Felis ISSN 2398-2950

Anesthesia: in orthopedic surgery

Contributor(s): Marieke de Vries, Enzo Vettorato

General considerations

Non-traumatic conditions

  • Anesthesia for these patients can be solely for diagnostic imaging (CT-scan, radiographs), surgical treatment, or both.
  • Often involves young animals (eg angular limb deformity, elbow dysplasia) and healthy animals (ASA-1 or -2).
  • Some orthopedic conditions may result in chronic pain because of osteoarthritis Arthritis: osteoarthritis (eg following patella luxation Patella: luxation or cranial cruciate ligament rupture Stifle: cranial cruciate ligament disease) which can prove challenging to treat. These patients may have been on long-term analgesic treatment.
  • Older patients may suffer from osteoarthrosis, and extra care has to be taken with positioning these patients during general anesthesia.
  • Other relevant concomitant conditions should be taken into account when deciding the most appropriate anesthetic protocol (eg brachycephalic airway obstructive syndrome (BAOS) Brachycephalic airway obstruction, juvenile patients).
  • For diagnostic purposes (eg radiographs and/or CT scan), sedation may be sufficient. Unless contra-indicated because of their cardiovascular effects, alpha-2 adrenoceptor agonists Analgesia: alpha-2 agonist (eg medetomidine Medetomidine or dexmedetomidine Dexmedetomidine) provide a dose-dependent sedation, which can be reversed at the end of the procedure with atipamezole Atipamezole.
  • Because of the synergistic action between alpha-2 adrenoceptor agonists and opioids, either butorphanol Butorphanol tartrate or methadone Methadone can be added to the sedation protocol Sedation - sedative protocols:
    • Butorphanol sedates better compared to methadone in dogs and better than buprenorphine Buprenorphine in cats.
    • Methadone is preferred over butorphanol and buprenorphine for more painful conditions.
    • The combined intravenous (IV) injection of methadone with an alpha-2 adrenoceptor can result in profound bradycardia; the intramuscular (IM) route may therefore be preferred. This is less of an issue when the alpha-2 agonist is combined with butorphanol and buprenorphine. In any case pulse-rate should be closely monitored during sedation.

Fracture repair

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Anesthetic considerations

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Risk of reflux and regurgitation

