title: [Differential indications of non-opioid drugs for postoperative analgesia II. Quantification of the analgesic effect of a combination of metamizol plus diclofenac via patient-controlled analgesia].
abstract: OBJECTIVE
  In a previous study we investigated the analgesic efficacy of metamizol. After laparoscopic operations, in particular, the reduction of postoperative opioid requirements within the first 24 h after surgery attained clinical relevance (-67%). In the present study we investigated the analgesic efficacy of supplementary diclofenac.
  
  
  METHODS
  86 patients, scheduled for minor orthopaedic surgery, laparoscopic cholecystectomy or resection of the thyroid gland, participated in a doubleblind, randomised, placebo-controlled study. The setting was comparable to our previous study, apart from the supplementary administration of diclofenac. Before induction of anaesthesia, verum-treated patients received a diclofenac suppository (100 mg), in addition to metamizol (1 g/100 ml NaCl 0.9% intravenous over 15 min). These infusions were repeated at 6h and 12h. In addition to the third infusion, the patients received a further diclofenac suppository (100 mg). Cumulated doses of buprenorphine (PCA, patient-controlled analgesia), pain scores (0-10), blood pressure, pulse and side effects were recorded during the first 6 h and again at 24 h.
  
  
  RESULTS
  All verum-treated patients had significantly less pain immediately after surgery and required lower cumulated doses of buprenorphine during the first 24 h after operation (laparoscopic cholecystectomy -33%, minor orthopaedic surgery -73%, resection of thyroid gland -60%).
  
  
  CONCLUSIONS
  Combination of metamizol and diclofenac cause a clinically relevant reduction in opioid requirements, in particular after minor orthopaedic surgery and resection of the thyroid gland. There is no need for supplementary diclofenac following laparoscopic surgery.
authors.affiliation: Klinik für Anästhesiologie, Universität Ulm.
authors.forename: P
authors.initials: P
authors.lastname: Steffen
authors.forename: A
authors.initials: A
authors.lastname: Drück
authors.forename: E
authors.initials: E
authors.lastname: Krinn
authors.forename: A
authors.initials: A
authors.lastname: Möller
authors.forename: M
authors.initials: M
authors.lastname: Georgieff
authors.forename: W
authors.initials: W
authors.lastname: Seeling
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D004008:Diclofenac / Q000008:administration & dosage* / Q000009:adverse effects; D004177:Dipyrone / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000145:classification / Q000188:drug therapy*; D013488:Suppositories
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories; D004008:Diclofenac; D004177:Dipyrone
vernacular_title: Untersuchungen zum differenzierten Einsatz von Nichtopioiden zur postoperativen Analgesie II. Quantifizierung des analgetischen Effektes der Kombination von Metamizol plus Diclofenac mittels der patientenkontrollierten Analgesie.