Page 80 - Clinical Manual of Small Animal Endosurgery

68 Clinical Manual of Small Animal Endosurgery

Anaesthetist

Instruments
Tower

Anaesthesia
machine

Patient

Surgeon
Assistant
Fig. 3.1 Theatre organisation for elbow arthroscopy. The surgeon and the
assistant are on the side of the laterally recumbent patient, and the
arthroscopy tower is located on the opposite side.

irrigation can be problematic. A 3.5 mm-diameter high-fluid-flow cannula
is available for the 1.9 mm scope which helps to maintain a haemorrhage-
free view when performing surgery; this high-flow cannula is useful when
allowed by the size of the joint treated.
The patient is positioned in lateral recumbency with the upper limb
tied caudally along the side of the thorax and the surgical limb laid on
the operating table, with the elbow joint positioned on a sandbag, near
the edge of the operating table (Fig. 3.1). Prior to giving intra-operative
analgesia, aspiration of joint fluid confirms intra-articular placement and
allows sampling for analysis for conditions for which joint fluid analysis
contributes to the diagnostic work-up. Intra-articular preoperative anal-
gesia is delivered using a combination of 1–3 ml of 7.5% ropivacaine
with 0.1 mg/kg morphine (Fig. 3.2). The injection needle is inserted into
the joint space from caudal, alongside the olecranon, passing the needle
under the medial epicondyle. Following injection, the needle and syringe
are left in place. During the few minutes of onset of the analgesia, the
theatre trolley is organised, the patient is draped using an adhesive fluid-
impervious drape and the arthroscopy equipment is set up and prepared.
This should include confirmation that the arthroscope is appropriately
focused and white-balanced, the irrigation system is operating and the
monitor and the recording equipment are functioning.
Surgically assisted elbow arthroscopy requires three portals: the egress,
the arthroscopic portal and an instrument portal (Fig. 3.3). The egress
portal is already established by the preoperative analgesia injection and
transfer of syringes to a 10 or 20 ml syringe enables distension of the