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Treatment of postoperative pain after total hip arthroplasty: comparison between metamizol and paracetamol as adjunctive to opioid analgesics—prospective, double-blind, randomised study

Archives of Orthopaedic and Trauma Surgery (2014)Cite this article

Abstract

Introduction

Metamizole use has been limited because of its risk of agranulocytosis. However, more recent literature seems to support its safety. This prospective, randomised, double-blind study was conducted to compare the analgesic effects of intravenous metamizole or intravenous paracetamol in combination with morphine PCA during the first 24 h following total hip arthroplasty.

Materials and methods

One hundred ten consecutive patients were selected for study. The two study groups were (A) metamizole, (B) paracetamol. Postoperative pain therapy was provided by Morphine PCA pump. In the first treatment group (A group), all patients received intravenous metamizole 1.5 g every 8 h during the first 24 postoperative hours. In the second treatment group (B group), all patients received intravenous paracetamol 1 g every 8 h during the first 24 postoperative hours. Postoperative pain intensity was measured 1, 2, 3, 4, 6, 8, 10, 14, 18, 22 h after the end of surgery by a VAS.

Results

Statistically significant differences in VAS pain values favoring metamizole were reported at 6-h (p = 0.038), 8-h (p = 0.036), 14-h (p = 0.011), 18-h (p < 0.001) and 22-h (p = 0.025) post-baseline. Mean cumulative pain values were 17.9 for metamizole and 30.6 for paracetamol.

Conclusions

In this study, we have also shown excellent efficacy of paracetamol and metamizole combined with opioids, but metamizole proved to be a better analgesic than paracetamol. It is also necessary to mention the financial aspect considering that intravenous paracetamol is about ten times more expensive than an equivalent analgesic doses of intravenous metamizole.

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Conflict of interest

The authors declare no conflict of interest. No financial support was received in preparation of the study.

Author information

Affiliations

  1. Anaesteziology Unit, Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, Salata 7, 10000, Zagreb, Croatia

    Zrinka Oreskovic & Branko Tripkovic

  2. Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, University of Zagreb School of Medicine, Salata 7, 10000, Zagreb, Croatia

    Goran Bicanic & Domagoj Delimar

  3. Croatian Institute for Brain Research, University of Zagreb School of Medicine, Salata 12, 10000, Zagreb, Croatia

    Pero Hrabac

Authors
  1. Zrinka Oreskovic
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  2. Goran Bicanic
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  3. Pero Hrabac
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  4. Branko Tripkovic
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  5. Domagoj Delimar
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Corresponding author

Correspondence to Goran Bicanic.

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Oreskovic, Z., Bicanic, G., Hrabac, P. et al. Treatment of postoperative pain after total hip arthroplasty: comparison between metamizol and paracetamol as adjunctive to opioid analgesics—prospective, double-blind, randomised study. Arch Orthop Trauma Surg (2014). https://doi.org/10.1007/s00402-014-1979-7

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  • DOI: https://doi.org/10.1007/s00402-014-1979-7

Keywords

  • Metamizole
  • Paracetamol
  • Multimodal analgesia
  • Total hip replacement
  • Intensive care unit analgesia