A Simple Technique of Sacroiliac Regional Analgesia and Therapy in Show Jumping Horses

Research Article

Austin J Anesthesia and Analgesia. 2015; 3(1): 1042.

A Simple Technique of Sacroiliac Regional Analgesia and Therapy in Show Jumping Horses

Shokry M*

Department of Veterinary Surgery, Anesthesiology & Radiology, Cairo University, Egypt

*Corresponding author: Shokry M, Department of Veterinary surgery, Anesthesiology & Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt

Received: September 25, 2015; Accepted: December 30, 2015; Published: December 31, 2015

Abstract

An easy axial approach using 15cm long spinal needles, 21-gauge to the cranial aspect of the sacral tuber and obliquely at 30 degrees to the vertical was very satisfactory for achieving successful analgesia and therapy of sacroiliac pain in show jumping horses.

Keywords: Sacroiliac joint; Jumping horses

Introduction

Sacroiliac Joint (SIJ) disorders have been considered as a significant cause of back pain and poor performance in sport horses [1-4]. Clinical signs of SIJ ailment are often non specific and include poor performance shifting hindlimb lameness, hind quarter asymmetry and reluctance to jump [3,5,6]. The SIJ is an atypical synovial articulation located at the osseous junction between the pelvis and the axial skeleton. The articular surfaces are located bilaterally on the ventral aspect of the iliac wing on the dorsal aspect of the sacral wing. The sacrum is firmly attached to the pelvis by the three strong paired sacroiliac ligaments which limit motion of the SIJ [7-9]. Regional anesthesia, radiography, ultrasonography, nuclear scintigraphy, thermography and kinematic evaluation have been described as useful modalities for diagnosing SIJ pathology [10-15]. Intra-articular anesthesia of the SIJ is nearly impossible because of limited access due to the overlying musculature. However, periarticular anesthesia of the SIJ can be of great benefit for diagnosing or treating sacroiliac pain [16]. The aim of this study was to demonstrate a simple feasible technique of sacroiliac regional injection for diagnostic and therapeutic purposes.

Materials and Methods

For easy and perfect accessibility of the SIJ, a frozen sacropelvic specimen of an adult horse were subjected to neighboring transverse sections of SIJ region at 3 levels to identify its structural relationships (Figure 1). In addition, osseous construction of sacropelvic components was used to facilitate an easy access landmark to SIJ region (Figure 2).

Figure 1: Transverse anatomical section of the first sacral vertebral region illustrating the potential direct approach with the needle to SIJ.

    

    
    

    

    Figure 1:  Transverse anatomical section of the first sacral vertebral region
illustrating the potential direct approach with the needle to SIJ.

Figure 2: Bony components of the sacropelvis with the needle in SIJ.

    

    
    

    

    Figure 2:  Bony components of the sacropelvis with the needle in SIJ.

Twenty six show jumping horses with suggestive sacroiliac complaint were used to try and evaluate the feasibility of diagnostic SIJ region analgesia procedure in the predetermined studied anatomical locations. The procedure was done after restraining the horse in stanchion and preparing the sacroiliac place aseptically. A 15-cm, 21-gauge needle was inserted axial to the cranial aspect of the ipsilateral tuber sacrale (left or right) according the rider’s complaint side of the horse. The needle was directed obliquely and caudally at 30 degrees to the vertical plane. The needle was then advanced till contact was made with the bony surface of the sacrum. At that point, the needle was slightly withdrawn and 20ml of the local analgesic Mepivacaine 2%* (Alexandria Pharmaceuticals, Egypt) were distributed periarticular. The injected horses were walked for 15 minutes before being riden and assessed. Cases responded positively to SIJ regional analgesia were reinjected with the anti-inflammatory Kenacort 40mg* (Triamacinolone acetomide, Squib, Egypt) as standard therapy.

Results

The procedure proved its effectiveness in all cases without any complications. Successful diagnostic sacroiliac regional analgesia was achieved and lasted for approximately one hour. Treated cases showed marked improvement of performance and regained their athletic activity.

Discussion

In the present study, the adopted sacroiliac regional analgesia procedure was proved satisfactory and effective diagnostic tool for sacroiliac disorders without any complications. The used procedure provided a direct access to the caudo-medial aspect of SIJ and the proper depth of the needle was identified when contact was made with the sacrum. Multiple approaches to the SIJ have described [16,17]. Ultrasound guidance may facilitate SIJ injection procedure [11]. The results of diagnostic local analgesia are consistent with many authors [3,18-20]. In other studies, regional infiltration techniques have been result in a diffuse distribution of large volumes of local anesthetic solution throughout the entire lumbar sacroiliac region, which is nonspecific to the SIJ and has the potential to produce false positive results [21].

