Maggies TPLO

History
Maggie is a 8 year old, Lab presented for an examination of a
possibly torn ACL and radiographs (per another vet while on
vacation)
Weight: 79.3 lbs
Temperature: 101.7 F
Radiograph showed probable ACL issue
Exam: Musculoskeletal cranial drawer sign of RIGHT knee;
prominent popping noise when bending knee
Plan: refer to our knee specialist and schedule TPLO ASAP

History Continued (Surgery Day)

Weight: 81 lbs
Temperature: 100.7 F
Pre meds administered IM: 0.08cc Acepromazine and 4cc
Hydromorphone
Placed 20g IV catheter in RIGHT cephalic vein
Admin. 3.2cc Rimadyl SQ in LEFT shoulder
Epidural: 0.8cc Hydromorphone/5.2cc Lidocaine
Maintained on a CRI with 0.8cc Hydromorphone, 2cc Lidocaine,
and 1.3cc Ketamine

History Continued (Surgery Day)

Pre op examination indicated positive cranial drawer of right stifle
and TPA of 33 degrees
Medial parapatellar incision and arthrtotomy indicated complete
tear of CCL, no meniscal damage noted and no meniscal release
performed
Performed osteotomy with 24mm blade and rotated 11.5mm
Secured osteotomy with 3.5mm VOI precontoured locking plate
Closed joint capsule/facia with 0 PDS, closed fascia with 2-0
Monocryl, stapled skin closure

Hydromorphone
Hydromorphone is used for every TPLO procedure to control pain
It is an injectable opiate that is good for sedation, analgesia, and
for use as a preanesthetic

Adverse effects in dogs include: nausea/vomiting, defication,

panting, vocalization, sedation, CNS depression, respiratory
depression, and bradycardia
It is a C-II controlled substance

Agonist
Hydromorphone acts as an agonist
Defined by Merriam-Webster Dictionary as a chemical substance
capable of combining with a specific receptor on a cell and
initiating the same reaction or activity typically produced by the
binding endogenous substance
It combines at the mu receptors for primary activity which
includes: analgesia, antitussive activity, respiratory depression,
sedation, emesis, physical dependence, and intestinal effects
(constipation/defication)

Agonist Continued
Receptors for opiate analgesics are found in high concentration in
the limbic system, spinal cord, thalamus, hypothalamus, striatum,
and midbrain
This is why the combination of the IM injection, epidural, and the
IV CRI work so well in controlling the pain

Metabolized and Elimination

Hydromorphone is metabolized in the liver, primarily by
glucuronidation (which is excreted by the kidneys)
Then it is eliminated by the kidneys and the rest of the urinary
system

Conclusion: Post Op
Recommend e-collar for 10 days and restricted activity for 8
weeks with radiographs at that time to confirm union
Recommend physical therapy to facilitate early return to full
weight bearing

Conclusion: 8 Weeks Post Op

Radiographs indicate complete union of osteotomy. No palpable
abnormalities and no pain upon ROM. Muscle atrophy present
Plan: recommend more aggressive physical therapy to strengthen
rear limb

References
Plumb, Donald C. Plumb's Veterinary Drug Handbook. 7th ed.
Stockholm, WI: PharmaVet, 2011. 509-11. Print.
Merriam-Webster Dictionary