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

Leslie Hearn; Sheena Derry; R Andrew Moore

doi:10.1002/14651858.CD011421.pub2

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Figure 1

Study flow diagram.

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Figure 2

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

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Figure 3

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

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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.

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Analysis 1.1

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

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Analysis 1.2

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

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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
Outcomes	intervention	comparator	Relative effect and NNT or NNTp (95% CI)	Number of studies, participants, events	Quality of the evidence (GRADE)	Comments
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.

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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]

Comparison 1. Oral dipyrone 500 mg versus placebo

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