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Postoperative visual analogue scale (VAS). There were no significant differences VAS in both groups. All measured values are presented as mean ± standard deviation. Preop: Preoperation, PACU: postanesthetic care unit. Group A received intravenous patient controlled analgesia (IV-PCA) using a combination of morphine 60 mg and ketorolac 180 mg (basal rate 1 ml/h, a bolus of 1 ml, and lockout time 15 min). Group B received IV-PCA using nefopam 200 mg (basal rate 1 ml/ h, a bolus of 1 ml, and lockout time 15 min).
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Background:
Nefopam is a non-opioid non-steroidal centrally acting analgesic. This study was conducted to assess the analgesic efficacy of intravenous patient-controlled analgesia (IV-PCA) using nefopam alone, compared with a combination of morphine and ketorolac, after laparoscopic gynecologic surgery.
Methods:
Sixty patients undergoing laparos...
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Background
Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCE...
Citations
... Various doses of nefopam ranging from 20-40 mg has been suggested to be infused intravenously over a period of 15-60 minutes ( Lee et al. , 2013;Mimoz et al. , 2001;Du et al. , 2003;Remérand et al. , 2013;Hwang et al., 2015;Na et al., 2016;Evans et al., 2008). Some studies recommended 1-5 mg/hr infusion ( Remérand et al. , 2013;Evans et al. , 2008;Kim et al. , 2014;Son et al. , 2017) or 1-2. 4 mg/ dose for intravenous patient-controlled analgesia ( PCA) with or without opioid ( Mimoz et al. , 2001;Hwang et al. , 2015;Kim et al., 2014;Son et al., 2017;Jin et al., 2016;Yoon et al., 2016). Nefopam has demonstrated efficacy in reducing postoperative pain scores and fentanyl requirements particularly in the immediate PACU period ( Kim et al. , 2017) . ...
Backgroud: Despite the widespread use of laparoscopic surgery across various procedures, effective postoperative pain management remains a challenge. Nefopam may be effective as an adjuvant analgesic for acute postoperative pain control. Objective: This study highlights the analgesic effects and risk of adverse events when using a low dose nefopam for laparoscopic surgical procedures. Methods: This study is double-blinded, prospective randomized controlled trial. There were 50 subjects who were divided into 2 groups. The nefopam group (n=25) received slow intravenous (IV) injection of 10 mg nefopam and IV 25 mcg fentanyl immediately in post-anesthetic care unit (PACU), while the placebo group (n=25) received IV isotonic saline and IV 25 mcg fentanyl. The primary outcomes include the numerical rating scales (NRS) of postoperative pain intensity, fentanyl consumption, adverse effects and patient satisfaction in PACU. Results: There was no difference in demographic data between groups. The NRS scores of the nefopam group at 30, 45 and 60 minutes postoperative were significantly lower than of the placebo group (p ˂ 0.05). The amount of fentanyl consumption in PACU is comparable between groups (p = 0.311). Patients in both groups experienced some adverse effects including nausea, vomiting, tachycardia, dry mouth, and dizziness, however the incidence was not different between groups. Additionally, the nefopam group tended to have better patient satisfaction. Conclusion: The additional low dose nefopam administered by slow IV injection could reduce acute pain intensity after laparoscopic abdominal surgery, while this approach did not increase the risk of adverse effects.
... Previous studies have reported on the effectiveness of several medications in preventing CRBD, and meta-analyses have shown that antimuscarinics, gabapentin, tolterodine, ketamine, trospium, dexmedetomidine, oxybutynin and nefopam are effective [5,6,[10][11][12][13][14][15][16][17][18]. Among them, nefopam is a well-known drug used in the eld of anesthesia to prevent emergence agitation or shivering after spinal anesthesia, or to reduce opioid consumption for intra-and postoperative analgesia [19][20][21][22][23][24]. The mechanism of action of nefopam is similar to that of triple receptor (serotonin, norepinephrine, and dopamine) reuptake inhibitors and anticonvulsants [25] (Fig. 5). ...
