Resumen
Con el objetivo de determinar la eficacia analgésica y las posibles alteraciones hematológicas y bioquímicas producidas durante el tratamiento del dolor posoperatorio con metamizol en felinos sometidos a ovariohisterectomía, se realizó un estudio en treinta gatas que fueron divididas aleatoriamente en 3 grupos: 1) (n=10) fue tratado con metamizol a dosis de 30 mg/kg IV cada 12 horas durante 3 días; 2) (n=10) fue tratado con metamizol a dosis de 20 mg/kg IV cada 12 horas durante 3 días; y 3) (n=10) fue tratado con meloxicam a dosis de 0,1 mg/kg IV cada 24 horas durante 3 días. Se tomaron muestras sanguíneas para hemoleucograma, alaninoaminotransferasa, creatinina, nitrógeno ureico sanguíneo, fosfatasa alcalina, albúmina, tiempo de protrombina y tiempo parcial de tromboplastina, al tiempo 0, 24 y 96 horas después de la primera aplicación del analgésico asignado. La valoración del dolor se realizó a las 6, 12, 24, 30, 36, 48, 54 y 60 horas, aplicando la versión en inglés de la escala de dolor compuesta multidimensional para evaluar el dolor posoperatorio en gatos UNESP-Botucatu. En relación con la evaluación del dolor, se encontraron diferencias significativas entre los grupos a las 12, 24, 30, 36, 54 y 60 horas, siendo menores los puntajes de dolor en los grupos tratados con metamizol con respecto al grupo tratado con meloxicam. El metamizol, administrado en dosis de 20 a 30 mg/kg IV cada 12 horas durante 3 días, provee una adecuada analgesia posoperatoria en gatas sometidas a ovariohisterectomía, comparado con el meloxicam. No se presentaron cambios hematológicos ni bioquímicos clínicamente significativos en la mayoría de pacientes tratados.Referencias
Mathews K, Kronen PW, Lascelles D, Nolan A, Robertson S, Steagall PV, et al. Guidelines for recognition, assessment and treatment of pain. J Small Anim Pract. 2014;55(6):E10-68. Disponible en: https://doi.org/10.1111/jsap.12200
Steagall PV, Monteiro BP. Acute pain in cats: Recent advances in clinical assessment. J Feline Med Surg. 2019;21(1):25-34. Disponible en: https://doi.org/10.1177/1098612X18808103
Gruen ME, Lascelles BDX, Colleran E, Gottlieb A, Johnson J, Lotsikas P, et al. 2022 AAHA pain management guidelines for dogs and cats. J Am Anim Hosp Assoc. 2022;58(2):55-76. Disponible en: https://doi.org/10.5326/JAAHA-MS-7292
Epstein M, Rodan I, Griffenhagen G, Kadrlik J, Petty M, Robertson S, et al. 2015 AAHA/AAFP pain management guidelines for dogs and cats. J Am Anim Hosp Assoc. 2015;51(2):67-84. Disponible en: https://doi.org/10.1177/1098612X15572062
Steagall PV, Robertson S, Simon B, Warne LN, Shilo-Benjamini Y, Taylor S. 2022 ISFM consensus guidelines on the management of acute pain in cats. J Feline Med Surg2022;24(1):4-30. Disponible en: https://doi.org/10.1177/1098612X211066268
Lebkowska-Wieruszewska B, Kim TW, Chea B, Owen H, Poapolathep A, Giorgi M. Pharmacokinetic profiles of the two major active metabolites of metamizole (dipyrone) in cats following three different routes of administration. J Vet Pharmacol Ther. 2018;41(2):334-339. Disponible en: https://doi.org/10.1111/jvp.12471
Steagall PV. Analgesia: What makes cats different/challenging and what is critical for cats? Vet Clin North Am Small Anim Pract. 2020;50(4):749-767. Disponible en: https://doi.org/10.1016/j.cvsm.2020.02.002
Feighelstein M, Shimshoni I, Finka LR, Luna SPL, Mills DS, Zamansky A. Automated recognition of pain in cats. Sci Rep. 2022;12(1):9575. Disponible en: https://doi.org/10.1038/s41598-022-13348-1
