DOI
https://doi.org/10.18849/ve.v8i4.671Abstract
PICO Question
In dogs and cats after surgery, does the peri-operative administration of injectable or oral metamizole (dipyrone) as opposed to no intervention result in lower postoperative pain scores or higher incidence of side effects?
Clinical bottom line
Category of research
Treatment.
Number and type of study designs reviewed
Three prospective, randomised, blinded, clinical studies were critically reviewed.
Strength of evidence
Weak.
Outcomes reported
Variables assessed included: different pain assessment methods, metamizole dose required to reduce peri- and postoperative pain scores, changes in cardiovascular variables (heart rate, systolic, mean and diastolic blood pressure), changes in respiratory variables and variations in haematological and biochemical variables.
Conclusion
In healthy cats and dogs undergoing ovariohysterectomy, the use of metamizole in the peri- and postoperative period was associated with some reduction in pain levels (i.e., lower pain score or reduced need for rescue analgesia). In dogs, metamizole alone provided insufficient analgesia. No study evaluating metamizole after orthopaedic surgery was found. No evidence suggested that using metamizole peri-operatively resulted in higher incidence of side effects.
How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
References
Campos, C., de Gregorio, R., García-Nieto, R., Gabo, F., Ortiz, P. & Alemany, S. (1999). Regulation of cyclooxygenase activity by metamizol. European Journal of Pharmacology. 378(3), 339–347. DOI: https://doi.org/10.1016/S0014-2999(99)00477-X
Giorgi, M., Łebkowska-Wieruszewska, B., Lisowski, A., Owen, H., Poapolathep, A., Kim, T.W. & De Vito, V. (2018). Pharmacokinetic profiles of the active metamizole metabolites after four different routes of administration in healthy dogs. Journal of Veterinary Pharmacology and Therapeutics. 41(3), 428–436. DOI: https://doi.org/10.1111/jvp.12484
Goncalves dos Santos, G., Vieira Dias, E., Teixeira, J.M., Pedro Athie, M.C., Magayewski Bonet, I.J., Herrera Tambeli, C. & Amilcar Parada, C. (2014). The analgesic effect of dipyrone in peripheral tissue involves two different mechanisms: Neuronal KATP channel opening and CB1 receptor activation. European Journal of Pharmacology. 741, 124–131. DOI: https://doi.org/10.1016/j.ejphar.2014.07.019
Gorczak, R., Avila Valandro, M., Welter Pereira, B., Segatto, T., Vilibaldo Beckmann, D. & Thiesen, R. (2022). Continuous infusion of dipyrone in bitches in the intraoperative period: cardiorespiratory effects. Semina Ciências Agrárias. 43(2), 827–840. DOI: https ://doi.org/10.5433/1679-0359.2022v43n2p827
Imagawa, V.H., Fantoni, D.T., Tatarunas, A.C., Mastrocinque, S., Almeida, T.F., Ferreira, F. & Posso, I.P. (2011). The use of different doses of metamizol for post-operative analgesia in dogs. Veterinary Anaesthesia and Analgesia. 38(4), 385–393. DOI: https://doi.org/10.1111/j.1467-2995.2011.00617.x
Kötter, T., da Costa, B.R., Fässler, M., Blozik, E., Linde, K., Jüni, P., Reichenbach, S. & Scherer, M. (2015). Metamizole-Associated Adverse Events: A Systematic Review and Meta-Analysis. PLoS ONE. 10(4), e0122918. DOI: https://doi.org/10.1371/journal.pone.0122918
Lebkowska-Wieruszewska, B., Kim, T.W., Chea, B., Owen, H., Poapolathep, A. & Giorgi, M. (2018). Pharmacokinetic profiles of the two major active metabolites of metamizole (dipyrone) in cats following three different routes of administration. Journal of Veterinary Pharmacology and Therapeutics. 41(2), 334–339. DOI: https://doi.org/10.1111/jvp.12471
Neugebauer, V., Schaible, H.G., He, X., Lücke, T., Gündling, P. & Schmidt, R.F. (1994). Electrophysiological evidence for a spinal antinociceptive action of dipyrone. Agents Actions. 41(1–2), 62–70. DOI: https://doi.org/10.1007/BF01986396
Shah, R.R. (2019). Metamizole (dipyrone)-induced agranulocytosis: Does the risk vary according to ethnicity? Journal of Clinical Pharmacy and Therapeutics. 44(1), 129–133. DOI: https://doi.org/10.1111/jcpt.12768
Silva, I.C., Maia, C.A.A., Raymundo, A.C., Prata, M.N.L., Romero, T.R.L., Duarte, I.D.G., Manrique, W.G., Pérez, A.C. & Belo, M.A.A. (2021). META-ANALYSIS OF THE THERAPEUTIC USE OF DIPYRONE IN DOGS: PHARMACOLOGICAL EFFECTS AND CLINICAL SAFETY. Ars Veterinaria. 37(1), 21–30. DOI: https://doi.org/10.15361/2175-0106.2021v37n1p21-30
Teixeira, L.G., Martins, L.R., Schimites, P.I., Dornelles, G.L., Aiello, G., Oliveira, J.S., da Silva, F.C., Brum, B.T., Mc Walter, T., Andrade, C.M. & Soares, A.V. (2020). Evaluation of postoperative pain and toxicological aspects of the use of dipyrone and tramadol in cats. Journal of Feline Medicine and Surgery. 22(6), 467–475. DOI: https://doi.org/10.1177/1098612X19849969
Tortorici, V., Vasquez, E. & Vanegas, H. (1996). Naloxone partial reversal of the antinociception produced by dipyrone microinjected into the periaqueductal gray of rats. Possible involvement of medullary off- and on-cells. Brain Research. 725(1), 106–110. DOI: https://doi.org/10.1016/0006-8993(96)00196-5
Veras de Paula, V., Araújo-Silva, G., Fernandes, N.S., Mouta, A.N., Nunes, T.L., Lopes Correia de Paiva, A., Barbalho de Macêdo, L., Nóbrega Arcoverde, K.& Pérez Urizar, J.T. (2023). Pharmacokinetic profiles of the two major active metabolites of metamizole, 4-methylaminoantipyrine (MAA) and 4-aminoantipyrine (AA), after intravenous injection in cats. Research in Veterinary Science. 155, 156–160. DOI: https://doi.org/10.1016/j.rvsc.2023.01.007
Zanuzzo, F.S., Teixeira-Neto, F.J., Teixeira, L.R., Diniz, M.S., Souza, V.L., Thomazini, C.M. & Steagall, P.V. (2015). Analgesic and antihyperalgesic effects of dipyrone, meloxicam or a dipyrone-meloxicam combination in bitches undergoing ovariohysterectomy. The Veterinary Journal. 205(1), 33–37. DOI: https://doi.org/10.1016/j.tvjl.2015.05.004
License
Copyright (c) 2023 Jakub Stadnicki, Mathieu Raillard
This work is licensed under a Creative Commons Attribution 4.0 International License.
Veterinary Evidence uses the Creative Commons copyright Creative Commons Attribution 4.0 International License. That means users are free to copy and redistribute the material in any medium or format. Remix, transform, and build upon the material for any purpose, even commercially - with the appropriate citation.
Most read articles by the same author(s)
- Joshua Coward, Mathieu Raillard, Propofol-diazepam or propofol-midazolam co-induction in healthy dogs: effects on propofol dosages, cardiovascular and respiratory events , Veterinary Evidence: Vol. 7 No. 2 (2022): The second issue of 2022
