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Efficacy of tramadol for postoperative pain management in dogs: systematic review and meta-analysis
Veterinary Anaesthesia and Analgesia ( IF 1.7 ) Pub Date : 2021-02-10 , DOI: 10.1016/j.vaa.2021.01.003
Pablo A Donati 1 , Lisa Tarragona 1 , Juan V A Franco 2 , Veronica Kreil 1 , Rodrigo Fravega 3 , Alfredo Diaz 1 , Natali Verdier 4 , Pablo E Otero 1
Affiliation  

Objective

To evaluate the evidence of analgesic efficacy of tramadol for the management of postoperative pain and the presence of associated adverse events in dogs.

Databases used

A comprehensive search using PubMed/MEDLINE, LILACS, Google Scholar and CAB databases with no restrictions on language and following a prespecified protocol was performed from June 2019 to July 2020. Included were randomized controlled trials (RCTs) performed in dogs that had undergone general anesthesia for any type of surgery. Two authors independently classified the studies, extracted data and assessed their risk of bias using Cochrane’s tool. RevMan and GRADE methods were used to rate the certainty of evidence (CoE).

Conclusions

Overall 26 RCTs involving 848 dogs were included. Tramadol administration probably results in a lower need for rescue analgesia versus no treatment or placebo [moderate CoE; relative risk (RR): 0.47; 95% confidence interval (CI): 0.26–0.85; I2 = 0%], and may result in a lower need for rescue analgesia versus buprenorphine (low CoE; RR: 0.50; 95% CI: 0.20–1.24), codeine (low CoE; RR: 0.75; 95% CI: 0.16–3.41) and nalbuphine (low CoE; RR: 0.05; 95% CI: 0.00–0.72). However, tramadol administration may result in an increased requirement for rescue analgesia versus methadone (low CoE; RR: 3.45; 95% CI: 0.66–18.08; I2 = 43%) and COX inhibitors (low CoE; RR: 2.27; 95% CI: 0.68–7.60; I2 = 45%). Compared with multimodal therapy, tramadol administration may make minimal to no difference in the requirement for rescue analgesia (low CoE; RR: 1.12; 95% CI: 0.48–2.60; I2 = 0%). Adverse events were inconsistently reported and the CoE was very low. The overall CoE of the analgesic efficacy of tramadol for postoperative pain management in dogs was low or very low, and the main reasons for downgrading the evidence were risk of bias and imprecision.



中文翻译:

曲马多对犬术后疼痛管理的疗效:系统评价和荟萃分析

客观的

评估曲马多对治疗犬术后疼痛和相关不良事件的镇痛效果的证据。

使用的数据库

2019 年 6 月至 2020 年 7 月,使用 PubMed/MEDLINE、LILACS、Google Scholar 和 CAB 数据库进行了全面搜索,没有语言限制,并遵循预先指定的方案。包括在接受全身麻醉的狗中进行的随机对照试验 (RCT)适用于任何类型的手术。两位作者独立地对研究进行分类、提取数据并使用 Cochrane 的工具评估他们的偏倚风险。RevMan 和 GRADE 方法用于评估证据的确定性 (CoE)。

结论

总共包括 26 项 RCT,涉及 848 只狗。不治疗或安慰剂相比,曲马多给药可能导致对挽救性镇痛的需求降低[中度 CoE;相对风险(RR):0.47;95% 置信区间 (CI):0.26–0.85;I 2 = 0%],丁丙诺啡(低 CoE;RR:0.50;95% CI:0.20–1.24)、可待因(低 CoE;RR:0.75;95% CI:0.16)相比 ,可能导致对挽救性镇痛的需求较低–3.41)和纳布啡(低 CoE;RR:0.05;95% CI:0.00–0.72)。然而,与美沙酮(低 CoE;RR:3.45;95% CI:0.66–18.08;I 2  = 43%)和 COX 抑制剂(低 CoE;RR:2.27;95%)相比,曲马多给药可能导致对挽救性镇痛的需求增加CI:0.68–7.60;I 2 = 45%)。与多模式治疗相比,曲马多给药可能对挽救性镇痛的需求影响很小甚至没有差异(低 CoE;RR:1.12;95% CI:0.48–2.60;I 2  = 0%)。不良事件报告不一致,CoE 非常低。曲马多对犬术后疼痛管理的镇痛效果的总体 CoE 低或非常低,降级证据的主要原因是偏倚风险和不精确性。

更新日期:2021-02-10
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