Metamizole for Postoperative Pain in Pediatric Patients Undergoing Subarachnoid Anesthesia

Abstract

Background: Efficient postoperative pain management, which is aimed at decreasing the risk of complications and drug-induced side effects, without affecting the quality of analgesia, is part of today's concept of enhanced recovery after surgery, that is, fast-track surgery. Study Question: The objective of this study was to determine whether effective management of acute postoperative pain was possible without opioids, while avoiding complications, drug-induced side effects, and suboptimal treatment. Introduction of metamizole, which has regained popularity, into a multimodal analgesia regimen was used, as opioids are not routinely administered. Study Design: The study was prospective, observational, unrandomized, and without the control group. Measures and Outcomes: This study was performed in a pediatric hospital with 300 beds and an average of 1700 annual surgical interventions. The study group comprised 378 patients aged 1–17 years, undergoing lower abdominal or limb surgery between June 2016 and June 2017. Children underwent subarachnoid anesthesia combined with intravenous sedation and received not routinely but on demand postoperative opioid analgesia. The pain was self-assessed by the pediatric patient or was assessed by the nurse using pain scores. Results: Metamizole proved to be safe, efficient, and very well tolerated by children. Multimodal analgesia using acetaminophen, nonsteroidal anti-inflammatory drug with metamizole for the treatment of moderate to severe pain in children undergoing surgery, required a single opioid dose in 292 patients (77.24%) of the 378 in this study. Conclusions: In pediatric patients undergoing surgery, subarachnoid anesthesia combined with intravenous sedation, multimodal analgesia that includes metamizole, and nonpharmacological complementary therapies in pain management enable avoidance or reduction of opioids to a single dose, without undertreatment. There is also a minimum of anesthesia, accelerated children's recovery and a rapid return to presurgical levels of function.

Interpreting the Benefit and Risk Data in Between-Drug Comparisons: Illustration of the Challenges Using the Example of Mefenamic Acid versus Ibuprofen

“…If the gastrointestinal risk prevails, a compound with higher COX-2 selectivity should be chosen. As an alternative pain medication, metamizole and paracetamol are suitable, especially for short-term administration, and again paracetamol or opioids for long-term administration [ 90 , 91 , 92 ]. It must be noted at this point, that opioids should only be administrated after careful consideration [ 9 , 93 , 94 , 95 ].…”

Biochemical Markers of Sudden Cardiac Death

“…Most often, in the forensic medicine practise, the samples from the body can have different degrees of haemolysis [21,22]. The use of frozen samples for biochemical post-mortem analysis should be avoided because freezing can cause severe hemolysis and can also affect the concentration of biochemical markers in different biological specimens.…”