Multicenter Study of Long-Term Outcomes and Quality of Life in PHACE Syndrome after Age 10.

OBJECTIVE: To characterize long-term outcomes of PHACE syndrome. STUDY DESIGN: Multicenter study with cross-sectional interviews and chart review of individuals with definite PHACE syndrome ≥10 years of age. Data from charts were collected across multiple PHACE-related topics. Data not available in charts were collected from patients directly. Likert scales were used to assess the impact of specific findings. Patient-Reported Outcomes Measurement Information System (PROMIS) scales were used to assess quality of life domains. RESULTS: A total of 104/153 (68%) individuals contacted participated in the study at a median of 14 years of age (range 10-77 years). There were infantile hemangioma (IH) residua in 94.1%. Approximately one-half had received laser treatment for residual IH, and the majority (89.5%) of participants were satisfied or very satisfied with the appearance. Neurocognitive manifestations were common including headaches/migraines (72.1%), participant-reported learning differences (45.1%), and need for individualized education plans (39.4%). Cerebrovascular arteriopathy was present in 91.3%, with progression identified in 20/68 (29.4%) of those with available follow-up imaging reports. Among these, 6/68 (8.8%) developed moyamoya vasculopathy or progressive stenoocclusion, leading to isolated circulation at or above the level of the circle of Willis. Despite the prevalence of cerebrovascular arteriopathy, the proportion of those with ischemic stroke was low (2/104; 1.9%). PROMIS global health scores were lower than population norms by at least 1 SD. CONCLUSIONS: PHACE syndrome is associated with long-term, mild to severe morbidities including IH residua, headaches, learning differences, and progressive arteriopathy. Primary and specialty follow-up care is critical for PHACE patients into adulthood.

Rubella virus-associated necrotizing granulomatous inflammation with extensive eyelid, ocular, and orbital involvement.

We present a case of cutaneous granulomatous disease associated with rubella virus in a 4-year-old girl without an identifiable immunodeficiency. In this case, a combination of anti-inflammatory, anti-viral, and anti-neutrophil therapies successfully treated vision-threatening eyelid, conjunctival, scleral, and orbital inflammation.

Sex impacts pain behaviour but not emotional reactivity of lambs following ring tail docking.

Studies in humans have shown sex differences in response to painful events, however, little is known in relation to sex differences in sheep. Understanding sex differences would enable improved experimental design and interpretation of studies of painful procedures in sheep. To examine sex differences in response to pain, 80 lambs were tested across five cohorts of 16. The lambs were penned in groups containing two male and two female lambs with their respective mothers. Lambs were randomly allocated from within each block to one of four treatment groups; FRing-Female lamb, ring tail docked without analgesia, MRing-Male lamb, ring tail docked without analgesia, FSham-Female lamb, tail manipulated and MSham-Male lamb, tail manipulated. Following treatment, lambs were returned to their pen and were video recorded for 45 mins for behavioural observations of acute pain and posture. An hour after treatment, lambs then underwent an emotional reactivity test that consisted of three phases: Isolation, Novelty and Startle. Following treatment, Ring lambs displayed more abnormal postures (mean = 2.5 ± 0.5) compared to Sham lambs (mean = 0.05 ± 0.4, P = 0.0001). There was an effect of sex on the display of acute pain-related behaviours in lambs that were tail docked (P < 0.001), with female lambs displaying more acute behaviours (mean count = +2.2). This difference in behaviour between sexes was not observed in Sham lambs. There was no effect of sex on display of postures related to pain (P = 0.99). During the Novelty and Startle phase of the emotional reactivity test, Ring lambs tended to (P = 0.084) or did (P = 0.018) show more fear related behaviours, respectively. However, no effect of sex was observed. The results of this study indicate that a pain state may alter the emotional response of lambs to novel objects and potential fearful situations. It was also demonstrated that female lambs display increased sensitivity to the acute pain caused by tail docking compared to males.

Evaluation of a commercial electrical stunning method for farmed grower saltwater crocodiles (Crocodylus porosus) using non-invasive EEG measurements.