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Post-operative care

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Further Reading

Publications

Refereed Papers

  • Recent references from VetMed Resource and PubMed.
  • Benigni L, Lafuente P, Viscasillas J (2019) Clinical comparison of two techniques of brachial plexus block for forelimb surgery in dogs. Vet J 244, 23-27 PubMed.
  • Bhalla R J, Trimble T A, Leece E A et al (2018) Comparison of intramuscular butorphaol and buprenorphine combined with dexmedetomidine for sedation in cats. J Feline Med Surg 20, 325-331 PubMed.
  • Bini G, Vettorato E, De Gennaro C, Corletto F (2018) A retrospective comparison of two analgesic strategies after uncomplicated tibial plateua levelling osteotomy in dogs. Vet Anaesth Analg 45, 557-565 PubMed.
  • Bustamante R, Aguado D, Cediel R et al (2018) Clinical comparison of the effects of isoflurane or propofol anaesthesia on mean arterial blood pressure and ventilation in dogs undergoing orthopaedic surgery receiving epidural anaesthesia. Vet J 233, 49-54 PubMed.
  • Evangelista M C, Monteiro B P, Doodnaught G M, Benoist P, Steagall P V (2018) Paravertebral brachial plexus blockade in cats: a cadaver study. J Feline Med Surg 20(6), 591-595 PubMed.
  • Portela D A, Verdier N, Otero P E (2018) Regional anesthetic techniques for the pelvic limb and abdominal wall in small animals: A review of the literature and technique description. Vet J 238, 27-40 PubMed.
  • Portela D A, Verdier N, Otero P E (2018) Regional anesthetic techniques for the thoracic limb and thorax in small animals: A review of the literature and technique description. Vet J 241, 8-19 PubMed.
  • Sarotti D, Cattai A, Franci P (2018) Combined spinal and general anaesthesia in 58 cats undergoing various surgical procedures: description of technique and restrospective perioperative evaluation. J Feline Med Surg doi: 10.1177/1098612X18819496 [Epub ahead of print].
  • Trimble T, Bhalla R J, Leece E A (2018) Comparison of sedation in dogs: methadone or butorphanol in combination with dexmedetomidine intravenously. Vet Anaesth Analg 45, 597-603 PubMed.
  • Murphy L A, Barletta M, Graham L F et al (2017) Effects of acepromazine and trazodone on anesthetic induction dose of propofol and cardiovascular variables in dogs undergoing general anesthesia for orthopedic surgery. JAVMA 250(4), 408-416 PubMed.
  • Tayary H, Tazioli G, Breghi G et al (2017) Ultrasound-guided femoral and obturator nerves block in the psoas compartment in dogs: anatomical and randomized clinical study. Vet Anaesth Analg 44, 1216-1226 PubMed.
  • Torrente C, Vigueras I, Manzanilla E G et al (2017) Prevalence of and risk factors for intraoperative gastroesophageal reflux and postanesthetic vomiting and diarrhea in dogs undergoing general anesthesia. JVECC 27(4), 397-408 PubMed.
  • van Haaften K A, Forsythe L R E, Stelow E A et al (2017) Effects of a single preappointment dose of gabapentin on signs of stress in cats during transportation and veterinary examination. JAVMA 251, 1175-1181 PubMed.
  • Otero P E, Verdier N, Zaccagnini A S, Fuensalida S E, Sclocco M, Portela D A, Waxman S (2016) Sonographic evaluation of epidural and intrathecal injections in cats. Vet Anaesth Analg 43(6), 652-661 PubMed.
  • Vettorato E, Corletto F (2016) Retrospective assessment of peripheral nerve block techniques used in cats undergoing hindlimb orthopaedic surgery. J Feline Med Surg 18, 826-833 PubMed
  • Ansón A, Laredo F G, Gil F, Soler M, Belda E, Ayala M D, Agut A (2015) Comparison of two techniques for ultrasound-guided axillary brachial plexus blockade in cats. J Feline Med Surg 17(6), 476-485 PubMed.
  • McCally R E, Bukoski A, Branson K R et al (2015) Comparison of short-term postoperative analgesia by epidural, femoral nerve block, or combination femoral and sciatic nerve block in dogs undergoing tibial plateau leveling osteotomy. Vet Surg 44(8), 983-987 PubMed.
  • Pascoe P J (2015) The cardiopulmonary effects of dexmedetomidine infusion in dogs during isoflurane anesthesia. Vet Anaesth Analg 42, 360-368 PubMed.
  • Sarotti D, Rabozzi R, Franci P (2015) Comparison of epidural versus intrathecal anaesthesia in dogs undergoing pelvic limb orthopaedic surgery. Vet Anaesth Analg 42, 405-413 PubMed.
  • De Gennaro C, Vettorato E, Corletto F (2014) Retrospective clinical evaluation of hypobaric spinal anaesthesia in dogs underoing pelvic limb orthopedic surgery. JSAP 55, 497-503 PubMed.
  • Lorenz N D, Comerford E J, Iff I (2013) Long-term use of gabapentin for musculoskeletal disease and trauma in three cats. J Feline Med Surg 15(6), 507-512 PubMed.
  • Steagall P V & Monteiro-Steagall B P (2013) Multimodal analgesia for perioperative pain in three cats. J Feline Med Surg 15(8), 737-743 PubMed.
  • Vettorato E, De Gennaro C, Okushima S et al (2013) Retrospective comparison of two peripheral lumbosacral plexus blocks in dogs undergoing pelvic limb orthopedic surgery. JSAP 54, 630-637 PubMed.
  • Lamata C, Loughton V, Jones M et al (2012) The risk of passive regurgitation during general anaesthesia in a population of referred dogs in the UK. Vet Anaesthes Analg 39, 266-274 PubMed.
  • Vettorato E, Bradbrook C, Gurnery M et al (2012) Peripheral nerve blocks of the pelvic limb in dogs: a retrospective clinica study. Vet Comp Orthop Traumatol 25, 314-320 PubMed.
  • Costa-Farre C, Blanch X S, Cruz J I et al (2011) Ultrasound guidance for the performance of sciatic and saphenous blocks in dogs. Vet J 198, 221-224 PubMed.
  • Vettorato E & Corletto F (2011) Gabapentin as part of multi-modal analgesia in two cats suffering multiple injuries. Vet Anaesthes Analg 38(5), 518-520 PubMed.
  • Panti A, Bennett R C, Corletto F et al (2009) The effect of omeprazole on oesophageal pH in dogs during anaesthesia. JSAP 50, 540-544 PubMed.
  • Pyendop B H, Ilkiw J E (2005) Assessment of the hemodynamic effects of lidocaine administered IV in isofluance-anesthetized cats. Am J Vet Res 66, 661-668 PubMed.
  • Keates H L, Crmond T, Smith M T (1999) Intraarticular and periarticular opioid binding in inflamed tissue in experimental canine arthritis. Anesth Analg 89, 409-415 PubMed.

Other sources of information

  • Otero P E, Portela D A (2019) Peripheral nerve block of the thoracic limb. In: Manual of Small Animal Regional Anesthesia. 2nd edn. Otero P E, Portela D A (eds). Chapter 4-10, pp 47-130.
  • Otero P E, Portela D A (2019) Peripheral nerve block of the pelvic limb. In: Manual of Small Animal Regional Anesthesia. 2nd edn. Otero P E, Portela D A (eds). Chapter 12-10, pp 137-218.
  • Kerr C L (2016) Pain management I: systemic analgesics. In: BSAVA Manual of Canine and Feline Anaesthesia and Analgesia 3rd edn. Duke-Novakovski T, de Vries M and Seymour C (eds) Ch. 10, 124-142.
  • Duke-Novakovski T (2016) Pain management II: local and regional anaesthetic techniques. In: BSAVA Manual of Canine and Feline Anaesthesia and Analgesia 3rd edn. Duke-Novakovski T, de Vries M and Seymour C (eds) Ch. 11, 143-158.


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