Hi, my name is Livia Bealto, and today we will talk about the pain recognition and amelioration in rabbits. This is quite an interesting and important topics, and pain management in this species has improved greatly during the last 1020 years really. And these days rabbits are commonly treated for acute pain, and this is generally caused by several medical and surgical conditions.

Therefore, it's paramount to be up to date, not only on analgesic protocol for this species, but also to know what cause pain in rabbits, how we can assess it and quantify it, and what tools are there, and also to have a good knowledge of the benefit and the side effect of analgesic drugs that are available these days. Pain is a debilitated experience for the animal that suffers, suffers it and when recognised properly can really improve the health and welfare of these animals. So the knowledge and experience of what could cause pain in rabbits can give us an indication not only the type of pain but also the intensity.

And will allow us to prescribe a better treatment. However, rabbit cannot verbally communicate the the the pain and therefore, the, the cause of pain or the type of pain is generally derived from the perception of those looking after after them, after rabbits. So we have a handful of study about rabbits and a little bit more regarding laboratory rabbits, and we know that a common condition like ileuss, dental disease, urinary disease, ear infection, and so on can be quite painful in rabbit.

We also know that a rabbit can suffer pain following a surgical procedure as much as other companion animals like cats and dogs. This is a graph that was taken from a study on the attitude of veterinary surgeons towards pain in rabbits. This graphs shows no surgical procedure and the participants were asked to score each surgical procedure in terms of intensity of pain from 0, no pain to 7, the worst pain.

And this is the results of this data collection and you can see that castration and lumpectomy, lumpectomy are considered like a procedure that can cause mild to moderate pain in, in rabbit. While ovarectomy and a cystotomy, abdominal procedure, then instead they tended to cause a more moderate pain and so they are more painful an ovarectomy is considered more painful than a castration, while an orthopaedic surgery is the worst pain ever, so we know that generally fracture can be quite painful. This comes it doesn't come as a surprise that these results confirmed another study in in in rabbits and other species like guinea pigs, but also are similar to our.

Of pain or suffering in cats and dogs. So this can give us an idea of the type of pain and the intensity so we know we can, we can treat it in the best way that we can. Pain assessment in rabbits is for sure challenging, and they can be affected by several factors.

First of all is the species. Rabbits are prey species and therefore they tend to hide signs of pain or chronic. Conditions and this is a normal reaction to be able to escape predators and rabbits tend to see people as predators, so that will make it more difficult for us.

To actually assess pain and the species. We also needed to consider the individual, the the character of each single rabbit. Some of them can be quite bold.

Others are shy and timid and therefore the, the behaviour that will exhibit will be quite different, similar to age and gender, especially age, depending if they are younger or older or if where they have grown, if it's been in a, in a family that has been handling them or in a frightenful environment. Also, we needed to consider the subjectivity of the observer, the knowledge and the experience that they have when treating, treating rabbits, and this can be quite different depending on the the observer. And in the novel environment also can confine the interpretation of the signs of pain.

And when we think about a clinical environment, definitely we can consider that as a novel environment for for the animal and can be stressful. And frightful and fearful, and the stress as well can can mask a sign of pain, a similar behaviour can be due to stress or can be due to behaviour and unfortunately these days we don't have a scales to assess the stress in this species. So once again it can be a little bit difficult to, to consider.

The the signs that that the the animal present. Moreover, there is a lack of gold standard in terms of pain recognition, although we are quite lucky that we have several pain assessment tools in this spaces as we will see soon. We still don't have a gold standard, and overall pain assessment is challenging not just in rabbits but also in other companion animals like cats and dogs or even human that can most of the time verbally communicate the pain.

Pain is a multi-dimensional experience that affects the animals in a different way, and it can cause physiological and behavioural changes in in the animal that suffers it. For example, a rabbit in pain will show an increase in heart rate and respiratory rate. And also there will be a change in behaviour.

So it will start exhibiting new behaviour, like for example, aggression and body flinting. Or will stop normal activity and normal behaviour like for example, eating and then moving a, moving around. So all these changes, these physiological and behavioural changes, then can be used to assess pain.

