Surgery

Selecting a Veterinarian

It is wise to check that the vet you are considering to do a spay or neuter on your rabbit is rabbit savvy. You can check this by asking the following question but when making calls to select a veterinarian, keep in mind that front office staff will most likely be the ones to answer your questions. They frequently are not aware of procedures unique to rabbits, especially if not many are seen at their clinic. They may need to ask a veterinary technician or the veterinarian for the answers to your questions. Questions you might want to ask - with desirable answers in italics include:

What type of anaesthesia is used? Injected sedation followed by gas anaesthesia is the best choice. Isoflurane is the most commonly used gas.
Martin Earles - one of NZ's rabbit savvy vets explains this for us in detail here - “Rabbits don't respond well to gas induction - they will hold their breath and not inhale the anaesthetic. Also they become very stressed with this and are susceptible to heart arrhythmias which can cause death. We give a pre-medicant which contains pain relief and something to relax the bunny and reduce stress and anxiety. This is followed by an injectable induction agent to get them asleep. From there we use oxygen +/- isoflurane (gas anaesthetic) to keep them asleep.”
Are fluids given during and after the surgery? IV fluids during and in the period after surgery can make an enormous difference to the speed of recovery for your rabbit and is highly recommended.
What type of suture material will be used – internal or external? Will you need to return for suture removal? Internal, dissolvable stitches + glue are the best options.
Are pain medications readily used? Are they sent home and how are they administered? Your rabbit should be administered pain medication at the time of surgery and also be sent home with 3-5 days pain medication. Rabbits metabolise medications faster than cats and dogs so the commonly used ‘long lasting jab’ will not be sufficient for your rabbit and it may need more pain relief as soon as 12 hours after surgery.
Does the vet ask that water and/or food be restricted (fasting) prior to or following surgery? Your rabbit needs to eat and drink right up to their surgery.
Is your rabbit kept overnight following surgery? If at all possible it is best for your rabbit to come home on the day of surgery to reduce stress. Make sure you are prepared with emergency supplies on hand to force feed if necessary.
Are antibiotics given during or after surgery? This is not normally needed with rabbits post desexing.
How often does the vet do this type of surgery? Ideally the vet performs rabbit desex operation regularly.

Rabbit Analgesia
In New Zealand the sad truth is that many veterinarians are not sufficiently trained or experienced enough in regard to recognising and treating pain in rabbits. The consequences of this are that far too many rabbits suffer severe and unnecessary pain following procedures such as desexing due to woefully inadequate levels of analgesia.

Rabbit savvy vet specialist Martin Earles recommends a dose rate of 0.3mls/kg of Dog Metacam (1.5mg/ml), twice a day post desex.

World renown Rabbit Veterinarian Molly Varga has addressed Rabbit Analgesia in the following article which considers the recognition and treatment of distress and pain in this species -
Analgesia and pain management in rabbits - Molly Varga (2016) Analgesia and pain management in rabbits, Veterinary Nursing Journal, 31:5, 149-153, DOI: 10.1080/17415349.2016.1164449
Article Link: https://doi.org/10.1080/17415349.2016.1164449

Supported by current research which investigates the dose and dosing intervals of the use of Meloxicam in rabbits (per Carpenter, Pollock, Koch, & Hunter, 2009; Cooper, Metcalf-Pate, Barat, Cook, & Scorpio, 2009; Delk, Carpenter, KuKanich, Nietfeld, & Kohles, 2014; Fredholm, Carpenter, KuKanich, & Kohles, 2013) Ms Varga states -

"Rabbits require a much higher dose than a dog of the same weight
(approximately eight times the dose) and require this more often (twice daily rather than once daily dosing)."

Ms Varga concludes -
"Recognition of pain and implementation of appropriate pain relief can significantly improve both the welfare and the clinical outcome of our rabbit patients."

Pain relief doses for rabbits are constantly being reviewed by experienced rabbit vets. The following chart is sourced from a 2023 webinar by Dr Sophie Jenkins BVetMed PgC EAS CertExAP MRCVS, Advanced Practitioner in Zoological Medicine which was hosted on The Webinar Vet website. - Pain Management in Rabbits - More than just Meloxicom.
The chart below; sourced from the webinar, illustrates how much the recommended doses has changed recently and how vital it is to use the correct dose.

