Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina.
Argentine Cochrane Centre, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina.
Vet Anaesth Analg. 2021 May;48(3):283-296. doi: 10.1016/j.vaa.2021.01.003. Epub 2021 Feb 10.
To evaluate the evidence of analgesic efficacy of tramadol for the management of postoperative pain and the presence of associated adverse events in dogs.
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).
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; I = 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; I = 43%) and COX inhibitors (low CoE; RR: 2.27; 95% CI: 0.68-7.60; I = 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; I = 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.
评估曲马多用于治疗犬术后疼痛的镇痛效果证据，并评估其相关不良事件。
2019 年 6 月至 2020 年 7 月，我们对 PubMed/MEDLINE、LILACS、Google Scholar 和 CAB 数据库进行了全面检索，未对语言进行任何限制，并按照预设方案进行检索。纳入了接受全身麻醉进行任何类型手术的犬进行的随机对照试验（RCT）。两位作者独立对研究进行分类、提取数据，并使用 Cochrane 工具评估其偏倚风险。RevMan 和 GRADE 方法用于评估证据确定性（CoE）。
共纳入 26 项 RCT，涉及 848 只犬。与无治疗或安慰剂相比，曲马多给药可能降低了对解救性镇痛的需求[中等 CoE；相对风险（RR）：0.47；95%置信区间（CI）：0.26-0.85；I²=0%]，与布托啡诺（低 CoE；RR：0.50；95% CI：0.20-1.24）、可待因（低 CoE；RR：0.75；95% CI：0.16-3.41）和纳布啡（低 CoE；RR：0.05；95% CI：0.00-0.72）相比，也可能降低对解救性镇痛的需求。然而，与美沙酮（低 CoE；RR：3.45；95% CI：0.66-18.08；I²=43%）和 COX 抑制剂（低 CoE；RR：2.27；95% CI：0.68-7.60；I²=45%）相比，曲马多给药可能增加对解救性镇痛的需求。与多模式治疗相比，曲马多给药对解救性镇痛的需求可能无差异或差异较小（低 CoE；RR：1.12；95% CI：0.48-2.60；I²=0%）。不良反应报告不一致，CoE 非常低。曲马多用于治疗犬术后疼痛的镇痛效果总体 CoE 为低或非常低，证据降级的主要原因是偏倚风险和不精确性。
