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 Distal tibia: angular deformity, elbow dysplasia 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: medial 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 obstructive syndrome, 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

Anesthetic considerations

Risk of reflux and regurgitation

Post-operative care

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• 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 (4), 325-331 PubMed.
• Bini G, Vettorato E, De Gennaro C et al (2018) A retrospective comparison of two analgesic strategies after uncomplicated tibial plateua levelling osteotomy in dogs. Vet Anaesth Analg 45 (4), 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.
• 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 21 (12), 1127-33 PubMed.
• 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.
• Tayari 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 (5), 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 (10), 1175-1181 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 (10), 826-833 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 (4), 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 (4), 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 (10), 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 (12), 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 (3), 266-274 PubMed.
• Vettorato E, Bradbrook C, Gurnery M et al (2012) Peripheral nerve blocks of the pelvic limb in dogs: a retrospective clinical study. Vet Comp Orthop Traumatol 25 (4), 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 187 (2), 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 (10), 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 (4), 661-668 PubMed.
• Keates H L, Cramond T, Smith M T (1999) Intraarticular and periarticular opioid binding in inflamed tissue in experimental canine arthritis. Anesth Analg 89 (2), 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 3^rd 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 3^rd edn. Duke-Novakovski T, de Vries M and Seymour C (eds) Ch. 11, 143-158.