Abstract：
Equine practitioners frequently inject local anaesthetics (LA) intra-articularly in both diagnosis of lameness and for pain management intra- or post-operatively with synovial endoscopy. Recent reviews of the human and veterinary literature support the concept that chondrotoxicity of LA on joint tissues depends on the type of drug, dose administered, and duration of exposure. The purpose of this review is to summarise the current literature describing intra-articular local anaesthetic use, including both in vitro and in vivo studies, and to draw some comparisons to literature from other species where potential toxicity and duration of effect have been evaluated with the goal of advancing the field\'s understanding of intra-articular local anaesthetic use in horses, and indicating future directions for the field. The aggregate data available from all species, while generally sparse for horses, indicate that LA are rapidly cleared from the synovial fluid after injection, often within 30 min. In vitro data strongly suggest that lidocaine and bupivacaine are likely more chondrotoxic than other LA, although to what extent is still unknown, and cytotoxicity of LA may be mitigated through concurrent injection with HA, PRP, and drug combinations including nonsteroidal anti-inflammatories and opioids. The current body of in vitro research is not reflective of the in vivo environment, and further in vitro work, if performed, should focus on mimicking the native joint environment, utilising PK data and joint/injection volumes to replicate the native environment more accurately within the joint and the expected exposures to LA.
摘要：
马从业者经常在关节内注射局部麻醉剂（LA），以诊断跛行，并在滑膜内窥镜检查中或术后进行疼痛管理。最近对人类和兽医文献的评论支持以下概念：LA对关节组织的软骨毒性取决于药物的类型。给药剂量,和暴露的持续时间。这篇综述的目的是总结目前描述关节内局部麻醉药使用的文献，包括体外和体内研究，并与其他物种的文献进行一些比较，这些物种的潜在毒性和作用持续时间已被评估，目的是推进该领域对马关节内局部麻醉使用的理解，并指出该领域的未来方向。所有物种的汇总数据，虽然马通常稀疏，表明LA在注射后迅速从滑液中清除，通常在30分钟内。体外数据强烈表明，利多卡因和布比卡因可能比其他LA更具软骨毒性，尽管在多大程度上仍然未知，LA的细胞毒性可以通过与HA同时注射来减轻，PRP,和药物组合，包括非甾体类抗炎药和阿片类药物。目前的体外研究机构不能反映体内环境，和进一步的体外研究，如果执行，应该专注于模仿原生关节环境，利用PK数据和关节/注射体积在关节内更准确地复制天然环境和预期的LA暴露。
