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

• Published in: Veterinarni medicina Vol. 69; no. 4; pp. 123 - 129
• Main Authors: Kim, Dalhae, Shin, Dongmin, Yun, Sookyung, An, Gayeon, Jung, Joohyun, Son, Won-Gyun
• Format: Report
• Language: English
• Published: 01.04.2024
• ISSN: 0375-8427
• DOI: 10.17221/118/2023-VETMED

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.