The aim of this study was to assess welfare outcomes of electrical stunning as a means of restraint in farmed grower saltwater crocodiles (Crocodylus porosus). Physical handling of a stunned, unconscious crocodile is far safer for the operator than handling a fully conscious animal. Electroencephalogram (EEG) was recorded before and after the application of electrical stunning at 50 Hz or 400 Hz using an electrical stunner applied to the cranial plate (Position 1: P1-50 Hz; n = 31, P1-400 Hz; n = 29) or immediately behind the skull (Position 2: P2-50 Hz; n = 29; P2-400 Hz; n = 30). For all electrical stuns, percentage total EEG power in a 10-s epoch decreased in the alpha and beta frequency bands; and increased in the delta and lower frequencies bands. All electrical stuns resulted in increased strength of signal, based on the quadratic mean EEG power in all frequency bands of the EEG. Greatest change in power occurred in the delta frequency band, with P1-50 Hz. This was greater than with P2-50 Hz; while decibel change using 400 Hz at either position was intermediate and not significantly different from either. Application of either electrical stunner at position 1 resulted in seizure-like activity and activation in low frequencies, but at position 2 this was not consistent across all animals. The ability of the electrical stunning equipment to consistently induce recoverable unconsciousness could be ranked in decreasing order as: P1-50 Hz > P1-400 Hz = P2-50 Hz > P2-400 Hz. Based on behavioural observations, all animals in the study appeared to stunned however evaluation of duration of EEG changes indicates that use of the electrical stunning equipment at 50 Hz would allow some margin for inaccuracies in tong placement, while achieving a consistently reliable stun.

Dual treatment of cutaneous leishmaniasis with topical amphotericin B and photodynamic therapy in a pediatric patient.

Cutaneous leishmaniasis is a parasitic infection that can result in scarring, contributing to significant morbidity when a cosmetically sensitive area is involved. We report a case of a 13-year-old boy with cutaneous leishmaniasis involving the face and arm. He was treated with a combination of photodynamic therapy as well as topical amphotericin with a cosmetically satisfying outcome. This combination of noninvasive treatment regimens has not been reported to our knowledge and merits further study in the pediatric population.

Sweet Syndrome in the Pediatric Population.

Pediatric Sweet syndrome (SS) is thought to be a hypersensitivity reaction to an underlying inflammatory or infectious state and typically is diagnosed using criteria created for adult patients. Although more studies are needed to understand the etiology and natural course of pediatric SS, guidelines for work-up and treatment have been suggested. Herein, the available literature is reviewed and guidelines summarized for the clinical evaluation and management of pediatric SS.

Perinatal Stress in Immature Foals May Lead to Subclinical Adrenocortical Dysregulation in Adult Horses: Pilot Study.

The persistent endocrinological effects of perinatal stress due to gestational immaturity in horses are unknown, although effects have been reported in other livestock species. This pilot study tested the hypothesis that persistent adrenocortical dysregulation is present in horses that were gestationally immature at birth by assessing the salivary cortisol response to exogenous ACTH. Case horses (n = 10) were recruited with histories of gestation length < 315 d or dysmaturity observable through neonatal signs. Positive controls (n = 7) and negative controls (n = 5) were recruited where possible from related horses at the same locations. Cases and positive controls received an intramuscular, low-dose (0.1 ug/kg) of synthetic ACTH (Tetracosactrin 250 mg/mL, Synacthen); negative controls received no ACTH. Saliva samples were collected from all horses at baseline T = 0 and at 30 min intervals post injection from T = 30 to T = 150. These were assayed for salivary cortisol concentration (SCC) using a commercially available ELISA kit (Salimetrics). All baseline values (T = 0) were within normal published ranges. Peak and AUC values (corrected for baseline) for case horses were significantly different (ANOVA P < .001) to positive controls, with either higher (H-cases) or lower (L-cases) SCC values, outside the 95% Confidence Interval of the reference population. There was no significant effect of breed, age, sex, test month, or location on results. The results suggest that gestational immaturity may lead to subclinical adrenocortical dysregulation, with affected horses presenting an elevated or blunted response to a low-dose ACTH stimulation, despite normal basal levels.

Welfare of Farmed Crocodilians: Identification of Potential Animal-Based Measures Using Elicitation of Expert Opinion.

