Ultrasound-Guided Celiac Plexus Block: A Breakthrough for Equine Intestinal Motility

Send us a text

A groundbreaking approach to equine intestinal motility takes center stage as Drs. Barbara Delvescovo and Marta Cercone join us to discuss their pioneering research on ultrasound-guided celiac plexus blocks in horses. Their remarkable findings reveal that this technique not only restores but actually enhances intestinal motility beyond baseline levels in normal horses—without causing discomfort.

Post-operative ileus remains one of the most challenging conditions in equine medicine, significantly increasing mortality rates after colic surgery. Traditional treatments often fall short, requiring a multimodal approach with limited options. This innovative nerve block technique offers a promising new tool that equine practitioners with basic ultrasound skills can implement in their practice.

The conversation takes fascinating turns as we explore the researchers' diverse backgrounds, from Marta's long-standing interest in neuromodulation to Barbara's clinical practice insights. Their journey reveals how mentorship and curiosity drive scientific discovery, perfectly captured in Marta's guiding principle: "True knowledge exists in knowing that you know nothing." They also share encouraging news for horse owners—contrary to common belief, many horses return to full athletic performance after colic surgery with modern management techniques. The team is now extending their research to clinical cases and inflammatory conditions, potentially transforming how we approach equine gastrointestinal disorders. For veterinarians seeking innovative solutions to challenging cases, this episode offers valuable insights into the intersection of regional anesthesia, ultrasonography, and equine medicine.

AJVR open access article: https://doi.org/10.2460/ajvr.24.11.0328

INTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA ® OR AJVR ® ?

JAVMA ® : https://avma.org/JAVMAAuthors

AJVR ® : https://avma.org/AJVRAuthors

FOLLOW US:

JAVMA ® :

Facebook: Journal of the American Veterinary Medical Association - JAVMA | Facebook

Instagram: JAVMA (@avma_javma) • Instagram photos and videos

Twitter: JAVMA (@AVMAJAVMA) / Twitter

AJVR ® :

Facebook: American Journal of Veterinary Research - AJVR | Facebook

Instagram: AJVR (@ajvroa) • Instagram photos and videos

Twitter: AJVR (@AJVROA) / Twitter

JAVMA ® and AJVR ® LinkedIn: https://linkedin.com/company/avma-journals

Episode Transcript

Speaker 1 (00:01):
Mealtime is more than a bowl of food.
It's the foundation for a longand healthy life.
At Wellness, dry recipes arecrafted with the highest quality
natural ingredients for a tastethat pets love and
scientifically proven throughAFCO feeding trials to ensure
that every complete and balancedmeal supports the five signs of
wellbeing.
With Wellness Pet Foods, petparents can share a life of

(00:25):
well-being together with theirpet.

Speaker 2 (00:31):
This is Veterinary Vertex, a podcast of the AVMA
Journals.
In this episode we chat abouthow an ultrasound-guided celiac
plexus block increasesintestinal motility in normal
horses, with our guests BarbaraDelBescovo and Marta Circone
Welcome to Veterinary Vertex.

Speaker 3 (00:49):
I'm Editor-in-Chief Lisa Fourier, and I'm joined by
Associate Editor Sarah Wright.
Today we have my very goodfriends and colleagues from
Cornell University joining us.
Barbara and Marta, thank you somuch for taking that time out
of your busy schedules to bewith us here today.

Speaker 4 (01:03):
Thank you very much for having us.

Speaker 2 (01:05):
Thank you all.
All right, let's try on over.
So, marta, your AJBR articlediscusses how an
ultrasound-guided celiac plexusblock increases intestinal
motility in normal horses.
Please share with our listenersthe background on this article.

Speaker 4 (01:21):
Yes.
So a few years ago I waswatching a roundtable about
colleagues from one of theCongress talking about this

(01:44):
approach that they were tryingand referring to an ongoing
clinical trial that they weredoing in collaboration with the
University of Milan.
So I got interested in thetopic, because I'm interested in
neuromodulation mostly, and soI started studying more into it

(02:09):
and figuring out, based on theirinitial work, if we could try
to identify really how thingswould respond to these
anesthetic block, starting fromnormal horses, and maybe try to

(02:29):
design a ultrasound-guidedapproach to it.

