Metamizole (dipyrone) for multimodal analgesia in postoperative pain in adults

Background: Metamizole (dipyrone) is a non-opioid analgesic used in perioperative analgesia in some countries. The drug has analgesic, antipyretic, and spasmolytic effects. The complex mechanism has not been fully explained yet. Presumably, the analgesic effect is based on the inhibition of the activity of COX-1 and COX-2 cyclooxygenases and prostaglandin synthesis. Moreover, the activation of the opioidergic, cannabinoid, and endovanilloid systems also plays an important role. Metamizole is a relatively safe analgesic, although it is not completely free of adverse effects. Among them, the most serious and controversial are myelotoxicity, idiosyncratic drug-induced liver injury (DILI), and allergic reactions. The aim and objective is to present data on the use of metamizole for treating acute postoperative pain in adults. Methods: The search, which included PubMed/Medline, Web of Science, and Scopus databases, has been performed to find information about the use of metamizole in perioperative pain management. Results : The data on the role of metamizole in perioperative pain management seems to be insufficient. Moreover, most studies concerning the use of metamizole focus on postoperative administration regimens. The use of metamizole in preventive and multimodal analgesia is represented by sparse or controversial data. Conclusions: There is some evidence in the literature of the effectiveness of metamizole in the treatment of postoperative pain. Moreover, experience based on clinical practice indicates the high usefulness of metamizole as a perioperative analgesic. Thus metamizole could be considered an important part of multimodal analgesia. Although this drug could be a dominant component of multimodal analgesia, its use is limited by the occurrence of serious adverse reactions. Therefore, special precautions should be taken when using it. However, there is a need for further research, especially to determine its effectiveness in multimodal and preventive analgesia regimens.