title: The addition of metamizole to morphine and paracetamol improves early postoperative analgesia and patient satisfaction after lumbar disc surgery.
abstract: OBJECTIVE
  Combined analgesic regimens produce sufficient analgesia by additive or synergistic effects, and reduce the total dose of analgesics and minimise adverse effects. We investigated the metamizole, paracetamol and morphine combination with respect to postoperative pain treatment in lumbar disc surgery.
  
  
  METHODS
  After Ethics Committee approval and informed consent, 63 patients were allocated to three treatment groups; as Group paracetamol: paracetamol (1 g), Group paracetamol-metamizole: paracetamol (1 g) and metamizole (1 g), and Group placebo: no analgesic. All the patients received intravenous (i.v.) morphine with a patient-controlled analgesia device (PCA) as the rescue analgesic. Pain was assessed by the numerical pain rating scale (NRS, 0-3). Total morphine consumption at 24 hours, patient satisfaction and side effects were investigated.
  
  
  RESULTS
  NRS of Group paracetamol-metamizole was low at 15th min, 30th min and 1st hour, and the difference reached statistical significance at 30th min (p=0.033). Patient satisfaction at the same measurement times was high in this group. Total morphine consumption and side effects were not statistically different between the three groups.
  
  
  CONCLUSIONS
  Addition of metamizole to paracetamol along with iv morphine PCA offers an advantage over single iv morphine PCA and paracetamol, with respect to early postoperative pain treatment and patient satisfaction.
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Ankara, Turkey. sennuruzun@superonline.com
authors.forename: Sennur
authors.initials: S
authors.lastname: Uzun
authors.forename: Ilker Onguc
authors.initials: IO
authors.lastname: Aycan
authors.forename: Ismail Aydin
authors.initials: IA
authors.lastname: Erden
authors.forename: Altan
authors.initials: A
authors.lastname: Sahin
authors.forename: Ulku
authors.initials: U
authors.lastname: Aypar
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery*; D008713:Methimazole / Q000627:therapeutic use*; D009020:Morphine / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D010919:Placebos; D011184:Postoperative Period; D012449:Safety
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D010919:Placebos; D000082:Acetaminophen; D008713:Methimazole; D009020:Morphine; D005283:Fentanyl