Canobolas Family Pet Hospital / Post op care

Canobolas Family Pet Hospital

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The postoperative course begins upon completion of the surgical procedure and continues until the patient achieves the expected end point of recovery.

GENERAL CARE
TEMPERATURE, PULSE, RESPIRATORY RATE (TPR)
The TPR should be taken and recorded every 15 minutes following surgery until the animal has completely recovered from anesthesia. If blankets or heating pads are used to increase body temperature, they should be monitored to prevent burns. Body temperature, specifically, should be monitored until a return to normal or until it levels off at a higher temperature.

Elevations in body temperature may reflect a previous preoperative fever, fever due to the absorption of necrotic debris around the site of trauma, inflammation, infection, or fever of unknown origin. Hopefully, the cause of the fever can be determined and the fever treated appropriately. Aspirin is a very effective antipyretic agent that works well in such cases; it should not be used in the animal on anticoagulant therapy, however.

Most animals with fever following surgery have an elevated body temperature for reasons other than infection. There is no rationale for using antibiotics unless the surgeon knows of infection or suspects that contamination occurred at the time of surgery.

ANTIBIOTICS
The use or abuse of antibiotics has become a controversial topic. Each surgeon has an opinion that can be supported by the literature. In general, antibiotics are used more commonly to assuage surgeons' and owners' fears of possible infection than for medical reasons.

Known cases of infection (osteomyelitis, infected nonunion, infected fracture site or septic arthritis) should be treated with appropriate antibiotics. A culture and sensitivity will be necessary to determine the correct drug.

Contaminated injuries, such as those contaminated through open fracture, open wound, prolonged surgical time (over 2 hours), or a break in surgical asepsis, should be cultured at surgery and an antibiotic sensitivity performed. If the contaminated wound is properly flushed, debrided, and drained, antibiotics may be unnecessary. If the surgeon questions the efficacy of cleaning the wound or of the surgery itself, a broad-spectrum antibiotic should be given until the culture results are known. If the culture is positive, antibiotics can be used according to the sensitivity. If the culture is negative, antibiotics should be stopped.

Clean, elective surgeries of less than l l/2 to 2 hours duration require no antibiotics postoperatively.

ANALGESICS
Most animals do not require analgesics postoperatively. If handled with care to prevent manipulation of the surgical area, animals evidence little apparent discomfort. Acute pain or discomfort evidenced by crying while Iying unmolested does require medication. Aspirin and phenylbutazone (Butazolidin) administered at appropriate doses are the first line of treatment, and if ineffective are followed by narcotic or narcoticlike drugs. The narcotics are used to effect and then gradually withdrawn. Continued need for analgesia after one week usually reflects a problem associated with surgery and necessitates re-evaluation.

EXTERNAL FIXATION
External fixation may be the primary form of orthopaedic management or may be only supplementary to an operative procedure. If external devices are used, they must be applied while maintaining the limb in proper midrange position. The splint or cast should be kept dry and clean, which can be facilitated by a large plastic bag (e.g., trash can liner) over the external fixation. The limb should be observed every 4 to 6 hours to be certain that the device has been applied properly, i.e., is not loosening or constricting the vasculature in the limb. Any alterations may require removal of the device and reapplication. (For a complete description of external fixation see Chapter 16.)

When the animal is ready for discharge, owners must be educated in the proper care of the cast or splint. A written description of proper splint care should be given to the owner.

HOME CARE OF ANIMALS WITH SPLINTS OR CASTS
It is of extreme importance for the well-being of your pet that a splint or cast be well cared for at all times. You, as the pet owner, must assume this responsibility.

It should be realized that under certain conditions (i.e., getting wet, slippage from its original position, etc.) the splint or cast may not perform its function properly or may even do severe damage to the animal, such as causing gangrene of the foot. Examine the splint or cast daily. Watch for swelling of the leg above the splint, and pinch the toes through the splint daily to ensure the animal has good sensation in them and that the toes have not become swollen.

Keep the splint or cast dry at all times. When the animal must go outside during wet weather, a plastic bag can be used to keep the splint or cast dry. Remove this when the animal is back inside.

Talcum powder or cornstarch helps to prevent friction sores that may occur where the splint or cast rubs in the groin or the armpit of the animal.

If any of the following events occur, return the animal to the hospital that day, where you will be attended to by either the orthopaedic staff, if available, or someone from the emergency service:

1. Any change in position or shape of the splint or cast on the limb
2. Any excessive chewing of the splint or cast by the animal
3. Any sign of excessive discomfort
4. Any unusual or bad odors coming from the splint or cast
5. Any unexplained soiling of the splint or cast that was not present before
6. Any pronounced sores that develop at the top of the splint or cast that do not respond to talcum powder or cornstarch application
7. Swelling of the toes, or the leg above the splint
8. Inappetence, depression, or fever in your pet

Be sure to make and keep an appointment to have the splint or cast examined and adjusted by the doctor in charge.

No splint or cast can be worn in complete comfort by the animal, and minor licking or chewing is to be expected. A few animals will persist in mutilating even the most carefully made and fitted splints or casts. If there is even a suggestion of trouble, it is always best to have the animal examined right away.

INTERNAL FIXATION
Owners become a critical part of postoperative care when the animal returns home.They tend to be more lax if the animal has internal fixation rather than external fixation. If a splint is not present, the assumption is that the animal may return to normal function. Proper aftercare should be discussed with the owner and reinforced with a set of written instructions.

Animals should be restricted to the house, cage, small run, or leash walks until there is radiographic evidence of union. A return to normal function, namely, free running, prior to union will result in complications. This is true of all fractures.

POSTOPERATIVE RADIOGRAPHS
Radiographs should be taken immediately following surgery and every 2 to 5 weeks until union. Films should be taken following removal of internal fixation.

REHABILITATION
Most ambulatory dogs do not require active rehabilitation. Animals should be encouraged to continue limited exercise (e.g., leash walks) as soon as possible. Passive manipulation of the affected limb can be effective; swimming is also beneficial in most instances.

DIET
Following orthopaedic surgery the animal's diet should be of adequate quantity and well balanced. The addition of supplementary vitamins and minerals is of doubtful value. If pathologic fractures are present as a result of osteoporosis, calcium phosphorus and vitamin D are indicated (For a more complete discussion see Chapter 59.)