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Multimodal analgesia and ongoing monitoring, ideally using a recognized veterinary pain scale, is important for the successful management of these patients [17]. Pain management may include opioid analgesics such as morphine (dogs 0.25–1 mg/kg IM every 4–6 hours; cats 0.05–0.5 mg/kg IM, SQ every 4–6 hours) or methadone (dogs 0.1–0.4 mg/kg IV every 4–6 hours; cats 0.05–0.2 mg/kg IV every 4–6 hours). To manage severe pain, fentanyl (dogs loading dose 1–2 μg/kg, maintenance 2–5 μg/kg/hour constant rate infusion, CRI; cats loading dose 1 μg/kg, maintenance 1–5 μg/kg/hour CRI) or morphine–lidocaine–ketamine infusions are sometimes indicated (see Chapter 1, Table 1.3 for detailed information on analgesia). Bupivacaine is a local anesthetic agent of relatively long duration used to block intercostal nerves during surgery. It can be diluted and administered into the pleural space, via the thoracic drain, postoperatively. The author uses a 0.25% solution at 2 mg/kg diluted to a volume that will adequately distribute to bathe the intercostal incision (i.e., 5–10 ml depending on the animal's size). Administration begins around six hours postoperatively, once the intercostal block performed at the time of surgery wears off. Non‐steroidal anti‐inflammatory drugs (NSAIDs, e.g., meloxicam 0.2 mg/kg IV loading dose, then 0.1 mg/kg daily from day 2 to day 5) may be indicated for patients that are not hypotensive, azotemic, or suffering from gastroenteritis. Acetaminophen (10 mg/kg IV every 12 hours) provides adjunctive analgesia in dogs and may be combined with NSAIDs. Acetaminophen is toxic to cats. Omeprazole (0.5–1.5 mg/kg IV every 24 hours) and sucralfate (500 mg–2 g/dog orally every 8 hours) are used to treat or prevent the establishment of esophagitis, reduced lower esophageal sphincter tone, and gastroesophageal reflux, which can contribute to patient morbidity, and the risk of subsequent esophageal stricture formation. Because these patients are at risk for aspiration pneumonia, broad‐spectrum antibiotics (e.g., cefuroxime 10–15 mg/kg every 8–12 hours) are indicated. Regular monitoring of respiratory status via clinical examination, pulse oximetry measurement, arterial blood gas analysis, and by thoracic imaging, if indicated, should be performed. Chest tubes are normally maintained for 12–24 hours. The timing of removal depends on the volume and nature of drain egress as well as any continuing need for a route of interpleural administration of local anesthetic agents. Endoscopically placed gastrostomy tubes are maintained for a minimum of 10 days, to allow an adhesion to form between the stomach and body wall. Surgically placed gastrostomy tubes may be removed at any time, because the stomach is pexied to the body wall by sutures. Gastrostomy tubes may be useful in the administration of postoperative nutrition and medications.