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PAIN MEDICINE

The Efficacy of the Non-Opioid Analgesics Parecoxib, Paracetamol and Metamizol for Postoperative Pain Relief After Lumbar Microdiscectomy

Ulrich Grundmann, MD^*, Clemens Wörnle, MD^*, Andreas Biedler, MD^*, Sascha Kreuer, MD^*, Marc Wrobel, MD^*, and Wolfram Wilhelm, MD

From the *Department of Anesthesiology and Intensive Care Medicine, University of Saarland, Homburg/Saar, Germany; and Department of Anesthesiology and Intensive Care Medicine, St.-Marien-Hospital Lünen, Lünen, Germany.

Address correspondence and reprint requests to Ulrich Grundmann, MD, Department of Anesthesiology and Intensive Care Medicine, University of Saarland, D-66421 Homburg/Saar, Germany. Address e-mail to grundmann.ulrich{at}web.de.

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.

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