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Ensaio clínico para avaliação do benefício da administração peri-operatória de paracetamol em cães submetidos a extração dentária
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O paracetamol é um analgésico, antipirético e fraco anti-inflamatório, amplamente utilizado em Medicina Humana e que pode ser utilizado no maneio da dor peri-operatória no cão. Apesar de apresentar uma janela terapêutica reduzida, o seu uso tem aumentado por ter efeitos adversos gastrointestinais e renais negligenciaveis e não possuir efeito antiagregante plaquetário. A hepatotoxicidade ocorre, no entanto, em casos de sobredosagem, o que pode acontecer com alguma facilidade no contexto de uso sem recomendação médico-veterinária.
O objetivo desta dissertação consistiu em avaliar a eficácia analgésica do paracetamol em cães submetidos a extração dentária. Para tal, foi realizado um estudo clínico prospetivo, aleatório e cego, no contexto de procedimentos de extração dentária. Os animais foram divididos em dois grupos, de acordo com a administração ou não de paracetamol. As variáveis recolhidas foram os parâmetros de monitorização anestésica, as pontuações de dor obtidas através da escala de dor de Melbourne às 0 horas, 2 horas e 4 horas e uma escala de dor numérica de 0 a 10 após 24 horas.
Não foram observadas diferenças estatisticamente significativas entre os níveis de dor às 0 e às 2 horas (p=0.783) nem entre as escalas de dor às 2 e às 4 horas (p=0.254), para todos os animais. Quanto à diferença de escalas de dor entre o grupo de controlo e o grupo do paracetamol, não se observaram diferenças estatisticamente significativas em nenhum dos momentos estudados: às 0 horas (p=0.199), 2 horas (p=0.813), 4 horas (p=0.193), e 24 horas (p=0.745). Nenhum dos animais necessitou de resgate analgésico. Observaram-se diferenças estatisticamente significativas entre os dois grupos para a frequência cardíaca máxima (p=0.036) e a pressão diastólica mínima (p=0.021), no período intra-operatório. Observou-se ainda efeito de interação (p=0.017) entre as variáveis Grupo e Tempo, verificando-se um decréscimo da dor média no grupo do paracetamol, de 4.2 às 0 horas para 2.4 às 4 horas. No grupo controlo observou-se um aumento do nível médio de dor de 2.4 às 0 horas para 3.8 às 4 horas.
Não foi possível concluir acerca do benefício analgésico do paracetamol integrado no maneio da dor perioperatória em cães submetidos a extração dentária, devido ao erro de tipo 2 associado à amostra pequena. No entanto, o decréscimo da dor no grupo do paracetamol sugere que este fármaco poderá ser útil como adjuvante analgésico em cães submetidos a extrações dentárias.
ABSTRACT - Clinical trial to evaluate the benefit of perioperative administration of paracetamol to dogs undergoing dental extraction - Paracetamol is an analgesic, antipyretic and weak anti-inflammatory, commonly used in human medicine and it may be used to manage perioperative pain in dogs. It has a small therapeutic window, but its use has been increasing since it has negligible gastrointestinal and renal adverse effects and it doesn’t have platelet anti-aggregation effect. Hepatotoxicity is possible in cases of overdose, especially used without veterinary prescription. The main goal of this dissertation is to evaluate the analgesic efficiency of paracetamol in dogs submitted to dental extraction. We realized a prospective, random and blind clinical trial, in the context of dental extractions. The animals were divided in two groups, according to the administration or not of paracetamol. The variables collected were: anesthesia parameters, pain scores obtained from Melbourne pain scale at 0 hours, 2 hours and 4 hours and one numeric pain scale between 0 and 10 after 24 hours. The results obtained showed no significant statistical difference between the levels of pain at 0 and 2 hours (p=0.783) and the scales between 2 and 4 hours (p=0.254), for all animals. As to the difference of the pain’s level between control group and paracetamol group, there were no significant statistical difference at any of the studied moments: 0 hours (p=0.199), 2 hours (p=0.813), 4 hours (p=0.193) and 24 hours (p=0.745). None of the animals needed analgesic rescue. There was significant statistical difference between groups on the maximum heart rate (p=0.036) and minimum diastolic pressure (p=0.021), during the surgery. There was as well an interaction effect (p=0.017) between Group and Time. There was a decrease from 4.2 (0 hours) to 2.4 (4 hours) of the average pain level in the paracetamol group. In the control group there was an increase of the average pain level, from 2.4 (0 hours) to 3.8 (4 hours). It was not possible to conclude if the paracetamol has analgesic benefits on pain control of dogs submitted to dental extraction, because of the small population. But the decrease of the pain’s level in the paracetamol group shows that is possible that the paracetamol is useful as an adjuvant on pain control to dogs submitted to dental extraction.
ABSTRACT - Clinical trial to evaluate the benefit of perioperative administration of paracetamol to dogs undergoing dental extraction - Paracetamol is an analgesic, antipyretic and weak anti-inflammatory, commonly used in human medicine and it may be used to manage perioperative pain in dogs. It has a small therapeutic window, but its use has been increasing since it has negligible gastrointestinal and renal adverse effects and it doesn’t have platelet anti-aggregation effect. Hepatotoxicity is possible in cases of overdose, especially used without veterinary prescription. The main goal of this dissertation is to evaluate the analgesic efficiency of paracetamol in dogs submitted to dental extraction. We realized a prospective, random and blind clinical trial, in the context of dental extractions. The animals were divided in two groups, according to the administration or not of paracetamol. The variables collected were: anesthesia parameters, pain scores obtained from Melbourne pain scale at 0 hours, 2 hours and 4 hours and one numeric pain scale between 0 and 10 after 24 hours. The results obtained showed no significant statistical difference between the levels of pain at 0 and 2 hours (p=0.783) and the scales between 2 and 4 hours (p=0.254), for all animals. As to the difference of the pain’s level between control group and paracetamol group, there were no significant statistical difference at any of the studied moments: 0 hours (p=0.199), 2 hours (p=0.813), 4 hours (p=0.193) and 24 hours (p=0.745). None of the animals needed analgesic rescue. There was significant statistical difference between groups on the maximum heart rate (p=0.036) and minimum diastolic pressure (p=0.021), during the surgery. There was as well an interaction effect (p=0.017) between Group and Time. There was a decrease from 4.2 (0 hours) to 2.4 (4 hours) of the average pain level in the paracetamol group. In the control group there was an increase of the average pain level, from 2.4 (0 hours) to 3.8 (4 hours). It was not possible to conclude if the paracetamol has analgesic benefits on pain control of dogs submitted to dental extraction, because of the small population. But the decrease of the pain’s level in the paracetamol group shows that is possible that the paracetamol is useful as an adjuvant on pain control to dogs submitted to dental extraction.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Paracetamol dor analgesia multimodal extração dentária paracetamol pain analgesia dental extraction
Contexto Educativo
Citação
Raimundo MPN 2019. Ensaio clínico para avaliação do benefício da administração peri-operatória de paracetamol em cães submetidos a extração dentária. [dissertação de mestrado]. Lisboa: FMV-Universidade de Lisboa
Editora
Universidade de Lisboa, Faculdade de Medicina Veterinária