Clinical efficacy of an ultrasound-guided bilateral rectus sheath block for umbilical hernia repair in calves: A prospective randomized trial

Introduction

Surgical umbilical hernia repair is a frequent procedure in newborn calves, requiring mandatory pain management. This study aimed to develop an ultrasound-guided rectus sheath block (RSB) and to evaluate its clinical efficacy in calves undergoing umbilical herniorrhaphy under general field anesthesia.

Methods

Gross and ultrasound anatomy of the ventral abdomen and the diffusion of a new methylene blue solution after injection within the rectus sheath were described in seven fresh calf cadavers. Then, fourteen calves undergoing elective herniorrhaphy were randomly assigned to receive either bilateral ultrasound-guided RSB with 0.3 mL/kg of bupivacaine 0.25% and 0.15 µg/kg of dexmedetomidine or 0.3 mL/kg of 0.9% NaCl (control). Intraoperative data included cardiopulmonary variables and anesthetic requirements. Postoperative data included pain scores, sedation scores and peri-incisional mechanical threshold assessed by force algometry at specific time points after anesthetic recovery. Treatments were compared using Wilcoxon rank-sum, Student's t-test, and Cox proportional hazard model as appropriate. Mixed effect linear models on rank, with random effect calf; fixed effects time, treatment, and their interaction were used to compare pain scores and mechanical thresholds over time. Significance was set at p = 0.05.

Results and Discussion

Calves receiving RSB recorded lower pain scores between 45 - 120 minutes (p < 0.05) and at 240 min after recovery (p = 0.02). And they recorded higher mechanical thresholds between 45 and 120 min after surgery (p < 0.05). Ultrasound-guided RSB provided effective perioperative analgesia in calves undergoing herniorrhaphy under field conditions.

Can Lambs in Pain Identify Medicated Feed?

Lambs in Australia undergo painful husbandry procedures as part of common husbandry. The magnitude and duration of pain are difficult to assess in lambs. Most currently used methods rely on behavioral expressions and physiological markers that may fail to detect the state of pain an animal experience. This study examined motivation of 12-week-old lambs experiencing chronic pain to self-medicate by consumption of feed containing an analgesic agent as an indicator of pain in lambs. In this study, 36 male Merino lambs were individually penned and acclimated to pelleted feed and two artificial odors: strawberry and banana. Once acclimated to odored feed, lambs were tested for their individual preference for the odors. Lambs were then assigned to one of two groups: Sham—sham handled day 0 and 7 or Ring—Ring castrated day 0 and tail docked day 7. To enable self-medication testing, lambs underwent a conditioning period (day 0–3) followed by the self-medication period (day 7–12). On day 0 lambs were castrated or sham handled, and then offered only medicated feed that contained an odor cue (either strawberry or banana). On day 7, lambs underwent tail-docking or sham handling and were offered both the conditioned medicated feed and non-medicated feed. Amount of each feed consumed was recorded 1 and 12 h after offer each day. Blood samples were taken for cortisol and white blood cell analysis and behavioral observations were recorded for 12 h following treatment. There was no difference in preference for medicated feed between Ring and Sham lambs during the self-medication phase (P = 0.18). Lambs in both groups displayed a significant preference for strawberry cued medicated feed during the self-medicated period when compared to the other testing periods (P = 0.05). Ring lambs displayed more active pain behaviors (mean = 15.1) than Sham (mean = 0.4, P &lt; 0.05). Following castration, Ring lambs had a higher neutrophil/lymphocyte ratio at 6, 24, 48, and 72 h. This study was not able to demonstrate that lambs can self-medicate for a state of pain.

Analgesia for Sheep in Commercial Production: Where to Next?

Simple Summary

Increasing societal and customer pressure to provide animals with ‘a life worth living’ continues to apply pressure on industry to alleviate pain associated with husbandry practices, injury and illness. Although a number of analgesic solutions are now available for sheep, providing some amelioration of the acute pain responses, this review has highlighted a number of potential areas for further research.

