Page 59 - Clinical Manual of Small Animal Endosurgery

Diagnostic Arthroscopy 47

Fig. 2.17 Patient draped with impervious drape adhesed to the elbow
joint using surgical adhesive spray.

routine of procedures to clip and prepare the limb as for open surgery,
since sometimes it is necessary to convert the arthroscopic procedure to
an open arthrotomy and it is preferable to have the patient suitably
aseptically prepared for such an eventuality. To keep the patient pro-
tected from the arthroscopic irrigation fluids, an impervious drape should
be applied to the arthroscopic approach surface of the joint, with the
drape being large enough to prevent wetting of the patient. Either a self-
adhesive drape or alternatively an adhesive spray should be used to retain
the impervious drape on the surgical field (Fig. 2.17). Beyond the surgical
field, clips or clothes pegs can be applied to fix the drape to the operating
table, maintaining the slippery drape in its intended position.
Arthroscopy is a surgical procedure and penetrating the joint, and
distracting and twisting the limb to open joint spaces, are painful events
that require anaesthesia and appropriate analgesia. In addition to sys-
temically administered analgesic agents and to inhalational anaesthetic
agents, intra-articular administration of local anaesthetic (e.g. ropi-
vacaine 0.75%, 1–2 ml) a few minutes prior to commencement of
arthroscopy can improve intra-operative pain control. Similarly, postop-
eratively an intra-articular injection of a combination of ropivacaine
(0.75%, 1–2 ml, not exceeding 2 mg/kg) and morphine (0.1 mg/kg) can
augment the efficacy of the analgesic protocol used.
The operating room should be prepared with some thought, so that
the surgeon, the patient and the arthroscopy tower are all aligned, with
the surgeon looking directly beyond the patient at the monitor on the
arthroscopy tower (Fig. 2.18). This alignment of patient and equipment
is comfortable and it allows intuitive movements of the arthroscope
and instruments. Once connected to the arthroscope, it is important to