So good evening everybody, and thank you for joining us for this evening's webinar. So tonight, I'm going to introduce Gayle. Hallo well.

Gayle graduated from the University of Cambridge and then completed a rotating internship. She then completed a large animal internal medicine and critical care residency at the Royal Veterinary College in London. She completed a PhD in investigating aortic valve prolapse at the University of Nottingham.

And she's currently professor in veterinary internal medicine and critical care at the University of Nottingham as well. She's an American specialist in large animal internal medicine. An American specialist in large animal emergency and critical care and associate diplomat of the European College of Veterinary Diagnostic Imaging.

Her main interests are large animal cardiology, gastroenterology, imaging, which particularly autosography, analgesia, and emergency and critical care. And tonightail is going to be discussing farm animal analgesia. So, I'm gonna ask you if you have any questions for Gayle, if you want to type them in the question and answer box, and then we'll get to them at the end of the presentation.

So I'd like to hand over to Gayle, and thank you very much. Thanks very much, Caroline. Good evening, everyone.

So tonight, I'm gonna talk about farm animal analgesia, and where we're already doing a great job as farm animal vets and other things that we might want to consider. So I thought before we started and got into what I'm gonna talk about this evening, thinking about where analgesia fits in terms of that triad of balanced anaesthesia, because frequently in our patients we're very much. Focusing on the analgesia part and using systemic and local analgesia and we perhaps use sedation, anaesthesia and muscle relaxation a lot less than we would do if we were working with horses or small animals.

So the overview of what I'm gonna talk about tonight is to think a bit about the physiology of pain and why we do what we do or why we should do some of the things maybe we don't. Think about that concept of multimodal analgesia, which many of us are already doing and look on how we might build on that. Think about some of the classes of analgesic drugs, what their modes of action are, side effects, routes of administration.

And although when we're thinking about food producing animals, we're very much limited to what we've got that's licenced or currently, what we can use under the European Medicines Agency list of drugs that have got zero milk and meat withdrawal, but also thinking about some of the other drugs that are out there that we might want to use for pet ruminants, and I know everyone has got a different view how they get around that, in. In terms of hardcore people believing that they're food producing animals and should only be given licenced drugs to other people, sort of having generic sign off sheets and that sort of sign them out of the food chain. And then I've got some cases that we can talk about, about, approaches that we might have, where we're dealing with animals that definitely are, food producing or are gonna go into the food chain, and perhaps some of those others that are in a grey zone.

So let's start with what is pain. So pain is defined as an unpleasant sensory or emotional experience associated with actual or potential tissue damage. And some of that is caused by activation of.

No susceptors caused by noxious stimuli. Some of that is maybe neuropathic pain and is an area we perhaps are less good at looking at in large animal when we're thinking about large animal analgesia, and then we've got visceral pain. And when we think about pain, we've got sort of the acute pain, which largely is gonna be relatively easy to manage.

It is debated when acute pain becomes chronic pain. And then we've got those chronic painful conditions that we definitely do see on farm, and understanding why some of the drugs we use that would work for acute pain don't seem to work in those, in those patients that have got chronic pain. And we'll talk about that a bit later.

So what I've done here is I've put down all the classes of drug, now perhaps that's wrong, many of the classes of drug that we've got that we know have got analgesic properties. So we start with the things that we're very familiar with, such as the non-steroidals, and we've got several of those that are licenced in food producing animals, some of which are listed there. We've then got the opioids, where we don't have drugs licenced, but we do have quite a lot of information because they are, widely used in North America in food producing animals.

We've got lots of data on what they do, and maybe have got some some validity for using it for perhaps for farm pets. Then we've got the sodium channel blockers, which we'll all use for local blocks, and they can be used systemically as well. Then got the NMDA receptor antagonist, so, and although ketamine's not licenced in food producing animals, it has a zero milk and meat withdrawal, in Europe.

Now who knows what that's gonna mean, with whatever happens with Brexit, but for now it certainly suggests that there are probably minimal problems with us using those drugs, in, in individual animals that we might need it. We've then got the alpha 2 agonist, which we maybe don't use as often as we might because of either severe challenges that we've got in small ruminants or the fact that they cause unpredictable recumbency in, in cattle. And then we've got some of the random drugs, that I've listed here.