Lees P, Toutain PL, Elliott J, Giraudel JM, Pelligand L, King JN. Pharmacology, safety, efficacy and clinical uses of the COX-2 inhibitor robenacoxib. J Vet Pharmacol Ther. 2022;45(4):325-51. Disponible en: https://doi.org/10.1111/jvp.13052
Bradbrook CA, Clark L. State of the art analgesia- recent developments in pharmacological approaches to acute pain management in dogs and cats. Part 1. Vet J Lond Engl 1997. 2018;238:76-82. Disponible en: https://doi.org/10.1016/j.tvjl.2018.06.003
Bradbrook C, Clark L. State of the art analgesia. Recent developments pharmacological approaches to acute pain management in dogs and cats: Part 2. Vet J Lond Engl 1997. 2018;236:62-67. Disponible en: https://doi.org/10.1016/j.tvjl.2018.04.009
Court MH. Feline drug metabolism and disposition: pharmacokinetic evidence for species differences and molecular mechanisms. Vet Clin North Am Small Anim Pract. 2013;43(5). Disponible en: https://doi.org/10.1016/j.cvsm.2013.05.002
Kondo T, Ikenaka Y, Nakayama SMM, Kawai YK, Mizukawa H, Mitani Y, et al. Uridine Diphosphate-Glucuronosyltransferase (UGT) 2B subfamily interspecies differences in carnivores. Toxicol Sci Off J Soc Toxicol. 2017;158(1):90-100. Disponible en: https://doi.org/10.1093/toxsci/kfx072
Sparkes AH, Heiene R, Lascelles BDX, Malik R, Sampietro LR, Robertson S, et al. ISFM and AAFP consensus guidelines: long-term use of NSAIDs in cats. J Feline Med Surg. 2010;12(7):521-538. Disponible en: https://doi.org/10.1016/j.jfms.2010.05.004
U.S. Food and Drug Administration. Get the facts about pain relievers for pets [Internet]. FDA. 2022. Disponible en: https://shorturl.at/efgF8
Mathews K, Kronen PW, Lascelles D, Nolan A, Robertson S, Steagall PV, et al. Guidelines for recognition, assessment and treatment of pain. J Small Anim Pract. 2014;55(6):E10-68. Disponible en: https://doi.org/10.1111/jsap.12200
Sattasathuchana P, Phuwapattanachart P, Thengchaisri N. Comparison of post-operative analgesic efficacy of tolfenamic acid and robenacoxib in ovariohysterectomized cats. J Vet Med Sci. 2018;80(6):989-996. Disponible en: https://doi.org/10.1292/jvms.17-0443
Ingwersen W, Fox R, Cunningham G, Winhall M. Efficacy and safety of 3 versus 5 days of meloxicam as an analgesic for feline onychectomy and sterilization. Can Vet J Rev Vét Can. 2012;53(3):257-64.
Khwanjai V, Chuthatep S, Durongphongtorn S, Yibchok-Anun S. Evaluating the effects of 14-day oral vedaprofen and tolfenamic acid treatment on renal function, hematological and biochemical profiles in healthy cats. J Vet Pharmacol Ther. 2012;35(1):13-18. Disponible en: https://doi.org/10.1111/j.1365-2885.2011.01282.x
Steagall PVM, Moutinho FQ, Mantovani FB, Passarelli D, Thomassian A. Evaluation of the adverse effects of subcutaneous carprofen over six days in healthy cats. Res Vet Sci. 2009;86(1):115-120. Disponible en: https://doi.org/10.1016/j.rvsc.2008.04.002
Kamata M, King JN, Seewald W, Sakakibara N, Yamashita K, Nishimura R. Comparison of injectable robenacoxib versus meloxicam for peri-operative use in cats: results of a randomised clinical trial. Vet J Lond Engl 1997. 2012;193(1):114-118. Disponible en: https://doi.org/10.1016/j.tvjl.2011.11.026
Speranza C, Schmid V, Giraudel JM, Seewald W, King JN. Robenacoxib versus meloxicam for the control of peri-operative pain and inflammation associated with orthopaedic surgery in cats: a randomised clinical trial. BMC Vet Res. 2015;11:79. Disponible en: https://doi.org/10.1186/s12917-015-0391-z
