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

Pablo A Donati; Lisa Tarragona; Juan V A Franco; Veronica Kreil; Rodrigo Fravega; Alfredo Diaz; Natali Verdier; Pablo E Otero

doi:10.1016/j.vaa.2021.01.003

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

Vet Anaesth Analg. 2021 May;48(3):283-296. doi: 10.1016/j.vaa.2021.01.003. Epub 2021 Feb 10.

Authors

Pablo A Donati¹, Lisa Tarragona¹, Juan V A Franco², Veronica Kreil¹, Rodrigo Fravega³, Alfredo Diaz¹, Natali Verdier⁴, Pablo E Otero⁵

Affiliations

¹ Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina.
² Argentine Cochrane Centre, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina.
³ Hospital Veterinario de Santiago, Santiago, Chile.
⁴ Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina; Department of Anesthesiology and Perioperative Intensive Care, University of Veterinary Medicine, Vienna, Austria.
⁵ Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina. Electronic address: potero@fvet.uba.ar.

PMID: 33745825
DOI: 10.1016/j.vaa.2021.01.003

Abstract

Objective: To evaluate the evidence of analgesic efficacy of tramadol for the management of postoperative pain and the presence of associated adverse events in dogs.

Databases used: 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).

Conclusions: 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; I² = 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; I² = 43%) and COX inhibitors (low CoE; RR: 2.27; 95% CI: 0.68-7.60; I² = 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; I² = 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.

Keywords: COX inhibitors; analgesia; meloxicam; multimodal therapy; opioids.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Analgesia* / veterinary
Animals
Dog Diseases* / drug therapy
Dogs
Nalbuphine*
Pain Management / veterinary
Pain, Postoperative / drug therapy
Pain, Postoperative / veterinary
Tramadol* / therapeutic use

Substances

Tramadol
Nalbuphine