I haven't got the cannabinoids, who knows what will happen when cannabinoids become more available, for medical use in Europe, and particularly in the UK, but we've got paracetamol, we have got some data on paracetamol, in, in ruminants, and gabapentin, the same. And then we've got some of the other things that we can do, that perhaps we don't always think about, limb stabilisation for, severe lamenesses and fractures. We've got the use of heat and cold, and we've got, there's, there is some data for the use of acupuncture in ruminants for pain, although I personally don't have any experience of that.

So we've got our drugs, we've got this plethora of drugs and we'll come back and talk about each of those and then try and put them into context with some cases. So when we're thinking about multimodal analgesia, the thoughts are that we use more than one mechanism of action of a drug in order to block pain or to modulate pain at different parts of the pathway. And we really want to be thinking about what we're gonna do before surgery, what we're gonna do to make sure that analgesia lasts through surgery, and then what we're gonna do following surgery.

And again, there's some good data in ruminants about why each of those, covering each of those three steps becomes really important. And there's data from a multitude of species that show combinations of drugs provide more effective pain relief. And The one thing to note is that sodium channel blockers, which actually as farm vets, we use a lot of the time, are the only drug that truly blocks pain transmission.

All of the other drugs that I've got in my list simply modify, simply modify that, that how that pain is perceived either in the spinal cord or in the brain. So why is it important for us to try and have a plan that covers pain pre-surgically, surgically and post-surgically? And the answer to that is we want to prevent wind up.

And wind up is where we get to a point where the degree of pain that is felt becomes exacerbated and we end up with this state of hyperalgesia. And once it occurs. It can be pretty difficult or impossible to make those animals comfortable and I think it's, you know, one of those.

Factors why some of these animals we encountered have got chronic pain, become very, very difficult to manage in a welfare issues. So why do we care about using preemptive and multimodal analgesia? Well, we know that there's good data, in cattle.

Comfortable animals are more likely to eat and behave normally, they have more normal growth rates compared to animals that don't receive that, the, the basic things such as castration and . And disbudding, and we know that significant and prolonged pain results in depression and immunosuppression, increasing likelihoods of concurrent disease. Also, when you've got activation of the sympathetic nervous system, as happens with moderate to severe pain, it can have adverse effects on GI motility, increasing the likelihood of rhein stasis, abemasal and sel dilatation and vular.

And intestinal ileus. And in people, certainly they've shown mobility several weeks post abdominal surgeries much better in those patients that perceive they received appropriate analgesia and perioperatively. So we've got this sort of dairy cow here standing on the right, and I'm sure many of us have seen sometimes several, several and sometimes tens of several of these cows on specific farms where, where they've been painful for periods of time with things like foot abscesses, white Lyme disease, septic arthritis, .

General poor, foot management. And they can be really, really difficult to manage compared to animals that have got acute musculoskeletal, disorders that have been spotted much more quickly. And, you know, this car is in that sort of, on her way if she's not already into that chronic pain state.

And if you want to Try and manage these patients with chronic pain, you end up needing much higher doses of drugs, combined drugs, and, and longer courses to see effects. And obviously when we're starting to think about combined drugs, that becomes really challenging when we have a limited number that are available to us that are licenced in and food producing animals. The other thing that becomes tricky is that pain relief, particularly following surgery or for conditions that you are treating, you do need to give appropriate dosing intervals in order to make sure that that pain is controlled for the entire 24 hour period.

And this can sometimes be a real challenge for us with licencing, where drugs get licenced and they have to show that it, that those drugs. In Europe, at least, have a clinical effect, but they don't have to show that they have an optimal clinical effect. So sometimes there's this balance with licencing between what's wanted and what works, but not necessarily what works most optimally.

And we'll come on to talk about that with some of the, certainly some of the non-steroidals, in ruminants, thinking about their licencing, but what, in fact, in clinical studies have been shown to be more effective. And we know from what we've just talked about in order for preventing wind up, we need to give analgesia before and make sure that that action lasts throughout a surgical procedure, and then following that at appropriate dosing intervals in recovery. And I've talked about multimodal analgesia already.