Background
Patients with Foley catheter may experience catheter-related bladder discomfort (CRBD) after surgery. Previous studies have indicated that nefopam can reduce the incidence and severity of CRBD; however, they could not compare dose-dependent effects (20 mg vs. 40 mg). Therefore, we aimed to investigate the dose-dependent effects, effective dose of nefopam for CRBD, and the incidence of side effects.
Methods
From August 2016 to December 2022, we reviewed the electronic medical records of patients aged 18–70 years with American Society of Anesthesiologists physical status I-III who underwent elective transurethral ureteroscopic lithotripsy under general anesthesia. Patients were either administered premedication to prevent CRBD (intravenous nefopam 20 mg, group N20, or 40 mg, group N40) or not (group C).
Results
The incidence of CRBD were 85.7% in Group C, 81.3% in Group N20, and 24.3% in Group N40. There was a significant difference in the incidence between the groups (P = 0.0034). As the dose of nefopam increased, the incidence of CRBD decreased linearly, and the difference was statistically significant (P = 0.002). In the trend test, severity also decreased as the dose of nefopam increased, which was statistically significant (P < 0.001). Evaluation of hemodynamic stability during surgery and postoperative nausea and vomiting showed no significant differences among the three groups.
Conclusions
Nefopam 40 mg reduced both the incidence and severity of CRBD compared to the control group.
Trial registration number:
ID- KCT0008381 (https://trialsearch.who.int/Trial2.aspx?TrialID=KCT0008381)
Date of registration – 2023-04-25
... These side effects are 6 major causes for the inefficient discontinuation of intravenous PCA. 7 To minimize opioid-related side effects, a combination of opioids with adjunctive medications, 8 such as propacetamol [5], ketorolac [6], nefopam [7], and dexmedetomidine [8], is used. The existing 9 intravenous PCA device is a single-chamber pump. ...
... These side effects are 6 major causes for the inefficient discontinuation of intravenous PCA. 7 To minimize opioid-related side effects, a combination of opioids with adjunctive medications, 8 such as propacetamol [5], ketorolac [6], nefopam [7], and dexmedetomidine [8], is used. The existing 9 intravenous PCA device is a single-chamber pump. ...
Background:
A combination of opioids with adjunctive drugs can be used for intravenous patient-controlled analgesia (PCA) to minimize opioid-related side effects. Herein, we investigated whether two different analgesics administered separately via a dual-chamber PCA may have fewer side effects with adequate analgesia than single fentanyl PCA in gynecologic patients undergoing pelviscopic surgery.
Methods:
This prospective, double-blinded, randomized and controlled study included 68 patients who underwent pelviscopic gynecological surgery. Patients were randomly allocated to either the dual (ketorolac and fentanyl delivered by a dual-chamber PCA) or the single (fentanyl alone) group. PONV and analgesic quality were compared between the two groups at 2, 6, 12, and 24 h postoperatively.
Results:
The dual group showed a significantly lower incidence of PONV during postoperative 2-6 h (P = 0.011) and 6-12 h (P = 0.009). Finally, only 2 patients (5.7%) in the dual group and 18 (54.5%) in the single group did experience PONV during the entire postoperative 24 h, who could not maintain intravenous PCA (OR, 0.056; 95% CI, 0.007-0.229; P < 0.001). Despite less fentanyl was administered via intravenous PCA during the postoperative 24 h in the dual group than in the single group (66.0 ± 77.8 μg vs. 383.6 ± 70.1 μg, P < 0.001), postoperative NRS for pain had no significant intergroup difference.
Conclusions:
Two different analgesics, continuous ketorolac and intermittent fentanyl bolus, administered via dual-chamber intravenous PCA, showed fewer side effects with adequate analgesia than conventional intravenous fentanyl PCA in gynecologic patients undergoing pelviscopic surgery.