Speaker 2 (02:34):
Very cool.
And have you heard of ourtechnical tutorial videos by
chance?

Speaker 4 (02:40):
Yes, thinking about it.

Speaker 2 (02:44):
Awesome.
And for our listeners who don'tknow, these are video articles.
They're peer-reviewed andthey're fully citable, so they
receive a DUI recognized by theDean's and Scholarly Outputs.
So very cool.
We'll look forward to maybesome content then from you in
the future for that articlecategory.
So, Barbara, what are theimportant take-home messages
from this AJVR article?

Speaker 5 (03:02):
What are the important take-home messages
from this AJVR article.
Yeah, I think you know, asMarta said, this could be a new
technique and a techniqueapplicable to post-operative
ileus, which is such achallenging condition to treat
and is usually treated with amultimodal approach, and so I

(03:23):
think this new technique couldbe implemented in this
multimodal treatment for post-opileus and I think this could be
really exciting.
And I think also this being aultrasound guided technique,
this, for the practitioner,would require some basic skills
with ultrasound guidedinjections and knowledge of the

(03:46):
anatomy and targeted points, butis also something that is very
applicable to our horsepopulation.
So I think these are the maintake-home messages for the
equine practitioner.

Speaker 3 (03:59):
Marty, you've been interested in neuromodulation
and ultrasound guided techniquesfor a long time, but that's a
really broad category.
More specifically, what sparkedyour interest in this regional
type of local, regionalanesthesia?

Speaker 4 (04:13):
So it was the fact.
In humans there is a lot aboutvagal stimulation to treat
several different conditions,and the things that fascinate me
is how much the brain, andanyway the nervous system, can

(04:33):
affect in general all the otherbody systems.
It's so fascinating.
And then I've been working onelectrical stimulation for some
neurologic disease or peripheralneuropathy, like for a head
shaking or recurrent laryngealneuropathy in the horse, and so

(05:00):
it really pushed me into findingout more.
So what really happens if weblock that plexus?
That's why we got moreinterested in identifying
exactly what happened, even justin normal forces, and then try

(05:20):
to progress later on in otherinvestigations.
So I'm like I have a lot ofquestions and I try to work on
finding the answers, even ifmost of the time there are only
more questions showing up morethan the answer.
But it's a nice process.

Speaker 3 (05:44):
It's just important to be curious, but you guys are
obviously a great team in beingfinishers and getting this work
done and across the publicationline, which is not easy, so
congratulations.
Thank you, barbara.
Earlier, sarah asked you whatwere some of the take-home
messages, but, as Marta justsaid, every time you do a study,
more questions, somethingsurprises you.

(06:05):
For you, what were some of themost surprising findings from
this article?

Speaker 5 (06:09):
Yeah, good question.
I think one of the mostsurprising facts looking at the
results of this study wasknowing that the motility
increased even beyond baseline.
And so in these healthy,sedated horses, right, we had
the baseline motility assessmentand then when in some of them,
in a group of them, we did theblock, the motility actually

(06:32):
went beyond baseline.
And so we were expecting orhoping for some effect on the GI
motility.
But when we saw the actualresults we were very pleased and
we were really surprised bythat.

Speaker 3 (06:45):
Follow-on thing that people listeners might be
wondering does that make themcrampy?

Speaker 5 (06:50):
And not in this case.
So in this healthy, sedatedpopulation, they were not crampy
, no.

Speaker 4 (06:58):
Pretty cool, yeah.
In fact, we couldn't see muchhappening on these courses until
we really went and evaluatedthe ultrasound video blindly.
So that was rewarding also, for, anyway, we didn't know what to
.
No-transcript.

Speaker 2 (07:27):
So, marta, what are the next steps for research in
this topic?

Speaker 4 (07:57):
and also an inflammatory response in horses
in which we induced endotoxiniaby injecting LPS.
So that was our second researchexperiment and at the same time
we've been conducting also aclinical trial here at Cornell
on cases that are admitted forcolic and trying to evaluate

(08:19):
also beyond the post-operativeilus if we can provide more
anesthetic relief in horses, forexample going through spending
laparotomy.

