Intraarticular administration

Intraarticular administration of triamcinolone hexacetonide 20 to 40 mg may be useful for acute gout limited to one or two joints. 

Intraarticular administration, local infiltration and ocular administration are useful in equine medicine and are covered in Chapters 7, 15, and 13, respectively. 

Table 7.1 Anti-Inflammatory potency and duration of action of corticosteroids used commonly for intraarticular administration...

Lloyd K C, Stover S M, Pascoe J R et al 1988a Plasma and synovial fluid concentrations of gentamicin in horses after intraarticular administration of buffered and unbuffered gentamicin. American Journal of Veterinary Research 49 644-649... 

Tulamo R M 1991 Comparison of high-performance liquid chromatography with a radiometric assay for determination of the effect of intraarticular administration of corticosteroid and saline solution on synoviai fluid hyaluronate concentration in horses. American Journal of Veterinary Research 52 1940-1944... 

Amphotericin B has been used intrathecally in patients with coccidioidal or cryptococcal meningitis. The side effects associated with this route of administration are headache, paraesthesia, nerve palsy, and visual impairment. To treat coccidioidal arthritis, amphotericin B may be injected intraarticularly (Figure 45.2). 

Route of administration Oral, topical, inhalation Parenteral or targeted (IV, SC, IM, intracardiac, intrathecal, intraarticular, etc.)... 

Gentamicin sulfate is approved for intrauterine use in mares. Other unapproved routes of administration (i.v., i.m., s.c. and intraarticular routes) are used frequently. An ophthalmic solution of gentamicin is also approved for veterinary use. 

Amikacin sulfate is approved for i.m. or s.c. injection in horses (50 or 250 mg/ml solution) and for intrauterine infusion (250 mg/ml solution). Other routes of administration that are not within the label indications (i.v. and intraarticular) are used frequently. 

Postoperative analgesia from morphine has been shown to be the most effective if administered at the completion of the procedure (Brandsson et al 2000, Reuben et al 2001, Tetzlaff et al 2000). In these cases, it appears that the postoperative use of morphine allows the clinician to reduce both the level and the duration of other analgesics. This is not to say that the only potential benefit of morphine is in the postoperative patient. Morphine has also been shown to be of equivalent effect to corticosteroid administration in other forms of chronic arthritides (Keates et al 1999, Stein et al 1999). The reductions in inflammatory cell influx, reduced edema formation and analgesia provided with minimal systemic effects make intraarticular morphine a very attractive postoperative therapy. I most commonly use a combination of 5-15 mg morphine with 6 mg lidocaine for postoperative analgesia and have seen no untoward effects. The beneficial effects with respect to improved analgesia and ability to reduce the usage of NSAIDs remains to be proven. 

Parenteral (injected) administration of drugs provides a solution to many problems associated with the oral delivery route. A drug injected into the blood circulation is considered to be completely bioavail-able thaefore, the quantity of the surfactants and otha inactive excipients in intravenous dosage forms are usually strictly limited. The most common alternative routes of parenteral drug administration are intramuscular or subcutaneous injections [2], Several otha injection routes are available to elicit rapid local reaction, such as intrathecal, intraarticular, and intracardiac. 

In this maimer, capsaicin binds to the same group of nociceptors which lead to the sensation of pain, heat, and acid. Then lead for a reduction in pain and inflammation by depleting the neurotransmitter pain signaling [111]. This effect has been observed for example when an intraarticular injection of capsaicin is administrated to reduce the mechanical hyperalgesia induced in osteoarthritis [112]. Additionally, capsaicin appears to be effective in protecting bone from osteoarthritic damage, supporting the hypothesis that capsaicin-sensitive sensory neurons contribute to bone lesions. Therefore capsaicin may be useful for the development of new therapeutic approaches to pain control and prevention of osteoarthritis-dependent bone loss [113]. 

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