Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/39730
Title: Additive or synergistic analgesic effect of metamizole on standard pain treatment at home after arthroscopic shoulder surgery A randomised controlled superiority trial
Authors: STESSEL, Bjorn 
Lambrechts , Mathieu
EVERS, Stefan 
Vanderstappen, Cedric
CALLEBAUT, Ina 
Ory, Jean-Paul
Herbots , Jeroen
Dreesen, Inge
Vaninbroukx, Michael
van de Velde, Marc
Issue Date: 2023
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Source: EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 40 (3) , p. 171 -178
Abstract: BACKGROUNDThere is growing evidence that the analgesic effect of metamizole is mediated at least partly by central mechanisms, including the endocannabinoid/endovanilloid system. Consequently, metamizole may have additive or even synergistic analgesic effects with paracetamol and nonsteroidal anti-inflammatory drugs (NSAID).OBJECTIVEThis study aimed to assess if triple therapy with metamizole, ibuprofen and paracetamol (MIP) is superior to double therapy with ibuprofen and paracetamol (i.p.) in treating pain at home after ambulatory arthroscopic shoulder surgery.DESIGN/SETTING/PATIENTS/INTERVENTIONIn this double-blind, controlled, high-volume single centre, superiority trial, 110 patients undergoing elective ambulatory arthroscopic shoulder surgery were randomised to receive either MIP (n = 55) or i.p. (n = 55) orally for 4 days between December 2019 and November 2021. Pain intensity at movement and rest, using a numeric rating scale (NRS), perceived pain relief, use of rescue medication and adverse effects of study medication were recorded at the post-anaesthesia care unit (PACU) and on postoperative day (POD) 1 to 4 and 7. Quality of Recovery (QoR) and satisfaction with study medication were measured at POD 7 with telephone follow-up.MAIN OUTCOME MEASUREThe primary outcome measure was postoperative pain intensity on movement measured by an 11-point NRS (where 0 = no pain and 10 = worst pain imaginable) on POD 1.RESULTSFor the primary outcome, superiority of MIP in reducing postoperative pain at movement on POD 1 was not confirmed: mean difference NRS [95% confidence interval (CI), -0.08 (-1.00 to 0.84)]. For pain on movement and at rest, no significant differences were found between groups in the PACU nor on POD 1 to 4 or day 7. Nausea was reported significantly more frequently in the metamizole group (22.6 vs. 58.5; P < 0.001). Other adverse effects of study medication, rescue opioid consumption, perceived pain relief, QoR at POD 7, and overall patient satisfaction were similar in both groups.CONCLUSIONClinically, triple oral treatment with metamizole, paracetamol and ibuprofen is not superior to oral paracetamol and ibuprofen in multimodal pain treatment at home after ambulatory arthroscopic shoulder surgery.
Notes: Stessel, B (corresponding author), Jessa Hosp Hasselt, Dept Intens Care & Anaesthesiol, Virga Jesse Campus,Stadsomvaart 11, B-3500 Hasselt, Belgium.
bjorn.stessel@jessazh.be
Document URI: http://hdl.handle.net/1942/39730
ISSN: 0265-0215
e-ISSN: 1365-2346
DOI: 10.1097/EJA.0000000000001792
ISI #: 000925562900004
Rights: 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Category: A1
Type: Journal Contribution
Appears in Collections:Research publications

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