However, physiological parameters tend to be less reliable than behavioural parameters, and this is because they can also be changed by stress and concurrent infection, and they can actually mask the sign of pain. Behavioural parameters are instead considered much more reliable in terms of recognising the pain in, in rabbits, and this because even subtle changes of behaviour can give an indication that the animal is not happy and might be in in discomfort. So Moreover, also the return to a normal behaviour means that the, the pain has been treated or has has passed.

So to consider the behaviour really can give us an idea of how the animal is is doing. Behavioural indicators are commonly used in. In laboratory, rabbits, and they generally are used with ehograms.

Ethograms are a list of behaviour, well described behaviour that a rabbit might exhibit and they can be either normal or pain related. However, to assess the changes in behaviour as a consequence of pain can be quite time time consuming and it's not really practical in a veterinary environment. However, we know that in a busy clinic, we can still assess these changes in behaviour, and there are some behaviours that are more commonly associated in pain than others.

For example, We tended to look at if the animal is eating or not, if it has an appetite, teeth grinding can be a sign or or really painful condition, the hunched position with the animal reluctant to move, and also we tend to look at the eyes if they are closed or or not. So this is the the most common one that we would look at in a clinic. However, as I mentioned before, it is important to have experience and knowledge of How a rabbit would behave, but also, an individual, the actual rabbit that we are treating, because they might have a different character and a different way of coping with with pain.

So one advice that I generally give is to if we need to, for example, to hospitalise an animal for a an elective surgery, would be to actually write down or assess the behaviour of the animal before the procedure. And after the procedure and we will be able to compare those in order to have a better idea if the animal is in discomfort or not. I give you an example with a dog, for example, a small Yorkshire terrier.

Some of these animals can be a little bit of distress, or some, they might not like an environment that start screaming just because of the distress. So if we know that, and then we see the same Yorkshire terrier screaming after the surgery, we know that perhaps the screaming is more due to stress and fear rather than pain. So if we apply this to a rabbit, for example, if we have a rabbit that when it comes in is a pain-free, but sits at the, the back of the canoe because he's worried or hides and will do the same at after the surgery, then perhaps it is not due, the behaviour is not due to pain, but stress.

If instead is animal that is a happy moving around in the kennel, but after surgery will sit in a corner at the back of the kennel, then perhaps that is due to pain, and we compare the before and after. So to have a knowledge of how rabbits behave normally, but also the individual that we are treating is paramount to be able to assess and recognise pain. These days we have many pain assessment tools that can be used in in rabbits, and it would be good to use pain scales alongside the assessment of the rabbit's behaviour.

Pain scales can be very helpful in assessing not only if the animal is suffering pain or not, but also to recognise the intensity of of pain. So higher is the score, highest level of of pain. So in this example, we have a couple of uni-dimensional pain scales that are in some way the easiest way, very easy to understand, very practical, quicker to use.

We have a numerical rating scale that it goes from 0 to 10, where 0 is no pain and 10 is the worst pain. We we have a vision on a longer scale like say again where we We tended to assess the pain along the the line, or we have like a facial expression where generally with a smiler is a is a subject that is comfortable while instead it is said the crying is the worst pain. This uni uni dimension and pain scale, they are very easy to, to use, however, can be quite subjective depending on the observer.

Also, they are rarely validated for a species or a specific condition, so we, we know that they can measure the, the, the pain, but they are not specific for, for that for that animal. We know that amongst the older unit dimensional pain scale, perhaps the numerical rating scales are considered more reliable in terms of assessing pain in in species like dogs, and although there are no studies in rabbits, we could assume that they are also. A good approach compared to maybe the visual analogue scale.

The grimmer scales are very popular scales that are based on facial units that changes depending on the intensity of pain in the animal, and these are based on either pictogram or photos of this facial unit. These days we have grimmer scales for many species including ferrets, rats and mice. And for many years we have had the rabbit grimmer scale that was the only one available for this this species and it was developed by the University of Newcastle and you can actually find it online and they can even send you the poster of the rabbitrima roma scale.

