• Harriëtte T Koster, Hans J Avis, Markus F Stevens, and Markus W Hollmann.
• Academisch Medisch Centrum, afd. Anesthesiologie, Amsterdam, the Netherlands.
• Ned Tijdschr Geneeskd. 2012 Jan 1;156(14):A4323.

AbstractPostoperative pain management is an essential part of surgical management. In the Netherlands paracetamol, NSAIDs and, if necessary, opioids are the most commonly used drugs for perioperative analgesia. Metamizole is a non-opioid analgesic that is rarely used in the Netherlands, although it is one of the most frequently used analgesics around the world. Metamizole is registered in the Netherlands for intravenous therapy for acute pain. However, the drug has been rarely used since the 1970s because of what was thought to be an unacceptable risk of agranulocytosis. Recent scientific data do not justify this reasoning. Its mechanism of action is still under discussion, but the main action is likely to be an inhibition of prostaglandin synthesis in both peripheral tissues and the central nervous system. Based on the current literature, metamizole deserves a role in the management of post-operative pain in the Netherlands. It seems to be a safe and effective drug for acute pain management especially when compared with NSAIDs.

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