... Nefopam is a centrally acting non-opioid, non-steroidal analgesic that has been used as an alternative to opioids for analgesia in patients with moderate to severe pain [13]. Nefopam, as an adjuvant analgesic for fentanyl-based PCA, has been shown to provide similar postoperative analgesia to ketorolac, a common NSAID used as an adjuvant analgesic with fentanyl-based PCA [14]. ...
... Intravenous PCA using nefopam alone (2 mg/h) was not inferior to opioid-based PCA (morphine 0.6 mg/h and ketorolac 1.8 mg/h [equivalent doses: fentanyl 6 μg/h and nefopam 1.2 mg/h]) at 12 h postoperatively [mean difference (95% CI): −0.30 (−1.25 to 0.65), non-inferiority margin: 1.5]; this produced a mean VAS of 3.3 and a lower incidence of nausea in patients undergoing laparoscopic gynecologic surgeries [13,17,18]. In this study, we also found that the postoperative analgesic effect showed non-inferiority with the noninferiority margin (1.0) between groups using nefopam alone (4 mg/h) and combined nefopam-fentanyl (fentanyl 10 μg/h and nefopam 2 mg/h). ...
... Son et al. [18] revealed that the use of nefopam 120 mg (1 mg/h) as an adjuvant PCA analgesic with fentanyl 600 μg (5 μg/h) was effective in maintaining NRS scores of 3 to 4 at 6 h postoperatively, but resulted in a high overall incidence of PONV (59%) during the first 48 postoperative hours. Some authors have tried to evaluate the analgesic effect of intravenous nefopam alone for postoperative analgesia [13,16,18]. Postoperative analgesia with an intravenous PCA using nefopam alone was as effective as using a combination of an opioid and a non-opioid analgesic [13] and has shown non-significant differences in postoperative pain intensity compared to the use of fentanyl [16,19]. ...
Background and Objectives: We investigated the non-inferiority of patient-controlled analgesia (PCA), using either nefopam alone or combined nefopam-fentanyl for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Materials and Methods: In this prospective, randomized, controlled study, 78 patients were allocated to receive nefopam 240 mg (Group N240) or nefopam 120 mg with fentanyl 600 μg (Group NF), equivalent to fentanyl 1200 μg, with a total PCA volume of 120 mL. Patients were given a loading dose (0.1 mL/kg) from the PCA device along with ramosetron (0.3 mg) and connected to a PCA device with a background infusion rate of 2 mL/h, bolus dose amount set at 2 mL, and lockout interval set at 15 min. Pain scores were obtained using the numeric rating scale (NRS) at 30 min after recovery room (RR) admission, as well as 8 and 24 h postoperatively. The primary outcome was analgesic efficacy evaluated using NRS-rated 8 h postoperatively. Other evaluated outcomes included the incidence rate of bolus demand, rescue analgesic and antiemetic requirements, and postoperative adverse effects. Results: NRS scores were not significantly different between the groups throughout the postoperative period (p = 0.539). NRS scores of group N240 were not inferior to those of group NF at 30 min after RR admission, or at 8 and 24 h postoperatively (mean difference [95% CI], −0.05 [−0.73 to 0.63], 0.10 [−0.29 to 0.50], and 0.28 [−0.06 to 0.62], respectively). Postoperative adverse effects were not significantly different between the two groups (p = 1.000) and other outcomes were also not significantly different between the two groups (p ≥ 0.225). Conclusion: PCA using nefopam alone has a non-inferior and effective analgesic efficacy and produces a lower incidence of postoperative adverse effects compared to a combination of fentanyl and nefopam after laparoscopic cholecystectomy.
... One study reported that, when comparing the analgesic effect of nefopam on opioids, 20 mg of nefopam exhibits equal efficacy to that of 6-12 mg of morphine [6], and another study reported that 20 mg of nefopam is equipotent to 7.5 mg of morphine [7]. The analgesic effect of nefopam alone 2 of 9 was not lower than that of a combination of morphine and ketorolac on pain control after laparoscopic gynecological surgery [8]. ...
