Stamer U M, Stammschulte T, Erlenwein J, Koppert W, Freys S, Meißner W, Ahrens P, Brede E-M, Lindig M, Dusch M, Heitfeld S, Hoffmann E, Lux E A, Müller E, Pauli-Magnus D, Pogatzki-Zahn E, Quaisser-Kimpfbeck C, Ringeler U, Rittner H, Ulma J, Wirz S
Klinik für Anästhesiologie und Schmerztherapie, Universitätsklinik Bern, Inselspital, Universität Bern, Freiburgstraße, 3010, Bern, Schweiz.
Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland.
Schmerz. 2019 Aug;33(4):287-294. doi: 10.1007/s00482-019-0389-8.
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.
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.
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.
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.
双氯芬酸钠（安乃近）在其上市的国家中被广泛用于围手术期疼痛管理；然而，考虑到粒细胞缺乏这种罕见的不良事件，该药物的安全使用存在不确定性。
由于缺乏已发表研究的证据，一个专家小组制定了双氯芬酸钠围手术期使用的建议。经过正式、结构化的共识过程，这些建议得到了相关医学协会的批准。
专家小组一致认为，除非患者有中性粒细胞减少的风险，否则血细胞计数不应作为围手术期短期使用的标准。医务人员应了解疑似粒细胞缺乏时的症状和应对措施。应告知患者双氯芬酸钠的风险和益处以及潜在的替代药物。专家组得出结论，与其他非阿片类镇痛药相比，双氯芬酸钠的风险效益比相对较好。该小组强烈建议，如果患者连续数天使用双氯芬酸钠和/或出院后继续治疗，应告知患者粒细胞缺乏的症状，因为粒细胞缺乏可能在停用安乃近几天后发生。进一步的建议涉及出院后接管患者护理的医生的信息，以及避免曾患双氯芬酸钠诱导的粒细胞缺乏症的患者再次接触该药物。
应传达该小组的建议，以提高医务人员和患者对围手术期正确使用双氯芬酸钠的认识。
