Page 107 - Clinical Manual of Small Animal Endosurgery

Operative Arthroscopy 95

continued postoperatively for several days until the joint is comfortable.
There is patient- and condition-associated variation in the duration for
which there is musculoskeletal discomfort and for which NSAIDs provide
a pain-relieving effect but, in general, NSAIDs should be administered
for the duration for which discomfort is anticipated. For some patients,
a 10-day period of treatment may be sufficient in duration, but many of
the joint diseases treated arthroscopically are associated with marked
and often chronic inflammation and pain, and resolution of discomfort
does not occur rapidly following the arthroscopic procedure. For these
patients, ongoing postoperative discomfort can be anticipated and a 2–4-
week course of a licensed and safe NSAID may be required.
Some joint problems that are treated with arthroscopic intervention
require considerable intra-operative manipulation and stressing of liga-
ments, causing intra-operative and postoperative pain. Some joint prob-
lems are associated with significant pain before the arthroscopic procedure
and postoperative pain is anticipated. Such cases are indications for
support in a compressive and supportive dressing which protects the joint
from potentially painful movement in the early postoperative period. The
compression from the dressing also helps to control the tendency for
postoperative swelling. A supportive dressing may be maintained over-
night following a procedure, or for several days, depending on the sever-
ity and controllability of the predicted postoperative pain. A supportive
dressing prevents early postoperative movement and, in human beings,
this promotes joint stiffness. However, it is not readily possible to achieve
in animals the early postoperative ranges of joint motion achieved in
humans with the use of continuous regional intravenous local anaesthetic
infusions, combined with machine-delivered automated excursions of the
operated joint. Consequently, the analgesic effect of a supportive dressing
appears to offer the veterinary patient a better level of postoperative care
than leaving the joint unsupported while attempting to perform passive
range-of-motion activities that are markedly limited in terms of excur-
sion by postoperative pain.
Some workers advocate the use of postoperative cold therapy applied
intermittently using gel packs applied around the circumference of the
arthroscopically treated joint. Cold therapy may be helpful in providing
analgesia and in assisting resolution of swelling. In contrast to accepted
wisdom regarding the beneficial effects of cold therapy, recent scientific
evidence suggests that cold therapy may have adverse effects on tissue
healing through interfering with the elevations in insulin-like growth
factor that are important in tissue healing following injury (Lu et al.,
2011).
Following surgery, once the patient is beginning to use the treated
limb, if there is significant postoperative debility, a patient-specific reha-
bilitation programme should be implemented to encourage a gradual
increase in function of the operated joint and gradually increasing
weight-bearing with ambulation. The objective of the rehabilitation
programme should be to restore the patient towards preoperative