Page 128 - BSAVA Guide to Pain Management in Small Animal Practice

7 | Thoracic pain

VetBooks.ir CASE EXAMPLE 1 CONTINUED ■ The maximum recommended time that a

(McCobb, protocol written for Mila
■ Postoperatively, bupivacaine may be catheter should be left in place is days
given as an intermittent bolus every 6 International .
hours at a dose of . mg kg in dogs
ansen et al., 1 .

e ex p e Pleural e u ion

HISTORY AND PRESENTATION 2
A year old female entire hippet, fentanyl g/kg i.v. +
presented with a 4 month history of episodes midazolam . mg g i.v.
of tachypnoea and laboured breathing at rest. alfa alone ml i.v.
. mm
CLINICAL SIGNS circle ventilator
ml g h
Clinical signs included pink and moist
mucous membranes, a capillary re ll time of
less than seconds, a heart rate of 17 bpm, Surgical management comprised thoracic
palpable and synchronous femoral pulses, a duct ligation and subtotal pericardiectomy via
respiratory rate of breaths per minute, a thoracoscopic approach and cisterna chyli
increased expiratory e ort and a temperature ablation via a right paracostal approach.
o
of 8.6 C. Thoracic auscultation showed Bilateral pleural ports were also placed.
mu ed lung sounds. Peripheral lymph nodes
and abdominal palpation were unremarkable. PERIOPERATIVE MANAGEMENT
No signs of pain were present.
A bolus of methadone . mg kg i.v. was
INVESTIGATIONS AND TREATMENT given and a fentanyl continuous rate infusion
CRI g kg h started before the begin-
A conscious lateral thoracic radiograph ning of surgery. An inter costal nerve block
revealed marked pleural e usion. horacic was performed before port placement with
ultrasonography con rmed marked bilateral bupivacaine . mg kg . A lumbosacral
pleural e usion. horacic drainage retrieved epidural block with morphine .1 mg kg
6 ml of a lightly red, turbid uid. Cytological was performed before recovery and a bolus
and biochemical evaluation of the uid were of methadone . mg kg was repeated
consistent with a chylous e usion. 4 hours after the rst dose. eloxicam
Bacteriological analysis yielded no growth. . mg kg i.v. was given at recovery.
Echocardiography and computed tomographic
imaging showed no cause for the e usion and POSTOPERATIVE MANAGEMENT
were consistent with a presumptive diagnosis
of idiopathic chylothorax. Medical manage- Pain assessment was regularly performed
ment was initiated. No improvement was and guided by the use of the Glasgow
observed in the following weeks and surgical Composite easure Short orm Pain
intervention was elected. The animal was Scale. he fentanyl CRI 4 g kg h was
anaesthetized and prepared for surgery. continued for 6 hours and methadone

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