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使用两种疼痛评分系统评估加巴喷丁和丁丙诺啡对接受卵巢子宫切除术的猫的镇痛效果:一项随机临床试验

Analgesic effects of gabapentin and buprenorphine in cats undergoing ovariohysterectomy using two pain-scoring systems: a randomized clinical trial.

作者信息

Steagall Paulo V, Benito Javier, Monteiro Beatriz P, Doodnaught Graeme M, Beauchamp Guy, Evangelista Marina C

机构信息

1 Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Canada.

2 Animal Pharmacology Research Group of Québec, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Canada.

出版信息

J Feline Med Surg. 2018 Aug;20(8):741-748. doi: 10.1177/1098612X17730173. Epub 2017 Sep 18.

Abstract

Objectives The aim of the study was to evaluate the analgesic efficacy of gabapentin-buprenorphine in comparison with meloxicam-buprenorphine or buprenorphine alone, and the correlation between two pain-scoring systems in cats. Methods Fifty-two adult cats were included in a randomized, controlled, blinded study. Anesthetic protocol included acepromazine-buprenorphine-propofol-isoflurane. The gabapentin-buprenorphine group (GBG, n = 19) received gabapentin capsules (50 mg PO) and buprenorphine (0.02 mg/kg IM). The meloxicam-buprenorphine group (MBG, n = 15) received meloxicam (0.2 mg/kg SC), buprenorphine and placebo capsules (PO). The buprenorphine group (BG, n = 18) received buprenorphine and placebo capsules (PO). Gabapentin (GBG) and placebo (MBG and BG) capsules were administered 12 h and 1 h before surgery. Postoperative pain was evaluated up to 8 h after ovariohysterectomy using a multidimensional composite pain scale (MCPS) and the Glasgow pain scale (rCMPS-F). A dynamic interactive visual analog scale (DIVAS) was used to evaluate sedation. Rescue analgesia included buprenorphine and/or meloxicam if the MCPS ⩾6. A repeated measures linear model was used for statistical analysis ( P <0.05). Spearman's rank correlation between the MCPS and rCMPS-F was evaluated. Results The prevalence of rescue analgesia with a MCPS was not different ( P = 0.08; GBG, n = 5 [26%]; MBG, n = 2 [13%]; BG, n = 9 [50%]), but it would have been significantly higher in the BG (n = 14 [78%]) than GBG ( P = 0.003; n = 5 [26%]) and MBG ( P = 0.005; n = 4 [27%]) if intervention was based on the rCMPS-F. DIVAS and MCPS/rCMPS-F scores were not different among treatments. A strong correlation was observed between scoring systems ( P <0.0001). Conclusions and relevance Analgesia was not significantly different among treatments using an MCPS. Despite a strong correlation between scoring systems, GBG/MBG would have been superior to the BG with the rCMPS-F demonstrating a potential type II error with an MCPS due to small sample size.

摘要

目的 本研究旨在评估加巴喷丁 - 丁丙诺啡与美洛昔康 - 丁丙诺啡或单独使用丁丙诺啡相比的镇痛效果,以及猫的两种疼痛评分系统之间的相关性。方法 52只成年猫纳入一项随机、对照、盲法研究。麻醉方案包括乙酰丙嗪 - 丁丙诺啡 - 丙泊酚 - 异氟烷。加巴喷丁 - 丁丙诺啡组(GBG,n = 19)接受加巴喷丁胶囊(口服50 mg)和丁丙诺啡(0.02 mg/kg肌肉注射)。美洛昔康 - 丁丙诺啡组(MBG,n = 15)接受美洛昔康(0.2 mg/kg皮下注射)、丁丙诺啡和安慰剂胶囊(口服)。丁丙诺啡组(BG,n = 18)接受丁丙诺啡和安慰剂胶囊(口服)。加巴喷丁(GBG)和安慰剂(MBG和BG)胶囊在手术前12小时和1小时给药。在卵巢子宫切除术后长达8小时使用多维综合疼痛量表(MCPS)和格拉斯哥疼痛量表(rCMPS - F)评估术后疼痛。使用动态交互式视觉模拟量表(DIVAS)评估镇静情况。如果MCPS≥6,则救援镇痛包括丁丙诺啡和/或美洛昔康。采用重复测量线性模型进行统计分析(P<0.05)。评估MCPS与rCMPS - F之间的Spearman等级相关性。结果 使用MCPS进行救援镇痛的发生率无差异(P = 0.08;GBG,n = 5 [26%];MBG,n = 2 [13%];BG,n = 9 [50%]),但如果基于rCMPS - F进行干预,BG组(n = 14 [78%])的发生率将显著高于GBG组(P = 0.003;n = 5 [26%])和MBG组(P = 0.005;n = 4 [27%])。各治疗组之间DIVAS和MCPS/rCMPS - F评分无差异。在评分系统之间观察到强相关性(P<0.0001)。结论及相关性 使用MCPS时各治疗组的镇痛效果无显著差异。尽管评分系统之间存在强相关性,但由于样本量小,GBG/MBG组在rCMPS - F方面优于BG组,而MCPS可能存在II类错误。

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