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Nonopioid analgesics for postoperative pain management

Pogatzki-Zahn, Esthera; Chandrasena, Chandanib; Schug, Stephan A.b,c

Current Opinion in Anesthesiology: October 2014 - Volume 27 - Issue 5 - p 513–519
doi: 10.1097/ACO.0000000000000113
PAIN MEDICINE: Edited by Esther Pogatzki-Zahn

Purpose of review Postoperative pain remains poorly treated in many patients. One reason is the inadequate use of nonopioid analgesics. This review examines the most recent findings on nonopioid analgesics and how these translate into clinical practice.

Recent findings Commonly used nonopioid analgesics are paracetamol, NSAIDs and metamizol (dipyrone). For paracetamol, the efficacy is obviously inferior to NSAIDs and the risk of adverse events might have been underestimated in the past. For NSAIDs, there are increasing data supporting similar efficacy of nonselective and cyclooxygenase-2 selective NSAIDs, although the adverse effects of the latter might make them the preferred option for short-term use in the perioperative setting. Metamizol (dipyrone) is a very effective nonopioid analgesic not worldwide available; the discussion on the relevance of the very rare adverse event agranulocytosis continues.

Summary Nonopioid analgesics are important components of multimodal postoperative analgesia. The selection of the most appropriate compound for an individual patient can be based more and more on ever increasing data on these important analgesics.

aClinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Muenster, Germany

bDepartment of Anaesthesia and Pain Medicine, Royal Perth Hospital

cSchool of Medicine and Pharmacology, University of Western Australia, Perth, Australia

Correspondence to Esther Pogatzki-Zahn, MD, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149 Muenster, Germany. Tel: +49 251 8347261; fax: +49 251 88704; e-mail: pogatzki@anit.uni-muenster.de

© 2014 Lippincott Williams & Wilkins, Inc.