So one of the things that we've said is, you know, limb stabilisation or stabilisation of other parts can have a massive impact upon, upon comfort levels. So this is an, this is an alpaca that actually had some field surgery for er an interception of its of its intestine, following large . Worm burden that it had got.

And actually, you know, that, the, the incision that got made was ventral midline. It got done under, under sedation, and local block. And, in fact, the comfort level once that bandage got put on, made a big difference because all the weight is going down onto that abdominal incision.

And obviously, the same applies for fractures, which, if you're gonna manage them, you would, you would do. The other thing challenge we have with, with ruminants is recognition of pain, and because they're prey species, that makes it much more difficult than perhaps it does in dogs and cats. And .

Often when they're in groups, they probably aren't observed enough to necessarily pick up all of these signs, although some of the senses we've got on dairy cattle now certainly would let us do that. So many of these animals, many ruminants will be subdued, they lie down more, they eat and ruminate less. They don't clear their nostrils as often, they might not lie in normal places, they will be less aggressive, which might mean that you'll see them in more, more involved in them being subservient, and they groom less and they are licked less.

So they're quite . They're quite sort of subtle signs that, you know, if you've got a small group, a small pet group, you might notice some of these things, but not necessarily when they're bigger, in bigger housing. So the group that we all know the best, probably, and that we use most frequently will be the non-steroidals.

The thoughts are that they're probably more effective for somatics, so for a musculoskeletal type pain, but I think that it depends on what models. Used in order to evaluate that. We know they're pretty good for mild to moderate pain.

There is very good data to suggest that they are well absorbed orally from both the rumen and the first compartment in camelids, because of their, their formulation. And that they generally, you know, do what they say on the team. We've obviously got transdermal, clinics in as well, that's got licenced, a few years ago.

The great thing with the nonsteroidals is they are anti-inflammatory and they are antipyretic. Although masking pyrexia doesn't mean you're fixing the problem, but it certainly will help those animals to feel better. We know from data in in in ruminants that non-steroidals will quickly reach high concentrations in joints and other inflamed areas.

There are thoughts, however, that they have a relatively narrow therapeutic range, and it's odd that it gets said that because we see very few animals in large animal practise that exhibit signs of toxicity. The link between non-steroidals and abemaal and third compartment ulceration in camelids is pretty unfounded and it's always hard to know, is it that the sick animals are likely to have reduced blood flow in their slant circulation and that results in ulceration. And are they the group that we give non-steroidals to, probably, but certainly when you look at clinical studies trying to induce abimazal and third compartment ulceration with non-steroidals at the doses we use, is, very unusual for us to see that.

There is also some theoretical thoughts it might inhibit wound healing. Normally when people say that, it seems to, it seems to try and be the reason why they aren't using non-steroidals, in animals that have had, abdominal surgery. And although, it's theoretical and it certainly happens in the laboratory, the, the cost benefits between a slight reduction in wound healing, and we all know wounds heal with non-steroidals cos we all use them.

And that, that benefit between wanting to provide all those benefits of non-steroidals certainly outweighs the problems. In terms of, special considerations, probably very young and very elderly animals are likely to metabolise nonsteroidals more slowly. We don't normally do very much about that other than think about it if we're using it in, these, we're normally thinking with elderly animals, we're gonna be thinking about farm pets, thinking about.

Whether there might be other choices if you do have animals that have got signs of hepatic or renal disease. We all use these drugs in pregnant animals. It's very theoretical about problems, whether or not, non-steroidals cause problems in that first trimester, or, just before, just before, birthing, depending what species we're talking about.

And very little drug will pass to the will pass to the foetus through milk. And then an offshoot of the non-steroidals is paracetamol. So paracetamol's obviously not relevant in our food producing, farm animals, but might have a place to play perhaps in some of our farm pets that we are, that are not gonna enter the food chain.

It's very well absorbed orally. It can be used alongside conventional non-steroidals. Its side effects are different, so you don't see gastrointestinal side effects.

They are primarily hepatic. We've got some anecdotal use in in food. Animals, that suggests it seems to have a synergistic effect when used alongside traditional non-steroidals, and we do have data it's, it's well absorbed, orally, but obviously we have no MRLs regarding, its use in food animals.

