A comparison between ketorolac and nefopam as adjuvant analgesics for postoperative patient-controlled analgesia: a randomized, double-blind, prospective study

Son, Ji-Seon; Doo, A Ram; Kwon, Young-Jun; Han, Youngjin; Ko, Seonghoon

doi:10.4097/kjae.2017.70.6.612

Cited by 12 publications

(19 citation statements)

References 25 publications

(29 reference statements)

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“…Although a large number of clinical trials have explored the use of nefopam in various surgical settings,[ 9 ] the efficacy of nefopam in PCA remains unclear. [ 17 ] Only a few studies have reported the efficacy and side effects of using nefopam combined with fentanyl in PCA,[ 13 – 15 , 27 ] as in the present study. Kim et al compared three PCA groups after cardiac surgery: nefopam alone, fentanyl alone, or nefopam and fentanyl.…”

Section: Discussionmentioning

confidence: 75%

“…[ 25 , 26 ] However, the incidence of PONV was often not reduced by opioid-sparing strategies with nefopam, as reported in several randomized trials. [ 1 , 13 , 14 ] Furthermore, a few studies have even showed a relatively frequent PONV incidence in patients treated with nefopam,[ 12 , 27 ] suggesting that nefopam is emetic. A previous systematic review showed nefopam was not significantly associated with PONV.…”

Section: Discussionmentioning

confidence: 99%

“…A recent randomized clinical trial comparing nefopam and ketorolac as adjuvant analgesics for IV PCA reported that the incidence of PONV was higher in the nefopam group than in the ketorolac group. [ 27 ] However, the investigators did not use prophylactic antiemetics, which did not conform to the PONV guidelines since most patients included in the study had two or three major PONV risk factors. Considering the unusually high incidence of PONV (59%) in nefopam group in the study,[ 27 ] the results should be cautiously interpreted.…”

Section: Discussionmentioning

confidence: 99%

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Association of nefopam use with postoperative nausea and vomiting in gynecological patients receiving prophylactic ramosetron: A retrospective study

et al. 2018

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BackgroundPostoperative nausea and vomiting (PONV) is a common adverse effect of opioid-based intravenous patient-controlled analgesia (IV PCA). Nefopam has been considered as a good candidate for inclusion in multimodal analgesia because of its opioid sparing effect, but it can be emetic. This study aims to examine whether the use of nefopam combined with fentanyl in IV PCA was associated with the higher incidence of PONV in patients receiving prophylactic ramosetron after gynecological surgery.MethodsData from 296 patients who underwent gynecological surgery were retrospectively reviewed. The patients received IV PCA containing either fentanyl 1500 μg and ketorolac 90 mg (Group K) or fentanyl 1500 μg and nefopam 80 mg (Group N). All patients in both groups received 0.3 mg of ramosetron at the end of surgery. The primary outcome measure was the incidence of PONV during the 3-day postoperative period.ResultsNo difference was observed in the incidence of PONV during the 3-day postoperative period between the two groups. However, the incidence of nausea on postoperative day 2 was significantly higher in Group N (10.3%) than in Group K (2.8%) (P = 0.016). Multivariable logistic regression analysis showed that the use of nefopam was not associated with a higher incidence of PONV (adjusted odds ratio, 1.616; 95% confidence interval, 0.952–2.743, P = 0.076). There were no differences in postoperative pain scores between the two groups.ConclusionThe combined use of nefopam with fentanyl in IV PCA was not associated with the higher incidence of PONV compared with the use of ketorolac and fentanyl combination in patients who received ramosetron as PONV prophylactic agent. However, prospective trials are required for a confirmative conclusion.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association of nefopam use with postoperative nausea and vomiting in gynecological patients receiving prophylactic ramosetron: A retrospective study

et al. 2018

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“…In addition, PCA cocktails often include either oxycodone or hydromorphone, both of which have a relatively long onset and duration of action. Most cocktails also include nefopam, which has a mechanism of analgesia that is different from that of opioids; the use of this agent helps reduce the dose of required opioids, which in turn reduces opioid-related side effects (Son et al 2017;Aveline et al 2009). To further reduce the opioid-induced side effects of nausea and vomiting, antiemetic drugs can be added to IV PCA (Estan-Cerezo et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Intravenous patient-controlled analgesia: in vitro stability profiles of mixtures containing fentanyl, hydromorphone, oxycodone, nefopam, ondansetron, and ramosetron

