Metamizol and diclofenac profoundly reduce opioid consumption after minor trauma surgery

Abstract

Abstract In the present work we investigate the analgesic combination of the pyrazole-derivative metamizol and the non-steroidal anti-inflammatory drug diclofenac after trauma surgery with respect to the postoperative opioid consumption (via patient-controlled analgesia (PCA)) in the first 24 h after surgery, and the reduction of pain in the immediate postoperative period. In a double-blind randomized placebo controlled study, 48 patients, scheduled for minor trauma surgery received either metamizol (three doses of 1 g intravenously) and diclofenac (two doses of 100 mg suppository) or placebo beginning immediately preoperatively and repeated postoperatively. Totally the verum group received metamizol 3 g and diclofenac 200 mg. Postoperative pain intensity was measured by the numeric rating scale (NRS). All patients were allowed to order levomethadone from a PCA-pump for 24 h after surgery. Pain scores and opioid consumption were evaluated in the first six postoperative hours, 12 and 24 h after end of surgery. The patients receiving verum had significantly less pain at all points in time except for 2 h and ordered a significantly lower cumulated dose of levomethadone during the first 24 h postoperatively than placebo treated subjects (opioid-sparing effect after 24 h: −74%). There were no significant differences in the incidence of side effects between the two groups. Perioperative application of metamizol and diclofenac results in better pain relief and significantly lowers opioid requirements in patients after minor trauma surgery.