I've just put this table in here looking at the published commonly used non-steroidal dosages. This happens to be from a paper looking at analgesia in small, ruminants and camelids, but in fact, you would mirror, you could mirror this if you were contemplating this for dairy cattle. And the interesting thing is, things like flinnexin and ketorofen, licence for use.

Every 24 hours. But in fact, the data suggests certainly with Minicine, and we have now got at least 1, if not 2 products back on the market that don't have dieethanolamine in them, and that they probably should be given twice a day rather than once a day for optimal effect. Now, practically, that might not be possible, but it's always worth knowing that that half the, half the dose twice a day will be better than 2 milligrammes per kilogramme once a day.

And then I'm just gonna quickly talk about the opioids. Obviously we have no opioids that are licenced in food producing animals, and it's worth if you are thinking of using these for farm pets or for camelids, thinking about what the differences are. That we've got.

So we've obviously got the pure new agonist. Headine hasn't been available for a little while, but I put it in in case I've met one or two vets that seem to have a very large stash of this left. But we've got methadone licenced in, in dogs, and we've got morphine that's obviously licenced, for use in people, dogs and cats and methadone.

And then we've got the partial agonist, we've got buprenorphine, which is licenced in horses, and then we've got morphinnol, which is licenced. So, brouprenorphine's licenced in horses and small animals, and butornol licenced in horses and small animals as well. And the major limitation with the opioids is not that they don't work, it's just that we don't have any MRO.

Either in the US or in Europe. We can give them IV or IN, and they are very useful to use in the epidural space, particularly if you want to provide analgesia for a day or even a little bit longer. They also work very well in joints, because opioid receptors within joints get off regulated with inflammation.

So again, it seems to work quite well. The data suggests that things like percu transcutaneous fentanyl, and many of our our our species have got quite thick skin, and we don't seem to be seeing very good oral bioavailability. So if you went down that route in a farm pet, there might be better, better ways of administering our.

I don't have an awful lot to say about Borphenol. It's a good sedative, not one that we use, frequently because we have no MRLs, and, but it's not a brilliant analgesic unless you give it at very high concentrations, and at those concentrations reported in both horses and in farm animals that they will compulsively, walk. We don't have a great number of studies investigating their use as analgesics.

We do know that it will completely stop ruin or motility for 40 minutes, so we probably know it lasts at least that, if not longer, if you were wanting to use it as a sedative or as a, a very low grade analgesic, but it's pretty, pretty expensive . In the UK at least. I've got some notes here on pethidine, not lots of reports, that have been published about its use as an analgesic in cattle and small ruminants.

It certainly has been used clinically and appeared to be effective when you talk to people, but, again, we've got no MRLs for, for our for our food producing ruminants. But we've then got methadone, so if we were, you know, using the cascade for camelids or for, those animals that we aren't gonna eat, because this has got a, a licence for small animals, this would be probably a good, . A good opioid to, to call on and certainly, can be a very effective analgesic, but experimentally, there's been quite a wide variability between response in individual animals.

Some individual animals become very comfortable, some appear less so. My experience with its use has been that it's been very good, but certainly it's, it's different in those experimental, models. It it can be administered on its own epidurally or intrasynovially.

Great thing about it being used epidally is it, it doesn't provide, it doesn't cause any form of hind limb ataxia or paraesis or paralysis. Plenty of listed unwanted side effects in opioids that practically we don't see an awful amount of in, in ruminants when you look at the data. Very rarely do you see euphoria or dysphoria in painful animals.

The most common thing would be that they will walk, more than normal if they are not particularly painful, but we probably wouldn't be using them in our patients if that. It's the case, they can reduce gastrointestinal motility, but there is little data about, and certainly no reports of ruminel impactions or other, Clinical signs of ileus that have been problematic following opioid use from studies that have come out of North America. And those are other theoretical side effects that are largely not relevant towards the large animal.

We certainly can reverse them, but if you reverse your opioids, you reverse your, your, if you reverse your opioid side effects, you will also reduce those analgesic properties. So then we moved to the local anaesthetics, and these are something we're gonna use pretty commonly. We use them in varieties of local blocks, primarily for abdominal surgery, but also for disbudding, dehorning and other forms of stuff we might do with the head.

. As I've said, they largely they are the only drug that will actually block transmission of pain. And In an ideal world, we'll use them in. Junction with non-steroidals and perhaps other things.

