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Dipyrone as pre-emptive measure in postoperative analgesia after tonsillectomy in children: a systematic review
Maira Isis S Stangler1, João Pedro Neves Lubianca2, Jaqueline Neves Lubianca3
1Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Pediatria, Porto Alegre, RS, Brazil; Santa Casa de Misericórdia de Porto Alegre, Hospital da Criança Santo Antônio, Porto Alegre, RS, Brazil.
Insights
Dipyrone may be effective for pain after pediatric tonsillectomy, showing benefits over placebo and similar results to paracetamol. However, more high-quality studies are needed to confirm its role in children.
Area of Science:
- Pediatric Surgery
- Pain Management
- Pharmacology
Background:
- Tonsillectomy is a common pediatric surgery with significant postoperative pain.
- Dipyrone is a widely used analgesic in children, but its safety and efficacy are debated globally.
- Concerns regarding severe adverse effects have led to restrictions on dipyrone use in many countries.
Purpose of the Study:
- To systematically review the existing literature on the analgesic use of dipyrone in children following tonsillectomy.
- To evaluate the evidence supporting dipyrone's efficacy and safety in pediatric postoperative pain management after this procedure.
Main Methods:
- A systematic literature review was conducted using major databases (MEDLINE/PubMed, EMBASE, Virtual Health Library).
- The review focused exclusively on randomized clinical trials (RCTs) investigating dipyrone for pain relief after tonsillectomy in children.
- Study quality was assessed using established criteria.
Main Results:
- Only two RCTs met the inclusion criteria, comparing dipyrone, paracetamol, and placebo.
- Due to heterogeneity in study design (e.g., timing of dipyrone administration), a meta-analysis was not feasible.
- Dipyrone demonstrated superior analgesic effects compared to placebo and comparable efficacy to paracetamol, based on validated pain scales.
Conclusions:
- Dipyrone appears to have a suitable profile for managing pain in children undergoing tonsillectomy.
- The limited number of high-quality RCTs necessitates further well-designed research.
- More robust studies are required to definitively establish dipyrone's role in the postoperative care of pediatric tonsillectomy patients.
Introduction:
Tonsillectomy is the 2nd most common outpatient surgery performed on children in the United States of America. Its main complication is pain, which varies in intensity from moderate to severe. Dipyrone is one of the most widely used painkillers in the postoperative period in children. Its use, however, is controversial in the literature, to the point that it is banned in many countries due to its potential severe adverse effects. Because of this controversy, reviewing the analgesic use of dipyrone in the postoperative period of tonsillectomy in children is essential.
Objective:
The aim of this study was to review the analgesic use of dipyrone in the postoperative period of tonsillectomy in children.
Methods:
Systematic review of the literature, involving an evaluation of the quality of articles in the databases MEDLINE/Pubmed, EMBASE and Virtual Health Library, selected with a preestablished search strategy. Only studies with a randomised clinical trial design evaluating the use of dipyrone in the postoperative period of tonsillectomy in children were included.
Results And Conclusion:
Only 2 randomised clinical trials were found. Both compared dipyrone, paracetamol, and placebo. We were unable to carry out a metanalysis because the studies were too heterogenous (dipyrone was used as pre-emptive analgesic in one and only postoperatively in another). The analgesic effect of dipyrone, measured by validated pain scales in childhood, was shown to be superior to placebo and similar to paracetamol. It appears that dipyrone exhibits a profile suitable for use in children. However, the scarcity of randomised clinical trials evaluating its analgesic effect in this age group leads to the conclusion that more well-designed studies are still needed to establish the role of dipyrone in the postoperative period of tonsillectomy in children.
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