Speaker 2 (08:35):
Very cool.
Thank you for sharing and forour listeners who are not
watching the video, lisa has avery cute puppy joining us this
morning on the podcast, and soartificial intelligence is a
really hot topic in veterinarymedicine.
There's even symposiums aboutit.
Now we have our very ownartificial intelligence
supplemental issue coming out inAJVR very soon.

Speaker 5 (09:03):
So, barbara, do you see a role for AI in this area
of research?
Yeah, for sure.
The most challenging, one ofthe highest challenges of this
study was to try to objectivelyevaluate it.
Evaluating motility, gimotility, and so what we did, we
tried to do the most objectivepossible evaluation, blinding
the videos and randomizing them,and then retrospectively

(09:26):
evaluating them and scoring them, and I think this could be
something that would be verywell done by an AI algorithm and
that could really provide, youknow, more objectivity to these
sort of similar evaluations aswell, and evaluating videos for
GI motility is definitely one ofthem.
So if we had had thatpossibility, that could have

(09:49):
definitely been implemented inthis study, for example really

(10:12):
know AI and folks like us whoknow clinics.

Speaker 3 (10:13):
So we're accumulating these questions and going to
provide them to those that arereally on the extreme side of AI
who don't know what theclinical questions might be.

Speaker 2 (10:22):
Yeah, so stay tuned.
Maybe we'll have to do apodcast episode on the
take-homes from that.
We'll see.
For those of you just joiningus, we're discussing how an
ultrasound-guided celiac plexusblock increases intestinal
motility in normal horses, withour guests Barbara and Marta.
And cinnamon yeah, forgetcinnamon.

Speaker 3 (10:44):
Marta, both you and Barbara, coming from Italy, have
fascinating backgrounds andvery diverse training, but how
did your training prepare you towrite this article?

Speaker 4 (11:15):
Well, in a way, working for my PhD on
ultrasonography definitely pavedthe way for just keep your own
doing that type of work.
And then I've been so lucky tohave great mentors, starting
from Italy with Dr Paper and formy PhD, and then coming in
Cornell, dr Ducharme and then,of course, julita in the most
most recent years.
So I've been very fortunate.
So I've been pushed through allmy possible limitations when

(11:38):
trying to do research orclinical work.
And, yeah, I own my mentors,all of these.

Speaker 3 (11:52):
Barbara, how about you?
Like it's not.
None of these paths are linear,so I think it's really cool to
tell listeners, especiallyjunior listeners, that you know
it wasn't for any of us, itwasn't a straightforward path.

Speaker 5 (12:04):
No, definitely not a straightforward path.
So I owe a lot to people whohave inspired me and trained me
as well.
I had more a clinical practicetype of background and, you know
, trying to see the challengesin clinical practice and then,
once you, you know, I got toCornell, approach more the
research world and try to answersome of the questions that came

(12:25):
up alongside my short career.
But mainly clinical was reallyhelpful.
It's kind of a path that iscoming all together.
So I'm really grateful toeverybody who has helped me and
is currently helping me.

Speaker 2 (12:39):
It's always nice to look back and thank our mentors,
so this next set of questionsis going to be very important
for our listeners, and the firstone is going to revolve around
the veterinarian's perspective.
Barbara, what is one piece ofinformation the veterinarian
should know about multimodalmanagement of colic and
paralytic ileus?

Speaker 5 (12:58):
Yeah, I think you know post-op ileus, or ileus in
general, is a very, very hardcondition to manage and to
resolve, and we know that itsignificantly increases our
mortality in our post-opcolleagues, and so it's a very,
very common and very hardcondition to manage that.
Unfortunately, we haven't founda single drug or management

(13:19):
strategy that works for sure,and so our management is always
multi-model, and so I think, inthe context of needing a
multi-model approach, this newtechnique could really be
implemented as one of thestrategies, one of the
treatments, and so this could besomething to add that might be

(13:41):
very helpful for managing thisvery challenging condition that
remains really challenging,although all the new ongoing
research that kind of runsaround it.

