Pain in critically ill patients requires effective analgesia, but unnecessary exposure to potent opioids increases risks of respiratory depression, hypotension, excessive sedation, dependence, and other adverse events, leading to more complications. Recent emphasis on multimodal analgesia highlights safer options like metamizole and tramadol in selected contexts. This retrospective observational study describes a cohort of 339 ICU patients receiving continuous metamizole-tramadol infusion for pain control, aiming to support this as an opioid-sparing alternative.

The cohort (mean age 37.0 years, median 32, range 1-97) showed clinical heterogeneity (neurocritical, obstetric, septic, surgical, respiratory, cardiac, pancreatitis). Analysis used SPSS for descriptives. No nausea, vomiting, or hypotension occurred; BPS scores indicated adequate pain control (all 3/12).

In selected critically ill patients, continuous metamizole-tramadol infusion is a reasonable opioid-sparing option in multimodal protocols, reducing potent opioid exposure and adverse effects.