Page 106 - Clinical Manual of Small Animal Endosurgery

94 Clinical Manual of Small Animal Endosurgery

arthroscopically assisted autogenous osteochondral grafting may become
the preferred method for this technique to reduce operative morbidity.

Arthroscopically assisted management of septic arthritis of the stifle joint
Management principles follow those described for the elbow.

Arthroscopically assisted surgery of the tarsus
Arthroscopic surgery of the tarsus is challenging due to the complex
anatomy, and because of the limitations of the small intra-articular joint
space. Arthroscopic assistance can be valuable in the surgical manage-
ment of tarsal OCD, for obtaining surgical biopsies and for the manage-
ment of septic arthritis. The reader is referred to the Further reading
section at the end of this chapter for more details.

Postoperative care following arthroscopic surgery

Although arthroscopic surgery generally has lower surgical morbidity
than traditional open joint surgery, control of postoperative pain remains
an important aspect of care for the arthroscopic patient. Whereas the
arthroscopic procedure often induces less surgical injury and pain than
a comparable traditional arthrotomy, many of the conditions treated
arthroscopically are of their own right painful. Patients consequently
require postoperative analgesia that is appropriate and effective, and
which is delivered with close monitoring in order to achieve good post-
operative comfort. Routinely, postoperative analgesia should be assisted
through the administration of intra-operative ropivacaine (0.5–1 mg/kg).
This is best given prior to commencement of the arthroscopic surgery,
since effective intra-operative analgesia reduces postoperative pain per-
ception. At the end of the arthroscopic procedure an additional intra-
articular injection is given (2 mg/kg), in combination with intra-articular
morphine (0.1 mg/kg). The maximum total recommended dose of ropi-
vacaine in dogs should not exceed 3 mg/kg, although in practice the
quantity of drug given is limited in most cases by the volume of the
7.5 mg/ml solution that can be readily instilled into the intra-articular
space, and doses approaching 1 mg/kg are more convenient given this
limitation. Intra-articular analgesia contributes to postoperative pain
management as part of a global approach to patient analgesia. Addi-
tional systemically administered analgesic agents should be given in the
postoperative period, as necessary, to patients that are predicted to be
or which are painful following the arthroscopic procedure.
Non-steroidal anti-inflammatory drug (NSAID) medication should be
prescribed routinely for patients undergoing arthroscopic surgery. Under
ideal circumstances, when clinical considerations permit, the NSAID is
given intra-operatively to reduce the surgical nociceptive stimulus and is