Texeira LG, Vaccarin CV, Schimites PI, Gasparotto JC, Costa GP, Griesang JM, et al. Grapiprant or carprofen following ovariohysterectomy in the cat: analgesic efficacy, hematological, biochemical and urinalysis evaluation. J Feline Med Surg. 2022;24(8): e153-e162. Disponible en: https://doi.org/10.1177/1098612X221097935
Brondani JT, Mama KR, Luna SPL, Wright BD, Niyom S, Ambrosio J, et al. Validation of the english version of the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in cats. BMC Vet Res. 2013;9:143. Disponible en: https://doi.org/10.1186/1746-6148-9-143
Hernandez-Avalos I, Mota-Rojas D, Mora-Medina P, Martínez-Burnes J, Casas Alvarado A, Verduzco-Mendoza A, et al. Review of different methods used for clinical recognition and assessment of pain in dogs and cats. Int J Vet Sci Med. 2019;7(1):43-54. Disponible en: https://doi.org/10.1080/23144599.2019.1680044
Pogatzki-Zahn E, Chandrasena C, Schug SA. Nonopioid analgesics for postoperative pain management. Curr Opin Anaesthesiol. 2014;27(5):513-519. Disponible en: https://doi.org/10.1097/ACO.0000000000000113
Jasiecka A, Maślanka T, Jaroszewski JJ. Pharmacological characteristics of metamizole. Pol J Vet Sci. 2014;17(1):207-214. Disponible en: https://doi.org/10.2478/pjvs-2014-0030
Imagawa VH, Fantoni DT, Tatarunas AC, Mastrocinque S, Almeida TF, Ferreira F, et al. The use of different doses of metamizol for post-operative analgesia in dogs. Vet Anaesth Analg. 2011;38(4):385-393. Disponible en: https://doi.org/10.1111/j.1467-2995.2011.00617.x
Pereira MA, Campos KD, Gonçalves LA, dos Santos RS, Flôr PB, Ambrósio AM, et al. Cyclooxygenases 1 and 2 inhibition and analgesic efficacy of dipyrone at different doses or meloxicam in cats after ovariohysterectomy. Vet Anaesth Analg. 2021;48(1):7-16. Disponible en: https://doi.org/10.1016/j.vaa.2020.10.004
Flôr PB, Yazbek KVB, Ida KK, Fantoni DT. Tramadol plus metamizole combined or not with anti-inflammatory drugs is clinically effective for moderate to severe chronic pain treatment in cancer patients. Vet Anaesth Analg. 2013;40(3):316-27. Disponible en: https://doi.org/10.1111/vaa.12023
Crunfli F, Vilela FC, Giusti-Paiva A. Cannabinoid CB1 receptors mediate the effects of dipyrone. Clin Exp Pharmacol Physiol. 2015;42(3):246-55. Disponible en: https://doi.org/10.1111/1440-1681.12347
Andrade S, Bartels DB, Lange R, Sandford L, Gurwitz J. Safety of metamizole: a systematic review of the literature. J Clin Pharm Ther. 2016;41(5):459-77. Disponible en: https://doi.org/10.1111/jcpt.12422
Hanson PD, Maddison JE. Non steroidal antiinflamatry drugs and chondroprotective agents. En: Madison JE, Page S, Church DB, editores. In small animal clinical pharmacology. Nottingham: Saunders; 2008. 287–308. p. Disponible en: https://doi.org/10.1016/B978-070202858-8.50015-4
Steagall PVM, Taylor PM, Brondani JT, Luna SPL, Dixon MJ. Antinociceptive effects of tramadol and acepromazine in cats. J Feline Med Surg. 2008;10(1):24-31. Disponible en: https://doi.org/10.1016/j.jfms.2007.06.009
Davis H, Jensen T, Johnson A, Knowles P, Meyer R, Rucinsky R, et al. 2013 AAHA/AAFP fluid therapy guidelines for dogs and cats. J Am Anim Hosp Assoc. 2013;49(3):149-159. Disponible en: https://doi.org/10.5326/JAAHA-MS-5868
Moody CM, Niel L, Pang DJ. Is training necessary for efficacious use of the Glasgow Feline Composite Measure Pain Scale? Can Vet J. 2022;63(6):609-616.
