Pain Management in the Veterinary Practice

Tasha McNerney, CVT, CVPP, anesthesia technician at the Center for Animal Referral and Emergency Services, discusses ways to enhance pain management practices.

Interview Transcript (slightly modified for readability).

“When talking about pain management, there are a lot of things that a practice could do to elevate their game or get a gold standard; but one of the simplest, cheapest, cheapest, cheapest [things] for your practice [to] do, is [use] local blocks. So if you’re not doing local blocks on your patients, you really should be doing them for every surgical procedure; for anything from spays, just doing a line block along the incision, makes a huge difference. Dentistry, anytime you’re taking out teeth, or taking a biopsy of a growth in the mouth, you want to be doing a local block. It’s going to change the way that you practice anesthesia because you’re going to use less inhalant anesthetic overall, right?

We know, we get into these dentistries, and if we’re not blocking, [we] start to take the tooth out and then what happens? That patient starts [breathing heavily, and] waking up under anesthesia because those pain signals are going to the brain. Well, if we put a local block in place, we eliminate those pain signals going into the brain, [and] they’re not needing more inhalant anesthetic during the actual anesthesia. Then, if we don’t have as much inhalant anesthetic on board, we’re seeing less hypotension. In these old, decrepit cats that need 13 extractions, we don’t want them in an isoflurane level of 4 or 5%, because we know that’s detrimental. So, if we do balanced anesthesia— an opioid, plus a local block, plus a little bit of inhalant anesthetic– we can make that procedure safer for the patient overall, instead of [administering just] a whopping dose of an inhalant anesthetic.

If your practice is not doing local blocks, I would suggest getting educated on local blocks, again, there are many resources online, that will talk about different local blocks, there are a lot of good books out that will look at local blocks, [such as] Pain Management for the Veterinary Technician where Mary Allen Goldberg is the editor and Nancy Shaffran is one of the other editors, is a great resource for technicians who are interested in pain management. They have a whole chapter on local blocks with landmarks and everything, from sacrococcygeal blocks to dentistry blocks to epidurals; everything you could need local block-wise.”