Preparing for Surgery

When scheduling non-emergency surgery, select a time when you will be available to more closely observe and care for your rabbit. Keep in mind your vet’s office may not be open on weekends or holidays should you have any questions or complications arise. Clarify if any emergency phone numbers you are given reach your vet directly or if they are referrals to emergency clinics. Emergency clinics frequently do not have veterinarians familiar with rabbit medicine.

Do not withhold food (fast) or water prior to surgery. Because this practice is important with dogs and cats, it is a common misconception regarding rabbits. Dogs and cats can vomit under anaesthesia and if any is aspirated (breathed into the lungs), a serious medical condition can result. Rabbits are physically unable to vomit, which is why hairballs are so dangerous. Therefore, withholding food is unnecessary. Rabbits can however, experience nausea from anaesthetic agents. Prior to surgery, just feed normally.

If your veterinarian’s staff gives you instructions to fast or withhold water prior to (or after) surgery it would be a good idea to clarify if this is their standard pre-surgery instruction for rabbits. Ask the staff to check with the veterinarian if this is a recommendation and if it is, you may wish to reconsider your vet’s familiarity with rabbits.

Rabbits are fast healers and may act and feel normal after only a day or two. However, it is a good idea to keep your rabbit confined for up to a week to prevent excessive running and jumping, especially if abdominal surgery was performed. Internal tissues need adequate time to heal.

By using an experienced rabbit veterinarian, most rabbits will not experience any complications due to surgery. Knowing how to prepare your rabbit prior to surgery and what to do for your rabbit’s post-surgery care, gives your rabbit the best possible chance for a non-eventful recovery.

Post Op Care - What to Expect

Have the following on hand in case you need them:

- 1ml syringe to forcefeed

- Critical Care or Burgess DualCare - DualCare is available from Westley’s World’s Shop.

- An MPS (Medical Pet Shirt) in the right size. You can fit and prepare it beforehand so that if it is needed you aren’t handling your post-op rabbit more than necessary. There’s more info below and in the Using a MPS or Baby Onesie Post Op file.

Unless our rabbits require day(s) of ongoing post-surgery veterinary care you are unable to provide ourselves, it’s best to bring them home the evening after surgery. Most Veterinarians do not have 24-hour staffing. Therefore, animals left overnight at a clinic will go 8-10 hours without any care or monitoring until staff arrives the next morning. Bringing your rabbit home alleviates the stress of being in a strange environment and allows you to monitor their condition during the important first post-op day.

You should provide a clean cage with soft bedding in a warm, darkened environment. If your rabbit’s cage is normally in an area with a lot of activity, you may want to move it to a calmer area for a few days. If your rabbit is normally uncaged, you will probably want to keep him confined to prohibit over activity. This also allows you to more easily monitor eating and elimination amounts. Expect your rabbit will be feeling the effects of anaesthesia as well as discomfort and will not be his usual self. Try not to lift or handle your rabbit except to check sutures or provide necessary care as instructed by your vet.

After most surgeries it is desirable to get a rabbit eating as soon as possible to prevent a shutdown of the digestive system (gut stasis). Fresh greens - weeds and long grass, hay, and pellets should be made available upon return home. Some suggestions to help entice your post op bun follow - Alfalfa is handy since it is a rich, high fibre treat that may induce an otherwise reluctant rabbit to eat. Aromatic herbs like Parsley, Basil, Fennel and Dill are good too. Many buns will go for fresh long grass or weeds such as Puha and Dandelion. Rabbits who begin eating soon after surgery usually have the quickest recovery. Your rabbit may not resume her normal eating habits for several days. As long as some food consumption begins within 12-24 hours, this is okay. If your rabbit has not eaten anything in the day following surgery, your veterinarian needs to be consulted and you will need to begin force-feeding. One product developed as a complete balanced food for force-feeding is Critical Care by Oxbow Hay Company. You may want to obtain this if syringe feeding is required. Burgess DualCare is a similar product. Provide a bowl of water even if your rabbit usually drinks from a bottle. It is important your rabbit re-hydrate herself following surgery. We frequently find a rabbit will consume more from a bowl since it takes less effort then lapping at a bottle. Using an electrolyte product, particularly the flavoured varieties, may help induce a reluctant rabbit to drink, but it is not essential.

