Page 130 - BSAVA Guide to Pain Management in Small Animal Practice

7 | Thoracic pain

VetBooks.ir CASE EXAMPLE CONTINUED TIPS OM T E AUT O

PERIOPERATIVE MANAGEMENT he author uses minimal pro le thoracostomy
drains from Mila International. The drains are
Following overnight stabilization, the placed using a modi ed Seldinger wire
animal was anaesthetized. A fentanyl CRI techni ue igure 7. . he drains are ideally
g kg h and ketamine CRI g kg placed before closure of the thoracotomy
min were started before surgery. wound so that correct placement can be
Bupivacaine . mg kg intercostal con rmed by visual inspection. hen placed
nerve blocks were performed. Exploration in a closed chest, radiographic con rmation is
and resection of the a ected areas over both necessary. When instilling bupivacaine via the
hemithoraces was performed. The thoracic thoracostomy tube, make sure the animal
cavity was lavaged and all wounds apposed. is positioned in lateral recumbency with
A minimal pro le thoracostomy drain was the incision site down or in dorsal recumbency
placed in the right hemithorax and an to allow the local anaesthetic to pool near the
oesophagostomy tube was left in place. incision site and close to the intercostal nerves.

3
methadone . mg g i.v.
propofol . ml i.v.
. mm
circle ventilator
ml g h

POSTOPERATIVE MANAGEMENT (a)
Pain assessment was regularly performed
and guided by the use of the Glasgow
Composite easure Short orm Pain Scale. A
morphine CRI .1 mg kg h and ketamine
CRI g kg min were administered for
the rst 4 hours and bupivacaine .
1 mg kg 6h was instilled through the
thoracostomy tube. After this period, feeding
via the oesophagostomy tube was initiated
and the ketamine CRI stopped. The morphine
CRI was continued for another 48 hours Placement of a minimal pro le thora
followed by buprenorphine g kg for 3 costomy drain during an intercostal
another 7 hours. he dog was sent home on thoracotomy using a modi ed Seldinger wire
meloxicam .1 mg kg orally once daily and technique. (a) The catheter is tunnelled subcuta-
4 mg paracetamol 9 mg codeine neously and introduced into the thoracic cavity over
a stylet, away from the surgical incision. The J-wire
phosphate half tablet, twice daily . is threaded through the catheter and advanced
cranioventrally. The catheter is removed over the
guide wire and the minimal pro le drain advanced
into the thoracic cavity over the guide wire. The
guide wire is then removed and the thoracostomy
tube is secured in place.

125

Ch07b Pain Management.indd 125 19/12/2018 10:40