Speaker 2 (13:55):
And Marta on the other side of the relationship.
What's one thing that clientsshould know?

Speaker 4 (14:01):
Yes, I think colic can be very scary for owners.
First of all, how the horsereally behaves during a colic
episode is pretty scary, and theidea of a major surgery and

(14:22):
then all the complications thatcan arise after that and would
the horse go back in work or notthose are all aspects that
frighten the owners a lot.
But I think there has been somuch improvement in the surgical
approach and in the medicalapproach for the management
post-op that I think there is asort of idea that after colic

(14:48):
surgery horses are done withtheir performance.
I don't think that is the case.
Every case is different fromthe others, but the percentage
of horses that return to fullactivity without any problem
it's getting better and better.
So I just would tell the ownersto give the horse a chance, if

(15:11):
there is an economic budget thatcan support that.

Speaker 3 (15:15):
Yeah, really well said.
It is a terrifying experience.
For the first time anybody seesit and it's really good to
remember that in the clients.
Super great to see both youguys, even if it's virtually.
Today.
As we wind down, we ask alittle more of a fun question.
So, marta, while we have you,what's the oldest?
And you're welcome to hold itup if you have it oldest or most

(15:41):
interesting item on your deskor in your desk drawer.

Speaker 4 (15:49):
So I cannot hold it because I taped it to my
computer, but it is so, just onthe line of what I was saying,
that we always have a questionthat we try to answer and trying
to expand our knowledge andrealizing that it's limitless.
When I first came in Cornelland I was assigned the task,

(16:12):
somebody before me left a tinypiece of paper with printed it
and motto that I thought itreally fit with my approach to
veterinary medicine and so Ikept it for the past 13 and more
years.
And this says that trueknowledge exists in knowing that

(16:34):
you know nothing.
And it really sort of reflectswhat I thought even before
getting in this route.

Speaker 3 (16:45):
Amen.
Do you know whose computer itwas?

Speaker 4 (16:48):
I don't know.
It was on one of the researchrooms.
I had an idea, but I'm not sureso I prefer not to mention it
at this moment.
But yeah, I think it was one ofthe PhD or postdocs from Dr

(17:10):
Ducharme's lab.

Speaker 3 (17:12):
Very good.
Well, maybe they're listeningand they'll give you a shout.
Maybe, Barbara, you know mychildren and I'm looking over at
my dining room table wherethere's one complete puzzle, one
that's half done, another onethat just came out of the box.
When you do puzzles, do youstart with the border exterior
or the middle internal pieces?

Speaker 5 (17:34):
Yeah, I have to say I find them quite hard,
especially the one with themillion tiny pieces, and so I
always have to start from theexterior.
I think it's my you know my wayto have a structure and kind of
feeling like I'm gettingsomewhere.
But truly I think otherwise Icouldn't complete one if I
wasn't starting from theexterior, where I know at least

(17:57):
that what I'm looking for.
And so yeah, but I don't dothem very often, I have to say.

Speaker 3 (18:08):
A full-blown career and a couple of young kids and a
husband.
So you're showing your surgeonshoes, sarah, and I have this
running tally that most of thetime, surgeons start with the
border and internists seem tostart with more like a color or
a theme or something in themiddle.
We get some hybrids too, butyou're definitely showing your
surgeon shoes.

Speaker 2 (18:29):
I actually was over at my aunt's house this weekend
and her son does all thesereally cool intricate Lego sets
and I was like, ooh, maybethat's a question for the future
.
If we have any Lego people, howdo you put together your really
intricate Lego sets?

Speaker 3 (18:41):
The instructions Try not to lose the tiny pieces.

Speaker 2 (18:46):
There's nothing worse than stepping on a Lego.
Well, thank you so much,barbara and Marta.
I really appreciate you beinghere today sharing your article
with AJVR and sharing yourknowledge, too, with our
listeners.
Thank you very much.

Speaker 4 (18:58):
It was quite a fun.

Speaker 5 (19:01):
Yeah, yeah, thank you so much much guys for having us
and to our listeners.

Speaker 2 (19:06):
you can read Barbara Marta's article on AJVR.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.