Ultrasound-guided transversus thoracis plane block as part of multimodal analgesia in a dog undergoing median sternotomy

Barrientos, Manuel Alejandro Fernández; Merlin, Tristan

doi:10.1016/j.vaa.2022.08.008

Cited by 5 publications

(8 citation statements)

References 7 publications

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“…In veterinary medicine, the clinical use of this block has been reported by Fernández and Merlin in a dog undergoing median sternotomy and lung lobectomy. 24 However, it has never been described to provide perioperative analgesia in feline patients undergoing thoracic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In human medicine, the US‐guided TTP block is a locoregional analgesia considered an effective and safe technique with a high success rate, reducing the requirement for systemic opioids to provide pain relief in patients undergoing thoracic surgery. In veterinary medicine, the clinical use of this block has been reported by Fernández and Merlin in a dog undergoing median sternotomy and lung lobectomy 24 . However, it has never been described to provide perioperative analgesia in feline patients undergoing thoracic surgery.…”

Section: Discussionmentioning

confidence: 99%

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Thoracic transversus plane block as part of a multimodal analgesia plan in a cat undergoing sternotomy

Pérez

Martínez

Jiménez

2023

Vet Record Case Reports

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A 12‐year‐old, neutered, male, domestic shorthair cat presented for investigation of acute‐onset respiratory distress and cough. Computed tomography scan showed bilateral pleural effusion and dorsal elevation of the trachea compatible with a mass effect. A median sternotomy was performed. Anaesthetic protocol consisted of premedication with intravenous methadone (0.2 mg/kg), induction with alfaxalone to effect and maintenance with isoflurane in oxygen. Transversus thoracic muscle plane block was performed injecting 0.4 mL/kg of 0.25% bupivacaine per side. Fentanyl (2 μg/kg) was administered as rescue analgesia once during surgery. The Glasgow Composite Pain Scale was assessed postoperatively. Methadone was given as rescue analgesia postoperatively when Glasgow pain score was greater than 5/20. The first administration of methadone was required at 8 hours after the transversus thoracic muscle plane block was performed. This case showed that the ultrasound‐guided transversus thoracic muscle plane block is a feasible technique in feline patients as part of a multimodal analgesia plan in a cat undergoing sternotomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thoracic transversus plane block as part of a multimodal analgesia plan in a cat undergoing sternotomy

Pérez

Martínez

Jiménez

2023

Vet Record Case Reports

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“…4 Locoregional anaesthesia has proved to be superior to systemic opioids in terms of analgesic effect and reduction of complications. 5 In veterinary medicine, thoracic epidural, 12,13 thoracic paravertebral block, 14 intercostal blocks 15 and USguided transversus thoracis plane block 16 have been reported to provide thoracic wall analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…The same authors reported that the injection of 0.5 mL/kg at two points (the third and sixth intercostal spaces) in canine cadavers achieved a consistent staining of intercostal nerves, from the second to seventh intercostal space. 8 Currently, there are only two published case reports regarding the analgesic efficacy of the US-guided transversus thoracis plane block during median sternotomy, one in a dog 16 and one in a cat. 9 However, to the authors' knowledge, this is the first time that the approach described by Zublena and colleagues for dogs 6 was applied in the feline species.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided parasternal block in a cat undergoing median sternotomy for pulmonary lobectomy

Degani

Dupont

Giansetto

et al. 2023

Vet Record Case Reports

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A 3.25-kg, 1-year-old, European shorthair cat was referred for acute respiratory distress. A thoracic computed tomography revealed the presence of multiple pulmonary abscesses, and a median sternotomy for pulmonary lobectomy was scheduled. The cat was premedicated with methadone and dexmedetomidine, anaesthesia was induced with alfaxalone and maintained with isoflurane in 100% oxygen. Ultrasound-guided parasternal block was performed before surgery with ropivacaine 0.5% (total dose 3 mg/kg). Rescue analgesia was needed only during abscess debridement and lung lobectomy. Postoperative pain was assessed every hour, using the short-form Glasgow Feline Composite Measure Pain Scale. The cat required rescue analgesia (0.2 mg/kg methadone) 7 hours after the completion of the block. This case report describes the feasibility of ultrasound-guided parasternal block in a cat undergoing median sternotomy, suggesting that it can usefully be added to a multimodal analgesic plan in the perioperative period.

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“… Barrientos and Merlin (2022) described the clinical application of a TTP block in dogs, and Perez et al. (2023) described it in cats; however, the continuous TTP block technique has not been described in veterinary medicine.…”

mentioning

confidence: 99%

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

Kim,

Shin,

Yun

et al. 2024

Vet. Med.

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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.

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Ultrasound-guided transversus thoracis plane block as part of multimodal analgesia in a dog undergoing median sternotomy

Cited by 5 publications

References 7 publications

Thoracic transversus plane block as part of a multimodal analgesia plan in a cat undergoing sternotomy

Thoracic transversus plane block as part of a multimodal analgesia plan in a cat undergoing sternotomy

Ultrasound‐guided parasternal block in a cat undergoing median sternotomy for pulmonary lobectomy

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

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