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Acute Postoperative Pain Control

Clinician's Brief (Capsule)

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This randomized, masked clinical trial aimed to compare analgesia achieved with carprofen vs tramadol in dogs post-enucleation. Though there are many published studies on the efficacy of carprofen to treat moderate postsurgical pain in dogs, there are little published data regarding analgesic efficacy of oral tramadol for postsurgical or chronic pain. The authors hypothesized that tramadol, because of its suggested multimodal analgesic properties, would provide better postoperative pain control than carprofen.

Forty-three dogs presented for routine enucleation were assigned to groups receiving either carprofen or tramadol orally 2 hours before surgery and 12 hours after first dose. Identical premedication (including hydromorphone) and inhalant anesthesia protocols were followed. A previously validated pain scoring system, using 5 behavioral categories, and a visual analog scale (VAS) were used to evaluate pain at baseline and multiple time points postoperatively, up to 30 hours postextubation. If total pain score was ≥9 (of 20), a behavioral category score was ≥3 (of 3 or 4), or VAS score was ≥35 (of 100) with a positive palpation score, hydromorphone was given as rescue analgesia and treatment failure recorded. There were no differences in age, sex, or baseline pain scores between groups. However, significantly more dogs receiving tramadol required rescue analgesia (6/21) than those receiving carprofen (1/22). Pain andVAS scores decreased linearly over time. Results suggest carprofen may provide superior analgesia to tramadol in dogs undergoing enucleation. 

Commentary

Although advances have been made in veterinary pain management, areas remain for further investigation. One example is effective oral analgesics for acute postoperative pain control in dogs, as an alternative or in addition to NSAIDs. A growing percentage of veterinarians prescribe tramadol as an alternative, but there is little evidence about its clinical efficacy. Moreover, the pharmacokinetic data are limited and inconclusive; many questions remain about indications for tramadol, effective doses, and administration frequency. This study shows how tramadol is a long way from becoming a reliable oral analgesic in dogs. In this dog model for postenucleation pain control, tramadol was inferior compared to carprofen. Despite the risk for side effects, the efficacy of NSAIDs is undisputed and should be used as a base for the analgesic protocol unless contraindicated.—Maria Angeles Jimenez Lozano, DVM, CertVA, DECVAA, MRCVS

References

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