The Efficacy of the Non-Opioid Analgesics Parecoxib, Paracetamol and Metamizol for Postoperative Pain Relief After Lumbar Microdiscectomy

Abstract

In this prospective, double-blind, randomized, placebo-controlled study we compared the efficacy of three IV non-opioid analgesics for postoperative pain relief after lumbar microdiscectomy. Eighty healthy patients were randomly divided into 4 treatment groups (n = 20 each) to receive either parecoxib 40 mg, paracetamol 1 g, metamizol 1 g, or placebo IV 45 min before the end of surgery. In the postanesthesia care unit (PACU) patients were treated using patient-controlled analgesia (PCA) with piritramide. In the metamizol group the pain score at arrival in the PACU was significantly lower compared with the paracetamol, parecoxib, and placebo groups. In addition, in the metamizol group significantly fewer patients required additional PCA compared with the other groups studied. However, in those patients who required additional pain therapy in the four treatment groups, there was no significant difference in time to first request for piritramide and cumulative consumption of piritramide as assessed by the PCA data in the PACU. The incidence of adverse side effects was infrequent in all groups. These results suggest that in patients undergoing lumbar microdiscectomy, metamizol is superior to parecoxib, paracetamol, and placebo for immediate postoperative pain relief with minimal side effects.

Comparison of the analgesic effects of paracetamol and tramadol in lumbar disc surgery

“…Paracetamol stands out among nonopioid analgesics due its effective analgesia and reduced side effect profile. However, many recent studies have reported adverse effects of paracetamol on postoperative pain and morphine consumption after surgery (15)(16)(17)(18). Tunali et al compared the postoperative analgesic effect of paracetamol and dexketoprofen and reported that dexketoprofen provides better analgesia (15).…”

“…Recent studies showed that paracetamol is an analgesic with few side effects, a wide dosage range, and easy use (16,23). Tramadol is an opioid with few side effects also and it is thought to have good analgesic activity (24).…”

Dipirona versus paracetamol no controle da dor pós-operatória

“…Em estudo comparativo entre paracetamol, dipirona e parecoxibe por via endovenosa, Grundmann et al 21 (2006) demonstraram a superioridade analgésica pós-operatória da dipirona em cirurgias de microdiscectomia lombar. Em contrapartida, Landwehr et al 22 (2005) obtiveram resultados similares entre paracetamol e dipirona em uso endovenoso no pós-operatório de cirurgia de retina.…”

“…Os resultados obtidos no presente estudo corroboram o trabalho de Grundmann et al 21 (2006), pois registraram superioridade na eficácia analgésica da dipirona em relação ao paracetamol no controle da dor pós-operatória em cirurgias para exodontia de terceiros molares inclusos, justificando assim o amplo uso clínico desse analgésico.…”

“…Já nas 24 horas finais, a análise estatística evidenciou diferença entre a atividade analgésica dos medicamentos, com vantagem da dipirona sobre o paracetamol, o que pode ser especialmente evidenciado pelo número reduzido de pacientes queixando-se de dor discreta e pelo número elevado de pacientes sem dor. Estes resultados corroboram estudos prévios que avaliaram os mesmos medicamentos 21,22,26 .…”