Procedural sedation combined with locoregional anesthesia for orthopedic surgery of the pelvic limb in 10 dogs: case series

Ten dogs weighing 36 (21.4–75) kg [median (min–max)] and aged 3 (1–9) years scheduled for orthopedic surgery involving the stifle and structures distal to it. Patients were classified as ASA I or II based on physical examination and basic hematology and biochemistry. Each dog was managed using combined femoral and sciatic nerve blocks and procedural sedation with an intravenous infusion of propofol (0.07–0.15 mg kg−1 minute−1) and dexmedetomidine (1 μg kg−1 hour−1). None of the patients required conversion to general anesthesia as a result of response to surgical stimulation. The level of sedation was considered adequate in all patients and was characterized by occasional head lifting, thoracic limb stretching, yawning, lingual movements and swallowing. The eye position ranged from central to partial ventromedial rotation and was accompanied by spontaneous blinking. Intra-operative cardiovascular and ventilatory variables were considered within acceptable limits. Muscle relaxation at the surgical field was adequate and surgical conditions were indistinguishable from those produced by general anesthesia. Intraoperatively, no additional analgesics were considered necessary. The quality of the recoveries was considered excellent in all cases. No additional pain relief was required in any of the dogs within the 10 hours following blockade. All dogs ate 5.5 (3.5–12) hours after recovery. Ambulation occurred at 4 (2–6) hours. No evidence of esophagitis or aspiration pneumonitis has been reported during a period of 1 year after the procedures in any of the dogs. When combined with femoral and sciatic nerve blocks, procedural sedation has the potential of being an alternative to general anesthesia for orthopedic surgery involving the stifle and structures distal to it in the dog.