Monitor your rabbit’s body language for pain. Grinding teeth, unusual body position, or decreased responsiveness may indicate pain. Your rabbit may show these signs later in the evening after surgery, once the effects of anaesthesia fully wear off. Many rabbits who undergo surgery usually show some signs the first night. Administer as necessary the pain medications you have previously discussed with your vet. Rabbits, like people, are individuals and pain thresholds can vary considerably. One standard does not fit all. A rabbit in pain is less likely to eat or drink adequately, thereby slowing down or severely impairing their recovery. A rabbit in severe pain may go into shock and die.

Keep close watch on your rabbit’s food and water consumption, as well as output, until back to normal. If normal eating or drinking does not return after a few days consult your vet. Also, if your rabbit’s eating begins to return to normal then lessens, consult your vet immediately. This can be a sign of infection, hernia or adhesion formation, and needs prompt medical intervention. Check the incision daily for a week or until non-dissolvable sutures/staples are removed. When your rabbit was discharged you should have been provided with information on incision care as any unusual redness, swelling, warmth, discharge or odour needs to be brought to the vet’s attention. If intradermal sutures were used, you may notice small lumps under the skin. These are probably the normal suture knots and will dissolve over several weeks. If your rabbit licks excessively, to the point of opening up the incision, your vet may need to put the rabbit under anaesthesia and re-close the area. If intradermal sutures were not used the first time, ask your vet to use them when re-suturing. Some vets will use an Elizabethan collar (e-collar) to prevent further irritation of the area. Rabbits do not tolerate these collars well and may refuse to eat while they are on. In order for your rabbit to eat, you may need to remove the collar for a while, in which case you will need to monitor your rabbit constantly. You may have to try alternate ways of keeping a rabbit from excessively licking its incision – some have used tube socks rolled up and fastened around the neck or cut pantyhose legs or socks to form a tube-like body stocking over the rabbit torso and abdomen or use a baby onesie (see below).

Your veterinarian may have given a dose of antibiotics during surgery to prevent infection during the procedure. We don’t recommend continuing antibiotics after routine surgeries (such as a spay or neuter) unless infection or other medical conditions warrant. Use of antibiotics can negatively affect gut flora at a time when your rabbit is not eating properly and can lead to complications.

Rabbits are fast healers and may act and feel normal after only a day or two. However, it is a good idea to keep your rabbit confined for up to a week to prevent excessive running and jumping, especially if abdominal surgery was performed. Internal tissues need adequate time to heal.

By using a knowledgeable rabbit veterinarian, most rabbits will not experience any complications due to surgery. Knowing how to prepare your rabbit prior to surgery and what to do for your rabbit’s post-surgery care, gives your rabbit the best possible chance for a non-eventful recovery.

Edited content based on and shared with permission from the HRRN Surgery page - Surgery Considerations

Surgery / Pre and Post Operative Care - Dana Kremples
Spaying, Neutering & Aftercare for Rabbits - Special Bunny
Spay & Neuter Post-Op Care - Georgia House Rabbit Society

Alternatives to an Elizabethan Collar for the Post Op period

Soft Collars
A variant of the Mae West Collar is the stuffed sock collar - here modelled by the very, VERY naughty Sparrow, a WW foster bun.

The video below shows how to make the stuffed sock collar. I prefer to use a 'sausage' of rolled up polar fleece because it is lighter than a flannel and you can make it bulkier if needed.

Here’s another approach to making a soft collar using crepe bandages -

The T-Shirt Option - Superior Post-surgical Feline & Canine Appliance. (Or: Dump the Cone!)

Tube or Sock body Covering
Tricia Bingham recommends using a sock - Cut the toe off a longish sock and a triangular wedge out near the other end leaving the top end of the sock intact. The elastic at the non toe end goes round the buns neck and the hole made by the wedge is for their front paws to go down. Roll the sock down the length of the body.

You could perhaps also leave the toe on and cut leg holes for the back leg, roll the sock on from the bottom up and once in place, carefully a cut a slit for the vent and pop the tail out.

A MPS (Medical Pet Shirt), Buster Suit or Baby Onesie

These can also be used - this is a especially useful for bun post neuter as it effectively covers the neuter site. There’s more info here - Using a Buster Suit, MPS or Baby Onesie.

Monica Wells’ bun - Manuka, underwent multiple complex abdominal surgeries and sadly was a determined stitch/staple puller. In the end the vet needed to ‘wrap’ him with special bandages to stop him. Photos below ...

