Current and Future Applications of CT in Equine Orthopaedics

Perioperative medications for joint and tendon sheath diseases often focus on controlling pain, inflammation, reducing any degenerative processes, and creating an environment to stimulate anabolic repair processes in the tissues. This often takes a combination of therapies and a strategy should be developed to address the diseased tissues. This strategy can be optimized when a complete understanding of the disease process can occur, which usually requires information from MRI or CT. Sometimes the full picture of the disease process cannot be acquired until the surgical procedure is performed. Perioperative medications should be considered preoperatively, intra-operatively, immediately postoperatively, and at various time points after surgery.

Preoperative consideration for medications are focused mainly on pain and inflammation control. The use of systemic non-steroidal anti-inflammatory drugs is contentious, and although likely has minimal effect on pain control, it may have some anti-inflammatory component aimed at the surgical site. For diseases in the hind limbs, preoperative epidural administration can be beneficial. Some advocate for the use of perineural analgesia both before and after surgery, but the approach is contentious.

Intraoperative medications can sometimes be justified. Intraoperative pain control can occur through the use of perineural or intra articular analgesia. There is some concern about the use of intra articular carbocaine, as in some studies it has shown some detrimental effects on chondrocytes. Some surgeons have advocated the use of intra articular morphine, in which there is some indication for its use. Again, in these cases pain control is the objective. Although the use of regenerative therapies can be considered intra-operatively, the widespread inflammation caused by the surgical procedure must be taken into account; however, in some cases in which mesenchymal stem cells may be indicated intralesionally, they may have benefit when administered during the time of surgery. In the immediate post-operative period, the preoperative analgesics and anti-inflammatory medications can be reduced.  [...]