The rabbit grimascala has been recently validated in pet rabbits, although initially it was developed for lab animals. The rabbit grimmer scale has 5 facial units that are the eyes, the cheek flattening, the shape of the nostril, the shape and the position of the, the whiskers, and the, the ear position. And then it has a 3 level of pain, where 0 is the animal is pain-free, 1 moderately present, and 2 inside is obviously present is an animal that actually is suffering and that is is in pain.

So for example, looking at the rabbit grimmer scale. If an animal is pain free, is generally relaxed, so the eyes are open, the, the, the cheek, the whiskers, and the nose are relaxed, and the, the ears are straight on top of the head. If instead an animal is in pain, tend to have the eyes closed, and then we have a sharp shape and a flat cheeks.

Sharp shape of the nostrils and also the whiskers are close to the, to the face. And then when we assess the penis, the penis are flat against the, the back. Once again, the rabbit grimmer scale is objective, can be used several times over over time, as I said, it's been recently validated also in a clinical environment.

We know it works and can assess if the animal is in pain or not and give you an idea of the intensity of this pain. It is quicker to use, because we have the photos and we can compare the rabbit we are treating with the pictures in the, in the poster. However, some of the expression, like, for example, the nostril shape or the cheek flattening can be a little bit difficult to, to assess.

But with time, using this scale over and over, we will become more confident it will be actually be much easier for us to, to assess this facial unit. Also, as this scale was developed in lab animals. It takes in consideration only the, the rabbits with the straight ears.

Instead of these days in a clinical environment, we tend to see lots of rabbits that have lobbed ears. So that is a little bit of a, a, a limitation because we will not be able to assess the, the pinna. A, a rabbit with lop ears will never be able to flatten them against the the back.

Something else about the scale is that there is not a cutoff point for rescue analgesia. However, it was never intended. It's generally something that we don't see in green mass scale, but we see more with the multi-dimensional pain scale.

Composite pain scale tended to be more reliable and objective in terms of assessing pain in in animals and this is because they take consideration the multi-dimensional aspect of of the pain. These type of scales, they, they are generally extensively considered during the development and normally they normally validated and the reliability is tested as well. So with the validation we check the degree of which the scale actually measures what is supposed to measure.

And when we tested the reliability instead, we tested the consistency, consistency of this scale to be, to be able to be used and be reliable and when used by several observers and also over, over time, so it's consistent all all the time. These days we are quite fortunate in terms of multi-dimensional pain scales and rabbit because we have two composite pain scale for this species. The first composite pain scale is the rabbit scale from the centre for Nonconventional Animals, of the University of Turin developed by Banki and colleagues.

This scale merges the rabbit grima scale with the physiological and behavioural parameters and also includes four classes of pain that are no pain, discomfort, moderate pain, and severe pain. So how does it work at this this scale? We first observe the, the animal, and then we score, each of these parameters, and the score can go from 2 to 4 each.

And then the final score is the total sum sum of the ones given to each parameter, and this will give us an idea of if the animal is in pain or not and also the intensity of pain. We know the facial units of the rabbit rima scale, so I will focus and explain a little bit more the parameters of this clinical parameter scales. We have, as I said, some physiological and behavioural parameters.

The first one is a pupil dilation. When we assess this parameter, we check if we see the pupil dilation or not. If he's present or not, so if he's present is 1 or not is 0.

Then we assess the heart rate but not the actual rate, but the percentage of the increase of the heart rate and for example if we have a 20%. Is a score one. If we have a 50%, it's more severe sign of pain, and we have a score 2.

Then we do the respiratory rate, and that is based on 60 breaths per minute. And if the animal is presented 60, then the score is 0, an animal with no pain, if instead is higher than 90, then it's a 3 with the worst pain. In terms of respiratory pattern, the authors that developed this scale suggested to check if the animal shows dysponia or not, and this gives us a score of 0 if it doesn't, or 1 if it does.

Then we assess the palpation of the Painful area. If there is no reaction is a 0. We have a 1 score 1, if there is a reaction at palpation, and 2, if there is reaction, move the movement of the animal even before the the palpation.

