U M Stamer1, T Stammschulte2, J Erlenwein3, W Koppert4, S Freys5, W Meißner6, P Ahrens7, E-M Brede8, M Lindig9, M Dusch4, S Heitfeld10, E Hoffmann11, E A Lux12, E Müller13, D Pauli-Magnus14, E Pogatzki-Zahn15, C Quaisser-Kimpfbeck16, U Ringeler17, H Rittner2,8, J Ulma18, S Wirz19. 1. Klinik für Anästhesiologie und Schmerztherapie, Universitätsklinik Bern, Inselspital, Universität Bern, Freiburgstraße, 3010, Bern, Schweiz. ulrike.stamer@dbmr.unibe.ch. 2. Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland. 3. Klinik für Anästhesiologie, GF Schmerzmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland. 4. Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland. 5. Chirurgische Klinik, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Deutschland. 6. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland. 7. Abteilung Anästhesie und operative Intensivmedizin, Aller-Weser-Klinik, Verden, Deutschland. 8. Klinik und Poliklinik für Anästhesiologie, Zentrum Interdisziplinäre Schmerzmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland. 9. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Lübeck, Deutschland. 10. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, UniversitätsSchmerzCentrum Dresden, Dresden, Deutschland. 11. Klinik für Anästhesie, operative Intensivmedizin, Notfall- und Schmerzmedizin, Evangelisches Krankenhaus Herne, Herne, Deutschland. 12. Klinik für Schmerz- und Palliativmedizin, Katholisches Klinikum Lünen-Werne, Lünen, Deutschland. 13. Klinik für Anästhesiologie, Universitätsmedizin Greifswald, Greifswald, Deutschland. 14. Klinik für Anästhesie, Schmerztherapie, Intensiv- und Notfallmedizin, DRK Kliniken Berlin Westend, Berlin, Deutschland. 15. Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Deutschland. 16. Abteilung für Anästhesie und Schmerztherapie, Klinikum Freising, Freising, Deutschland. 17. Abteilung für Anästhesiologie, Palliativ‑, Intensiv- und Schmerzmedizin, Paracelsus-Klinik Golzheim, Düsseldorf, Deutschland. 18. Klinik für Schmerzmedizin und Schmerzambulanz, Rotes Kreuz Krankenhaus Bremen, Bremen, Deutschland. 19. Abteilung für Anästhesie, Interdisziplinäre Intensivmedizin, Schmerzmedizin/Palliativmedizin, Zentrum für Schmerzmedizin, Weaningzentrum, CURA-GFO Kliniken Bonn, Bad Honnef, Deutschland.
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.
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.
Authors: Matthias Huber; Frank Andersohn; Elisabeth Bronder; Andreas Klimpel; Michael Thomae; Christine Konzen; Oliver Meyer; Abdulgabar Salama; Hubert Schrezenmeier; Martin Hildebrandt; Ernst Späth-Schwalbe; Andreas Grüneisen; Reinhold Kreutz; Edeltraut Garbe Journal: Eur J Clin Pharmacol Date: 2013-12-03 Impact factor: 2.953
Authors: Ulrike M Stamer; Joachim Erlenwein; Stephan M Freys; Thomas Stammschulte; Dirk Stichtenoth; Stefan Wirz Journal: Anaesthesist Date: 2021-07-19 Impact factor: 1.041
Authors: Ulrike M Stamer; Joachim Erlenwein; Stephan M Freys; Thomas Stammschulte; Dirk Stichtenoth; Stefan Wirz Journal: Chirurg Date: 2021-05-26 Impact factor: 0.955
Authors: Ulrike M Stamer; Joachim Erlenwein; Stephan M Freys; Thomas Stammschulte; Dirk Stichtenoth; Stefan Wirz Journal: Schmerz Date: 2021-08 Impact factor: 1.107