We do use them topically for things like corneal desensitisation if we're doing stuff with the surface of the eye, and in those very rare occasions where you might want to do, loudness evaluations in specific valuable animals, you can use them for ring blocks or for blocking specific nerves to to work out where, where animals are laying. So this will be a block most people will be pretty familiar with for, dehorning of the, of the, of the corneal, the corneal branch of the, of the nerve. And then in goats, obviously, we need to block both, the corneal branch of the infratrochlear, as well as of the, of the frontal nerve.

We can do infraorbital nerve blocks, the infraorbital foramen's really easy to palpate if you need to do nasal laceration repairs or for placement of nose rings, and you can. You can use reasonable amounts of, local anaesthetic that you need. It's quite easy to slide your needle up the infraorbital canal.

If you get resistance on, on injection, you just need to come back a little bit because you've often got that needle wedged into there. And then for surgeries for lips, particularly for ros rostral MO. Mandibular fractures, then you can do, mental nerve blocks.

You often need much less local than foramen is still pretty obvious, but it's not quite as big and it's a lot harder to get your needle into, but that will then let you, if you want to try and put wires around, cage wire round to, try and repair that mandible, then it will certainly let you, let you do that. And then we can obviously use local anaesthetics for various, either for specific nerve blocks, which are a much more problematic than in horses because we've got that, that splitting of the metacarpus all the way down to the, to the phalanges, which means we've got multiple nerves rather than it being much more simplistic. But if you don't want to do that, then being able to do intra-regional, anaesthesia, so having a tourniquet on, finding a, a vein, and I've listed a bunch of veins here, but I mean, practically, we're just gonna find a vein that we can see that you can then inject that local into.

And normally, even with procaine, which has a very short duration of action compared to, Compared to that that that lidocaine had, you'll get pretty fast onset, and you can leave that tourniquet on pretty safely for 45 minutes to an hour, and you should get, reasonable amounts of, of analgesia, as well as obviously that tourniquet providing you with some hemostasis during surgery. There have been reports of using lidocaine that's available without adrenaline, that you can use intravenously as an infusion. It's again, not something we're gonna do in our food producing animals, but can be considered if you have got, 6 more ruminants or.

Camelids, not only is it analgesic, but it also is a very good anti ileus agent and in theory is anti endotoxic or anti-SARS when we're dealing with, particularly with gastrointestinal, catastrophes, or where we've done gastrointestinal surgery. And then we move on to ketamine. So many of you will be familiar with ketamine as an analgesic agent, but ketamine is also very useful at much at sub-anesthetic doses to provide intense but quite short analgesia.

And this, if you like, could be our third arm in the food producing ruminant where non-steroidals and local block or multiple doses of non-steroidals haven't been enough because. We know from Europe this has, zero milk and meat withdrawal because ruminants metabolise ketamine at a rate of knots. So, we sort of think probably somewhere between probably 0.5 milligramme per kilogramme of ketamine that you can give IM as a sort of sun.

We'll probably give you half an hour to 45 minutes of extra analgesia. So it's not gonna give you something that's long lasting, but it is gonna be, . It, it is gonna to at least give you something else in that, in that period.

So it might be useful if you were, you know, trying to realign a a fracture and put it in a cast, ketamine as well as nonsteroidal, and, and or some local will, would certainly help. And just as we do in other species, it's been reported that ketamine in non-food producing animals can be combined with a whole bunch of other drugs, in order to provide multimodal analgesia infusions. And there's data on the use of these again out of out of North America.

So the thought with low dose ketamine is it's anti-hyperalgesic, so it helps to prevent wind up. It is it's tolerance protective, which means you can give it multiple times and you're still gonna get an effect. And it seems to, it seems to have a role in some really, really.

Difficult er types of pain, so might have a role to play if you've got something with chronic pain that you wanted to try and get on top of or do something about. And just as we talked about with the opioids, ketamine's very effective in the epidural space. It, probably lasts in ruminants somewhere between 4 to 6 hours.

And again, won't cause any ataxia, paresis or paralysis when it gets used in that area and, in non-food producing animals often combined with opioids and other things. So the alpha 2 agonists of the other group, obviously we've got that we have got xylazine and ditomidine both licenced for food producing ruminants. And the, you know, the great thing about them is they are very potent analgesics.

