INTRODUCTION: Various analgesics are used to control intense headaches in patients following subarachnoid hemorrhage. In addition to pain control, it has been shown that some analgesics can affect various pathophysiological cascades. Therefore, we devised a study to assess whether the use of metamizole has a significant impact on the development of ischemic complications, hydrocephalus, and the overall outcome in patients following aneurysmal subarachnoid hemorrhage in the context of the other non-opioids and opioids effects. METHODS: In our retrospective, single-center cohort study, we enrolled 192 patients diagnosed with subarachnoid hemorrhage. We recorded their initial clinical status, comorbidities, and the daily dosage of analgesics over 14 days of hospitalization after the onset of subarachnoid hemorrhage. Using univariate and subsequent multivariate logistic regression analysis, we assessed the influence of various factors, including analgesics, on the development of delayed cerebral ischemia and hydrocephalus, as well as on 2-week and 6-month outcomes. RESULTS: Although the administration of non-opioids, in general, had no effect on the development of delayed cerebral ischemia or hydrocephalus, the use of metamizole as the main analgesic was associated with a significantly lower chance of poor outcome at both 2-weeks and 6-months, as well as the development of delayed cerebral ischemia. As opioids were indicated primarily for analgosedation in mechanically ventilated patients with poor clinical status, their usage was associated with a significantly higher chance of poor outcome, delayed cerebral ischemia, and hydrocephalus. CONCLUSION: Our results suggest that the prescription of metamizole may be associated with better outcomes and a lower chance of delayed cerebral ischemia development in patients after subarachnoid hemorrhage. Considering the retrospective nature of our study and the limited worldwide availability of metamizole due to its prohibition in some countries, our results do not demonstrate a clear benefit but rather justify the need for subsequent prospective studies.
- MeSH
- Analgesics therapeutic use administration & dosage MeSH
- Anti-Inflammatory Agents, Non-Steroidal * therapeutic use administration & dosage MeSH
- Adult MeSH
- Hydrocephalus etiology MeSH
- Brain Ischemia drug therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Dipyrone * therapeutic use administration & dosage MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Subarachnoid Hemorrhage * drug therapy complications MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Platelet Aggregation drug effects MeSH
- Anti-Inflammatory Agents, Non-Steroidal MeSH
- Aspirin administration & dosage pharmacology therapeutic use MeSH
- Clinical Trials as Topic MeSH
- Drug Interactions * MeSH
- Chemical and Drug Induced Liver Injury MeSH
- Humans MeSH
- Dipyrone * administration & dosage pharmacology therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- Keywords
- Baricitinib,
- MeSH
- Alopecia Areata drug therapy immunology physiopathology MeSH
- Alopecia * drug therapy classification physiopathology MeSH
- Azetidines pharmacology therapeutic use MeSH
- Adrenal Cortex Hormones pharmacology therapeutic use MeSH
- 5-alpha Reductase Inhibitors pharmacology therapeutic use MeSH
- Lupus Erythematosus, Cutaneous drug therapy physiopathology MeSH
- Lichen Planus drug therapy physiopathology MeSH
- Humans MeSH
- Purines pharmacology therapeutic use MeSH
- Pyrazolones pharmacology therapeutic use MeSH
- Pyrazoles pharmacology therapeutic use MeSH
- Sulfonamides pharmacology therapeutic use MeSH
- Trichotillomania etiology psychology MeSH
- Check Tag
- Humans MeSH
- MeSH
- Fentanyl therapeutic use MeSH
- Humans MeSH
- Dipyrone therapeutic use MeSH
- Cancer Pain drug therapy MeSH
- Analgesics, Opioid * pharmacology classification therapeutic use MeSH
- Breakthrough Pain * etiology drug therapy MeSH
- Tapentadol therapeutic use MeSH
- Tramadol therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- MeSH
- Adjuvants, Anesthesia pharmacology classification adverse effects therapeutic use MeSH
- Analgesics administration & dosage pharmacology classification adverse effects MeSH
- Administration, Mucosal MeSH
- Fentanyl administration & dosage MeSH
- Dosage Forms MeSH
- Humans MeSH
- Pain Measurement methods MeSH
- Dipyrone pharmacology adverse effects therapeutic use MeSH
- Cancer Pain * drug therapy therapy MeSH
- Analgesics, Opioid administration & dosage classification adverse effects MeSH
- Breakthrough Pain diagnosis drug therapy classification MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Analgesics administration & dosage adverse effects therapeutic use MeSH
- Antirheumatic Agents administration & dosage adverse effects therapeutic use MeSH
- Pain * drug therapy MeSH
- Drug Therapy, Combination MeSH
- Humans MeSH
- Dipyrone administration & dosage adverse effects therapeutic use MeSH
- Acetaminophen administration & dosage adverse effects therapeutic use MeSH
- Tramadol administration & dosage adverse effects therapeutic use MeSH
- Check Tag
- Humans MeSH
Bolest je komplikovaná subjektivní entita, kterou je obtížné kvantifikovat a léčit. Jednotlivci se prostřednictvím svých životních zkušeností učí pojmu bolesti a koncepce vnímání bolesti se u člověka mění. Přestože bolest obvykle plní adaptivní roli, může mít nepříznivé účinky na kvalitu života – na funkční, sociální a psychologickou rovnováhu. Proto je třeba respektovat sdělení jednotlivce o tom, že prožívá a cítí bolest, či sledovat různé symptomy bolesti. Perioperační léčba bolesti je dnes součástí komplexní péče o pacienty, kteří se podrobují operačním zákrokům, a je spojena s četnými benefity pro pacienta i společnost. V současnosti je k dispozici dostatek léků, lékových forem, modalit léčby i dostatek literárních údajů, vč. poznatků o organizaci léčby pooperační bolesti. Komplexní péče začíná již před operačním výkonem na specializovaných ambulancích správnou přípravou pacienta na anestezii a operační výkon. Samotná léčba pooperační bolesti je podobně jako péče o pacienta po chirurgickém výkonu multidisciplinárním týmovým úkolem, na němž se podílejí zejména ošetřující lékař, operatér, anesteziolog a sestry pooperačního oddělení. Součástí této rozsáhlé spolupráce jsou specializované týmy na léčbu akutní pooperační bolesti, které mají úlohu především konziliární, vzdělávací a organizační a pomáhají zajišťovat specializované léčebné postupy tišení bolesti. Je nutné, aby všechny specialisty spojovaly základní znalosti a jejich uplatňování v praxi.
