An old school specialist once told me that dogs don’t need analgesia because it makes them run around more after surgery! Probably the most damning statement I have every heard!
Cruciate disease is a painful disease and appropriate perioperative analgesia is critical. This ensures smooth transition from light anaesthesia to surgery with rapid return to pain-free function postoperatively such that rehabilitation can commence immediately post-surgery.
The standard protocol for TPLO surgery at NCVS is:
- ACP / Methadone sedation / Alfaxan induction.
- Presurgical local anaesthetic blockade with three- point stifle blockade and intra-articular Bupivicaine (0.5 to 1mg/kg divided evenly)
- We rarely need to give epidurals for stifle surgery
- Fentanyl CRI perioperatively and intraoperatively
- Splash blockade of wounds and incision on closure
- Arthroscopy of stifle to minimise surgical pain intra and postoperatively
- Minimally invasive TPLO or isometric suture placement.
- Transdermal fentanyl placed at time of surgery
- Postop opioids q 4- 6 hours generally for 1-2 injections
- NSAID’s commencing at time or just before surgery and continuing for three weeks postop
- Bandage for 24-48 hours. (regardless of the debate for and against bandaging the limb post cruciate surgery are swollen a pressure bandage helps with swelling and discomfort).
- Ice applied to the bandage / wound on recovery and 2-3 days with heat and early gentle mobilisation immediately after bandage removal. Heat pack after that
- Lots of TLC
- Physiotherapy commences 1-2 weeks post-surgery.
We expect our patients to recover with no pain and in most cases they will be using the limb comfortably the day after surgery.
Analgesia is all about a multimodal approach and this combination in our hands provides for superb analgesia and smooth post operative recovery.These principles are generally applicable across both fore and hindlimbs.
If you have any questions regarding analgesia for stifle surgery please feel free to give us a call on 5453 7555 or emailing us at info@ncvs.net.au.