Often last long beyond their period of sedation. The challenge that we have with them obviously is, unpredictable recumbency and and then obviously they have very profound effects on the cardiovascular system. And then I've written here, so gabapentin.

So gabapentin, obviously not for the food producing ruminants, but may have a role in the hammolids and some of the, perhaps some of the longer term pain in the old, pet ruminants that we've got. Most difficult challenge. It has to be it's has to be slightly .

Oh, that's not very good, is it? It has, it has to be monitored very closely. So, it got developed in people for spastic disorders and epilepsy, but it's been shown to be very effective for the management of chronic pain that has an infla inflammatory or neuropathic origin.

So probably more. Useful for musculoskeletal disease. We don't thoroughly know how it works, but we do know, from some very early from from some preliminary studies that it is pretty well absorbed orally in ruminants.

And then I move on to some of the perhaps more blue skies thoughts. And so the next one I thought I'd start with was the vitamin B complex. So not much data yet looking at this in food animals, but there is some really good data in cats and rats that shows very high doses of MB1.

So it would end up with the current products we've got available to be a silly amount of vitamin B to be given. But that these very big, these very big doses of B1 seem to have synergistic effects for non-steroidals. And I think that if this was something that could be, evaluated, it might be possible to make a more concentrated form of B1 that we could use where we know.

You know, we use, we can use injectable vitamins pretty easily in our food producing patients. And then the last drug I wanted to talk about was magnesium, and magnesium's been used as an an adjunctive analgesic agent in people for decades. And the thought is that it helps to enhance the action of other analgesic drugs that we would use, particularly, local anaesthetics and their non-steroidals.

It can be, it's been used primarily in people for perioperative pain management, and obviously can be used in, in multiple different ways. There is a study that has shown its use in the epidural space, not in food animals, but in other species when it's been combined with lidocaine. And again, a little bit like we've just said about the B1, we'd need pretty big doses of magnesium and we'd need to think very carefully about how we get these causes big slugs of magnesium IV they never, it's, it's always fine until it isn't.

So this might be something that would be valuable for us to think about using subcutaneously where we would get. That slow release. But there's, there's more work needed with this, but I think again, this is a drug that we have available to us.

It's licenced for something else and food animals, and I think it's something that's quite exciting, not expensive, but we, we need to see if we can get some more, more research on and see how that might be valuable to us. And then obviously right at the end we've got some topical local anaesthetics that sometimes are useful to us. So, I'm not gonna talk through this particular slide.

I've talked to you about things we could use intra-articularly if we've got things that have got joint pain, so ketamine being easy one that we can use in food producing ruminants, but certainly, the opioids, if we were thinking. Along the lines of our, our farm pets, and then we've got the epidural Drug Administration, and you can push the, your epidural as far proximately as you can. And the volume is what determines how proximal your lock works.

Obviously, we don't want to be using local anaesthetics and alpha 2s in very large, volumes because we certainly wouldn't want to push them far enough up that it might have an impact on paralysis of the. Spiritual muscles, that would be obviously not good. But thinking about that, and it's often that balance, isn't it, of how, what volumes you would use in order that you can have the block that you want without causing, ataxia or recumbency, particularly in, in adult cattle.

And I've, I've put here some of the recommended, dosages that people have got for some of the drugs we may or may not want to use. And again, I've put some other drugs in here, these are, well, doomidine we certainly can use but these are some of the other, other drug dosages that people have reported for use in the epidural space. And some more there.

So you'll have these on, on your slides. So this slide is taken from, from a paper that has put together data from lots of, this is from a review that's put together data from lots of papers and sort of talks about some of the, duration of analgesia that they, that they observe. So, almost right on time, I thought I would end this by trying to put some of that theory into into some cases that I've, that I've got, and I'm more than happy to.

I'm gonna try and talk through these and think about what I might, what I might do. So whatever we do or don't believe about repairing umbilical hernias in, health scenes, we'll, we'll use this as our, as our example. So this is a hernia that someone has decided, requires a repair.

And, and so I will talk you through probably my thoughts on this. So, I would probably, I would sedate this animal. It would get non-steroidal.

