Species: dog
Breed: Newfoundlander
Sex: m, chemically neutered
Weight: 71.8 kg
Birth date: 2022-05-11 00:00:00
Primary diagnosis: Complete cruciate ligament rupture left with mild osteroarthritis und questionable mild medial meniscal injury left, minimal stifle osteoarthritis right with beginning cranial cruciate ligament disease, hip dysplasia
Situation: Post-surgery
Time since surgery: < 2 hrs
Recovered from anesthesia: No
Medical history: External consultation for radiographs 2 weeks ago: stifle right & left, pelvis. X-rays report (18.04.2024): Increased soft tissues within the left stifle joint and mild osteoarthritis; Minimal osteoarthritis femoropatellar joint right stifle; Moderate bilateral hip dysplasia with joint laxity and moderate osteoarthritis. Lameness hind left leg since a few weeks before presentation at the beginnin ng of may (so from april) after presumed trauma, no improvement with NSAIDs. First onsultation for MRI & x-rays for TPLO, then elective surgery was performed on the 17.05.2024. MRI report (03.05.2024): Complete cranial cruciate ligament rupture left stifle; Horizontal longitudinal tear in the abaxial border of the medial meniscus; Marked secondary stifle joint effusion with effusion within the long digital extensor tendon sheath and synovial thickening. X-rays report (03.05.2024): Marked distention of the stifle joint; Mild cranial subluxation of the tibia; Mild to moderate osteoarthritis of the stifle joint. After surgery control x-rays of the left stifle were taken, and as the drawer test was positive also on the right, also x-rays of the right stifle were taken. X-rays report right stifle (17.05.2024): Mild increased soft tissues of the stifle joint; Mild gonarthrosis -> Consider incrased filling of the right stifle joint, possibly beginning cranial cruciate ligament disease. On the 23.07.2024 the dog came back for control x-rays of the left stifle 9 weeks after surgery. On 05.08.2024 the dog came back to the clinic to undergo surgery the day after. A TPLO on the right side was performed on the 06.08.2024.
Medication: Before consultation: Robenacoxib 1.1mg/kg PO SID to EOD, Omega3 2 capsules BID, Dasuquin 1 tablet BID, Turmeric25 1 tablet BID, fish oil 5ml SID. Before surgery: Robenacoxib 1.1 mg/kg PO SID, (and Gabapentin at 09 but I didn't film the dog that morning). After surgery: 1x Ampicillin 30 mg/kg IV. No medication before observation 6. After surgery 06.08: Ampicillin 30 mg/kg IV TID, Methadon 0.2 mg/kg IV q4h, Robenacoxib 1 mg/kg IV, Ondansetron 0.3 mg/kg IV SID (?), Gabapentin 10 mg/kg PO TID (?), Trazodon 5 mg/kg PO TID (?).
Anesthesia: Intervention on 17.05.2024: TPLO left. Premedication at 10:04: Methadon 0.1 mg/kg IM, Dexmedetomidin 0.002 mg/kg IM, Dexmedetomidin 0.002 IV. Induction: Ketamin 1 mg/kg IV, Propofol 1 mg/kg IV, Alfaxolone 1 mg/kg IV. Maintenance: FiO2, Isofluran. Analgesia: Bolus Methadon 0.1 mg/kg, Local anaesthesia femoralis/ischiadicus Ropivacain 1.5 mg/kg. Antibiotics: Ampicillin/Sulbactam 30 mg/kg. Wake up phase: Bolus Methadon 0.2 mg/kg IV. Intervention duration: 105 minutes. Anaesthesia duration: 180 minutes. Intervention on 06.08.2024: Arthroscopy & TPLO right. Premedication: Acepromazin 0.005 mg/kg IV, Methadon 0.15 mg/kg IV. Induction: Ketamin 1 mg/kg IV, Propofol 3.6 mg/kg IV. Maintenance: FiO2, Isofluran. Analgesia: 2x Bolus Fentanyl 0.001 mg/kg IV, 3x Bolus (S-)Ketamin 1 mg/kg IV, local anaesthesia Femoralis / Ischiadicus block Ropivacain 12 ml. Complications: hyperthermia. Wake up phase: postoperative sedation 0.005 mg/kg IV, Bolus Methadon 0.15 mg/kg IV, Bolus Robenacoxib 1 mg/kg IV. Intervention duration: 180 min. Anaesthesia duration: 330 min.
Orthopedic exam: Gait: lameness grade 2/4 left hind leg, right hind limb seems stiff. Posture: intermittently no weight bearing of the right hind limb with straight back line. Orientating palpation: unclear increased filling of the left stifle. Special palpation: instability and pain of the left stifle.
Pain type: acute, orthopedic, somatic
Pain origin: hind legs
Estimated pain severity: 40