Species: dog
Breed: Crossbreed
Sex: m, not neutered
Weight: 41.3 kg
Birth date: 2021-12-14 00:00:00
Primary diagnosis: Bilateral cruciate ligament rupture (at least partial rupture), left patellar luxation grade 1, bilateral hip joint dysplasia
Situation: Post-surgery
Time since surgery: < 2 hrs
Recovered from anesthesia: Moderate sedation (2)
Medical history: Max has been lame in his hind limbs since he was 8 months old. Sometimes he walks a little better, sometimes a little worse. It is slightly better in the morning than in the evening. However, the lameness tends to be consistent. He sometimes puts his left hind paw backwards. The owner thinks he is more lame on the left, the private vet thinks he is more lame on the right. According to the owner, no trauma has ever been observed. He was first presented at our clinic in april 2024. X-rays of the hips and tifles were taken. X-rays report: Mild osteoarthritis and reduced coverage of the hips with laxity accentuated right; Bilateral mild to moderate osteoarthritis of the stifles accentuated right with articular and periarticular soft tissue swelling. The clinical and radiological findings suggest a bilateral at least partial cruciate ligament rupture and a grade 1 left patellar dislocation as well as bilateral hip joint dysplasia. Therapy with Robenacoxib 40 mg PO SID was started (until 1 week before surgery). On the 10.07 an arhtroscopy and TPLO of the left stifle were performed.
Medication: No medication the week before surgery & before observation 1. On the 09.07 evening Gabapentin was started: Gabapentin 10 mg/kg PO at 18 and 24. 10.07: Gabapentin 10 mg/kg PO TID, Methadon 0.2 mg/kg IV q4h (after surgery), Robenacoxib 1 mg/kg IV SID, Ampicillin 30 mg/kg IV TID. 11.07 (nothng given before observation 5): Gabapentin & Methadon & Ampicillin same as on 10.07, Robenacoxib 2 mg/kg PO SID, Paracetamol 12 mg/kg IV TID.
Anesthesia: Intervention on 10.07.2024: Arthroscopy & TPLO left stifle. Premedication at 09:00: Trazodonee 7 mg/kg PO, Methadon 0.2 mg/kg IV, Acepromazine 0.01 mg/kg IV. Induction: S-Ketamin 1 mg/kg IV, Propofol 2 mg/kg IV. Maintenance: FiO2, Isofluran (Sevofluran during postoperative x-rays because there was no Isofluran). Analgesia: 2x Bolus Fentanyl 0.003 mg/kg IV, IV Infusion Fentanyl 0.1 mg/kg/h for 25 min & 0.05 mg/kg/h for 30 min & 0.06 mg/kg for 70 min, local anaesthesia Femoralis / Ischiadicus block Ropivacain 6 ml (0.05 ml/kg = 2 ml for Ischiadicus, 0.1 ml/kg = 4 ml for Femoralis). Antibiotics: Ampicillin / Sulbactam 30 mg/kg. Complications: hypotension -> 1x Bolus RA 10 ml/kg, 1x Bolus Ephedrin 0.1 mg/kg IV. Wake up phase: Bolus Methadon 0.2 mg/kg IV, Bolus Robenacoxib 1 mg/kg SC. Intervention duration: 145 min. Anesthesia duration: 300 min.
Orthopedic exam: Orthopedic examination on 18.04.2024. Gait: alternating lameness of both hind limbs grade 1/5. Posture: all 4 limbs loaded evenly. Orientating palpation: knee joints on both sides increasingly filled, left moderately, right slightly; tarsal joint left slightly increasingly filled. Specific palpation: elbow left slight crepitation but not dolent; patellar luxation left grade 1 left; knee joints bilaterally moderately dolent in hyperextension; hip joints bilaterally moderately dolent in extension. Palpation under sedation: knee joints lax on both sides, tibial compression test positive on the right; hip joints lax on both sides; "meniscal click" on the right.
Pain type: acute, chronic, inflammatory, orthopedic, somatic
Pain origin: hind legs
Pain duration: More than 7 days
Estimated pain severity: 15