With the mental status, they attack if the animal is normal, active and reactive, or if it's depressed and quiet, but actually responsive to the surrounding environment, or an animal that was called 2 is considered that like it's quiet, responsive, and not responsive to the, the, the environment either. And the last parameter is the vocalisation and we would we would basically assess if there is present or not, but also if it's intermittent or continuous, and if it's continuous, it's quite severe, severe pain. So this scale can be also found online.

And the this physiological behavioural parameter have been extrapolated from other pain scales developed for dogs, so they are not specific. For, for rabbits, I have the, the authors nowledge that in their, in their study, and they, but they still consider them quite important. They think it's something that we should in any case assess and considering the rabbit that we, we treat and therefore to keep a record of these these changes.

This scale has recently been validated specifically for abdominal pain in, in pet rabbit. So the scale has been refined and reassessed and during the study they found that the respiratory pattern and vocalisation were actually poor parameters in terms of assessing pain for like assessing specific abdominal pain and therefore were removed from the scale. We needed to take that in consideration when we use this type of scale.

I did now move to the Bristol rabbit pain scale. This is the most recent pain scale developer in in rabbit. And has been developed with the idea to create a scale that is more along the line of composite pain scale available for cats and dogs, like for example, the Glasgow acute pain scale for cats and and dogs.

Has been developed with using a novel technique of focus group discussion with the stakeholder and specialist vets in order to listen and highlight the best indicator of pain in rabbits. And also, and this had then been assessed to using behavioural observation of rabbits during the perioperative pain to be sure that the indicator that that we have listed actually are recognised and exhibited by the animal that is is in pain. This is the Bristol Rabbit pain scale that has been developed by the Bristol University and can be found online on the Companion Animal behaviour and Welfare Research web page of the University of Bristol.

The this scale is includes 6 categories. We have a demeanour, locomotion, posture. Ears, eyes, and grooming, and 4 levels of pain that goes from 0 to 3, where 0 is no pain, 1 is mild pain, 2 is moderate pain, and 3 is a severe pain.

The total score goes from 0 to 18, so you score each category from 0 to 3, and the total score gives you the intensity of pain. And the cutoff point point of this scale is around 6 to 7. And where below 6 and 7 is an animal that is comfortable, generally pain free.

Instead above these numbers is an animal that is in discomfort and might need either analgesia or rescue analgesia. In terms of rescue analgesia, we consider that we have already given. Some analgesic drugs, we need to consider maybe other, other drugs that can make the animal comfortable.

With this pain scale, a rabbit that is generally, pain-free, is active, moving around, looking around, or is asleep. We know that it is an animal that is asleep is generally an animal that is, pain-free. Is is moving freely, is relaxed in terms of the postures, the eyes are open, is an animal that maybe stops and clean themselves, groomed themselves, and the, the, the ears, are moving.

And in this scale, the, the good thing is that we can assess every type of breeding rabbit breeds, both with floppy or straight ears, because it takes a consideration not only the position but also if the animal moves the ears. Rabbit can move the ears like cats and dogs and for example, horses depending if they hear a noise. So a rabbit that is pain-free will actually tend to move the the pinna towards the the sound.

A rabbit that instead becomes gradually more feeling more discomfort and pain is an animal that stops moving, is rigid, their postures are hunched, the eyes are closed. It's an animal that focuses just on the pain and nothing else and doesn't take into consideration the surrounding anymore. So the ears are not moving.

If they are straight, they are flat on the back. If they are floppy, they are just along the face, and there will definitely be an animal that is sitting with the legs under the the the abdomen without moving and will definitely not be grooming. Here we have the photos of the same rabbits before and after surgery.

So the one on the top left is the, the rabbit before surgery and the bottom right is after surgery. You can see before surgery is a rabbit with open eyes, is sitting, but overall it's quite comfortable, he is aware of what's happening. And is a rabbit with locked ears.

So in this case, some of them can actually move the ear towards the sound, and others with really heavy pinnas might not be able to move the pinna, but you will be able to see the base of the ear and there is still a movement. It might be subtle but still possible to assess. The rabbit on the bottom right after surgery instead you can see the eyes are semi-closed, it's sitting down, the legs start to disappearing under the, the body, the, the position is more hunched.