Animal-based measures are the measure of choice in animal welfare assessment protocols as they can often be applied completely independently to the housing or production system employed. Although there has been a small body of work on potential animal-based measures for farmed crocodilians, they have not been studied in the context of an animal welfare assessment protocol. Potential animal-based measures that could be used to reflect the welfare state of farmed crocodilians were identified and aligned with the Welfare Quality® principles of good housing, good health, good feeding and appropriate behaviour. A consultation process with a panel of experts was used to evaluate and score the potential measures in terms of validity and feasibility. This resulted in a toolbox of measures being identified for further development and integration into animal welfare assessment on the farm. Animal-based measures related to 'good feeding' and 'good health' received the highest scores for validity and feasibility by the experts. There was less agreement on the animal-based measures that could be used to reflect 'appropriate behaviour'. Where no animal-based measures were deemed to reliably reflect a welfare criterion nor be useful as a measure on the farm, additional measures of resources or management were suggested as alternatives. Future work in this area should focus on the reliability of the proposed measures and involve further evaluation of their validity and feasibility as they relate to different species of crocodilian and farming system.

Three Studies Evaluating the Potential for Lidocaine, Bupivacaine or Procaine to Reduce Pain-Related Behaviors following Ring Castration and/or Tail Docking in Lambs.

The use of local anesthesia at the time of ring castration and tail docking can improve lamb welfare. However, few local anesthetics are registered for sheep, and data on their duration of effect is limited. Three studies were conducted to evaluate the efficacy of procaine (P), lidocaine (L), and bupivacaine (B) in terms of observed alleviation of behavioral responses to castration and/or tail docking in 10-min blocks in the first 60 min post-treatment. In each study, comparisons were made between two groups of lambs castrated and/or tail docked with rubber rings and either receiving the agent using the NUMNUTS® instrument (N) or receiving no anesthetic agent (RR). Acute pain behavior was lower in NL (n = 28) than RRL (n = 15) males in the first 10 min post-procedure (p < 0.05); lower in NB (n = 16) than RRB (n = 16) males in periods 10-20 min (0.05 < p < 0.01), 20-30 min (p < 0.05) and 40-50 min (0.05 < p < 0.01); lower in NB (n = 16) than RRB (n = 16) females between 20 and 40 min post-procedure (0.05 < p < 0.01); lower in NP (n = 8) than RRP (n = 7) males in period 10-20 min (0.05 < p < 0.01), and lower in NP (n = 9) than RRP (n = 9) females in periods 0-10 min (0.05 < p < 0.01), and 10-40 min (p < 0.05). Benefits were modest, and the effects of procaine appear to last longer than lidocaine, while bupivacaine is slower to take effect than either procaine or lidocaine but may provide longer-lasting pain relief. The duration of action of local anesthetics is short in sheep, and detailed behavioral evaluations are required in the first hour post-procedure to establish efficacy.

Measuring the impact of clinical practice guidelines on infantile hemangioma referrals.

High-risk infantile hemangiomas may be associated with significant patient comorbidity. The American Academy of Pediatrics published clinical practice guidelines with recommendations to refer high-risk hemangiomas early. The results of this study suggest that these guidelines may have resulted in an earlier referral age of patients with high-risk IH to hemangioma specialists.

Local Anesthetic Delivered with a Dual Action Ring and Injection Applicator Reduces the Acute Pain Response of Lambs during Tail Docking.

Docking the tail of lambs is a standard husbandry procedure and is achieved through several techniques including clamps, hot or cold knives and latex rings, the last of which is the most popular. All tail docking methods cause acute pain which can be reduced by application of local anesthetic, however precise anatomical injection for optimal efficacy requires considerable skill. This pen trial evaluated the ability of local anesthetic (LA) delivered with a dual function ring applicator/injector to alleviate acute tail docking pain. Thirty ewe lambs were assigned to one of three treatment groups (n = 10 per group): ring plus local anesthetic (Ring LA), ring only (Ring) and sham handled control (Sham). Lambs were videoed and their behavior categorized every five minutes for the first hour and every 10 min for the subsequent two hours after treatment. There was a significant effect (p < 0.001) of treatment on total active pain related behaviors in the first hour, with Ring lambs showing higher counts compared to Ring LA or Sham. Ring lambs also displayed a significantly higher count of combined abnormal postures (p < 0.001) than Ring LA or Sham lambs. Delivery of 1.5 mL of 2% lignocaine via the dual action device abolished abnormal behaviors and signs of pain in Ring LA lambs. However, lambs in the Ring LA group spent less time attempting to suckle compared to Ring and Sham lambs, suggesting that some residual discomfort remained.

