{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:14:01Z","timestamp":1791976441594,"version":"4.4.0"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,6,27]],"date-time":"2016-06-27T00:00:00Z","timestamp":1466985600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Nonsteroidal anti\u2010inflammatory drugs (\n                      <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n                      s) play an important role in multimodal pain management. In patients with a contraindication for\n                      <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n                      s, pain management is challenging. A recent Dutch anesthesiology guideline propagates the use of metamizole (dipyrone) in these patients. Metamizole is a controversial drug, its use being previously discouraged because of the risk for agranulocytosis. We discuss whether metamizole could be an alternative to classical\n                      <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n                      s and opioids in postoperative pain management despite this drawback.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Literature review and pharmacovigilance research based on World Health Organization adverse effect registrations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Metamizole causes fewer gastric and duodenal ulcers than other nonselective\n                      <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n                      s, and the risk for bleeding is limited. It is unknown whether it is safer than a nonselective\n                      <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n                      combined with a proton pump inhibitor. Although the drug appears to be safe for renal function in healthy volunteers, data in high\u2010risk patients (eg, those with heart or renal failure) are lacking. The incidence of metamizole\u2010induced agranulocytosis is controversial, but the risk is likely to be limited with short\u2010term postoperative use in this selected group of patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Although firm evidence is lacking, metamizole may be safer for the upper intestinal tract and kidneys than other\n                      <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n                      s, and could alternatively be used in patients with an increased risk for stomach or renal problems. Hereby, improved postoperative pain relief can potentially be achieved. The risk for metamizole\u2010induced agranulocytosis is judged to be acceptable.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/papr.12467","type":"journal-article","created":{"date-parts":[[2016,6,27]],"date-time":"2016-06-27T03:09:56Z","timestamp":1466996996000},"page":"402-408","source":"Crossref","is-referenced-by-count":76,"title":["Metamizole (Dipyrone) as an Alternative Agent in Postoperative Analgesia in Patients with Contraindications for Nonsteroidal Anti\u2010Inflammatory Drugs"],"prefix":"10.1111","volume":"17","author":[{"given":"Jorieke","family":"Konijnenbelt\u2010Peters","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Canisius Wilhelmina Ziekenhuis Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"van der Heijden","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Canisius Wilhelmina Ziekenhuis Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corine","family":"Ekhart","sequence":"additional","affiliation":[{"name":"Netherlands Pharmacovigilance Centre Lareb \u2018sHertogenbosch the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Bos","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy Canisius Wilhelmina Ziekenhuis Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rgen","family":"Bruhn","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Radboud UMC Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis","family":"Kramers","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy Canisius Wilhelmina Ziekenhuis Nijmegen the Netherlands"},{"name":"Department of Internal Medicine Radboud UMC Nijmegen the Netherlands"},{"name":"Department of Pharmacology\u2010Toxicology Radboud UMC Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,6,27]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0265021507003031"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeh180"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.5055\/jom.2010.0014"},{"key":"e_1_2_5_5_1","unstructured":"Nederlandse Vereniging voor Anesthesiologie. 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