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[Considerations concerning the perioperative use of metamizole]

R Sittl1, P Bäumler1, A-M Stumvoll1

  • 1Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland.

Der Anaesthesist
|August 23, 2019
PubMed
Abstract

Insights

Metamizole (dipyrone) offers effective pain relief with a favorable side effect profile, making its perioperative use acceptable. The risk of metamizol-induced agranulocytosis (MIA) is low, but requires patient awareness for early recognition.

Area of Science:

  • Pharmacology
  • Anesthesiology
  • Clinical Medicine

Background:

  • Metamizole (dipyrone) is a non-opioid analgesic used for severe pain, particularly in the perioperative setting.
  • Its use is debated due to the risk of agranulocytosis, a serious adverse event.

Purpose of the Study:

  • To evaluate the evidence for metamizol-induced agranulocytosis (MIA) risk.
  • To compare the risks of perioperative metamizole with alternative analgesics.

Main Methods:

  • A rapid literature review was conducted.
  • Focused on MIA risk and adverse effects of non-opioid analgesics.

Main Results:

  • MIA incidence is approximately one case per million inhabitants annually, a low risk compared to other drugs.
  • Metamizole has a favorable risk profile regarding hepatotoxicity, nephrotoxicity, bleeding, and cardiovascular effects compared to alternatives.
  • No non-opioid analgesics are approved for intraoperative use.

Conclusions:

  • Perioperative metamizole use is feasible with careful indication assessment, offering good analgesia and a favorable side effect profile.
  • The small risk of agranulocytosis necessitates informed consent for early recognition.
  • Intraoperative administration may reduce severe postoperative pain, requiring documentation and justification.
Keywords:
Adverse eventsAgranulocytosisDipyronePain treatmentReview

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