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Review
. 2019 Aug;33(4):287-294.
doi: 10.1007/s00482-019-0389-8.

[Recommendations for the perioperative use of dipyrone : Expert recommendation of the working group on acute pain of the German Pain Society, the scientific working group on pain medicine of the German Society for Anesthesiology and Intensive Care Medicine and the surgical working group on acute pain of the German Society for Surgery with participation of representatives of the Drug Commission of the German Medical Association]

[Article in German]
U M Stamer  1 , T Stammschulte  2 , J Erlenwein  3 , W Koppert  4 , S Freys  5 , W Meißner  6 , P Ahrens  7 , E-M Brede  8 , M Lindig  9 , M Dusch  4 , S Heitfeld  10 , E Hoffmann  11 , E A Lux  12 , E Müller  13 , D Pauli-Magnus  14 , E Pogatzki-Zahn  15 , C Quaisser-Kimpfbeck  16 , U Ringeler  17 , H Rittner  2   8 , J Ulma  18 , S Wirz  19
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Free article
Review

[Recommendations for the perioperative use of dipyrone : Expert recommendation of the working group on acute pain of the German Pain Society, the scientific working group on pain medicine of the German Society for Anesthesiology and Intensive Care Medicine and the surgical working group on acute pain of the German Society for Surgery with participation of representatives of the Drug Commission of the German Medical Association]

[Article in German]
U M Stamer et al. Schmerz. 2019 Aug.
Free article

Abstract

Background: Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis.

Methods: As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies.

Results: The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis.

Conclusion: The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.

Keywords: Blood cell count; Dipyrone (metamizole), safety; Patient education; Perioperative care; Risk factors.

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References

    1. Thyroid. 1999 Jan;9(1):29-31 - PubMed
    1. J Clin Epidemiol. 1998 Dec;51(12):1357-65 - PubMed
    1. Lancet. 1991 Jan 12;337(8733):85-9 - PubMed
    1. Ann Intern Med. 2007 May 1;146(9):657-65 - PubMed
    1. Expert Opin Drug Saf. 2007 May;6(3):323-35 - PubMed

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