Abstract

Increasing societal and customer pressure to provide animals with ‘a life worth living’ continues to apply pressure on livestock production industries to alleviate pain associated with husbandry practices, injury and illness. Over the past 15–20 years, there has been considerable research effort to understand and develop mitigation strategies for painful husbandry procedures in sheep, leading to the successful launch of analgesic approaches specific to sheep in a number of countries. However, even with multi-modal approaches to analgesia, using both local anaesthetic and non-steroidal anti-inflammatory drugs (NSAID), pain is not obliterated, and the challenge of pain mitigation and phasing out of painful husbandry practices remains. It is timely to review and reflect on progress to date in order to strategically focus on the most important challenges, and the avenues which offer the greatest potential to be incorporated into industry practice in a process of continuous improvement. A structured, systematic literature search was carried out, incorporating peer-reviewed scientific literature in the period 2000–2019. An enormous volume of research is underway, testament to the fact that we have not solved the pain and analgesia challenge for any species, including our own. This review has highlighted a number of potential areas for further research.

Non-Steroidal Anti-Inflammatory Drugs: Pharmacokinetics and Mitigation of Procedural-Pain in Cattle

Common routine management practices in cattle, such as castration and disbudding, are recognized as being painful. In the United States (U.S.), these procedures are frequently performed without pain mitigation and there are currently no drugs federally approved for such use. Non-steroidal anti-inflammatory drugs, such as meloxicam, flunixin meglumine and aspirin, are the most commonly used analgesics in U.S. food-animal production systems. However, the body of research investigating the effectiveness of these pharmaceuticals to control pain in cattle at castration and disbudding has not been comprehensively evaluated. Therefore, this review examined existing literature to summarize meloxicam, flunixin and aspirin (1) pharmacokinetics (PK) and (2) administration outcome in regard to pain control during castration and disbudding procedures, in cattle. Following systematic searches and screening, 47 PK and 44 publications were extracted for data and are presented. The sample size contained notable variability and a general deficiency of validated and replicated methodologies for assessing pain in cattle remain substantial challenges within this research area. Future research should prioritize replication of pain assessment methodologies across different experimental conditions to close knowledge gaps identified by the present study and facilitate examination of analgesic efficacy.

Marking to weaning production aspects of lambs provided with NSAID analgesia compared with lambs receiving no analgesia at the time of elastrator ring marking

The provision of analgesia at the time of marking has been adopted by the Australian sheep industry, but data on production benefits are lacking. In the current study, alternate lambs were provided with either meloxicam (non-steroidal anti-inflammatory drug [NSAID], n = 781) or no analgesia (NONE, n = 822) at the time of ring castration and tail docking. Six distinct management groups of lambs were studied. Lambs were weighed immediately before marking and then again at weaning. There was no significant effect of treatment on average daily gain between marking and weaning in cross-bred lambs. In Merino lambs, average daily gain was 5 g/day lower (P < 0.005) in lambs receiving NSAID, but this may not be biologically significant. Lamb losses were significantly (P < 0.05) lower in the NSAID group (1.1%) than in the NONE group (2.7%). This observation is worth validating in larger studies, particularly considering that lamb mortality is a significant cost to production and welfare concern.

Effect of a buccal meloxicam formulation on the behavioural response to ring castration of calves

This study aimed to evaluate the effect of a buccal meloxicam formulation on the behavioural response to ring castration of calves. Sixty, 3-month-old, Angus calves (40 males, 20 females) were allocated to one of three treatments (n = 20 calves/treatment): (1) rubber ring castration (RING), (2) buccal formulation of meloxicam plus rubber ring castration (RING + BUCC) and (3) handled only (CON). After treatment, calves were observed in five pens (n = 4 calves/treatment/pen) and behaviour individually recorded for 1 min every 20 min, until 3 h post-treatment (9 min/calf). Castrated calves (RING and RING + BUCC) spent less time standing (P &lt; 0.001) and more time lying (P = 0.001) than CON calves. RING and RING + BUCC calves were also observed standing in a stretched positon (P = 0.001) and walking abnormally (P = 0.001) more than CON calves. Further, RING and RING + BUCC calves performed more kicks (P = 0.008) and less pawing (P = 0.04) than CON calves. RING + BUCC calves tended to ruminate (P = 0.085) more than RING calves. Ring castration caused behavioural changes in calves indicative of pain, however, administering a buccal formulation of meloxicam to calves immediately before ring castration did not appear to reduce the acute pain response to this procedure. To thoroughly evaluate the efficacy of a buccal formulation of meloxicam on the pain response to ring castration of calves it may be necessary to observe the animals for longer and to investigate the timing of drug administration further.