Peripheral Nerve Blockade for Medial Patellofemoral Ligament Reconstruction in Pediatric Patients: The Addition of a Proximal Single-Injection Sciatic Nerve Block Provides Improved Analgesia.

Purpose: We tested the hypothesis that the addition of a single-injection proximal sciatic nerve block to an adductor canal block would significantly reduce pain scores and opioid requirements compared to a group of patients that received only an adductor canal or femoral nerve block for medial patellofemoral ligament reconstruction in pediatric patients. The primary end-point is the number of patients achieving a Patient Acceptable Symptom State (PASS) (pain score less than four) for the entire 24-hour postoperative period in patients with and without a proximal sciatic block. Patients and Methods: This is a retrospective cohort study of 144 consecutive pediatric patients, ages 10 to 18 years, undergoing medial patellofemoral ligament reconstruction with peripheral nerve blockade for postoperative analgesia from 2016-2020 at a pediatric orthopedics children's hospital. Patients were divided into 2 cohorts with and without a proximal sciatic nerve block: group A/F: adductor canal or femoral CPNB and group AS: adductor canal CPNB and a proximal single-injection sciatic nerve block. Results: There was strong evidence for an increase in the number of patients who reported a pain score less than four for the entire 24-hour postoperative period in the group that received the additional proximal sciatic block. (PASS: A/F 13/62 (21%) vs AS 43/82 (52%), p<0.001) There was strong evidence for a reduction in mean and maximum pain scores and opioid requirements in the first 24-hours after surgery in the proximal sciatic group. Conclusion: The addition of a proximal sciatic nerve block was associated with significantly reduced mean and maximum pain scores and opioid requirements after medial patellofemoral ligament reconstruction in pediatric patients and supports a randomized clinical trial to confirm these findings. Based on the results of this study we recommend the addition of a proximal sciatic nerve block, anterior or posterior, to an adductor canal block to provide improved analgesia and reduced opioid requirements in the 24-hours after MPFLR in pediatric patients.

Effect of season and geographic location in the United States on detection of potential enteric pathogens or toxin genes in horses ≥6-mo-old.

We investigated the effects of season and geographic location on detection of nucleic acids of potential enteric pathogens (PEPs) or their toxins (PEP-Ts) in feces of horses ≥6-mo-old in the United States. Results of 3,343 equine diarrhea PCR panels submitted to Idexx Laboratories for horses >6-mo-old were reviewed. Submission months were grouped into 4 seasons, and states were grouped into 4 geographic regions. Logistic regression was performed to assess effects of season and region on detection rates of PEPs and PEP-Ts. Agresti-Coull CIs were determined. Detection rate of Salmonella enterica was higher in the South in summer compared to all other regions, and was also higher in the South in fall compared to the Midwest and Northeast. The Neorickettsia risticii detection rate was lower during summer in the West and higher in fall in the Midwest. Detection of Cryptosporidium spp. was lower during spring, summer, and winter in the West. Differences were not identified for detection rates of Clostridioides difficile, Clostridium perfringens, Lawsonia intracellularis, Rhodococcus equi, equine rotavirus, and equine coronavirus. Overall, our data support seasonal and regional differences in detection rates of S. enterica, N. risticii, and Cryptosporidium spp. in horses ≥6-mo-old in the United States.

Detection of pathogens in blood or feces of adult horses with enteric disease and association with outcome of colitis.

BACKGROUND: Rates of detecting ≥1 potential enteric pathogens (PEP) or toxins (PEP-T) in feces, blood, or both of horses ≥6 months of age with enteric disease and impact of multiple detections on outcome of horses with colitis has not been reported. OBJECTIVE: To determine detection rates of PEP/PEP-T in feces, blood, or both of horses with enteric disease and effect of detecting multiple agents on outcome of horses with colitis. ANIMALS: Thirty-seven hundred fifty-three fecal samples submitted to IDEXX Laboratories and 239 fecal and blood samples submitted to Michigan State University's Veterinary Diagnostic Laboratory (MSUVDL). METHODS: Retrospective evaluation of PEP/PEP-T testing results was performed to determine rates of detection of 1 or more PEP/PEP-T. Impact of detecting multiple agents on outcome was assessed in 239 horses hospitalized for colitis. RESULTS: One or more PEP/PEP-T was detected in 1175/3753 (31.3%) and 145/239 (60.7%) of samples submitted to IDEXX Laboratories and MSUVDL, respectively. In a hospitalized cohort, survival to discharge was lower (76%) in horses with 1 agent, compared to horses with either no (88%) or multiple (89%) agents. There was no difference (P = .78) in days of hospitalization between horses with 0 (1-17), 1 (1-33), and > 1 positive (1-20) result. There was no difference in cost of hospitalization (P = .25) between horses with 0 ($2357, $1110-15 553), 1 ($2742, $788-11 005), and >1 positive ($2560, $1091-10 895) result. CONCLUSIONS AND CLINICAL IMPORTANCE: Detection rates of PEP/PEP-T in horses with colitis vary with cohorts and tests performed. Detection of more than 1 PEP or PEP-T did not affect outcome.

