Tierärztliche Praxis Ausgabe K: Kleintiere / Heimtiere, Table of Contents

Tierarztl Prax Ausg K Kleintiere Heimtiere 2017; 45(04): 226-233
DOI: 10.15654/TPK-170049

Original Article

Schattauer GmbH

Comparison of two cold compression therapy protocols after tibial plateau leveling osteotomy in dogs

Vergleich von zwei Protokollen der Kälte-Kompressionstherapie nach Tibial Plateau Leveling Osteotomy bei Hunden

Niklas von Freeden

¹Clinic for Small Animal Medicine, University of Veterinary Medicine Hannover Foundation, Hannover, Lower Saxony, Germany

,

Felix Duerr

²Colorado State University, Department of Clinical Sciences, Fort Collins, Colorado, USA

,

Michael Fehr

¹Clinic for Small Animal Medicine, University of Veterinary Medicine Hannover Foundation, Hannover, Lower Saxony, Germany

,

Christian Diekmann

¹Clinic for Small Animal Medicine, University of Veterinary Medicine Hannover Foundation, Hannover, Lower Saxony, Germany

,

Cornelia Mandel

¹Clinic for Small Animal Medicine, University of Veterinary Medicine Hannover Foundation, Hannover, Lower Saxony, Germany

,

Oliver Harms

¹Clinic for Small Animal Medicine, University of Veterinary Medicine Hannover Foundation, Hannover, Lower Saxony, Germany

› Author Affiliations

Summary

Objective: To evaluate two different protocols of cold compression therapy (CCT) for pain management and functional recovery in dogs undergoing tibial plateau leveling osteotomy (TPLO). Material and methods: A total of 27 adult dogs (n = 30 stifles; staged bilateral procedures: n = 3) undergoing routine TPLO were randomly allocated to three groups (n = 10/group). Dogs of group I received CCT once before and immediately after surgery. In dogs of group II CCT was performed postoperatively four times at 6-hour intervals. Dogs of the control group did not receive CCT. Circumference of the stifle joint and the following pain-related parameters were measured by a single blinded observer before surgery and 1, 10 and 42 days after surgery: stifle joint range of motion (ROM), subjective degree of lameness, and score of a modified Glasgow Pain Scale (GPS). Results: Both CCT groups showed significantly greater ROM and lower GPS scores 24 hours after surgery compared to the control group. Ten days after surgery there was a significantly lower degree of lameness in both CCT groups compared to the control group. Fourty-two days after surgery a significantly greater ROM was observed in both CCT groups compared to the control group. Group II also showed a significant improvement in the degree of lameness and GPS. There were no significant differences in any of the parameters between the two CCT groups at any time point. Conclusion: CCT applied preoperatively and immediately postoperatively showed similar short- and long-term beneficial results compared to a previously established protocol of applying CCT four times postoperatively. This protocol may be more suitable for practical use. Clinical significance: The reported data can be used to establish the new protocol of CCT in a clinical surrounding and to support postoperative rehabilitation of the canine patient.

Zusammenfassung

Ziel: Vergleich von zwei verschiedenen Protokollen der Kälte-Kompressionstherapie (KKT) im Hinblick auf Schmerzmanagement und postoperative Rehabilitation bei Hunden nach Tibial Plateau Leveling Osteotomy (TPLO). Material und Methoden: 27 adulte Hunde (30 Kniegelenke; drei etappenweise bilaterale Eingriffe), bei denen eine routinemäßige TPLO erfolgte, wurden zufällig drei Gruppen zugeteilt (n = 10/Gruppe): Hunde der Gruppe I erhielten die KKT einmalig vor und unmittelbar nach der TPLO, bei Patienten der Gruppe II kam sie postoperativ viermalig im Abstand von 6 Stunden zur Anwendung und bei Tieren der Kontrollgruppe unterblieb sie. Ein einzelner geblindeter Untersucher bestimmte vor der TPLO sowie 1, 10, und 42 Tage nach dem Eingriff den Umfang des Kniegelenks sowie folgende schmerzrelevante Parameter: Bewegungsumfang (range of motion, ROM) des Kniegelenks, Lahmheit (subjektive Beurteilung) und Schmerzgrad anhand einer modifizierten Glasgow Pain Scale (GPS). Ergebnisse: In Gruppe I und II ergaben sich 24 Stunden nach der TPLO im Vergleich zur Kontrollgruppe signifikant höhere ROM-Werte und signifikant niedrigere GPS-Werte. Der Lahmheitsgrad war 10 Tage nach der Operation in Gruppe I und II signifikant geringer als in der Kontrollgruppe. 42 Tage nach TPLO zeigten Gruppe I und II im Vergleich zu der Kontrollgruppe signifikant höhere ROM-Werte. Für Gruppe II ließ sich zu diesem Zeitpunkt zudem eine signifikante Verbesserung hinsichtlich Lahmheitsgrad und GPS feststellen. Für keinen Parameter und zu keinem Messzeitpunkt bestanden signifikante Unterschiede zwischen den Gruppen I und II. Schlussfolgerung: Die jeweils einmalige Anwendung der KKT prä- und postoperativ zeigt ähnlich vorteilhafte kurz- sowie langfristige Ergebnisse wie ein etabliertes Protokoll mit viermalig postoperativ angewandter KKT. Dieses neue Protokoll kann in einer klinischen Umgebung praxistauglicher sein. Klinische Relevanz: Die ermittelten Daten können genutzt werden, um das neue Protokoll der KKT in die klinische Umgebung einzuführen und die postoperative Rehabilitation der Patienten zu unterstützen.

Keywords

Keywords

Cranial cruciate ligament rupture - TPLO - postoperative pain management - postoperative rehabilitation

Schlüsselwörter

Schlüsselwörter

Ruptur des vorderen Kreuzbands - TPLO - postoperatives Schmerzmanagement - postoperative Rehabilitation

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