Species: dog
Breed: White Swiss Sheperd
Sex: f, neutered
Weight: 34 kg
Birth date: 2020-08-07 00:00:00
Primary diagnosis: Moderate osteoarthritis of the right stifle joint with moderate peri/articular swelling -> suspected partial cranial cruciate ligament rupture.
Situation: post surgery
Time since surgery: 2-4 hrs
Recovered from anesthesia: Mild sedation (1)
Medical history: Presentation at clinic on 25.06.2024. Lameness of left hindlimb since 1 year. Intermittent, often after a walk or when inactive. During activity/playing the dog shows nothing. It got worse since 3-4 months, it is progressive. It happens more often that he doesn't put any weight at all on his left hindlimb (always in the same conditions as before). He shows no expression of pain. The private vet took x-rays of the stifle and referred the case to us. The dog got NSAIDs when needed for 2-3 weeks, last time they were given at the end of the week before presentation. The dog goes no longer lame at all with NSAIDs. Here at the clinic x-rays were taken. X-rays report (25.06): Moderate osteoarthritis of the right stifle joint with moderate peri/articular swelling; Mild osteoarthritis tibiotarsal joint -> Findings compatible with degenerative joint disease of the right stifle joint possibly due to (partial) cranial cruciate ligament rupture; Associated meniscal and other ligament injury are also possible; Joint distension due to effusion, synovial hypertrophy or a combination of the two. An arthroscopy & TPLO were planned for the 15.08.2024. On that morning Raïka was brought to the clinic and the surgery was performed and the dog was released the day after surgery.
Medication: No medication before consultation. Medication before presentation for surgery? 15.08 15 min before observation 2: Trazodon 6.3 mg/kg PO. 15.08 After durgery: Trazodon 4.7 mg/kg PO (started at midnight), Ampicillin 30 mg/kg IV TID (given after observation 3), Robenacoxib 2 mg/kg IV SID (given before observation 3), Methadon 0.2 mg/kg IV q4h (not given until after observation 4), Ondansetron 0.3 mg/kg TID (given after observation 3). 16.08: Trazodon & Ampicillin & Robenacoxib & Ondansetron same as on 15.08, switch from Methadon to Buprenorphin 0.02 mg/kg IV TID.
Anesthesia: Intervention on 15.08: Arthroscopy and TPLO left. Premedication at 08:56 (1h before sedation 200 mg = 6.25 mg/kg Trazodon): Acepromazin 0.01 mg/kg IM, Methadon 0.2 mg/kg IM, Medetomidin 0.003 mg/kg IM. Induction: Propofol 2 mg/kg IV, Ketamin 2 mg/kg IV. Maintenance: FiO2, Isofluran. Analgesia: Local anaesthesia Femoralis / Ischiadicus block Bupivacain 2 mg/kg (12 ml). Antibiotics: Cefazolin 22 mg/kg IV. Complications: bradycardia -> bradycardia (HR 40) and VES before induction then with 2 mg/kg Ketamin HR 105. Wake up phase: postoperative antagonisation Atipamezol 0.05 ml. Intervention duration: 180 min. Anaesthesia duration: 330 min.
Orthopedic exam: Palpation: moderate muscle atrophy on the left side compared to the right, moderate swelling of the knee on the left side. Stress tests: Dolence on extension of the left knee, drawer test and tibial compression test negative (both awake and under sedation)
Pain type: acute, chronic, inflammatory, orthopedic, somatic
Pain origin: hind legs
Pain duration: More than 7 days
Estimated pain severity: 35