Species: dog
Breed: Crossbreed
Sex: f, neutered
Weight: 25.1 kg
Birth date: 2020-01-09 00:00:00
Primary diagnosis: Disc extrusion L1/2 with severe haemorrhagic component
Situation: Post-surgery
Time since surgery: > 12 hrs
Recovered from anesthesia: No sedation (0)
Medical history: The dog was presented to the clinic on 14.10.2024. On Friday 11.10, Kajou ran into the edge of a table with a lot of force. Since then the dog has been progressively painful. On Friday she didn't want to play anymore, on Saturday she was still able to walk (40 minutes) but was more unsteady. Since Sunday she needs support to get up and since Sunday evening (13.10) she is no longer able to walk. She was able to pass urine and faeces normally until Sunday evening and is now questionably incontinent. On Sunday (13.10) the private veterinarian visited the dog at home: general clinical examination + administration of morphine. Today morning (14.10): they went to the private vet, that administrated Morphasol 1 mL (0.4 mg/kg) and Meloxicam 1.1 mL (0.22 mg/kg). At our clinic a neurologic examination was performed, then the dog got an MRI and went into surgery. MRI report (14.19): L1/2 intervertebral disc extrusion, with severe haemorrhagic component, with associated moderate to severe spinal cord compression T13-L3, cranially more left-sided and caudally more right-sided; Focal associated myelopathy; Secondary mild central canal widening cranial to the compression site; Mild disc protrusion between T12/13 to L3/4. Kajou went home on the 17.10.
Medication: Before presentation: Butorphanol 0.4 mg/kg IV, Meloxicam 0.22 mg/kg IV. Between observation 1 & 2: Methadon 0.1 mg/kg IV, Gabapentin 20 mg/kg PO. Just before observation 3: Dexmedetomidin 0.0015 mg/kg IV. After observation 3: Fentanyl CRI (1.25 ml/h?), Ketamin CRI (2.5 ml/h?), Gabapentin 10 mg/kg PO TID, Trazodon 5 mg/kg PO TID. 15.10: Methadon 0.1 mg/kg IV q4h (CAVE not normal times, see protocol), Gabapentin 10 mg/kg PO at 09 and 17, Trazodon 5 mg/kg PO at 09, Phenoxybenzamine 0.4 mg/kg PO BID. 16.10: switch from Methadon 0.1 mg/kg IV q4h (probably given the last time at 07) to Buprenorphin 0.02 mg/kg IV TID, Gabapentin 20 mg/kg PO TID (not given the last time), Phenoxybenzamine 0.4 mg/kg PO BID, Robenacoxib 1 mg/kg IV SID, Trittico 2 mg/kg PO BID. 17.10: Buprenorphin 0.015 mg/kg IV 1x (dog went home after), Gabapentin 20 mg/kg PO TID, Phenoxybenzamine 0.4 mg/kg PO BID, Robenacoxib 1 mg/kg IV SID, Trittico 2 mg/kg PO 1x (dog went home after).
Anesthesia: Intervention on 14.10.2024: MRI + Hemilaminectomy. Premedication at 12:05: Medetomidin 0.1 mg/kg IV, Dexmedetomidin 0.002 mg/kg IV, Acepromazine 0.005 mg/kg IV, Trazodon 7.5 mg/kg rectally. Induction: Ketamin 1 mg/kg IV, Propofol 2 mg/kg IV. Maintenance: FiO2, Isofluran. Analgesia: Fentanyl 2.5 µg/kg/h for 4h, Ketamin 1 mg/kg/h for 4h, local anaesthesia erector spinae block Ropivacain 10 ml. Antibiotics: Cefazolin 22 mg/kg IV. Complications: bradycardia --> Glycopyrrolate 0.01 mg/kg IV. Wake up phase: postoperative sedation Dexmedetomidin 0.0015 mg/kg IV, postoperative analgesia Fentanyl and Ketamin CRI. Intervention duration: 180 min. Anaesthesia duration: 300 min.
Neurologic exam: Mentation: very stressed. Posture: in lateral position Schiff-Sherrington, otherwise thoracic position, unable to stand. Gait: paraplegia. Postural reactions: absent on the hindlimbs. Cranial nerves: mydriasis on both sides (presumably stress-related), otherwise unremarkable. Spinal reflexes: front limbs unremarkable, hindlimbs flexor reflex slightly reduced, strong during deep pain testing, patellar reflex left slightly reduced, right unremarkable, perineal reflex unremarkable, panniculus absent caudal of approximately L3. Sensitivity: dolence on palpation of the thoraco-lumbal junction / cranial lumbar spine. Deep pain tested several times, reaction not always prompt (dog very stressed), but present. Neuroanatomical localisation: T3-L3 +/- spinal shock.
Pain type: acute, nociceptive, inflammatory, somatic
Pain origin: back
Pain duration: 24 hours to 7 days
Estimated pain severity: 23