You can see the ears are again are quite floppy, even the base is, is, is. Less rigid. So it's a rabbit that, is showing some level of the, of pain.

And this is another example when we assess a rabbit using the bristle rabbit pain scale on the top left we have a rabbit before surgery and once again sitting. The eyes are open. It's quite relaxed.

The ears are straight on top of the head. Instead of the bottom right is after surgery, and the, the penis are flat along the back, the eyes are closed and they present a little bit more of a hunt position, so a more rigid position once again there might be an animal, that might need analgesia rescue, analgesia. We now consider pain amelioration in rabbits and what is available these days for this species.

When we consider analgesic protocol, the aim is to ensure that the animal is comfortable and is able to exhibit a normal behaviour till it recovers from the painful condition. When pain is recognised and treated properly, can improve the health and the welfare of the animal, but can have also other benefits like it tended to reduce the risk and the anaesthesia and the animal will recover more quickly, from the, the painful condition or the, the surgery. So it's important that the animal is is comfortable.

These days in cats and dogs we consider concept like a preemptive and preventive analgesia multimodal approach. We know that these are exactly the same concept that we would use in rabbits as well. Preemptive analgesia is when we consider giving analgesic drugs before the, the painful stimulus, before, for example, we start surgery, to, to prevent and avoid.

The animal from actually feeling discomfort. Preventive analgesia that is still to prevent the animal from feeling pain, but that is not considered the time or when it's given before or after. It's something that we do to avoid the animal from feeling pain and this is something.

We often do it in rabbits as well as we know that rabbits that are in pain might develop illness and reduce gastrointestinal mortality leading to this biosis. We really want them to be comfortable all the time and preventive medicine and analgesia is definitely something to consider. The multimodal approach is a very common concept that consists in the administration of two or more drugs that provide analgesia, but they tended to act in different, in different ways and we know that it is the best way to to treat, to treat pain.

Another important thing to consider is to give and provide the animal with analgesic drugs till has fully recovered from the painful condition. And that means that if we have, for example, rabbit that has been admitted for a surgical procedure, we should prescribe analgesia also at discharge. So we want this animal to go home with painkillers and be comfortable.

There are not many studies on, on rabbits and for how long they feel pain after the procedure, but there is one that shows that it might take to a rabbit one week. To exhibit a normal behaviour, and going back to a normal body weight after an elective surgery. So I would like you to take in consideration these these days, .

This length of time, a possibility over the 7 days, and also remember. The different intensity and type of pain associated with surgical procedures, so we know castration is a mild moderate, and the hysterectomy might be more moderate type of pain and give and prescribe analgesic discharge that is appropriate for the animal and the painful condition. In rabbits, when we think about drugs, we know that opioids and non-steroidal drugs are commonly prescribed, and amongst the non-steroidal drugs, the meloxicam is the one that is more commonly tested but also prescribed.

Meloxicam is tended to be given or suggested at around 0.6 milligrammes per kilo once or twice daily, or it can be given around 1 milligramme per kilo once once a day. The difference in dosage range really depends on the interpretation of the studies that have been carried out in in meloxicam, or meloxicam.

There are several studies, so it's a, it's a well researched, drugs, that I would definitely advise in, in, in rabbits. And based on this, on this study, we know that for acute pain, 0.6 milligrammes per kilo is probably the, the lowest dosage that we should give.

0.3 is a little bit too low and maybe it might be considered for chronic pain. And also we, we do know now that 1 milligramme per kilo, once given once daily.

Is also, can be given long term. There is a study that shows that once given for nearly a month, 29 days, the animal didn't show any side effect. So it's a, it's a good, drugs with the, reduced risk and lots of benefits.

Meloxicam has been tested in as part of a multimodal approach as well, with the buprenorphine. And it was tested at a 0.1 milligramme, and in this study, it shows that actually the multimodal approach to this combination with the buprenorphine works quite well compared to the control group and other groups where there was only one drug prescribed.