... According to Kim et al., nefopam alone showed adequate postoperative analgesic effect after cardiac surgery [15]. Yoon et al. demonstrated that nefopam alone was non-inferior to morphine with ketorolac in patients undergoing gynecological surgery [8]. Fentanyl is a drug commonly used for postoperative pain control. ...
... Our findings suggest that pain control in PCA using nefopam alone was not non-inferior to that achieved with fentanyl in patients undergoing laparoscopic gynecological surgery. Because the fentanyl-equivalent dose of nefopam was not known and because a conversion analgesic dose of nefopam was applied, our results differ from those reported by Yoon et al. [8]. In addition, in our study, PCA was set to not exceed the daily allowance of 120 mg of nefopam. ...
Opioid-sparing effects of nefopam during patient-controlled analgesia (PCA) are well demonstrated. We hypothesized that postoperative pain control with an opioid-equivalent dose of nefopam as a single analgesic agent for PCA would not be inferior to fentanyl in laparoscopic gynecologic surgery. In total, 135 patients were randomly assigned to the N (nefopam 200 mg), NF (fentanyl 500 mcg + nefopam 100 mg), and F (fentanyl 1000 mcg) groups (n = 45 patients per group). The primary outcome was the numerical rating scale (NRS) score at rest at 6 h postoperatively, and the non-inferiority limit was set to 1. Secondary outcomes were pain severity and incidence of nausea and vomiting for 48 h postoperatively. Mean differences (MD) in primary outcome between the N and F groups were 0.4 (95% confidence interval (CI) -0.5 to 1.3). The upper limit of 95% CI exceeded the non-inferiority limit. The N group showed higher pain scores than the NF group (MD, 1.1; 95% CI, 0.3-1.9) in pairwise comparisons. No significant intergroup differences were observed in the cumulative dose of PCA usage and incidence of postoperative nausea and vomiting (PONV). In laparoscopic gynecological surgery, nefopam alone showed limited efficacy for postoperative pain control.
... Nefopam is a nonopioid analgesic drug with a centrally acting mechanism which has an equivalent analgesic effect to NSAIDs [1, 2, 6]. Yoon et al. [14] demonstrated the comparable analgesic efficacy using nefopam only and a combination of IV-PCA using of morphine and ketorolac in laparoscopic gynecologic surgery. Many studies showed lower incidence of postoperative nausea and vomiting in the nefopam group [11,15,16]. ...
Background:
Nefopam is a non-NSAIDs and opioid sparing centrally acting drug which is effective for a multimodal postoperative analgesia. The present study aimed to evaluate the analgesic efficacy of nefopam combined with parecoxib for gynecologic surgery.
Methods:
This randomized double-blinded control trial recruited participants (n = 72) who underwent gynecologic surgeries and divided them into either a nefopam or control group. The study group received parecoxib 40 mg plus nefopam 20 mg, while the control group received parecoxib 40 mg plus normal saline solution intravenously during open abdominal gynecological surgery. Both groups then received either nefopam or normal saline every 6 hours postoperatively for 24 hours. Intravenous patient-controlled analgesia with morphine was given for breakthrough pain within 24 h. The participants were evaluated for morphine consumption within 24 hours and postoperative pain using a verbal numerical rating scale (VNRS) at a postanesthetic care unit, at 6-, 12-, and 24-hour postoperative periods. Adverse effects were recorded.
Results:
Morphine consumption within 24 hours and adverse effects were not significantly different between both groups. Mean difference and 95% confident interval of morphine consumption between both groups was 1.00 (-4.56, 4.76), P=0.97. The VNRS on movement at 6 hours after surgery of the nefopam group was significantly different from that of the control group [mean (SD), 4.14 (2.11) vs. 5.14 (1.80), P=0.04]. The VNRS of the nefopam group at 12 hours after operation during resting and on movement was significantly different from that of the control group ([mean (SD), 1.47 (1.80) vs. 2.54 (2.15), P=0.03], [mean (SD), 3.22 (1.84) vs 4.17 (1.74), P=0.03]), respectively.