Analgesia for Sheep in Commercial Production: Where to Next?

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.

Efficacy of precisely injected single local bolus of lignocaine for alleviation of behavioural responses to pain during tail docking and castration of lambs with rubber rings.

Delivery of local anaesthetic at the time of castration and tail docking (marking) could improve welfare outcomes in lambs. This study examined pain responses in lambs marked using rubber rings, with or without local anaesthetic precision injected using the Numnuts® instrument. On each of two commercial farms, 150 prime lambs aged 4 to 10 weeks, balanced for sex, were randomly allocated to 3 treatments: handled in a lambing cradle (Sham), handled and marked with rubber rings (Ring) or handled and marked with rubber rings and treated with 30 mg lignocaine using the Numnuts® instrument (NNLA). Time to mother up (one trial site only), acute pain related behaviours at 5, 20, 35 and 50 min, and postures at 10 min intervals from 60 to 180 min were recorded. NNLA lambs tended to mother up more quickly than Ring lambs (P = 0.09), and more slowly (P = 0.07) than Sham lambs. Acute pain behaviours were significantly more frequent in Ring and NNLA than Sham (P < 0.001) from 5 to 50 min. NNLA was significantly lower than Ring at 5 min (P < 0.001) and 20 min (P = 0.001). Ring and NNLA did not differ at 35 or 50 min. Abnormal postures were higher in Ring and NNLA than Sham at 60, 70, 80, 90 and 150 min (P < 0.048). Ring and NNLA did not differ at any time point between 60 and 180 min. Delivery of lignocaine with the Numnuts® instrument improved welfare outcome of lambs during the acute pain response caused by castration and tail docking with rubber rings.

Attention behaviours but not pain-related behaviours are modified by the presence of a twin in lambs undergoing castration by rubber ring.

The social context of social species such as sheep can modify their physiological and behavioural responses to stressors, through social buffering and social facilitation. Social buffering can lead to amelioration of stress, while social facilitation can lead to stress responses in an observer animal in the presence of a conspecific in distress. The current study investigated twin lambs undergoing ring castration, grouped either homogeneously with a castrated lamb (actor), or heterogeneously with a non-castrated lamb (observer) to examine the impact of social grouping on behavioural responses. Each lamb was scored for two classes of behaviour: pain-related behaviours and postures that are putatively related to the response to castration; and attentional behaviours directed at its twin. Thus, each lamb participated in the experiment as an actor exhibiting pain-related behaviours and postures, and as an observer of its twin. When behaviours of lambs were assessed as actors, there was a significant (P < 0.05) effect of castration but no significant effect of social grouping on expression of pain-related behaviours. When behaviours of lambs were assessed as observers, homogeneous grouping of castrated lambs increased attention towards the other twin in comparison to non-castrated lambs grouped homogeneously or lambs grouped heterogeneously (P < 0.01). Non-castrated lambs grouped homogeneously demonstrated significantly lower numbers of head direction changes (P < 0.001) and lower number of ear posture changes (P < 0.05) than heterogeneously grouped or castrated lambs. This study indicates that social attention between twin lambs is not clearly dependent on pain status of the actor lamb. It suggests that in order for the observer lamb to provide significant attention to the actor lamb displaying pain-related behaviour, the observer lamb also needs to be experiencing pain concurrently. Furthermore, there is some evidence that the presence of pain-related behaviours can lead to increased attention to the surrounding environment in non-castrated lambs. Understanding the effect of concurrent experience and varying social context assists us to improve our understanding of results of other experiments on pain-related behavioural responses.

Prematurity and Dysmaturity Are Associated With Reduced Height and Shorter Distal Limb Length in Horses.