However, it is important to highlight that this dosage used the 0.1 milligrammes per kilo, these days is not advised at all, as I mentioned before, unless it's maybe for chronic or long term trap of treatment. There are many other non-steroidal drugs that we can use in rabbits, we know carprofen can be used between with the dosage of 1 to 5 milligrammes per kilo.

And these days, we, I tended to receive lots of . Emails and colleagues are asking me regarding paracetamol in in rabbits. Pacetamol is quite interesting because we really don't know much about the anti-inflammatory and analgesic effect on on rabbits.

It's not been researched in this species and when the little that we know is that is suggested a really high dosages between 200 and 500 milligrammes per kilo. That is something that I've been not advised. So in .

A drug formulary edited by Hadley and colleagues in 2020, they actually suggested to give a paracetamol at a dosage between 10 and 15 milligrammes per kilo, so much lower. Dosage and apparently is clinically effective. So can we give a paracetamol?

Yes, it's a really low dosage, but I would advise you to actually assess that we, we see behavioural changes in the animal and that the animal is more comfortable, or otherwise I would consider . Other non-steroidal drugs like it could be either meloxicam or carrofen. Opioids are a category of versatile drugs that are quite effective and can be used to to effect.

They are used in companion animals, cats and dogs and rabbits, because of the analgesic effect but also the, the sedative properties, and they can be used as, as part of anaesthesia and analgesic protocol, especially during the perioperative time. The most common opioid prescribed in rabbit is buprenorphine and it is suggested at a dosage of 0.03 to 0.06 milligrammes per kg every 6 to 12 hours.

And however, we needed to take in consideration that there are a couple of studies on buprenorphine given during the post-operative period. At a dosage of 0.02 and 0.05 milligrammes per kg, and in both studies, the buprenorphine alone at these dosages was unable to reduce the the brain muscle score in the animal.

This means basically that these dosages might not be as effective as we we think and perhaps 0.06 milligrammes per kg might be a better dosage in animals. However, we needed to take in consideration once again, .

Not only the, the drugs that we're given, but also, the, the condition we are treating, the individual we are treating, and perhaps, use the behaviour indicators and a pain scale to actually assess if the drug is, is working. When we consider opioids, also these days we think about morphine and methadone. And especially methadone is is an opioid that we tend to prescribe and to give instead of buprenorphine in when we treat severe conditions, painful.

Condition like for example, if we have to repair a fracture, methadone is definitely a drug that a good advise and in a recent study that compared the morphine to meth and method with methadone, they, we found that the analgesic effect of Method and were superior to those of morphine and also the animal the same smoking in terms of eating after the, the, the surgery, . Tramadol, the, the main benefit of tramadol is that it is one of those drugs that can, can give orally and therefore an animal can be sent home at a discharge with this one again if we want to carry on a multimodal analgesic approach even when the animal is discharged or it can be used when maybe non-steroidal drugs cannot be given. The dosage suggested for tramadol is between 3 and 10 milligrammes per kilo.

However, there is one study, only one study on tramadol in rabbits, and that was done with a dosage of 11 milligrammes per kilo in a really small sample of of rabbits and and shows that even 11 milligrammes per kilo did not reach. The therapeutic plasma concentration and, and, and, and therefore, we really need more research to evaluate the analgesic properties of this drug in in, in rabbits. O opioids like oxymorphone, hydromorphone, quite used, and they are generally advised to treat once again severe pain, and we have a little research has been really carried out on these two drugs.

To assess the, the clinical benefits of the clinical relevance. If we take into consideration the side effects of these two groups of of drugs, non-steroidal drugs shouldn't be given if we think there is a renal hepatic impairment or any condition that reduce the renal filtration, and, and also, we know that it can lead to gastric ulceration. Now, this is seems to be less of a problem in rabbits first because the, the stomach is always full and therefore there is less effect of these drugs on the gastric mucosa, I have, and also because rabbit, they do develop a gastric ulceration, but generally secondary to, to stress.

And chronic problems. So, but we still needed to take into consideration, if to give no steroid or not to the, the animal we are treating. In terms of all the opioids, the side effects are generally seen with the overdose of these drugs, and we tended to see, bradycardia, respiratory depression, maybe drowsiness, .

