Randomised trial of perioperative tramadol for canine sterilisation pain management

Abstract

Surgical sterilisation to manage free-roaming dog populations is widely used in many countries. However, few studies have examined optimal postoperative pain management regimens at low-resource, high-throughput veterinary clinics. The aim of this study was to examine the efficacy of two intravenous analgesic regimens, preoperative administration of meloxicam and tramadol, or meloxicam alone, in free-roaming dogs undergoing sterilisation. A total of 125 dogs were included, with 64 dogs in the meloxicam-tramadol arm and 61 dogs in the meloxicam-only arm in a non-inferiority study design. Pain levels in sterilisation surgery patients were assessed at four time points after surgery using the Colorado State University Canine Acute Pain Scale, a Visual Analogue Scale and a modified version of the Glasgow Composite Measure Pain Scale – Short Form. Non-inferiority was supported for each of the main scoring outcomes using non-inferiority margins of 0.5, 5 and 0.8, respectively. One dog from the meloxicam-tramadol group and four dogs in the meloxicam-only arm required rescue analgesia, with no difference between groups (P=0.21).The study demonstrated that meloxicam was effective in controlling postoperative pain in a high proportion of dogs. The addition of tramadol alongside meloxicam treatment was not found to be of clinical benefit.

Efficacy of tramadol for postoperative pain management in dogs: systematic review and meta-analysis

“…1 & Table 1). All of the included studies, except one (Meunier et al 2019), had a superiority design, out of which 11 were performed as multiarm trials (Mondal et al 2005;Martins et al 2010;Fajardo et al 2012;Kongara et al 2012;Rialland et al 2012;Davila et al 2013;Morgaz et al 2013;Cardozo et al 2014;Marques 2015;Zhang et al 2017;Ugwu et al 2020) and 14 as parallel trials (Mastrocinque & Fantoni 2003;Carareto et al 2007;Gupta et al 2009;Schuszler et al 2010;Kongara et al 2013;St anescu et al 2013;Centonze et al 2014;Delgado et al 2014;Benitez et al 2015;Oliveira et al 2016;Giudice et al 2017;Saberi Afshar et al 2017;Uscategui et al 2017;Read et al 2019). The mean sample size of the included studies was 33 ± 24 dogs.…”

“…The mean sample size of the included studies was 33 ± 24 dogs. Sample size was calculated in three of the 26 included studies (Delgado et al 2014;Uscategui et al 2017;Meunier et al 2019).…”

“…The surgeries performed were ovariohysterectomy (Mastrocinque & Fantoni 2003;Mondal et al 2005;Carareto et al 2007;Gupta et al 2009;Fajardo et al 2012;Kongara et al 2012;Morgaz et al 2013;St anescu et al 2013;Oliveira et al 2016;Saberi Afshar et al 2017;Uscategui et al 2017;Zhang et al 2017;Meunier et al 2019;Ugwu et al 2020), orchiectomy (Kongara et al 2013), cruciate ligament repair and other orthopedic surgeries (Schuszler et al 2010;Rialland et al 2012;Davila et al 2013;Cardozo et al 2014;Benitez et al 2015;Marques 2015), eye enucleation (Delgado et al 2014), hemilaminectomy (Giudice et al 2017), thoracic surgery (Read et al 2019), maxillectomy and mandibulectomy (Martins et al 2010) andmastectomy (Uscategui et al 2017).…”

“…Meunier et al 2019; p ¼ 0.82), or in those administered a dose 3 mg kg e1(Centonze et al 2014;Saberi Afshar et al 2017) versus those administered higher doses(Oliveira et al 2016;Saberi Afshar et al 2017;Meunier et al 2019; p ¼ 0.95).…”

Clinical pharmacology of tramadol and tapentadol, and their therapeutic efficacy in different models of acute and chronic pain in dogs and cats

“…On the contrary, according to the Glasgow Composite Measure Pain Scale, nefopam IV at 2 mg/kg conferred superior analgesia than the same dose of tramadol, whereas patients receiving tramadol required less rescue analgesia (1 mg/kg IV of nefopam) [ 57 ]. Furthermore, Meunier et al [ 58 ] reported that the preoperative IV application of 0.2 mg/kg meloxicam and 4 mg/kg tramadol as a multimodal analgesic regimen for free-roaming dogs subjected to OVH provided adequate analgesia but no clinical benefit over the use of meloxicam alone. Interestingly, the need for rescue analgesia was approximately four times greater in animals administered meloxicam than in the opioid group.…”