Vet Med - Czech, 2024, 69(4):123-129 | DOI: 10.17221/118/2023-VETMED

Repeated bolus injections of bupivacaine for continuous bilateral transversus thoracis plane block undergoing median sternotomy in a dog: A case reportCase Report

D Kim1, D Shin1, S Yun1, G An1, J Jung1, WG Son2
1 Ilsan Animal Medical Center, Goyang, Republic of Korea
2 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea

An 8-year-old, 6.5 kg, neutered female Shih-Tzu dog was presented for surgical resection of a mediastinal mass. A median sternotomy and left cranial lung lobectomy were performed. Intraoperatively, with the patient under general anaesthesia, a bilateral transversus thoracis plane (TTP) block was performed by injecting 0.5% bupivacaine (0.2 ml/kg) per side using real-time ultrasound guidance. After surgery, indwelling catheters for repeated bolus injections of bupivacaine in TTP were placed as follows: the fifth sternebra was palpated in dorsal recumbency, and the transducer was placed in the longitudinal plane lateral to the sternal border. A 16 gauge over-the-needle catheter was inserted caudo-cranially using an in-plane technique and located in the TTP. An intermittent bolus of bupivacaine (0.1 ml/kg) per side was injected via the indwelling catheter every 8 h for 3 days, with a constant rate infusion of an intravenous fentanyl (1 μg/kg/h) and ketamine (0.12 mg/kg/h) combination. Post-operative pain was evaluated using the Glasgow composite measure pain scale and the score was 4–5/24 on the day of surgery and gradually decreased over time. Additional rescue analgesia was not required. Repeated boluses of bupivacaine for a continuous bilateral TTP block may be a useful adjuvant for perioperative pain management strategies, including median sternotomy, in dogs.

Keywords: acute pain; indwelling catheter; lobectomy; thoracotomy; ultrasound-guided

Received: November 17, 2023; Revised: February 22, 2024; Accepted: March 19, 2024; Prepublished online: April 25, 2024; Published: April 26, 2024  Show citation

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Kim D, Shin D, Yun S, An G, Jung J, Son W. Repeated bolus injections of bupivacaine for continuous bilateral transversus thoracis plane block undergoing median sternotomy in a dog: A case report. Vet Med - Czech. 2024;69(4):123-129. doi: 10.17221/118/2023-VETMED.
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