Conclusions:
The combined administration of nefopam and parecoxib during gynecologic surgery slightly reduced the VNRS at 6 and 12 hours postoperatively more than treatment with parecoxib.
... Післяопераційний біль на ранніх стадіях формування можна характеризувати як позитивну фізіологічну реакцію з розвитком механізмів, що значно знижують наслідки травмуючої дії [31]. Це служить сигналом пошкодження тканин та ініціює процеси, необхідні для загоєння ран і одужання хворого. ...
The modern approach to the multimodal scheme of postoperative analgesia includes the mandatory use of drugs that have a small number of side effects and at the same time have a polymodal effect on the pathogenetic links of pain development. Nefopam hydrochloride is able to prevent the development of: opioid hyperalgesia, stop pain stimuli without respiratory depression, affect platelet aggregation and the condition of the mucous membrane and motility of the gastrointestinal tract, which distinguishes it from classical NSAIDs. Nefopam hydrochloride is characterized by a low risk of addiction with prolonged use, a pronounced anti-sensory effect, especially significant at the stage of awakening and in the early postoperative period.
Postoperative analgesia based on nefopam hydrochloride as a component of multimodal analgesia is effective and safe in the absence of absolute contraindications. The planned use of nefopam hydrochloride for the correction of pain reduces complications in the postoperative period and improves the quality of life of patients. Nefopam hydrochloride is one of the most effective drugs for the correction of postoperative tremor syndrome. The use of nefopam hydrochloride as a drug, which is a part of premedication before surgical interventions and a component of multimodal analgesia, improves the quality of the postoperative period due to: reduction of pain syndrome, planned correction of postoperative tremor syndrome and correction of complications arising from inadequate treatment of pain syndrome.
... Recently, clinical use of the nonopioid agent nefopam has increased due to relatively higher safety on hemorrhage, infection, and nephrotoxic patients. Nefopam has also been reported to decrease respiratory depression and PONV, which are adverse effects of opioids [15][16][17]. ...
... Although nefopam can induce adverse effects such as tachycardia, sweating, nausea, vomiting, drowsiness, asthenia, light headedness, and pain at the injection site, these symptoms are typically transient and non-severe [35][36][37][38]. Nefopam has recently been reported to lower PONV after laparoscopic gynecologic surgery and cardiac surgery [15][16][17]. ...
Background
Postoperative nausea and vomiting (PONV) frequently occurs following bimaxillary orthognathic surgeries. Compared to opioids, Nefopam is associated with lower incidences of PONV, and does not induce gastrointestinal tract injury, coagulopathy, nephrotoxicity, or fracture healing dysfunction, which are common side effects of Nonsteroidal anti-inflammatory drugs. We compared nefopam- and fentanyl-induced incidence of PONV in patients with access to patient-controlled analgesia (PCA) following bimaxillary orthognathic surgeries.
Methods
Patients undergoing bimaxillary orthognathic surgeries were randomly divided into nefopam and fentanyl groups. Nefopam 120 mg or fentanyl 700 µg was mixed with normal saline to a final volume of 120 mL. Patients were given access to nefopam or fentanyl via PCA. Postoperative pain intensity and PONV were measured at 30 minutes and 1 hour after surgery in the recovery room and at 8, 24, 48, and 72 hours after surgery in the ward. The frequency of bolus delivery was compared at each time point.
Results
Eighty-nine patients were enrolled in this study, with 48 in the nefopam (N) group and 41 in the fentanyl (F) group. PONV occurred in 13 patients (27.7%) in the N group and 7 patients (17.1%) in the F group at 8 hours post-surgery (P = 0.568), and there were no significant differences between the two groups at any of the time points. VAS scores were 4.4 ± 2.0 and 3.7 ± 1.9 in the N and F groups, respectively, at 8 hours after surgery (P = 0.122), and cumulative bolus delivery was 10.7 ± 13.7 and 8.6 ± 8.5, respectively (P = 0.408). There were no significant differences in pain or bolus delivery at any of the remaining time points.