And, and then we could do a local block. Probably if you went either side, because you're gonna enter this most likely, through the linear alba in order to close it, you, you might want to put a, do a ring block around that that will ensure you've got as, as good analgesia as you can. You've obviously got not got nerve fibres, in the linear elbow, but we've certainly got them coming up.

So I would try and use those drugs preemptively. You can see here somebody's wrapping this with some elasticlas, whether that's necessary or not. It probably for a hernia repair, isn't, isn't especially, necessary, much more useful if you have done, done abdominal ventral midline abdominal, a ventral midline abdominal incision for whatever other surgery it might be.

And then postoperatively, in an ideal world, this animal would continue with a non-steroidal maybe for 1 or 2 more days. That would be my thoughts with that. So we've got non-steroidals that are licenced, we would use propane, that's the licence, .

Licence soaking channel blocker that we have. And then this, cough could receive Tylazine. Then move on to castration of an older bull.

He looks particularly unpleasant, wouldn't be my ideal choice. And probably not quite this old, hopefully that we would be deciding to castrate where we might do. And so my thoughts with him would be, .

I probably would want to, the sedation part's always very difficult, the words and difficulties there. But certainly, intramuscular rather than, intravenous xylazine, and or use domidine. So you don't seem to have seen those, quite such marked cardiovascular effects, slash deaths with domidine.

That have been reported with, with xylazine in, in balls. Local anaesthetic, intra-testicular, local anaesthetic, that will make the biggest difference in terms of, safety, whether you do this ball, standing or whether you're doing recumbent, I think is a definite issue for debates. There's pros and cons each way, both in terms of Safety for you and safety for the, for the ball.

And then, but I think the low climber intratsicular low climb aesthetic's gonna make a massive difference. We know that it migrates very quickly into the spermatic cord and reduces, pain, and improves feeding in animals that are castrated if they, if they receive local anaesthetics, I don't know why you wouldn't. .

And then again, a non-steroidal should be administered and probably should be administered in some form for 24 to 48 hours later, that certainly would be my view. Then I've sort of gone to the other extreme, where we've got an eight year old pet son and goat that has got chronic fall and lameness. The goat's well, but has started lying down more.

And I think that this is a case we could debate forever, we could say. This goat is a food producing animal and therefore we're only gonna use drugs that are licenced for food producing animals. My experience of talking to lots of farm vets doing talks like this is many people have decided not to treat them, like that and have, consent forms, etc.

That sort of. Sign them out of the food chain in a very, Informal way. So I'm gonna talk about this goat as a pet ruminant rather than as a food producing ruminant.

So, I think we've got multiple options available if we manage that way. So we could look to see whether we can see anything wrong with its feet, make sure its feet have been appropriately trimmed, it doesn't have any foot rat or anything else that we need to manage, however that might be. And then, in terms of, Medical management, we could use oral or injectable non-steroidals, we can use intra-articular steroids, we have got dexamethasone which is licenced, or we've got we've got triamcinolone and Depends on the formulation of methylprednisolone that we have got that are not licenced.

There are people that have used Cartrifen, which is, licenced in, is used in dogs, but again, we've got no MRLs for that. And some people report, response of osteoarthritis in these animals to Cartrophin, and other people don't. As I've said earlier, oral non-steroidals, none are licenced, for this route, but we've obviously got drugs that we, that we can use.

The oral non-steroidal dosing ruminants is the same as that for courses. We've got Clinic in, we've got Carrofen, we've got meloxicam, if you want to go down the. Lines of trying to use drugs that have got a licencing food animals.

And obviously, if you were doing that, you would not use phenylbutisone. Personally for me, phenylbusone's not my favourite in goats because it's pretty difficult to, measure out accurate doses, which we can certainly do if we're using, if we're using other formulations. We've then got oral paracetamol, we've maybe got gabapentin and things like intraregional analgesia can be helpful in the short term if you're trying to fix specific fix specific problems.

And then my next case is an alpaca caesarean. It's a 4 year old, alpaca that's got a dystosia, and you decide to not do that under general anaesthesia, you're unhappy with doing that. So, thoughts here were about thinking about optimal pre-Perry.