The long-term effects of gestational immaturity in the premature (defined as < 320 days gestation) and dysmature (normal term but showing some signs of prematurity) foal have not been thoroughly investigated. Studies have reported that a high percentage of gestationally immature foals with related orthopedic issues such as incomplete ossification may fail to fulfill their intended athletic purpose, particularly in Thoroughbred racing. In humans, premature birth is associated with shorter stature at maturity and variations in anatomical ratios, linked to alterations in metabolism and timing of physeal closure in the long bones. We hypothesized that gestational immaturity in horses might similarly be associated with reduced height and different anatomical ratios at maturity. In this preliminary study, the skeletal ratios of horses with a history of gestational immaturity, identified through veterinary and breeder records, were compared with those of unaffected, closely related horses (i.e., sire, dam, sibling). External measurements were taken from conformation photographs of cases (n = 19) and related horses (n = 28), and these were then combined into indices to evaluate and compare metric properties of conformation. A principal component analysis showed that the first two principal components account for 43.8% of the total conformational variation of the horses' external features, separating horses with a rectangular conformation (body length > height at the withers), from those that are more square (body length = height at the withers). Varimax rotation of PC1 and analysis of different gestational groups showed a significant effect of gestational immaturity (P = .001), with the premature group being more affected than the dysmature group (P = .009, P = .012). Mean values for the four dominant indices showed that these groups have significantly lower distal limb to body length relationships than controls. The observed differences suggest that gestational immaturity may affect anatomical ratios at maturity, which, in combination with orthopedic issues arising from incomplete ossification, may have a further impact on long-term athletic potential.

A Radiographic Technique for Assessment of Morphologic Variations of the Equine Caudal Cervical Spine.

Equine Caudal Cervical Morphologic Variation (ECCMV) is a congenital malformation of the caudal cervical spine distinct from the more commonly recognized Cervical Vertebral Stenotic Myelopathy (CVSM). The most common presentation of ECCMV is recognized on the sixth cervical vertebra (C6). In "normal" presentations, the transverse processes on the left and right sides have a caudal lamina projecting ventrally below the caudal vertebral body in a heel shape. With ECCMV, variations occur to the structure of the caudal ventral lamina on one or both sides of C6 and may include the seventh cervical (C7) and first thoracic (T1) vertebrae and ribs, in varying configurations. Whereas the prevalence of ECCMV is not known, it has been recognized for many years and has been reported to occur with relatively high frequency within multiple populations of domesticated horses. To date, there is no documented link between the occurrence of ECCMV and clinical signs. However, based on retrospective studies, multiple authors have recognized the potential impact on performance that this condition may have. Establishing a reliable radiographic protocol for the consistent diagnosis of ECCMV would allow quantitative, scientific evaluation of the problem and support clinicians working in this field. We present a radiographic technique, which has been illustrated by diagnosis of ECCMV in three horses and confirmation of the diagnoses in two cases via postmortem examination.

Using Movement Sensors to Assess Lying Time in Horses With and Without Angular Limb Deformities.

Chronic musculoskeletal pathologies are common in horses, however, identifying related effects can be challenging. This study tested the hypothesis that movement sensors and analgesics could be used in combination to confirm the presence of restrictive pathologies by assessing lying time. Four horses presenting a range of angular limb deformities (ALDs) and four nonaffected controls were used. The study comprised two trials at separate paddock locations. Trial A consisted of a 3-day baseline phase and 2 × 3-day treatment phases, during which two analgesics were administered to two ALD horses and two controls in a standard crossover design. Trial B replicated trial A, except that as no difference between analgesics had been evident in trial A, only one analgesic was tested. Movement sensors were used to measure the horses' lying time and lying bouts. In trial A, ALD horses' basal mean lying time was significantly less than controls (means ± SD for ALD horses 213 ± 1.4 minutes and for controls 408 ± 46.7 minutes, P = .007); with analgesic administration, the difference became nonsignificant. In trial B, ALD horses' basal mean lying time was also significantly less than controls (ALD horses 179 ± 110.3 minutes; controls 422.5 ± 40.3 minutes, P < .001), again becoming nonsignificant with analgesic administration. Given the increases in ALD horses' lying time with analgesic administration, it is possible that their shorter basal lying time is associated with musculoskeletal discomfort. Despite the small sample size, movement sensors effectively measured this behavior change, indicating that they could be a useful tool to indirectly assess the impact of chronic musculoskeletal pathologies in horses.

Flawed mothering or infant signaling? The effects of deficient acoustic cues on ovine maternal response.