And, and changes in the, the blood pressure. Also with the opioids, sometimes there is the potential to reduce the gastrointestinal mortality. However, we know these days that this is not clinically relevant in, in rabbits, especially with buprenorphine and butanol.

We or and tramadol. There are still questions regarding morphine and methadone. However it seems like the, the potential of reducing gastro mortility might not really be linked if you see it in an animal you are treated, might not be linked to the opioids but actually maybe of the animal that is if is in pain or discomfort.

So perhaps this the motility changes in motility are not. Clinical relevant as a side effect for opioids. Local anaesthetic drugs are generally given as part of the multimo analgesic approach, and there is more common these days to consider this type of of drugs also because the side effects tended to be less than the actual benefit, although we still needed to take that into consideration, be careful, especially with the dosage.

The most common, known probably local anaesthetic drugs is the ELA, cream that is a mixture of prolocaine and lidocaine. That is given and strongly advised to, to give when we before taking taking blood in in in rabbits or before placing an IV catheter. The Ela cream is actually quite, is a really good, drugs, that really considerably reduces, discomfort in the animal but also reduces, head shaking, head movement of, of the animal.

So. It can be given applied before, when a puncture before taking blood, and also before placing an IV catheter, . Generally can be quite effective, but I would suggest a minimum of 1015 minutes to apply, go away and then take blood to give time for the cream to actually, works.

Other, other local anaesthetic drugs are like generally lidocaine, Vivicaine. Our injection are instead advised, for example, during surgical skin incision or for nerve blocking during castration and especially during dental extractions, malocclusion of the incisors in rabbits, it can be quite common and it's definitely . Painful procedure if we needed to to remove them instruct them, and therefore I would definitely advise dental nerve block alongside opioids and non-steroidal drugs when we decided to carry out this type of procedure.

Contant rate infusion, anaesthesia is used more and more often these days, not, not only in cats and dogs, but also in, in rabbits, although it maybe. Consider lesser than the previous drugs that we, we discussed. The, the concentrate infusion basically provides, a continuous analgesia maintaining a stable therapeutic plasma level of the drugs, .

That are generally delivered by intravenous roots, but in in rabbits it can also be given by intralysis routes taking consideration is a more painful route to the intravenous, but both are quite good. So the, the, the benefit is that they have a stable and continuous therapeutic plasma drug level in the system. Rather than ups and downs like when we inject or give .

The drugs on different levels, in different, different rates. The, the main problem, let's say limitation of this, this type of analgesia is that in pet rabbits is reported anecdotally, and there are really a few study carried out in terms of efficacy in this species and however, we know that they, they have some. Benefit, that, as a part again of a multimodal approach, the animal can really benefit from this type of, an analgesia.

Once again, if we use it, Alongside a pain assessment tools, we will have a good idea if the animal is comfortable or not, or if there is something else, that we should prescribed. In conclusion, pain management in rabi has has really improved over the the years, although we still have a lot of gaps and we need further research and studies in both pain recognition and amelioration in this species and definitely. Is a field that has greatly advanced over the over the the years.

We have many pain assessment tools available for rabbits, including two multi-dimensional pain scales. We are aware of what can cause the pain and the species and the type of intensity of the pain it can give and how the rabbit will react and which behaviours might change as a consequence of of pain. When we assess pain, we look at the behavioural changes alongside the use of any pain, pain scales, and this will give us a better idea of the, the pain intensity.

Also, a pain scale will allowed us to assess if an analgesic protocol is, is working, if it's effective, or if it despite analgesic protocols, the animals are still in discomfort and needs rescue, rescue analgesia. And we provide the, the analgesia till the animal actually is that as recovered from the, the painful condition. The multimodal, analgesic approach is the best way to treat pain in, in rabbits.

It's a combination of two or more drugs, with different mechanisms that can be given, . During the perioperative time, if following a surgical procedure, but also to discharge till the animal is back to its normal, normal behaviour. Thank you for listening.

I really hope you enjoyed it and that you find, you find that this topic very interesting. Thank you.