And postoperative, analgesia. Most people do, that I've seen have done flank with these cases. So I, again, I think for me it would be, I would probably use, I would definitely use an intravenous non-steroidal, some form of block, whether you do that as a, an inverted L whether you do that as a, The words escaped me.

But some form of abdominal block that you might do, walking off the transverse processes. The name will come to me in a minute. And you could use a ketamine stone if you wanted to, that they are actually very effective in this species.

So, we've got sort of options here. There's no reason, alpacas are, interesting creatures, because most people will have a consent form that says, No drug that we use in these animals is going to be, it, it, it won't be licenced in them. So you could use, an opioid in this, in this animal under the prescribing cascade.

And if I was gonna do that, then I would probably choose methadone. These. Which may or may not be necessary.

It would depend on the state of the animal. And then postoperatively, I, I do like wrapping, alpaca abdomens. It seems to really improve their comfort.

They have relatively pendulous round abdomens with quite thin, body walls. So they do seem to benefit from some form of wrapping to support the wound. Obviously, the downside is if you cover the wound, you can't see what's going on.

And then I would definitely provide non-steroidals in this animal for at least 3 days postoperatively. So, on that, thank you very much for your attention, and I'm happy to do my very best to take any questions. Thank you very much, Gayle, for that really interesting talk this evening and hoping that everyone who's been who's attended this evening can actually take, will be able to take some, hints and tips away for, for your, for your own use in, in practise, or, not in practise, or externally in the farm.

So does anyone have any questions for this for Gail? If you want to just type them into the question and answer box, and I can pass them on to Gail and we can answer them. Just give you guys a couple of minutes just if you want to type anything in.

So I guess it must make it pretty difficult for you guys, Gayle, when you are trying to, to deal with a food producing animals and how how limited that you are, with actually being able to choose what analgesia to actually use for these. Yeah, that must be quite difficult. And I think that's where looking at some of these other drugs like magnesium and B1, which we've been using in farm practise for decades, looking to see if we can get some research, cos it's a lot easier if we can use things we're already using, even if we adapt how we use them, because, you know, licencing drugs and getting meat and milk residues just cost lots of money and, you know, it's .

It's just never quite a big enough er. Field for for drug companies to necessarily want to invest in that. No, I take it, yes.

So, because I, because I don't, I don't work with, large animals at all, do you, do you, is there a certain cutoff point? Could it be, are you flat out not allowed to use these medications for food producing animals? Or is it a certain cutoff, you've got to use it, you've got to wait.

6 weeks or 6 months? Or does it, is it medication dependent? Yeah, no, it's a good question.

And the, the answer is, if you interpret it as it's meant, then the answer to that should be, they're either licenced for food producing animals or stretch it a bit with something else. Its food producing species, but, but it's pretty tricky. The, the, the grey zones are always the alpacas and the pet ruminants where we know they're not going to eat them, but in theory they are food producing animals.

They they potentially, yes. OK, we've had one question come through. Thank you, Bob.

Do you use epidurals for alpaca caesareans? Yeah, that's a really good question and the answer is, yes, absolutely, and I probably, I'm sorry I didn't mention that as I was, as I was going through, but there, I think the answer is you absolutely can. If you use you know, procaine with ketamine and an opioid, which we can do largely in alpacas, then you'll get your local anaesthetics where you want it to be, and then that ketamine and opioid will give you another 24 hours.

So, yes, absolutely, and I put some of those doses in and right at the end of the presentation before the cases, but no, great question. I'm sorry I didn't bring that up. OK, well, I think that's all we have for this evening.

There was just that one question. I'll give you a couple of seconds to see if anyone else wants to send any questions on on in. If not, I think it'll be a dash to the cup to the kettle to get that cup of tea brewing, after this.

Fantastic. No, yes. No, I, I think you, you're off the hook a little bit there, Gayle, so I think you can get back to, yeah, get, get to go and get that cup of tea and if anyone's got any questions afterwards, I'm always happy to, happy to answer by email as well.

Thank you very much and thank you very much, Gayle, for this evening. I've really enjoyed that. And thank you for coming.

Thank you very much Phil in the background who's doing all of the technical stuff in the background, and thank you everyone else for attending. I hope you all have a lovely evening. Thank you.

Take care. Thanks, bye bye.