title: The efficacy of the non-opioid analgesics parecoxib, paracetamol and metamizol for postoperative pain relief after lumbar microdiscectomy.
abstract: In this prospective, double-blind, randomized, placebo-controlled study we compared the efficacy of three IV non-opioid analgesics for postoperative pain relief after lumbar microdiscectomy. Eighty healthy patients were randomly divided into 4 treatment groups (n = 20 each) to receive either parecoxib 40 mg, paracetamol 1 g, metamizol 1 g, or placebo IV 45 min before the end of surgery. In the postanesthesia care unit (PACU) patients were treated using patient-controlled analgesia (PCA) with piritramide. In the metamizol group the pain score at arrival in the PACU was significantly lower compared with the paracetamol, parecoxib, and placebo groups. In addition, in the metamizol group significantly fewer patients required additional PCA compared with the other groups studied. However, in those patients who required additional pain therapy in the four treatment groups, there was no significant difference in time to first request for piritramide and cumulative consumption of piritramide as assessed by the PCA data in the PACU. The incidence of adverse side effects was infrequent in all groups. These results suggest that in patients undergoing lumbar microdiscectomy, metamizol is superior to parecoxib, paracetamol, and placebo for immediate postoperative pain relief with minimal side effects.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Saarland, D-66421 Homburg/Saar, Germany. grundmann.ulrich@web.de
authors.forename: Ulrich
authors.initials: U
authors.lastname: Grundmann
authors.forename: Clemens
authors.initials: C
authors.lastname: Wörnle
authors.forename: Andreas
authors.initials: A
authors.lastname: Biedler
authors.forename: Sascha
authors.initials: S
authors.lastname: Kreuer
authors.forename: Marc
authors.initials: M
authors.lastname: Wrobel
authors.forename: Wolfram
authors.initials: W
authors.lastname: Wilhelm
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004177:Dipyrone / Q000627:therapeutic use; D017586:Diskectomy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use; D008159:Lumbar Vertebrae; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D007555:Isoxazoles; D000082:Acetaminophen; D004177:Dipyrone; C409945:parecoxib