Perbandingan Preemptif Paracetamol dan Metamizole Terhadap Nyeri Pascaoperasi Elektif dengan Anestesi Umum Di RSUD Dr. Saiful Anwar Malang: A Retrospective Propensity Score Matching Study
Abstract
Background: More than 50% of patients complain of acute postoperative pain. Inappropriate management of acute postoperative pain can develop into chronic pain and excessive opioid consumption, requiring attention from an anesthesiologist. Paracetamol and metamizole, as the most widely used non-opioid analgesics, have the potential to act as preemptive analgesia based on previous research. However, the effectiveness and safety between the two are still inconsistent. Thus, this study aims to compare its effectiveness as preemptive analgesia in reducing pain in elective surgery. Methods: In the current study, 131 patients were carefully selected. Propensity score matching was executed with a 1:1 ratio, resulting in 120 patients (paracetamol n = 40, metamizole n = 40, and controls n = 40) possessing closely matched baseline characteristics. All patients received consistent general anesthesia and equal access to additional opioids as needed. Patient data was carefully collected using the REDCap® web platform and subjected to rigorous statistical analysis. Results: Propensity score matching analysis yielded data with more comparable variance. Paracetamol showed a significant reduction in pain 24 hours postoperative compared to controls (p = 0.004), While metamizole significantly reduced opioid consumption compared to controls (p = 0.013). No side effects were reported. Conclusions: Paracetamol is most effective in reducing pain 24 hours after surgery. Meanwhile, metamizole is effective in reducing postoperative opioid consumption. Both are safe from side effects.
References
Nielen RGC, Vissers KCP, Van der sande R, et al. Relationship Between Postoperative Pain and Overall 30-day complications in a broad surgical population: an observational study. Ann Surg. 2019;269(5):856-65. Doi: 10.1097/SLA.0000000000002583
Buvanendran A, Fiala J, Patel KA, Golden AD, Moric M, KroinJS. The incidence and severity of postoperative pain followinginpatient surgery. Pain Med. 2015;16(12):2277–83. Doi: 10.1111/pme.12751
Argoff CE. Recent management advances in acute postoperativepain. Pain Pract. 2014;14(5):477–87. Doi: 10.1111/papr.12108
Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287-298. Doi: 10.2147/JPR.S144066.
Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol. 2016;33(3):160-71. Doi: 10.1097/EJA.0000000000000366
Mitra S, Carlyle D, Kodumudi G, Kodumudi V, Vadivelu N. New advances in acute postoperative pain management. Curr Pain Headache Rep. 2018; 22(5): 1-11. Doi: 10.1007/s11916-018-0690-8
Doleman B, Leonardi-Bee J, Heinink TP, Boyd-Carson H, Carrick L, Mandalia R, et al. Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery. Cochrane Database Syst Rev. 2021;6(6):1-187. Doi: 10.1002/14651858.CD012978.pub2
Xuan C, Yan W, Wang D, Li C, Ma H, Mueller A, et al. Efficacy of preemptive analgesia treatments for the management of postoperative pain: a network meta-analysis. Br J Anaesth. 2022;129(6):946-58. Doi: 10.1016/j.bja.2022.08.038
Silva F, Costa G, Veiga F, Cardoso C, Paiva-Santos AC. Parenteral ready-to-use fixed-dose combinations including NSAIDs with paracetamol or metamizole for multimodal analgesia-approved products and challenges. Pharmaceuticals (Basel). 2023;16(8):1-31. Doi: 10.3390/ph16081084
Ohashi N, Kohno T. Analgesic effect of acetaminophen: A review of known and novel mechanisms of action. Front Pharmacol. 2020;11:1-6. Doi: 10.3389/fphar.2020.580289
Collares EF, Troncon LEA. Effects of dipyrone on the digestive tract. Braz J Med Biol Res. 2019;52(2): 1-9. Doi: 10.1590/1414-431X20188103
Laksono RM, Isngadi, Murti AH. Intravenous paracetamol as a preemptive analgesia to reduce postoperative pain after major oncologic surgery. Anaesth Pain Intensive Care. 2019;23.1.
Xuan C, Yan W, Wang D, Mueller A, Ma H, Wang J. Effect of Preemptive Acetaminophen on Opioid Consumption: A Meta-Analysis. Pain Physician. 2021;24(2):E153-E160.
