or treat postoperative ileus and reduce the effects of intestinal ischaemia-reperfusion injury. However, its clinical efficacy has not been evaluated in a large population of horses undergoing small intestinal surgery. The aim of the current study was to evaluate whether systemic lidocaine administration reduced the prevalence, volume and duration of postoperative reflux and improved rates of survival following surgical treatment of small intestinal lesions. Data were collected as a part of two prospective studies investigating postoperative survival of surgical colic patients admitted to a UK equine referral hospital during the periods 2004–2006 and 2012–2014. Kaplan-Meier plots of cumulative probability of survival and the log-rank test were used to compare survival between horses that did or did not receive lidocaine. The Wilcoxon rank-sum test was used to compare the total reflux volume and duration of reflux between the groups. A multivariable Cox proportional hazards model was used to identify pre- and intraoperative risk factors for non-survival. RESULTS: Data from 318 horses were included in the final analysis. The overall prevalence of postoperative reflux was 24.5 %. This was significantly higher (34.8 %) in horses admitted in 2012–2014 compared to the 2004–2006 cohort (16.7). Perioperative lidocaine treatment had no effect on total reflux volume, duration of reflux or rates of postoperative survival nor was it a risk factor associated with altered postoperative survival. Variables identified to be associated with increased risk of postoperative mortality included packed cell volume on admission (hazard ratio [HR] 1.03 95 %, 95 % confidence interval [CI] 1.004–1.06, p = 0.024), heart rate on admission (HR 1.014, 95 % CI 1.004–1.024, p =0.008) and duration of surgery (HR 1.007, 95 % CI 1.002–1.01, p = 0.008). CONCLUSIONS: Lidocaine therapy had no effect on the prevalence of postoperative reflux, total reflux volume and duration of reflux nor did it have any effect on postoperative survival in horses undergoing surgical management of small intestinal disease for treatment of colic. There is a need for a well-designed multicentre, prospective randomised controlled trial to fully investigate the efficacy of lidocaine across different hospital populations. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12917-016-0784-7) contains supplementary material, which is available to authorized users. BioMed Central 2016-07-27 /pmc/articles/PMC4962447/ /pubmed/27459996 http://dx.doi.org/10.1186/s12917-016-0784-7 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Salem, Shebl E.
Proudman, Chris J.
Archer, Debra C.
Has intravenous lidocaine improved the outcome in horses following surgical management of small intestinal lesions in a UK hospital population?
title Has intravenous lidocaine improved the outcome in horses following surgical management of small intestinal lesions in a UK hospital population?
title_full Has intravenous lidocaine improved the outcome in horses following surgical management of small intestinal lesions in a UK hospital population?
title_fullStr Has intravenous lidocaine improved the outcome in horses following surgical management of small intestinal lesions in a UK hospital population?
title_full_unstemmed Has intravenous lidocaine improved the outcome in horses following surgical management of small intestinal lesions in a UK hospital population?
title_short Has intravenous lidocaine improved the outcome in horses following surgical management of small intestinal lesions in a UK hospital population?
title_sort has intravenous lidocaine improved the outcome in horses following surgical management of small intestinal lesions in a uk hospital population?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962447/
https://www.ncbi.nlm.nih.gov/pubmed/27459996
http://dx.doi.org/10.1186/s12917-016-0784-7
work_keys_str_mv AT salemsheble hasintravenouslidocaineimprovedtheoutcomeinhorsesfollowingsurgicalmanagementofsmallintestinallesionsinaukhospitalpopulation
AT proudmanchrisj hasintravenouslidocaineimprovedtheoutcomeinhorsesfollowingsurgicalmanagementofsmallintestinallesionsinaukhospitalpopulation
AT archerdebrac hasintravenouslidocaineimprovedtheoutcomeinhorsesfollowingsurgicalmanagementofsmallintestinallesionsinaukhospitalpopulation