Belli M, de Oliveira AR, de Lima MT, Trindade PHE, Steagall PV, Luna SPL. Clinical validation of the short and long UNESP-Botucatu scales for feline pain assessment. PeerJ. 2021;9:e11225. Disponible en: https://doi.org/10.7717/peerj.11225
Evangelista MC, Silva RA, Cardozo LB, Kahvegian MAP, Rossetto TC, Matera JM, et al. Comparison of preoperative tramadol and pethidine on postoperative pain in cats undergoing ovariohysterectomy. BMC Vet Res. 2014;10:252. Disponible en: https://doi.org/10.1186/s12917-014-0252-1
Merola I, Mills DS. Systematic review of the behavioural assessment of pain in cats. J Feline Med Surg. 2016;18(2):60-76. Disponible en: https://doi.org/10.1177/1098612X15578725
Brondani JT, Luna SPL, Crosignani N, Redondo JI, Granados MM, Bustamante H, et al. Validez y confiabilidad de la versión en español de la escala multidimensional de la UNESP-Botucatu para evaluar el dolor postoperatorio en gatos. Arch Med Vet. 2014;46(3):477-486. Disponible en: https://doi.org/10.4067/S0301-732X2014000300020
Carroll GL, Howe LB, Peterson KD. Analgesic efficacy of preoperative administration of meloxicam or butorphanol in onychectomized cats. J Am Vet Med Assoc. 2005;226(6):913-919. Disponible en: https://doi.org/10.2460/javma.2005.226.913
Charlton AN, Benito J, Simpson W, Freire M, Lascelles BDX. Evaluation of the clinical use of tepoxalin and meloxicam in cats. J Feline Med Surg. 2013;15(8):678-690. Disponible en: https://doi.org/10.1177/1098612X12473994
de Paula VV, Araújo-Silva G, Fernandes NS, Nunes Mouta A, Lins Nunes T, Lopes Correira de Paiva A, et al. Pharmacokinetic profiles of the two major active metabolites of Metamizole, 4-Methylaminoantipyrine (Maa) and 4-Aminoantipyrine (Aa), after intravenous injection in cats. SSRN. 2022. Disponible en: https://doi.org/10.2139/ssrn.4261931
Teixeira LG, Martins LR, Schimites PI, Dornelles GL, Aiello G, Oliveira JS, et al. Evaluation of postoperative pain and toxicological aspects of the use of dipyrone and tramadol in cats. J Feline Med Surg. 2020;22(6):467-475. Disponible en: https://doi.org/10.1177/1098612X19849969
Zanuzzo FS, Teixeira-Neto FJ, Teixeira LR, Diniz MS, Souza VL, Thomazini CM, et al. Analgesic and antihyperalgesic effects of dipyrone, meloxicam or a dipyrone-meloxicam combination in bitches undergoing ovariohysterectomy. Vet J Lond Engl 1997. 2015;205(1):33-37. Disponible en: https://doi.org/10.1016/j.tvjl.2015.05.004
Loane SC, Thomson JM, Williams TL, McCallum KE. Evaluation of symmetric dimethylarginine in cats with acute kidney injury and chronic kidney disease. J Vet Intern Med. 2022;36(5):1669-1676. Disponible en: https://doi.org/10.1111/jvim.16497
Yerramilli M, Farace G, Quinn J, Yerramilli M. Kidney Disease and the nexus of chronic kidney disease and acute kidney injury: The role of novel biomarkers as early and accurate diagnostics. Vet Clin North Am Small Anim Pract. 2016;46(6):961-993. Disponible en: https://doi.org/10.1016/j.cvsm.2016.06.011
Hassan K, Khazim K, Hassan F, Hassan S. Acute kidney injury associated with metamizole sodium ingestion. Ren Fail. 2011;33(5):544-547. Disponible en: https://doi.org/10.3109/0886022X.2011.569107
de Loor J, Daminet S, Smets P, Maddens B, Meyer E. Urinary biomarkers for acute kidney injury in dogs. J Vet Intern Med Am Coll Vet Intern Med. 2013;27(5):998-1010. Disponible en: https://doi.org/10.1111/jvim.12155
Willard MD, Twedt DC. 9 - Gastrointestinal, Pancreatic, and Hepatic Disorders. En Willard MD, Tvedten H, editores. Small animal clinical diagnosis by laboratory methods (5th Edition). Saunders; 2012. p. 191-225. Disponible en: https://doi.org/10.1016/B978-1-4377-0657-4.00009-0
Zanuzzo FS, Teixeira-Neto FJ, Thomazini CM, Takahira RK, Conner B, Diniz MS. Effects of dipyrone, meloxicam, or the combination on hemostasis in conscious dogs. J Vet Emerg Crit Care San Antonio Tex 2001. 2015;25(4):512-520. Disponible en: https://doi.org/10.1111/vec.12336
Palabras clave
gatos
hematología
metamizol
dipirona