The Effect of Nefopam on Postoperative Fentanyl Consumption: A Randomized, Double-blind Study

Jee Youn Moon, Sang Sik Choi, Shin Young Lee, Mi Kyung Lee, Jung Eun Kim, Ji Eun Lee, So Hyun Lee, Jee Youn Moon, Sang Sik Choi, Shin Young Lee, Mi Kyung Lee, Jung Eun Kim, Ji Eun Lee, So Hyun Lee

Abstract

Background: Nefopam is a non-opioid, non-steroidal, centrally acting analgesic drug. The concomitant use of opioids and nefopam is believed to have many advantages over the administration of opioids alone for postoperative pain management. We conducted a randomized, double-blind study to determine the fentanyl-sparing effect of co-administration of nefopam with fentanyl for postoperative pain management via patient controlled analgesia (PCA).

Methods: Ninety female patients who underwent laparoscopic total hysterectomy under general anesthesia were randomized into 3 groups, Group A, fentanyl 1,000 µg; Group B, fentanyl 500 µg + nefopam 200 mg; and Group C, fentanyl 500 µg + nefopam 400 mg, in a total volume of 100 ml PCA to be administered over the first 48 h postoperatively without basal infusion. The primary outcome was total fentanyl consumption during 48 h; secondary outcomes included pain scores and incidence of side effects.

Results: Eighty-one patients were included in the analysis. The overall fentanyl-sparing effects of PCA with concomitant administration of nefopam during the first 48 h postoperatively were 54.5% in Group B and 48.9% group C. Fentanyl use was not significantly different between Groups B and C despite the difference in the nefopam dose. There were no differences among the three groups in terms of PCA-related side effects, although the overall sedation score of Group B was significantly lower than that of Group A.

Conclusions: The concomitant administration of nefopam with fentanyl for postoperative pain management may allow reduction of fentanyl dose, thereby reducing the risk of opioid-related adverse effects.

Keywords: Deep sedation; Double blind study; Hysterectomy; Nefopam, Opioids; Pain measurement; Patient-controlled analgesia; Postoperative pain.

Figures

Fig. 1. The cumulative dose of postoperative…
Fig. 1. The cumulative dose of postoperative fentanyl (FTN) administered via PCA over 48 hours. FTN consumption during the 48 h follow-up period is significantly lower in Groups B and C than in Group A. PACU 1 h: the 1st hour after extubation at the Post anesthesia care unit (PACU), PACU 2 h: the 2nd hour after extubation at the PACU, 6 h: the 6th hour after extubation on the ward, 12 h: the 12th hour after extubation on the ward; 24 h: the 24th hour after extubation on the ward; 48 h: the 48th hour after extubation on the ward. Group A: FTN 1,000 µg, Group B: FTN 500 µg + Nefopam (NFP) 200 mg, and Group C: FTN 500 µg + NFP 400 mg. *< 0.01 compare to Group A.

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Source: PubMed

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