Effect of an In Vitro Proximal Gastrointestinal Tract on Viability of Commercially Available Equine Probiotics.

Probiotics, by definition, are live micro-organisms and should remain viable when they reach the intended site of action which is typically the cecum and/or colon. In humans, probiotics often need enteric protection to survive transit through the proximal gastrointestinal (GI) tract. Typically, equine probiotics do not advertise enteric protection and to the author's knowledge the viability of equine probiotics after exposure to the proximal GI tract has not been evaluated. The objective of this study was to evaluate the effect of an in vitro simulation of the equine proximal GI tract on probiotic viability. We hypothesized that the simulated proximal GI tract would adversely effect microbial viability and that the adverse effects would be partially ameliorated by increasing the gastric pH to 4. A total of 11 products were evaluated of which six had at least one micro-organism that was adversely effected by exposure to the proximal GI tract and four of which had at least one micro-organism that was adversely affected when the gastric pH was increased to 4.0. Results from this study indicate that some micro-organisms in equine probiotics do not appear to be adversely affected by exposure to the equine proximal GI tract.

A New Low Dose of Tranexamic Acid for Decreasing the Rate of Blood Loss in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

BACKGROUND: Previous studies have demonstrated that the use of tranexamic acid (TXA) reduces blood loss and transfusion requirements in children undergoing scoliosis surgery. Although TXA is safe and effective, significant adverse events have been reported. Using the lowest effective dose of TXA is advisable. We evaluated a new low dosing regimen for TXA based on an improved pharmacokinetic model and therapeutic plasma concentration. The purpose of this study is to evaluate the effectiveness of this new low dosing regimen in reducing blood loss and transfusion requirements in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion when compared with a control group who did not receive TXA. METHODS: We retrospectively reviewed 90 consecutive patients with idiopathic scoliosis undergoing posterior spinal fusion at our institution from 2017 to 2020. Forty patients received TXA at the new dosing regimen (10 mg/kg load, 5 mg/kg/h infusion) and 50 patients were in the non-TXA control group. The same 2 orthopaedic surgeons, working as a team, performed all surgical procedures. We assessed the use of TXA as an independent risk factor for estimated blood loss and transfusion requirement after adjusting for age, surgical duration, body mass index, major coronal curve, and sex. RESULTS: A comparison of the intraoperative cumulative blood loss in the 2 groups showed a significantly lower blood loss in the TXA group. (583.5±272.0 vs. 479.5±288.7 mL, P=0.03) This difference persisted when blood loss was calculated as percent of total blood volume and per vertebral level. Transfusion requirements were lower in the TXA group (4/50 patients vs. 0/40 patients, P=0.13). No patient in the TXA group required a blood transfusion during their hospitalization. CONCLUSION: This study is the first to provide evidence that a new low dosing regimen of TXA can significantly reduce blood loss and transfusion requirements for idiopathic scoliosis patients and supports the need for a prospective, randomized clinical trial to confirm these findings. LEVEL OF EVIDENCE: Level III-retrospective cohort study.

The Effect of Water Flavor on Voluntary Water Intake in Hospitalized Horses.

Hospitalized horses are at risk for colic due to several factors, all of which may reduce voluntary water intake (VWI) further contributing to the development of colic during hospitalization. Our objectives were to determine if using flavored water (sweet feed, peppermint, or apple-flavored electrolyte) increases VWI of hospitalized horses and to determine if horses consumed more flavored water versus plain water. We hypothesized that (1) in hospitalized horses the availability of flavored water results in more VWI than the availability of unflavored water and that (2) average intake of flavored water is larger for flavored versus unflavored within the experimental (flavored) group. Four groups of hospitalized horses (n = 10/group) were recruited. All horses were provided two buckets of water. Control horses were provided two buckets of plain water. The other three groups were provided one bucket of plain water and one bucket of flavored water (sweet feed, peppermint, or a commercial apple-flavored electrolyte). The total and the flavor-specific water consumed was recorded during a 72-hour period. There was weak evidence to suggest that the use of flavored water increases median total water intake of hospitalized horses by a factor of 1.76 [95% CI: 0.98 to 3.11] for sweet feed (P = .05) and 1.85 [95% CI: 1.03 to 3.33] for peppermint (P = .04). The results strongly supported that horses consumed more sweet feed-flavored water (27.0 mL/kg/day [95% CI: 14.6 to 39.3] more water) compared with plain water (P = .0001).

In Vitro Evaluation of the Effect of Storage at -20°C and Proximal Gastrointestinal Conditions on Viability of Equine Fecal Microbiota Transplant.

