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Cochrane Database of Systematic Reviews

Dosis única de dipirona (metamizol) para el dolor postoperatorio agudo en adultos

Information

DOI:
https://doi.org/10.1002/14651858.CD011421.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 20 April 2016see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Pain, Palliative and Supportive Care Group

Copyright:
  1. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Leslie Hearn

    Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), University of Oxford, Oxford, UK

  • Sheena Derry

    Correspondence to: Oxford, UK

    [email protected]

  • R Andrew Moore

    Plymouth, UK

Contributions of authors

All review authors contributed to writing the revised protocol.

LH and SD searched for studies, selected studies for inclusion, and carried out data extraction.

RAM acted as arbitrator.

All authors were involved in analysis and writing the full review.

SD will be responsible for updating the review, if appropriate.

Sources of support

Internal sources

  • Oxford Pain Relief Trust, UK.

    General institutional support

External sources

  • No sources of support supplied

Declarations of interest

LH none known

SD none known

RAM has received institutional grant support from RB relating to individual patient level analyses of trial data on ibuprofen in acute pain and the effects of food on drug absorption of analgesics (2013), and from Grünenthal relating to individual patient level analyses of trial data regarding tapentadol in osteoarthritis and back pain (2015). He has attended boards with Menarini concerning methods of analgesic trial design (2014), with Novartis (2014) about the design of network meta‐analyses, and RB on understanding pharmacokinetics of drug uptake (2015).

Acknowledgements

This review received infrastructure support from the Oxford Pain Relief Trust.

Funding acknowledgement: the National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Pain, Palliative and Supportive Care Review Group. Disclaimer: the views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the NIHR, the National Health Service (NHS), or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2016 Apr 20

Single dose dipyrone (metamizole) for acute postoperative pain in adults

Review

Leslie Hearn, Sheena Derry, R Andrew Moore

https://doi.org/10.1002/14651858.CD011421.pub2

2014 Dec 05

Single dose dipyrone (metamizole) for acute postoperative pain

Protocol

Leslie Hearn, Sheena Derry, R Andrew Moore

https://doi.org/10.1002/14651858.CD011421

Differences between protocol and review

We have assessed the quality of the evidence using the GRADE approach and included a 'Summary of findings' table in the full review, which were not included in the Protocol.

Notes

For the latest update (2016) we did not identify any potentially relevant studies that were published after 1999. Therefore, this review has now been stabilised following discussion with the authors and editors. The review will be re‐assessed for updating if new evidence likely to change the conclusions is published, or if standards change substantially which necessitate major revisions.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Oral dipyrone 500 mg versus placebo, outcome: 1.1 Participants with ≥ 50% pain relief over 4 to 6 hours.
Figures and Tables -
Figure 4

Forest plot of comparison: 1 Oral dipyrone 500 mg versus placebo, outcome: 1.1 Participants with ≥ 50% pain relief over 4 to 6 hours.

Comparison 1 Oral dipyrone 500 mg versus placebo, Outcome 1 Participants with ≥ 50% pain relief over 4 to 6 hours.
Figures and Tables -
Analysis 1.1

Comparison 1 Oral dipyrone 500 mg versus placebo, Outcome 1 Participants with ≥ 50% pain relief over 4 to 6 hours.

Comparison 1 Oral dipyrone 500 mg versus placebo, Outcome 2 Participants using rescue medication over 4 to 6 hours.
Figures and Tables -
Analysis 1.2

Comparison 1 Oral dipyrone 500 mg versus placebo, Outcome 2 Participants using rescue medication over 4 to 6 hours.

Oral dipyrone 500 mg compared with placebo for acute postoperative pain

Patient or population: adults with acute postoperative pain

Settings: clinic

Intervention: oral dipyrone 500 mg

Comparison: placebo

Outcomes

Probable outcome with

Relative effect and NNT or NNTp
(95% CI)

Number of studies, participants, events

Quality of the evidence
(GRADE)

Comments

intervention

comparator

At least 50% of maximum pain relief over 4 to 6 h

730 in 1000

320 in 1000

RR 2.4 (95% CI 1.8 to 3.1)

NNT 2.4 (1.9 to 3.1)

5 studies, 288 participants, 151 events

Moderate

Small studies, few events

Participants remedicating within 4 to 6 h

70 in 1000

340 in 1000

RR 0.21 (0.11 to 0.40)

NNTp 3.6 (2.7 to 5.4)

4 studies, 248 participants, 51 events

Low

Small studies, very few events

Participants with at least one adverse event

Insufficient data for analysis

Participants with a serious adverse event

None reported

None reported

5 studies, 288 participants, no events

Very low

Small studies, no events

CI: confidence interval; h: hour; RR: risk ratio; NNT: number needed to treat for an additional beneficial outcome; NNTp: number needed to treat to prevent an event.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Figures and Tables -
Comparison 1. Oral dipyrone 500 mg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Participants with ≥ 50% pain relief over 4 to 6 hours Show forest plot

5

288

Risk Ratio (M‐H, Fixed, 95% CI)

2.39 [1.84, 3.11]

2 Participants using rescue medication over 4 to 6 hours Show forest plot

4

248

Risk Ratio (M‐H, Fixed, 95% CI)

0.21 [0.11, 0.40]

Figures and Tables -
Comparison 1. Oral dipyrone 500 mg versus placebo