# Loco-Regional Anaesthesia during Standing Laparoscopic Ovariectomy in Equids: A Systematic Review (2003–2023) of the Literature

## TL;DR

This review examines the use of local anesthesia during standing laparoscopic ovariectomy in horses to manage pain and improve surgical outcomes.

## Contribution

The study provides a systematic evaluation of loco-regional anesthesia techniques for equine laparoscopic ovariectomy from 2003 to 2023.

## Key findings

- Only five studies met the criteria for evaluating loco-regional anesthesia in equine laparoscopic ovariectomy.
- Injectable and epidural anesthesia combined is recommended for effective intraoperative pain management.
- Few studies have focused on assessing the quality of analgesia in this procedure.

## Abstract

Laparoscopy is a minimally invasive surgical technique used to explore and treat conditions within the abdomen. In equids, this procedure is generally performed standing, with animals sedated and restrained in stocks. Laparoscopic ovariectomy in equids has gained popularity as it avoids the risk of general anaesthesia, greatly improves visualisation and manipulation of the ovary and its blood supply, reduces the recovery period, and provides a superior aesthetic result. Indications for ovariectomy include neutering, fertility problems, ovarian tumours, hematomas or cysts, disorders of sexual development, and the elimination of undesirable behaviour related to oestrus. During the procedure, pain management is achieved with a combination of systemic or loco-regional anaesthesia. The objective of this systematic review was to evaluate studies in the equine veterinary literature, published between 2003 and 2023, in which loco-regional anaesthesia was used during standing laparoscopic ovariectomy in equids to assess the different drugs, techniques, and outcomes.

Laparoscopic ovariectomy is generally performed with equids in the standing position, with the animals heavily sedated and restrained in stocks. This procedure may be quite painful, and it is essential first to manage intraoperative pain to complete the surgery, respecting the animal’s welfare and, at the same time, ensuring the safety of the operators. Laparoscopy requires multiple small incisions to introduce the instruments, with one to two incisions enlarged sufficiently to remove the ovary. The surgical procedure must be associated with effective pain control, usually obtained with loco-regional anaesthesia, mesovarian injection, mesovaric or ovarian topical anaesthesia, and epidural anaesthesia. This systematic review aims to discuss articles published from 2003 to 2023 on treating loco-regional anaesthesia in standing laparoscopic ovariectomy in association with an evaluation of pain. The literature review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines on three databases (NCBI-PubMed, Web of Science, and SciVerse Scopus). Despite the collected papers numbering 36, we identified only five eligible papers, demonstrating that few studies are performed in order to evaluate the quality of analgesia with loco-regional anaesthesia in standing laparoscopic ovariectomy in equids. The authors of this systematic review agree that the association of injectable and epidural anaesthesia is the best solution to manage intraoperative pain in standing laparoscopic ovariectomy in equids.