Copyright © European Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited. Efficacy of intravenous paracetamol, metamizol and lornoxicam on postoperative pain and morphine consumption after lumbar disc surgery Ozlem Korkmaz Dilmen, Yusuf Tunali, Ozlem S. Cakmakkaya, Ercument Yentur, Ayse C. Tutuncu, Ercan Tureci and Mois Bahar Background and objective The combination of opioids with supplemental analgesics is commonly used for additive or synergistic analgesic effects. We aimed to determine the most advantageous supplemental analgesic for postoperative pain relief after lumbar disc surgery. Methods This prospective, placebo-controlled, randomized, double-blind study compared the effects of intravenous metamizol, paracetamol and lornoxicam on postoperative pain control, morphine consumption and side effects after lumbar disc surgery. Eighty patients with American Society of Anesthesiologists classification 1 or 2 scheduled for elective lumbar disc surgery under general anaesthesia were treated using patient-controlled analgesia with morphine until 24 h postoperatively and randomized to receive additional intravenous injections of metamizol 1 g, paracetamol 1 g, lornoxicam 8 mg or isotonic saline 0.9% (placebo). The primary endpoint was pain over 24 h after surgery measured by visual analogue scale. Secondary endpoints were morphine consumption and side effects. Results During the 24 h study period, pain was reduced in the metamizol (P ¼ 0.001) and paracetamol (P ¼ 0.04) groups, but not in the lornoxicam (P ¼ 0.20) group compared with the control group. Further analysis revealed that pain scores in the metamizol group were significantly lower than in the lornoxicam group (P ¼ 0.031). Although the rate of morphine consumption in the paracetamol group was decreased over time (P < 0.001), the total amounts of morphine consumed in 24 h were not different between groups. No significant differences with respect to morphine-related side effects were observed between groups. Conclusion Metamizol or paracetamol, but not lornoxicam, provides effective analgesia following lumbar disc surgery. Eur J Anaesthesiol 2010;27:428–432 Keywords: lornoxicam, lumbar disc surgery, metamizol, paracetamol Received 15 July 2009 Revised 15 December 2009 Accepted 22 December 2009 Introduction Postoperative pain control is an important responsibility of the anaesthesiologist. Effective postoperative pain control might help to decrease pain-related complications, enable mobilization and food intake and thereby improve post- operative outcome. 1,2 Several nociceptive mechanisms might influence the pathophysiology of postoperative pain. 3 Therefore, opioids are combined with supplemental analgesics to utilize additive or synergistic effects 4,5 and to decrease their consumption. 6–8 A reduction in the amount of systemic opioids lowers the incidences of common side effects such as sedation, respiratory depression, nausea, vomiting, rash and urinary retention. 6,7,9 The effect of supplemental analgesics may vary in differ- ent types of surgery. After breast surgery, paracetamol resulted in a significant reduction in the number of patients requiring opioids to provide adequate pain control com- pared with metamizol, 10 whereas the analgesic effect of paracetamol was found to be less than metamizol during the first 2 h after lumbar disc surgery. 11 After septorhino- plasty, lornoxicam patient-controlled analgesia (PCA) was found to be more effective than metamizol PCA, 12 but the analgesic potency of intramuscular administration of lor- noxicam was comparable to metamizol after septoplasty. 13 The analgesic effect of lornoxicam was reported to be better than paracetamol after radical prostatectomy. 14 In our clinical practice, we often use morphine with metamizol or paracetamol or NSAIDs, such as lornoxi- cam, as supplemental analgesics for postoperative pain management after lumbar disc surgery. Determining the most advantageous supplemental analgesic according to the type of surgical procedure is important for effective postoperative pain management. We aimed to determine the optimum supplemental analgesic for postoperative pain relief after lumbar disc surgery. This prospective, placebo-controlled, double-blind study was conducted to compare the analgesic effects of intra- venous (i.v.) metamizol or paracetamol or lornoxicam in combination with morphine PCA during the first 24 h following lumbar disc surgery. In addition, the differ- ences in opioid consumption and morphine-related side effects were investigated. Methods With informed consent and after approval from the Ethics Committee of the Cerrahpasa Medical Faculty, 80 ORIGINAL ARTICLE From the Department of Anesthesia and Intensive Care, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey Correspondence to Ozlem Korkmaz Dilmen, MD, Staff Anesthesiologist, Department of Anesthesia and Intensive Care, Cerrahpasa Medical Faculty, University of Istanbul, Cerrahpasa, Istanbul 34098, Turkey Tel: +90 212 414 34 35; fax: +90 216 386 30 14; e-mail: ozlemkorkmaz1978@mynet.com 0265-0215 ß 2010 Copyright European Society of Anaesthesiology DOI:10.1097/EJA.0b013e32833731a4