ORTHOPEDICS
PRP IN PRACTICE: Tips on safe injection techniques P a u l
Platelet-rich-plasma (PRP) has increasingly
been used in equine medicine for the treatment of joints, bursae and soft tissue injuries. During the past 5 years, A. Kent Allen, DVM, ISELP, and his colleagues at Virginia Equine Imaging, have used PRP in more than 400 horses totaling about 800 individual joints, and he’s confident in the beneficial effects of PRP in equine practice. He recently passed along some helpful tips dur-
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Volume, frequency, and gain
“You want to be comfortable with ultrasound-guided injections and have a plan for reducing the pain of the needle passage,” Dr. Allen said. “Whether it’s a regional nerve block or a skin block, come up with a plan beforehand on how you can reduce the pain of this injection technique.” It is crucial to avoid over-pressurizing the lesion, joint, or bursa by keeping an eye on the volume that is being injected. If there is any resistance on the plunger of the syringe or if tissue separation starts to become evident, back off and perhaps draw the syringe out slightly. “Those situations will look very much like a flarelike syndrome, but they come from pressurizing that joint and structure,” he added. For the ultrasound probe, make sure it is positioned well enough to easily see the needle passage. For guided injections, the frequency should be set a little lower and the gain should be set a little higher than what practitioners typically set for ultrasound imaging. “That accentuates the needle,” Dr. Allen explained. “The needle is passing in the thin plane of the probe, which is only about 2 mm thick. You have to stay in that plane, so anything that helps you see that a little better is something you need to do.” For sacroiliac injections, he also recommended clipping the haircoat—particularly in the winter. If the PRP is not flowing easily into the lesion, scarring that was not appreciated beforehand may be giving the needle a bumpy ride. “You think you’re going into a fairly hypoechoic lesion and the PRP is going to flow easily, but once you get the needle in there you may find that it’s not happening,” he said. “Always be prepared to have a secondary plan for depositing the PRP perilesionally.” Using a reasonable needle gauge (eg, 20-gauge) with the horse in a non-weightbearing stance, it’s
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