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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article provides an overview of multimodal analgesia in large animal field restraint.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EAnesthesia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EVeterinary Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EWorking Animals \u0026amp; Livestock\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EAnesthesiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EHans Coetzee, PhD, Iowa State University, Ames, Iowa, USA, gave an overview of multimodal analgesia in large animal field restraint. The opioid nalbuphine has several advantages as an alternative to butorphanol. Because nalbuphine is an opioid k agonist\/\u03bc antagonist, it has very low abuse potential. It is currently a nonscheduled drug in the United States except in Kentucky where it is scheduled because of abuse potential in equines. It is also less expensive than butorphanol, costing $2.50 per mL compared with $8.60 per mL for butorphanol. In addition, its use is not associated with any cardiovascular, respiratory, or gastrointestinal adverse effects. All opioids, including nalbuphine, have very short half-lives in ruminants. \u201cOpioids in my experience have not necessarily been my mainstay analgesic drug when it comes to ruminants. I use them as an adjunctive therapy in combination with xylazine and ketamine,\u201d Dr. Coetzee said.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe Ketamine Stun is a combination of the dissociative anesthetic ketamine and the \u03b1-2 agonist xylazine, with butorphanol added if needed. For large groups of cattle, a stock solution for a standing stun can be made (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). This solution should not be stored for future use.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15028\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15028\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15028\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EKetamine Stun 5 mL Stock Solution for Standing Restraint\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EThis combination can be modified if a recumbent stun is needed, as follows: xylazine 0.025 to 0.05 mg\/kg (same as standing stun), butorphanol 0.05 to 0.1 mg\/kg (10x standing stun), and ketamine 0.3 to 0.5 mg\/kg intravenously (IV; 5 \u00d7 standing stun). Animals become recumbent gracefully in approximately 1 minute and the effect lasts for 15 to 25 minutes. For 15 minutes of anesthesia, xylazine 0.05 mg\/kg IV is administered first followed by ketamine 2 mg\/kg IV (20 \u00d7 standing stun) once sedated. In cases where longer anesthesia is required, the combination of xylazine 0.05 to 0.1 mg\/kg intramuscularly (IM) and ketamine 4 mg\/kg IM provides 30 to 40 minutes of recumbency. Animals do not need to be fasted before the standing stun or recumbent stun, but should be fasted 24 to 48 hours before anesthesia.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Coetzee also provided some alternatives to xylazine alone. Romifidine 0.05 mg\/kg can be used for recumbency in sheep and a dose of 2 to 3 mg IV provides excellent standing restraint in adult cows. Detomidine 2.5 to 10 \u03bcg\/kg IV provides sedation and recumbency in cattle lasting 30 to 60 minutes. Medetomidine at a dose of 30 \u03bcg\/kg IM produces recumbency in calves and a dose of 10 \u03bcg\/kg IV produces recumbency in sheep for approximately 1 hour.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe acidic properties of lidocaine produce a painful injection in animals. Because of this, Dr. Coetzee highly recommends the use of lidocaine buffered with sodium bicarbonate, using a 10:1 ratio of 2% lidocaine to a commercially available 8.4% sodium bicarbonate solution. This practice is supported by published reports that buffered lidocaine reduces injection pain [McKay et al. \u003Cem\u003EAnes Analg\u003C\/em\u003E 1987], may enhance analgesia [Curatolo M et al. \u003Cem\u003EAnes Analg\u003C\/em\u003E 1998], and may reduce nerve block onset time [Sinnott CJ et al. \u003Cem\u003EAnethesiology\u003C\/em\u003E 2000].\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/25\/7.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzozgd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzozgd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}