If you work in a veterinary practice or in the pet industry or in a business that supplies goods or services to the industry and you have something to say - why not become a 'Guest Blogger'?
For more information click here to read our: Guidelines for Guest Bloggers
By Dr Daisy May, MRCVS BVSc, VetPrac
It’s only fair to make you aware from the start: this blog post is going to contain a lot of similes.
Similes? Those sound familiar, but maybe it’s been a while.
A simile is saying something is like something else. Those of us with kids currently studying around the Year 3 English level are probably painfully familiar with similes.
An example: your ultrasound machine is like a Sat Nav. That would be a simile.
Meanwhile, anatomy is like a landscape. And, if we may be poetic for a second, just like the terrain around us shifts, anatomy is also not always the same. Overly exuberant shrubbery (or fat pads) might absorb and obscure rural road signs in summer, or snow (rogue blood vessels) might make a planned route treacherous when you most need to take it.
And so, as you travel, you must work around the landscape; it does not work around you. It will change more times than a teenager changing their clothes before a festival, and – since we’ve moved to a new metaphor – also just like a moody 16-year-old, it may not seem very amenable. In this case, your approach needs to change.
Don’t forget about those little cartographic nuances, either. A combination of femoral and sciatic blocks will cover most of the stifle very effectively for a TPLO, but they can’t catch every side street:
The stifle has complex, overlapping innervation, so a little pain may still sneak through along country lanes. For example, obturator nerve sensory stifle innervation has been reported in more than one in four dogs. Hence there is still room for a nod of gratitude towards your dom, meth, ket and inhalant.
Now, at the risk of this post having more jumps than a jumpscare movie, let’s return to our landscape simile, because it most aptly suits what’s coming next: local nerve blocks are the most direct way to interrupt nociceptive traffic en route, before it backs up into an extremely painful jam.
This matters. It’s 2026, not 1996. Adequate (ideally better than adequate!) pain management is not optional. WSAVA’s pain guidelines frame this as a medical and ethical duty – and that ‘d’ word carries some significant weight, when you pause to think about it.
AAHA’s anaesthesia guidelines are even more directly routed, recommending specifically that local anaesthetics be used with every surgical procedure (where possible). Local and regional blocks are often overlooked, although very practical for day-to-day practice. They belong in your toolbox.
Don’t ask your systemic drugs to carry the whole load. Whacking up doses can invite a host of highly unpleasant side effects. Bye bye blood pressure. Hello, slow recovery. Please take your shoes off at the door, hypothermia. Why not? Oh, I see…you’re too cold.
A well-placed block is a ‘STOP’ sign, halting intra-operative nociception and postoperative pain signals slap bang in the middle of the road. These blocks are cheap as chips by the way, or with today’s cost of living, maybe cheaper. Certainly a lot cheaper than gas – luckily, within this metaphorical scenario, gas is free. A small volume of local, a needle, and the GPS you already have. Blocks punch well above their weight financially.
Now – here’s the part worth circling in red, the take-home, the crux of our occasionally questionable (thank you for pretending not to notice) clinical simile: You still need directions.
While in the past we may have suffered through with paper maps – ye olde textbooks – we now have a Sat Nav available in almost every clinic. A metaphorical Google Maps, or a Waze.
The hardest part was following that paper map; translating textbook anatomy into this patient, on this table, in that position, with this body condition…and honestly, who the hell knows where the nerve is actually at? It’s not clearly signposted.
Ultrasound helps you confirm landmarks, appreciate depth, identify neighbouring structures as well as (crucially) the nerve itself, and notice early when you are drifting off course.
Here’s the general idea:
What procedure are you performing and what area needs to not hurt? Which nerve, nerve group or fascial plane are you trying to reach? No point firing up the GPS until you know where you’re going.
Have you set your sights between the greater trochanter and the ischial tuberosity to approach the sciatic nerve? Or perhaps you’re currently backing up to take a run at an epidural. Identify your ideal route, but be prepared to adapt for different shapes, sizes and body condition scores of patients – variable landscapes.
If you can’t clearly answer ‘where am I heading?’, then don’t turn your key in the ignition. Go back and check your map. Or watch a quality video, like this one where Dr Fernando Martinez-Taboada explains clearly, practically and visually how to perform sciatic and femoral nerve blocks. This demo is completely free, by the way.
Before the probe touches the patient, be aware of the structures you expect to see as you go. What potholes and roadblocks (things to avoid) lie nearby? And what scenery and sights would make sense to run into along the road?
If the image is poor, the target is unclear or the spread (if you’re expecting to see it) doesn’t look right, recalculate. Get your Sat Nav settings in order. Reposition the patient, if needed. Return to a location you recognise and recommence along the route, following your landmarks again.
If you lose your way repeatedly, it’s time to:
If attempts are truly becoming unproductive this time, adapt your analgesia plan and consider whether further local nerve block training may be useful going forward.
Stopping to check and re-check the map ten times along the way was always the time consuming part. Plus having that poor tech stand, nobly holding the gargantuan tome open at your page until their arms began to quiver, felt nothing short of diabolic.
But when you get good with your Sat Nav, and familiar with the landscape – typically achievable with a genuinely concise chunk of training – then you don’t need to stop and check your map at all. You fly along comfortably…Chitty Chitty Bang Bang style.
Now the plot twist: you thought this was a revision of scientific principles.
It was surreptitiously, in fact, a Level 3 English lesson.
Margie is the Director of VetPrac and a globally respected veterinary anaesthetist, dedicated to practical, inclusive, and human-centred veterinary education. She began her career in general practice across Australia and the UK, grounding her teaching in real-world clinical experience. Specialising in anaesthesia and analgesia, Margie earned Membership of the Australian and New Zealand College of Veterinary Scientists, completed a residency at Cornell University (USA), and became a Diplomate of the American College of Veterinary Anesthesia and Analgesia. Her academic roles in the USA and Australia have focused on veterinary education, communication, and skills training. Since 2019, Margie has led VetPrac, delivering hands-on workshops and online courses that continue to inspire lifelong learning for veterinarians, nurses, and technicians.
Connect with Dr Margie:
When you’re considering offering CBD for your dog patients, you’re not looking for trends. You’re looking for evidence. Is this something veterinarians are actually studying?Is there real research behind it?Is it safe for long-term use? Over the past decade,...