Conclusion
Patients who underwent bimaxillary orthognathic surgery and were given nefopam via PCA did not experience a lower rate of PONV compared to those that received fentanyl via PCA. Furthermore, nefopam and fentanyl did not provide significantly different postoperative pain control.
... Continuous nefopam administration via patient-controlled analgesia produced analgesic effects that were not inferior to those of morphine and ketorolac-based patient-controlled analgesia. 20 In the present study, the ED50 of a single dose nefopam in patients with moderate pain was 62.1 mg (95% CI, 52.9-72.9 mg). ...
Objective
Nefopam is thought to reduce postoperative pain; however, the evidence is insufficient. The recommended dose is 20 mg, and the median effective dose (ED50) in the surgical setting reportedly ranges from 17 to 28 mg. However, nefopam frequently produces inadequate postoperative analgesia. We evaluated the ED50 of nefopam as a single agent in patients undergoing laparoscopic cholecystectomy.
Methods
Twenty-nine patients were scheduled for laparoscopic cholecystectomy. Postoperative pain was evaluated using a numerical pain scale (NPS). When the NPS score was >3, patients were administered a predetermined dose of nefopam. The dose was calculated using the up-and-down allocation technique based on the previous response. The initial dose was 28 mg, with adjustment intervals of 5 mg. An effective response was defined as a decrease in the NPS score to <3 at 30 minutes after infusion.
Results
The ED50 of nefopam was 62.1 mg (95% confidence interval, 52.9–72.9 mg). Eight patients reported pain upon injection, and three were excluded due to severe injection pain and phlebitis.
Conclusions
The estimated ED50 was higher than the predetermined dose based on previous studies. We recommend that the dose of nefopam be chosen after careful consideration of individual variations and clinical settings.
... Because the current study did not directly compare the nefopam-fentanyl combination versus fentanyl alone, caution is advised on the interpretation of our results. Yoon et al. [28] demonstrated that nefopam reduces the incidence of PONV compared with a combination of morphine and ketorolac in IV-PCA. Our study compared nefopamfentanyl with ketorolac-fentanyl combinations but, the study compared nefopam alone and morphine-ketorolac combination. ...
Background
We compared the analgesic efficacy and side effects of ketorolac and nefopam that were co-administered with fentanyl via intravenous patient-controlled analgesia.
Methods
One hundred and sixty patients scheduled for laparoscopic cholecystectomy were randomly assigned to ketorolac (Group K) or nefopam (Group N) groups. The anesthetic regimen was standardized for all patients. The analgesic solution contained fentanyl 600 µg and ketorolac 180 mg in Group K, and fentanyl 600 µg and nefopam 120 mg in Group N. The total volume of analgesic solution was 120 ml. Postoperative analgesic consumption, recovery of pulmonary function, and pain intensities at rest and during the forced expiration were evaluated at postoperative 2, 6, 24, and 48 h. The postoperative side effects of analgesics were recorded.
Results
Cumulative postoperative analgesic consumptions at postoperative 48 h were comparable (Group K: 93.4 ± 24.0 ml vs. Group N: 92.9 ± 26.1 ml, P = 0.906) between the groups. Pain scores at rest and during deep breathing were similar at the time of each examination. The recovery of pulmonary function showed no significant differences between the groups. Overall, postoperative nausea and vomiting incidence was higher in Group N compared with Group K (59% vs. 34%, P = 0.015). The other side effects were comparable between both groups.
Conclusions
Analgesic efficacies of ketorolac and nefopam that were co-administered with fentanyl for postoperative pain management as adjuvant analgesics were similar. However, postoperative nausea and vomiting incidence was higher in the nefopam-fentanyl combination compared with the ketorolac-fentanyl combination.