Suljević I, Hadžiavdić M, Šurković I, Suljević O, Turan M, Mušija E. The preemptive effect of tramadol and metamizole on the intensity of postoperative pain. Med Glas (Zenica). 2020;17(2):285-89. Doi: 10.17392/1118-20
Stasiowski MJ, Lyssek-Boroń A, Zmarzły N, Marczak K, Grabarek BO. The adequacy of anesthesia guidance for vitreoretinal surgeries with preemptive paracetamol/metamizole. Pharmaceuticals (Basel). 2024;17(1):1-19. Doi: 10.3390/ph17010129
von Elm E, Altman DG, Egger M, Pacock SJ, Gotzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495-499. Doi: https://doi.org/10.1016/j.ijsu.2014.07.013
Ozmete O, Bali C, Cok OY, Ergenoglu P, Ozyilkan NB, Akin S, et al. Preoperative paracetamol improves post-cesarean delivery pain management: a prospective, randomized, double-blind, placebo-controlled trial. J Clin Anesth. 2016;33:51-7. Doi: 10.1016/j.jclinane.2016.02.030
Bandey S, Singh V. Comparison between IV paracetamol and tramadol for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. J Clin Diagn Res. 2016;10(8): 5-9. Doi: 10.7860/JCDR/2016/21021.8274
Yin F, Wang XH, Liu F. Effect of Intravenous paracetamol on opioid consumption in multimodal analgesia after lumbar disc surgery: A meta-analysis of randomized controlled trials. front. Pharmacol. 2022; 13: 1-13. Doi: 10.3389/fphar.2022.860106
Stangler MIS, Lubianca JPN, Lubianca JN, Lubianca Neto JF. Dipyrone as pre-emptive measure in postoperative analgesia after tonsillectomy in children: a systematic review. Braz J Otorhinolaryngol. 2021;87(2):227-36. Doi: 10.1016/j.bjorl.2020.12.005
Caliskan E, Sener M, Kocum A, Ozyilkan NB, Ezer SS, Aribogan A. The efficacy of intravenous paracetamol versus dipyrone for postoperative analgesia after day-case lower abdominal surgery in children with spinal anesthesia: a prospective randomized double-blind placebo-controlled study. BMC Anesthesiol. 2013;13(1):1-8. Doi: 10.1186/1471-2253-13-34
Landwehr S, Kiencke, P, Giesecke, T, Eggert D, Thumann, G, Kampe S. A comparison between IV paracetamol and IV metamizol for postoperative analgesia after retinal surgery. Curr. Med. Res. Opin. 200521(10): 1569–575. Doi; 10.1185/030079905X61857
Oreskovic Z, Bicanic G, Hrabac P, Tripkovic B, Delimar D. 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; 134(5): 631-6. Doi: 10.1007/s00402-014-1979-7
Cakan T, Inan N, Culhaoglu S, Bakkal K, Basar H: Intravenous paracetamol improves the quality of postoperative analgesia but not decrease narcotic requirements. J Neurosurg Anesthesiol. 2008, 20 (3): 169-73. Doi: 10.1097/ANA.0b013e3181705cfb
Rogosch T, Sinning C, Podlewski A, Watzer B, Schlosburg J, Lichtman AH, et al. Novel bioactive metabolites of dipyrone (metamizol). Bioorg Med Chem. 2012;20(1):101-07. Doi: 10.1016/j.bmc.2011.11.028
Freo, U.; Ruocco, C.; Valerio, A.; Scagnol, I.; Nisoli, E. Paracetamol: A review of guideline recommendations. J. Clin. Med. 2021, 10:1-22. Doi: 10.3390/jcm10153420
Fux D, Metzner M, Brandl J, Feist M, Behrendt-Wippermann M, von Thaden A, et al. Pharmacokinetics of metamizole (dipyrone) as an add-on in calves undergoing umbilical surgery. PLoS One. 2022;17(3):1-15. Doi: 10.1371/journal.pone.0265305
Klose S, Pflock R, König IR, Linder R, Schwaninger M. Metamizole and the risk of drug-induced agranulocytosis and neutropenia in statutory health insurance data. Naunyn Schmiedebergs Arch Pharmacol. 2020;393(4):681-90. Doi: 10.1007/s00210-019-01774-4
Roberts E, Delgado Nunes V, Buckner S, Latchem S, Constanti M, Miller P, et al. Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Ann Rheum Dis. 2016;75(3):552-59. Doi: Roberts E, Delgado Nunes V, Buckner S, et al. Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Ann Rheum Dis. 2016;75(3):552-59. Doi: 10.1136/annrheumdis-2014-206914
Copyright (c) 2025 Andika Bachtiar Effendi, Fanny Cahya Ramadhan, Galuh Ica Ristiawan Muji Laksono, Ristiawan Muji Laksono, Taufiq Agus Siswagama
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The Contributor and the company/institution agree that all copies of the Final Published
Version or any part thereof distributed or posted by them in print or electronic format as permitted herein will include the notice of copyright as stipulated in the Journal and a full citation to the Journal.