Pain is a complicated subjective entity that is difficult to quantify and treat. Individuals learn the concept of pain through their life experience, and a person’s concept of pain perception changes. Although pain usually fulfills an adaptive role, it can have adverse effects on quality of life – functional, social and psychological balance. Therefore, it is necessary to respect the communication of the individual experiencing and feeling pain, or to monitor the various symptoms of pain. Today, perioperative pain management is part of the comprehensive care of patients undergoing surgery, and is associated with numerous benefits for the patient and society. Currently, there are enough drugs, dosage forms, treatment modalities available, as well as enough literary data, incl. knowledge about the organization of postoperative pain treatment. Comprehensive care begins even before surgery in specialized outpatient clinics with the proper preparation of the patient for anesthesia and surgery. The treatment of postoperative pain itself is similar to the care of a patient after a surgical procedure, a multidisciplinary team task, in which the attending physician, surgeon, anesthetist and nurses of the postoperative department participate in particular. Part of this extensive collaboration are specialized teams for the treatment of acute postoperative pain, which primarily have a conciliatory, educational and organizational role, and help to provide specialized treatment procedures for pain relief. It is necessary for all specialists to combine basic knowledge and their application in practice.
- MeSH
- Analgesics administration & dosage pharmacology classification MeSH
- Analgesia methods MeSH
- Anti-Inflammatory Agents, Non-Steroidal administration & dosage pharmacology classification adverse effects MeSH
- Surgical Procedures, Operative adverse effects MeSH
- Adrenal Cortex Hormones administration & dosage MeSH
- Humans MeSH
- Dipyrone administration & dosage MeSH
- Morphine administration & dosage MeSH
- Analgesics, Opioid administration & dosage classification MeSH
- Acetaminophen administration & dosage MeSH
- Perioperative Care methods MeSH
- Pain, Postoperative * drug therapy therapy MeSH
- Postoperative Care * methods MeSH
- Enhanced Recovery After Surgery MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Chronická bolest představuje závažný zdravotní problém, který zatěžuje celý systém zdravotnictví. Její léčba by měla být vedena racionálně a na podkladě současných vědeckých poznatků. Článek shrnuje současný pohled na tuto problematiku a poukazuje na nová analgetika a doporučení.
Chronic pain is a serious health problem that puts a strain on the entire health system. Her treatment should be conducted rationally and on the basis of current scientific knowledge. The article summarizes the current view of this issue and points to new painkillers and recommendations.
- MeSH
- Analgesics administration & dosage therapeutic use MeSH
- Anti-Inflammatory Agents, Non-Steroidal therapeutic use MeSH
- Chronic Pain * drug therapy MeSH
- Drug Combinations MeSH
- Humans MeSH
- Dipyrone administration & dosage therapeutic use MeSH
- Neuralgia drug therapy MeSH
- Analgesics, Opioid adverse effects therapeutic use MeSH
- Breakthrough Pain drug therapy MeSH
- Check Tag
- Humans MeSH
V současné době stoupá celosvětově spotřeba všech léků a mezi nimi i léků na bolest. Zároveň s tím vzrůstá i počet nežádoucích účinků v důsledku užívání těchto léků. Problematika hypersenzitivních reakcí na léky ze skupiny nesteroidních antirevmatik je obzvláště komplikovaná z důvodu možných zkřížených reakcí a různých mechanismů vzniku hypersenzitivní reakce. V této kazuistice představujeme pacienta, u kterého došlo k časné reakci po obstřiku páteře, během něhož dostal několik různých léků. Podrobným anamnestickým rozborem, laboratorním vyšetřením a kožními testy jsme určili, že za reakci byl odpovědný metamizol.
In recent times there has been an increase in consumption of drugs worldwide and amongst them painkillers. At the same time there has been an increase of adverse effects. The issue of drug hypersensitivity from group of nonsteroidal anti-inflammatory drugs is especially complex due to possibility of cross-reaction a various mechanisms origin of these reactions. In this case study we present a patient, who had an early reaction after administration od analgetic spine injections, during which the patient was administered several different drugs. With detailed review of patients’ history, laboratory diagnostics and skin test, we have been able to identify metamizole as the cause of the reaction.
- MeSH
- Anaphylaxis chemically induced MeSH
- Angioedema chemically induced MeSH
- Antirheumatic Agents * adverse effects therapeutic use MeSH
- Drug Hypersensitivity * diagnosis classification MeSH
- Middle Aged MeSH
- Humans MeSH
- Dipyrone adverse effects therapeutic use MeSH
- Urticaria chemically induced MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Review MeSH