Fecal microbiota transplant (FMT), a technique used to restore normal intestinal microbial communities, has been successful in treating humans with Clostridioides difficile colitis. Subsequently, FMT is being used in veterinary patients with suspected intestinal dysbiosis. Unfortunately, little data are available regarding best practices for FMT in horses. The objective of this study was to evaluate the effects of storing manure prepared for equine FMT (MP-FMT) at -20°C for up to 4 weeks and passage through a simulated proximal gastrointestinal (GI) tract on the viability of MP-FMT. The results of this study indicate that storage at -20°C for greater than 1 week and exposure to conditions consistent with the proximal GI tract significantly decreased viability of the microbial population, with gram-negative enteric bacteria most significantly impacted. This preliminary evaluation indicates that further work is necessary to determine best practices to preserve the viability MP-FMT in horses.

Outcome of horses with enterocolitis receiving oncotic fluid support with either plasma or hetastarch.

The objective of this study was to determine whether there was an association between type of colloid administered and survival of horses with enterocolitis (N = 92). A retrospective review of medical records of horses with enterocolitis treated with plasma or hetastarch (HES) between January 1, 2005 and December 31, 2011 was performed. Data collected included signalment, outcome, physical and clinicopathologic findings, and volume and type of colloid administered. Sixty-nine horses (75%) were treated with plasma and 23 horses (25%) were treated with HES. After accounting for confounding variables, horses treated with plasma (80% survival) were more likely to survive to discharge than horses treated with HES (47% survival; P = 0.041) despite similar disease severity at admission. This study provides support that use of natural colloids may be superior to treatment with synthetic colloids in horses with enterocolitis. A prospective, multi-center trial comparing outcome of critically ill equine patients treated with natural or synthetic colloids is warranted.

Issue des chevaux avec entérocolite recevant un traitement de support par fluide oncotique avec soit du plasma ou de l'héta-amidon. L'objectif de la présente étude était de déterminer s'il y avait une association entre le type de colloïde administré et la survie de chevaux avec entérocolite (N = 92). Une revue rétrospective des dossiers médicaux de chevaux avec entérocolite traités avec du plasma ou de l'héta-amidon (HES) entre le 1er janvier 2005 et le 31 décembre 2011 fut effectuée. Les données amassées incluaient l'anamnèse, l'issue, les trouvailles physiques et clinico-pathologiques, ainsi que le volume et le type de colloïde administré. Soixante-neuf chevaux (75 %) furent traités avec du plasma et 23 chevaux (25 %) furent traités avec du HES. Après avoir pris en considération les variables confondantes, les chevaux traités avec le plasma (80 % de survie) étaient plus susceptibles de survivre jusqu'au congé que les chevaux traités avec HES (47 % de taux de survie; P = 0,041) malgré la similarité de la sévérité de la condition lors de l'admission. Cette étude fournie des arguments que l'utilisation de colloïdes naturels serait supérieure au traitement avec des colloïdes synthétiques chez des chevaux avec entérocolite. Une étude prospective, multicentres comparant l'issue de patients équins sévèrement malades traités avec des colloïdes naturels ou synthétiques est requise.(Traduit par Dr Serge Messier).

Outcome and complications in horses administered sterile or non-sterile fluids intravenously.

BACKGROUND: Obtaining commercial fluids for intravenous administration (IVF) was challenging during a recent shortage. This necessitated use of custom-made non-sterile fluids for intravenous administration (JUGs) in some hospitals. There are no studies comparing outcome of horses treated with JUG versus IVF and limited information is available about adverse effects of JUGs. HYPOTHESIS/OBJECTIVES: To evaluate death, complications, blood pH, and plasma electrolyte concentrations of horses that received JUG versus IVFs. ANIMALS: One hundred eighty-six horses that received IVFs and 37 that received JUGs. METHODS: A retrospective review of medical records was performed to identify horses that received IVFs or JUGs during hospitalization. Information including survival to discharge, complications (fever [>38.5°C], jugular vein phlebitis/thrombosis, arrhythmia, or laminitis), blood pH, and plasma electrolyte concentrations were obtained. RESULTS: There was no difference (P = .67) in survival to discharge for horses that received JUGs (78%) compared to horses that received IVFs (87%). Horses that received JUGs were more likely to develop a jugular vein complication (3 of 37 versus 1 of 186, odds ratio 17.2 [95% CI 1.9-389.8], P = .04). Horses that received JUGs were more likely to have electrolyte abnormalities consistent with hyperchloremic metabolic acidosis. CONCLUSION AND CLINICAL IMPORTANCE: Veterinarians using JUGs should obtain informed client consent because of a potential increased risk of jugular vein complications. Chloride content of JUGs should be considered to limit development of hyperchloremic metabolic acidosis.