The neonate distress cry, which displays a similar acoustic structure across a range of mammalian species, is highly effective in attracting, even compelling, parental care. However, if this cry is defective, as found in human and rodent neonates with poor neurobehavioral function, is the signal less enticing? Using playback recordings of a ewe's own co-twins as stimuli in a two choice test, we compared the preference of each sheep dam for acoustic features of lamb distress calls to assess the impact of signal quality on maternal response. The results of this study indicate that lamb vocalizations with acoustic parameters reflecting poor vocal fold engagement and arousal were less likely to be preferred by their dam. Additionally, these calls were associated with delayed vocal initiation and poor infant survival behavior suggestive of subtle cognitive deficit; and support the possibility that, as in deer and rodents, ovine vocalizations within a specific fundamental frequency range may well be a trigger for optimal maternal behavior. This research has important implications for understanding failed maternal-young interactions in ungulate and other species, and for verifying standardization of infant stimuli used in maternal behavior studies.

A pen study evaluation of buccal meloxicam and topical anaesthetic at improving welfare of lambs undergoing surgical mulesing and hot knife tail docking.

Mulesing is a painful husbandry procedure commonly used to reduce the risk of breech strike in sheep. This study assessed the behavioural (over 6 h), cortisol, haptoglobin and haematology responses to surgical mulesing plus tail hot knife docking (mulesing); modulated by a buccal meloxicam formulation (Buccalgesic), a topical local anaesthetic wound dressing (Tri-Solfen) or both agents. 24 lambs were allocated to each of: 1) Placebo and sham handled (Sham); 2) Placebo and mulesing (Mules); 3) Buccalgesic and mulesing (Mules + B); 4) Tri-Solfen and mulesing (Mules + T); 5) Placebo, Tri-Solfen and mulesing (Mules + T + P); 6) Buccalgesic, Tri-Solfen and mulesing (Mules + T + B). Compared with Mules, Mules + T had a lower cortisol response (72.5 ±â€¯8.7 nmol/L v 122.9 ±â€¯8.7 nmol/L) at 30 min, reduced statue standing at 2 h (3.9% v 11.4%) and increased lying (20.9-25.0% v 7.3-12.5%). Mules + B had reduced cortisol response at 6 h (48.1 ±â€¯8.5 nmol/L), reduced Neutrophil:Lymphocyte ratio at 6 h (Mules + B: 1.25; Mules: 2.44), reduced statue standing at 2 h and 4-6 h (4.1-8.3%), and increased lying at 5 h (27.4%). Mules + B + T had lower cortisol concentrations at 30 mins (86.51 ±â€¯8.71 nmol/L), TWCC not significantly different from Sham at 6 h (9.07 vs 8.09) and 24 h (9.05 vs 8.38). Mules + T + B had significantly lower TWCC than Mules at 12 h (9.56 vs 11.05) and 24 h (9.05 vs 10.42). Mules + T + B did not.

A randomised field study evaluating the effectiveness of buccal meloxicam and topical local anaesthetic formulations administered singly or in combination at improving welfare of female Merino lambs undergoing surgical mulesing and hot knife tail docking.

This study was a field-based behavioural assessment of the pain responses to surgical mulesing modulated by a buccal formulation of meloxicam (Buccalgesic) and a topical local anaesthetic wound dressing (Tri-Solfen). 20 lambs were randomly allocated to each of: 1) Placebo and sham handled (Sham); 2) Placebo and mulesing (Mules); 3) Buccalgesic and mulesing (Mules+B); 4) Tri-Solfen and mulesing (Mules+T); 5) Placebo, Tri-Solfen and mulesing (Mules+T+P); 6) Buccalgesic, Tri-Solfen and mulesing (Mules+T+B). Lamb behaviour was observed by scan sampling every 15 min for 6 h post mulesing then for 1.5 h daily over the subsequent 10 days. Wound score, wound sensitivity and body weight were recorded on day 4, 7 and 10. On the day of mulesing, abnormal behaviours were reduced for all groups that received the analgesic drugs compared to the Mules group (P < 0.05). Tri-Solfen reduced expression of abnormal behaviours in the first 4 h; Buccalgesic reduced expression of abnormal behaviours between 2 and 6 h; and combination treatment reduced expression of abnormal behaviours over the entire observation period. On the subsequent two days, the drug combination resulted in fewer abnormal postures than Tri-Solfen alone. The drug combination tended to result in lower pain sensitivity (965.3 g tolerated) than either Mules+T+P (828.8 g), or Mules+B (791.2 g) on day 7 (P < 0.05). Use of Tri-Solfen and Buccalgesic singly or in combination improved the welfare of lambs undergoing surgical mulesing. The residual effect of pain and discomfort caused by mulesing, were evident despite provision of analgesic drugs.