Regional perfusion of the SIJ region with the anti-inflammatory (Triamacinolone acetate) for therapeutic purposes yielded satisfactory results and almost all the treated horses returned to their athletic activity shortly after injection. Almost similar results were also reported [22,23].

References

  1. Rooney JR. Sacroiliac arthrosis and "stifle lameness”. Mod Vet Pract. 1977; 58: 138-139.
  2. Dalin G, Magnusson LE, Thafvelin BC. Retrospective study of hindquarter asymmetry in Standard bred trotters and its correlation with performance. Equine Vet J. 1985; 17: 292-296.
  3. Dyson S, Murray R. Pain associated with sacroiliac joint region: A clinical study of 74 horses. Equine Vet J. 2003; 35: 240-245.
  4. Haussler KK. Review of the examination and treatment of back and pelvic disorders. Lamness and Imaging. AAEP Meeting, Fort Collins, Colorado. 2007; 187-201.
  5. Jeffcott LB, Dalin G, Ekman S, Olsson SE. Sacroiliac lesions as a cause of chronic poor performance in competitive horses. Equine Vet J. 1985; 17: 111-118.
  6. Cauvin E. Assessment of back pain in horses. In pract. 1997; 19: 522-533.
  7. Nickel R, Schummer A, Wille KH, Wilkens H. Sacroiliac Joint in. The Anatomy of the Domestic Animals. The Locomotor System of the Domestic Mammals. Editors: R. Nickel Schummer and E. Seiferle. Paul Parey Verlag Berlin. 1986; 1: 202-203.
  8. Denoix JM. Ligament injuries of the axial skeleton in the horse: supraspinal and sacroiliac desmopathies. In: Proceedings of Dubai International Symposium. 1996; 273-286.
  9. Tomlinson E, Sage A, Turner A, Daniela J, Feeney A. Detailed ultrasonographic mapping of the pelvis in clinically normal horses and ponies. Am J Vet Res. 2001; 62: 1768-1775.
  10. Von Schweinitz DG. Thermographic diagnostics in equine back pain. Vet Clin North Am Equine Pract. 1999; 15: 161-178.
  11. Kersten AA, Edinger J. Ultrasonographic examination of the equine sacroiliac region. Equine Vet J. 2004; 36: 602-608.
  12. Wennerstrand J, Johnston C, Roethliscberger-Holm K, Erichsen C, Eksell P, Drevemo S. kinematic evaluation of the back in the sport horse with back pain. Equine Vet J. 2004; 36: 707-711.
  13. Engeli E, Yeager AE, Hollis NE, Haussler KK. Ultrasono-graphic technique and normal anatomic features of the sacro-iliac region in horses. Vet Radiol Ultrasound. 2006; 47: 391-403.
  14. Cousty M, Rossier Y, David F. Ultrasound guided periarticular injections of the sacroiliac region in horses: a cadaveric study. Equine Vet J. 2008; 40: 160-166.
  15. Gorgas D, Luder P, Lang J, Marcus G, Ueltschi G, Kircher P. Scintigraphic and radio-graphic appearance of the sacroiliac region in horses with gait abnormalities or poor performance. Vet Radiol Ultra-sound. 2007; 50: 208-214.
  16. Haussler KK. Diagnosis and management of sacroiliac joint injuries. In: Ross MW, Dyson SJ, editors. Diagnosis and Management of Lameness in the Horse, St. Louis, MO-WB Saunders. 2011; 583-591.
  17. Engeli E, Haussler KK, Erb HN. Development and validation of periarticular injection technique of the sacroiliac joint in horses. Equine Vet J. 2004; 36: 324-330.
  18. Marks D. Back pain. In: Robinson NE, editors. Current therapy in Equine medicine. Philadelphia PA, Saunder. 1997; 6-12.
  19. Engeli E, Haussler KK. How to inject the sacroiliac joint region in horses. Proceedings AAEP. 2002; 48: 257-260.
  20. Dyson S. Pain associated with the sacroiliac joint region: A diagnostic challenge. Proc. Am Assoc Equine Pract. 2004; 50: 357-360.
  21. Engeli E and Haussler KK. Review of injection techniques targeting the sacroiliac region in horses. Equine Vet Education. 2012; 24: 529-541.
  22. Marks D. Medical management of back pain. Vet Clin North Am Equine Pract. 1999; 15: 179-194.
  23. Haussler KK. Treatment options for sacroiliac joint disease. Proc Am Assoc Equine Pract. 2004; 50: 392-395.

Citation: Shokry M. A Simple Technique of Sacroiliac Regional Analgesia and Therapy in Show Jumping Horses. Austin J Anesthesia and Analgesia. 2015; 3(1): 1042. ISSN: 2381-893X