Watanabe Ryota, Monteiro Beatriz P, Evangelista Marina C, Castonguay Amélie, Edge Daniel, Steagall Paulo V
Department of Clinical Sciences and Animal Pharmacology Research Group of Quebec (GREPAQ; Groupe de recherche en pharmacologie animale du Québec), Faculty of Veterinary Medicine, Université de Montréal, 3200 rue Sicotte, Saint-Hyacinthe, QC, J2S 2M2, Canada.
Zoetis Inc, Parsippany, NJ, USA.
BMC Vet Res. 2018 Oct 5;14(1):304. doi: 10.1186/s12917-018-1628-4.
Buprenorphine is a potent lipophilic opioid analgesic that is largely used in the multimodal treatment of acute pain. Simbadol (buprenorphine hydrochloride) is the first and only FDA-approved high-concentration formulation of buprenorphine for use in cats. The aim of this study was to evaluate the analgesic efficacy of carprofen in combination with one of two commercial formulations of buprenorphine (Simbadol and Vetergesic, 1.8 mg/mL and 0.3 mg/mL, respectively) in dogs undergoing ovariohysterectomy. Twenty-four dogs were included in a randomized, prospective, controlled, clinical trial. Patients were randomly divided into 2 groups as follows. Dogs were premedicated with acepromazine (0.02 mg/kg) and either 0.02 mg/kg of Vetergesic or Simbadol intramuscularly (Vetergesic group - VG; Simbadol group - SG, respectively; n = 12/group). General anesthesia was induced with propofol and maintained with isoflurane in 100% oxygen. Carprofen (4.4 mg/kg SC) was administered after induction of anesthesia. Heart rate, respiratory rate, blood pressure, pulse oximetry, pain scores using the Glasgow Composite Pain Scale Short Form (CMPS-SF), sedation scores using a dynamic interactive visual analogue scale and adverse events were evaluated before and after ovariohysterectomy by an observer who was unaware of treatment administration. If CMPS-SF scores were ≥ 5/20, dogs were administered rescue analgesia (morphine 0.5 mg/kg IM). Statistical analysis was performed using linear mixed models and Fisher's exact test (p < 0.05).
Pain and sedation scores and physiological parameters were not significantly different between treatments. Three dogs in VG (25%) and none in SG (0%) required rescue analgesia (p = 0.109). Adverse effects (i.e. vomiting and melena) were observed in two dogs in SG and were thought to be related to stress and/or nonsteroidal anti-inflammatory drug toxicity.
The administration of buprenorphine with carprofen preoperatively provided adequate postoperative analgesia for the majority of dogs undergoing OVH without serious adverse events. Prevalence of rescue analgesia was not significantly different between groups; however, it could be clinically relevant and explained by a type II error (i.e. small sample size). Future studies are necessary to determine if analgesic efficacy after Simbadol and Vetergesic is related to individual variability or pharmacokinetic differences.
丁丙诺啡是一种强效亲脂性阿片类镇痛药，广泛用于急性疼痛的多模式治疗。辛巴多（盐酸丁丙诺啡）是首个也是唯一获美国食品药品监督管理局批准用于猫的高浓度丁丙诺啡制剂。本研究的目的是评估卡洛芬与两种市售丁丙诺啡制剂（分别为辛巴多和维特杰西克，浓度分别为1.8毫克/毫升和0.3毫克/毫升）之一联合使用对接受卵巢子宫切除术的犬的镇痛效果。24只犬被纳入一项随机、前瞻性、对照临床试验。将患者随机分为以下2组。犬只术前用乙酰丙嗪（0.02毫克/千克）和0.02毫克/千克的维特杰西克或辛巴多进行肌肉注射预处理（分别为维特杰西克组 - VG；辛巴多组 - SG；每组n = 12）。用丙泊酚诱导全身麻醉，并用异氟烷在100%氧气中维持麻醉。麻醉诱导后给予卡洛芬（4.4毫克/千克皮下注射）。由一名不知道治疗用药情况的观察者在卵巢子宫切除术前和术后评估心率、呼吸频率、血压、脉搏血氧饱和度、使用格拉斯哥综合疼痛量表简表（CMPS - SF）的疼痛评分、使用动态交互式视觉模拟量表的镇静评分以及不良事件。如果CMPS - SF评分≥5/20，则给犬只给予解救镇痛（吗啡0.5毫克/千克肌肉注射）。使用线性混合模型和费舍尔精确检验进行统计分析（p < 0.05）。
各治疗组之间的疼痛和镇静评分以及生理参数无显著差异。VG组有3只犬（25%）需要解救镇痛，SG组无犬需要解救镇痛（p = 0.109）。SG组有2只犬出现不良反应（即呕吐和黑便），认为与应激和/或非甾体抗炎药毒性有关。
术前给予丁丙诺啡与卡洛芬可为大多数接受卵巢子宫切除术的犬提供足够的术后镇痛，且无严重不良事件。两组之间解救镇痛的发生率无显著差异；然而，这可能具有临床相关性，并且可由II类错误（即样本量小）来解释。未来有必要开展研究以确定辛巴多和维特杰西克后的镇痛效果是否与个体差异或药代动力学差异有关。