***This is ONLY to be done by a vet and is only used in extreme cases - it is NOT to be attempted at home***

PAIN
Rabbits and guinea pigs represented a small percentage of the caseload of veterinarians in this study. From an animal welfare perspective this may be of concern as, anecdotally, these species are common pets. However, further study regarding the actual number of these animals kept as pets in New Zealand is required for validation. Veterinary perception of anticipated pain, and willingness to perform procedures, varied between procedures, but was not influenced by gender of veterinarian. Many respondents felt their knowledge of issues relating to pain recognition, anaesthesia and analgesia in rabbits and guinea pigs was inadequate.
Attitudes towards perception and management of pain in rabbits and guinea pigs by a sample of veterinarians in New Zealand

Recognising Pain in rabbits
This manual describes the five action units that comprise Rabbit Grimace Scale (RbtGS)
and how these action units should be scored. These action units have been shown to
increase in intensity in response to post-procedural pain (Keating et al. 2012).
The five action units in the Rabbit Grimace Scale are:
• Orbital tightening
• Cheek flattening
• Nostril shape
• Whisker change & position
• Ear shape & position
Rabbit Grimace Scale (RbtGS) Manual - a full PDF copy of the manual

Rabbits in the wild are at the bottom of the food chain. It’s hard-wired into them not to show any sign of weakness. If they show any sign of illness or disability, to make them look slow and vulnerable, they’ll end up as somebody’s dinner. This instinct is present in our pet rabbits too.
Pain Management for Rabbits - RWAF

Medicating Your Rabbit/Force Feeding - You MUST seek veterinary advice BEFORE any syringe feeding to ensure the rabbit does not have an intestinal blockage.

“Rabbits are very sensitive creatures and they stress very easily. Your veterinarian or a veterinary technician will probably show you how to give pills, administer eye or ear drops, or syringe feed your rabbit. But sometimes rabbits who are as good as gold when they’re at the clinic put up quite a struggle when you try the same procedure at home. Every rabbit/person pair will work out their own routines. But to give you a head start, members of the House Rabbit Society have pooled their experience and come up with the following tips for medicating bunnies at home.”
Medicating Your Rabbit - House Rabbit Society

“It is vital that rabbits keep eating steady amounts throughout the day and night, however sick rabbits or those that are recovering from an anaesthetic or in pain may be reluctant to do so. This is where assisted feeding is needed. A rabbit’s system can shut down very quickly in cases like this.”

Syringe Feeding Guide - RWAF

Taking Your Rabbit’s Temperature

TAKE THE BUNNY'S TEMPERATURE. This is something every bunny owner should know how to do BEFORE IT IS AN EMERGENCY! Use a flexible digital thermometer and lubrication. Have a plan for warming or cooling the bunny if necessary. If you are in the midst of an emergency, please watch this this how-to video by the GHRS! It shows step by step instructions and includes some must know information:
Additional information and Video on how to take your bunny's temperature - Georgia House Rabbit Society

* Anything above 103°F is a fever!

* Between 101°F to 103°F is normal.

* Anything below 101°F is considered hypothermia which is more dangerous than a fever!

“If temp is above 103°F, cool them down (high temps can cause seizures and brain damage).
Suggested methods to cool down your bunny safely:
* Fill a bottle with cold water and keep it against the rabbit. Make sure the bottle has a good seal.
* Wet a towel with cold water, wring it out as completely as possible, shake it in the air to get it cool, and wrap it around the rabbit. Do your best not to get the bunny wet.

If temp is below 101° F , warm them up. (Your bunny is hypothermic and their systems could shut down; it also will slow their absorption of medications.)

Suggested methods to warm your bunny:
* Fill a bottle with hot water, wrap a small towel around it, and put it against the rabbit. Make sure the bottle has a good seal. (WARNING: As it cools, it will begin to take heat away from the rabbit, so check it every 20 minutes)
* Heat a microwavable “bunny warmer” and then place it against the rabbit. (Make sure it isn't hot to the touch or you could burn your bunny.)
* Heat a bath towel in a microwave, 30 seconds at a time and when it is very warm, wrap it around the rabbit. This doesn’t last long, but it gives heat all over the body. (Warning: Do not allow your rabbit to get wet! Getting wet may cause the rabbit’s body temperature to drop faster!)
* Use a heating pad to cover your bun, allowing plenty of space to move away if they get too hot. The heating pad should have a soft, absorbent cover and the cord should be keep out of reach of your bunny.”
Source: Detecting Illness Before it's an Emergency - Dana Kremples

Supermarket / Farmer’s Market Produce

Syringe Feeding and Giving Medication