[Considerations concerning the perioperative use of metamizole].
Überlegungen zum perioperativen Einsatz von Metamizol.
Adverse events
Agranulocytosis
Dipyrone
Pain treatment
Review
Journal
Der Anaesthesist
ISSN: 1432-055X
Titre abrégé: Anaesthesist
Pays: Germany
ID NLM: 0370525
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
pubmed:
23
8
2019
medline:
28
10
2020
entrez:
23
8
2019
Statut:
ppublish
Résumé
The non-opioid analgesic metamizole (dipyrone) is approved for the treatment of severe pain and is often used in the perioperative period. As it can cause agranulocytosis, a severe adverse event, its perioperative administration is controversially discussed. Is there enough evidence for a high risk of metamizol-induced agranulocytosis (MIA)? What are the consequences of its perioperative use with respect to the risk profiles of alternative analgesics? Rapid review of the literature on the risk of MIA and adverse effects of non-opioid analgesics. The incidence of MIA is estimated to be one case per million inhabitants per year. The risk seems low compared to other drugs associated with a risk of agranulocytosis, such as antithyroid drugs and ticlopidine. The risk profile of metamizole concerning hepatotoxicity, nephrotoxicity, bleeding and cardiovascular adverse effects is favorable compared to other non-opioid analgesics. None of the non-opioid analgesics are licensed to be administered intraoperatively. The perioperative use of metamizole is possible after a thorough evaluation of the indications as it provides good analgesia with a generally favorable side effect profile and is administered intravenously. The risk of agranulocytosis is small but needs to be mentioned during patient informed consent in order to optimize early recognition. Intraoperative administration aims at reducing the expected severe postoperative pain. A documentation and justification for the evaluation of the indications are recommended.
Sections du résumé
BACKGROUND
The non-opioid analgesic metamizole (dipyrone) is approved for the treatment of severe pain and is often used in the perioperative period. As it can cause agranulocytosis, a severe adverse event, its perioperative administration is controversially discussed.
OBJECTIVE
Is there enough evidence for a high risk of metamizol-induced agranulocytosis (MIA)? What are the consequences of its perioperative use with respect to the risk profiles of alternative analgesics?
MATERIAL AND METHODS
Rapid review of the literature on the risk of MIA and adverse effects of non-opioid analgesics.
RESULTS
The incidence of MIA is estimated to be one case per million inhabitants per year. The risk seems low compared to other drugs associated with a risk of agranulocytosis, such as antithyroid drugs and ticlopidine. The risk profile of metamizole concerning hepatotoxicity, nephrotoxicity, bleeding and cardiovascular adverse effects is favorable compared to other non-opioid analgesics. None of the non-opioid analgesics are licensed to be administered intraoperatively.
CONCLUSION
The perioperative use of metamizole is possible after a thorough evaluation of the indications as it provides good analgesia with a generally favorable side effect profile and is administered intravenously. The risk of agranulocytosis is small but needs to be mentioned during patient informed consent in order to optimize early recognition. Intraoperative administration aims at reducing the expected severe postoperative pain. A documentation and justification for the evaluation of the indications are recommended.
Identifiants
pubmed: 31435718
doi: 10.1007/s00101-019-00637-0
pii: 10.1007/s00101-019-00637-0
doi:
Substances chimiques
Analgesics, Non-Narcotic
0
Dipyrone
6429L0L52Y
Types de publication
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM
Pagination
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