What question did this study set out to answer?

To assess a novel regional anesthesia technique for enhanced recovery in dogs undergoing surgery.

March 14, 2026Open Access

Novel ultrasound-guided Flags Assisted WalKing block for Enhanced recovery after Surgery (FAWKES) in three dogs undergoing tibial plateau levelling osteotomy

Key Points

To assess a novel regional anesthesia technique for enhanced recovery in dogs undergoing surgery.
Described a case series of three dogs undergoing tibial plateau levelling osteotomy.
Utilized a combination of nerve blocks, including FLAGS and saphenous blocks, with specific anesthetic agents.
Monitored physiological parameters like heart rate and blood pressure during the procedure.
Two out of three dogs ambulated on the operated limb within one hour of recovery.
Postoperative analgesia was achieved with minimal additional medication required.
All dogs were discharged without complications within 12 hours of surgery.

Abstract

This case series describes a novel, regional anesthesia technique in three dogs of various breeds, aged 2.5, 8 and 10 years old, weighing 42.6 kg, 32.6 kg and 13.4 kg, respectively, presenting for tibial plateau levelling osteotomy. Physical examination was unremarkable aside from evidence of a ruptured cranial cruciate ligament. Following anesthetic premedication and induction of general anesthesia, the affected limb was aseptically prepared. A combination of regional nerve blocks were performed, including the inFiLtrating Around Genicular Structures (FLAGS) block, saphenous block and periarticular knee infiltration; together, termed the Flags Assisted WalKing block for Enhanced recovery after Surgery (FAWKES). A mixture of 0.5% ropivacaine (4 mg kg -1 ), dexmedetomidine (1.6 ug kg -1 ), dexamethasone sodium phosphate (0.004 mg kg -1 ), and epinephrine (4 ug kg -1 ) were used for the FLAGS (0.2 mL kg -1 ), saphenous (0.1 mL kg -1 ) and periarticular knee infiltration (0.125 mL kg -1 per site; four sites). There were no increases in heart rate, respiratory rate, or mean arterial blood pressure greater than 20% from surgical start time to end time, aside from expected elevations following administration of anticholinergics or vasopressors. All dogs retained motor function postoperatively. Two of three dogs ambulated on the operated limb within one hour of recovery. The third was non-weight bearing but able to flex the stifle and elevate the limb. One dog was given a single postoperative dose of intravenous methadone (0.2 mg kg -1 ) 12 hours after surgery while the remaining dogs required no rescue analgesia. All dogs ate within 12 hours of surgery and were discharged without complications. These findings suggest that the described multimodal analgesic plan, including the FAWKES block, provided adequate intraoperative analgesia, while preserving motor function postoperatively. Controlled studies are required to evaluate the efficacy and safety of the FAWKES block, along with more detailed anatomical investigations of the canine stifle joint.

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