et al. 2020

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Background and objectives Patient-controlled analgesia often involves combinations of multiple drugs. This study aimed to determine the stability of drug mixtures commonly used for intravenous patient-controlled analgesia. Materials and methods We examined four of the most commonly used drug combinations in intravenous patient-controlled analgesia at our institution. Mixtures contained fentanyl (400 μg), either oxycodone (10 mg) or hydromorphone (4 mg), nefopam (20 mg), and either ondansetron (10 mg) or ramosetron (0.3 mg). Each drug mixture was diluted in 0.9% saline and stored in a portable patient-controlled analgesia system at room temperature (24 °C) for 96 h. Physical attributes including color, turbidity, and precipitation were assessed using digital imaging and optical microscopy. Sterility testing was conducted to assess for microbiological contamination. The pH of each mixture was monitored for up to 96 h after mixing. The concentration of each drug in the mixture was also evaluated using high-performance liquid chromatography. Results All mixtures remained colorless and transparent with no visible sediment for 96 h. After 14 days of culture, none of the samples showed bacterial or fungal growth. The pH for all mixtures was maintained between 4.17 and 5.19, and the mean pH change in any mixture was less than 0.4 over the study period. The concentration of each drug remained between 90 and 110% of the initial value for 96 h after mixing. Conclusion Four drug mixtures commonly used for intravenous patient-controlled analgesia are physiochemically stable and remain sterile for 96 h after mixing.

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“…Ketorolac is an NSAID with potent analgesic, antiinflammatory, and antipyretic properties, which can be used for painful sickle cell crisis. Studies demonstrated that ketorolac is comparable with morphine in relieving pain (19,20). Wright et al (21), Ender et al (14), Jacob and Mueller (22), Perlin et al (23), and Udeza and Herrera (6) reported that anti-inflammatory agents such as ketorolac do well in treating pain crisis in SCD patients.…”

Section: Discussionmentioning

confidence: 99%

Pain Relief in the Sickle-Cell Crisis: Intravenous Morphine Versus Ketorolac; A Double-Blind, Randomized Clinical Trial

Doluee¹,

Kakhki²,

Mir³

et al. 2019

Iran Red Crescent Med J

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Background: Sickle cell disease (SCD) is a congenital hemoglobinopathy. A low Hb level and high hemoglobin-to-hematocrit ratio may lead to the vaso-occlusive crisis in patients, for the management of which hyperbaric oxygen, hydration, and pain relief therapy are proposed. Objectives: In this study, we sought to compare the effects of morphine and ketorolac on relieving painful sickle cell crisis. Methods: In this double-blind, randomized clinical trial, we recruited 92 SCD patients who referred to the Emergency Department of a university-affiliated hospital, in Mashhad, Iran, from December 2016 to May 2017. The patients were randomly assigned to two groups of ketorolac and morphine injections for relieving pain crisis according to the clinical conditions of the patients. Pain severity was measured by the visual analogue scale before and after the intervention. Data were analyzed using SPSS software. Results: A total of 92 SCD patients were evaluated, while, 19 (21%) were female and 73 (79%) were male, with the mean age of 20.77 ± 8.6 years. At the pre-injection phase, the mean pain scores were 9.1 ± 0.4 and 9.1 ± 0.7 in the ketorolac and morphine groups, respectively. After the intervention, the mean pain scores were 3.7 ± 1.2 and 4.9 ± 2.1 in the ketorolac and morphine groups, respectively. A significant association was found between the pain score after drug injection and the administered drug (P = 0.006). Conclusions: The management of pain crisis with ketorolac injection yielded the same results as the morphine injection in SCD patients. However, ketorolac was found to be associated with fewer side effects than morphine; thus, it can be beneficial for managing SCD patients suffering pain crisis.

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A comparison between ketorolac and nefopam as adjuvant analgesics for postoperative patient-controlled analgesia: a randomized, double-blind, prospective study

Cited by 12 publications

References 25 publications

Association of nefopam use with postoperative nausea and vomiting in gynecological patients receiving prophylactic ramosetron: A retrospective study

Association of nefopam use with postoperative nausea and vomiting in gynecological patients receiving prophylactic ramosetron: A retrospective study

Intravenous patient-controlled analgesia: in vitro stability profiles of mixtures containing fentanyl, hydromorphone, oxycodone, nefopam, ondansetron, and ramosetron

Pain Relief in the Sickle-Cell Crisis: Intravenous Morphine Versus Ketorolac; A Double-Blind, Randomized Clinical Trial

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