Species: dog
Breed: Miniature Poodle
Sex: f, not neutered
Weight: 5.6 kg
Birth date: 2019-06-09 00:00:00
Primary diagnosis: 24.06: Oblique fracture of the fourth metatarsal bone, transverse fracture and subluxation of the fifth metatarsal bone. 28.06: mild malalignment of the proximal fragment of the 5th metatarsal bone with both metatarsal diaphysis and 4th tarsal bone
Situation: post surgery
Time since surgery: > 12 hrs
Recovered from anesthesia: No sedation (0)
Medical history: Yesterday (23.06) evening the dog hid under a horse and was hit by it. Since then the dog doesn't put any weight on the left hindlimb. A metatarsus fracture was suspected. At the clinic therapy with Methadon, Meloxicam, Gabapentin and Trazodone was started and a bandage was made. Today (24.06) X-rays were taken and the dog went into surgery. X-rays report: Acute oblique fracture of the fourth metatarsal bone; Acute transverse fracture and subluxation of the fifth metatarsal bone; Moderate soft tissue swelling. The dog went to surgery: Osteosynthesis of the fourth and fifth metatarsal fractures was performed using two intramedullary pins and a bi-cortical oblique pin; Postoperatively, a modified Robert-Jones bandage and splint were applied. The dog went home on the 25.06 and came back two days later because she lost her cast -> she remained unnoticed for a moment, the dog had been on the stairs without the cast, the owners were very worried that the osteosynthesis has come loose and the dog was very painful. The dog was put under analgesia, a splint bandage was made and the day after x-rays were taken again. X-rays report: Mild malalignment of the proximal fragment of the 5th metatarsal bone with both metatarsal diaphysis and 4th tarsal bone; Suspected increased radiolucency around the proximal and distal aspect of the oblique pin of the 5th metatarsal bone; Otherwise unchanged osteosynthesis of acute fractures of the fourth and fifth metatarsal bones using two intramedullary and one oblique pin through proximal 5th metatarsal bone and multiple tarsal bones; Moderate soft tissue swelling with minimal residual emphysema. A new (splint?) bandage was made.
Medication: 23.06: Methadon 0.2 mg/kg IV and Meloxicam 0.2 mg/kg IV at 22:00, Gabapentin 17.5 mg/kg PO and Trazodone 4.4 mg/kg PO at 24:00. 24.06 before surgery: Methadon 0.2 mg/kg IV at 06:00 (before observation 1), at 09 (after obervation 1) Methadon 0.2 mg/kg IV & Gabapentin 17.5 mg/kg PO & Trazodone 6.6 mg/kg PO. 24.06 after surgery: 1x Methadon 0.2 mg/kg IV then switch to Buprenorphine 0.02 mg/kg IV TID, Meloxicam 0.1 mg/kg IV SID, Kefzol 20 mg/kg IV TID, Gabapentin PO 20 mg/kg TID, Trittico 5 mg/kg PO TID. 25.06: Buprenorphine & Meloxicam & Kerfzol & Gabapentin & Trittico same as 24.06. 28.06: Methadon 0.1 mg/kg IV q4h, Meloxicam 0.1 mg/kg PO SID, Cefalexin 13 mg/kg PO BID, Gabapentin 15 mg /kg po BID/TID, Trazodone 4.4 mg/kg PO when needed (given before obervation 5).
Anesthesia: Intervention on 24.06.2024: Osteosynthesis of fourth and fifth metatarsal fracture. Premedication at 10:10: Methadon 0.1 mg/kg IV, Medetomidin 0.005 mg/kg IV. Induction: Propofol 3.6 mg/kg IV. Maintenance: FiO2, Isofluran. Analgesia: local anaesthesia Femoralis / Ischiadicus block Ropivacain 1 ml. Cefazolin 20 mg/kg IV. Complications: hypotension -> 2x Bolus RA 10 ml/kg. Intervention duration: 135 min. Anaesthesia duration: 315 min.
Pain type: acute, inflammatory, orthpedic, somatic
Pain origin: hind legs
Pain duration: 24 hours to 7 days
Estimated pain severity: 35