For veterinary professionals
October 26, 2026
Median sternotomy is uncommon in pet rabbits, and when it happens the analgesic plan has to be solid. Local anesthetic blocks that we use in dogs and cats are still sparsely described in rabbits. Melega and colleagues report bilateral ultrasound-guided transversus thoracic plane (TTP) blocks as part of multimodal analgesia in two rabbits undergoing sternotomy and mediastinal mass excision. It is a small series, but it is practical.
Two pet Lionhead rabbits underwent median sternotomy for mediastinal mass excision.
Local block: bilateral ultrasound-guided TTP blocks at the 2nd and 5th intercostal spaces. Bupivacaine 0.5% was used at a total dose of 2 mg/kg, split over four injection sites, with volumes of about 0.9 to 1.0 mL.
Systemic plan: premedication with methadone, dexmedetomidine, and midazolam; maintenance with isoflurane plus a ketamine CRI.
Intraoperatively, only one rabbit showed a brief nociceptive response. The second rabbit died about four hours after surgery from respiratory compromise related to thoracic drain malfunction. That death is a monitoring and equipment lesson as much as an analgesia one.
The report shows that ultrasound-guided TTP blocks can be performed in rabbits at clinically relevant sites for sternotomy, with a clear dose and volume description. Pairing the block with a familiar multimodal systemic plan makes the approach transferable for teams that already run ketamine CRIs.
Limitations are obvious: two rabbits, no control group, and no formal pain scoring comparison. One rabbit died from a postoperative drain problem, which limits what we can say about recovery quality after TTP blockade. Extrapolation from canine and feline TTP literature remains part of the reasoning until larger rabbit series exist.
For a rabbit facing sternotomy or another major thoracic approach, I would still build the plan around multimodal analgesia: appropriate premedication, inhalant or balanced injectable maintenance, a ketamine CRI when indicated, and local anesthesia wherever anatomy and skill allow. This paper supports adding a bilateral TTP block when ultrasound and dosing confidence are there.
I would verify the bupivacaine calculation twice, keep injection volumes small and distributed, and brief the recovery team specifically on drain function and respiratory monitoring for the first several hours. Families should hear that thoracic surgery carries meaningful risk beyond the incision itself.
If your practice rarely performs rabbit sternotomy, referral to a clinician comfortable with exotic companion mammal anesthesia and thoracic surgery is appropriate. See the referral information for veterinarians.
Melega I, Creț A, Turcu MC, et al. Bilateral ultrasound-guided transversus thoracic plane block as part of a multimodal analgesic plan in two rabbits undergoing median sternotomy. Vet Sci. 2026;13(9). doi:10.3390/vetsci13090863
If you want to talk through TTP block technique, ketamine CRI setup, or whether a thoracic rabbit case is a good fit for referral, I'm glad to help. I see referrals and colleague consults at Priest Lake Veterinary Hospital, (615) 361-4646. See the referral information for veterinarians.
This content is for educational purposes for veterinary professionals. It doesn't establish a VCPR or replace clinical judgment for an individual patient. Drug use and doses should be checked against current references and adjusted for each case.