Analgesic efficacy of intravenous nefopam after spine surgery: a randomized, double-blind, placebo-controlled trial

Eiamcharoenwit, Jatuporn; Chotisukarat, Haruthai; Tainil, Kanjana; Attanath, Nalinrat; Akavipat, Phuping

doi:10.12688/f1000research.22909.2

Cited by 7 publications

(4 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…morphine consumption in this study was less in the nefopam group, the result did not reach statistical significance. Our results were in concordance with those of another recent investigation [ 21 ] on the use of nefopam in patients undergoing lumbosacral spine surgery. That study chose a single dose of 30 mg of nefopam, which was given either before the surgical incision or before the end of the operation.…”

Section: Discussionsupporting

confidence: 93%

Postoperative analgesia of intraoperative nefopam in patients undergoing anterior cervical spine surgery: A prospective randomized controlled trial

et al. 2022

View full text Add to dashboard Cite

Background: Nefopam is a non-opioid, non-nonsteroidal anti-imflammatory drug, analgesic drug that inhibits the reuptake of serotonin, norepinephrine, and dopamine. It is widely used as an adjuvant for pain. This study investigated whether the intraoperative, intravenous infusion of nefopam (20 mg) reduces postoperative morphine consumption, pain scores, and alleviates neuropathic pain in patients undergoing cervical spine surgery.Methods: A prospective, paralleled design, randomized study was conducted on 50 patients (aged 18-75 years) in a universitybased hospital. The patients were assigned to an intervention or a control group (25 patients in each). The intervention group received a 1-hour infusion of nefopam (20 mg) before the end of surgery. The control group received normal saline (NSS). The outcome measures were morphine consumption during the first 24 postoperative hours, numerical rating scale (NRS) pain scores, and scores for the Thai version of the Neuropathic Pain Symptom Inventory (NPSI-T) in patients with neuropathic pain and adverse drug reactions. The NPSI-T scores were assessed on the preoperative day, postoperative day 1, 3, 15, and 30. The outcome assessors were blinded to group allocation.Results: Fifty patients were analyzed. During the first 24 postoperative hours, morphine consumption was 8 mg (nefopam) and 12 mg (NSS; P = .130). The intervention and control groups demonstrated no significant differences in the median NRS scores or total NPSI-T scores or adverse drug reactions.Conclusions: A single, intraoperative infusion of 20 mg of nefopam did not significantly reduce postoperative (24 hours) morphine consumption in patients undergoing anterior cervical spine surgery.

show abstract

Section: Discussionsupporting

confidence: 93%

Postoperative analgesia of intraoperative nefopam in patients undergoing anterior cervical spine surgery: A prospective randomized controlled trial

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Nefopam administration both before the skin incision and upon the completion of surgery failed to exert a discernible influence on the total morphine consumption or the intensity of post-operative pain, as indicated by a study encompassing patients undergoing open spine procedures [19]. In a similar vein, an investigation involving patients subjected to minimally invasive spine surgery unveiled that the incorporation of a 24-hour nefopam infusion did not yield any incremental analgesic benefits or lead to improved functional outcomes post-surgery [20].…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Efficacy of Methocarbamol and Nefopam in Orthopedic Surgical Pain

Al-Nasrawi,

Al-Ibrahim,

Aljabran

2024

Cureus

View full text Add to dashboard Cite

IntroductionPain after orthopedic surgeries represents a special concern in patients with fractures. The use of multimodal analgesia significantly reduced the opioid need and reduced the risk of their side effects. ObjectivesThis study compared the effectiveness and safety of methocarbamol and nefopam in the reduction of postoperative pain for patients undergoing orthopedic surgeries. MethodThis prospective, double-blind, randomized controlled trial took place at Al-Sader Teaching Hospital in Basrah, Iraq, from the first of February 2022 to the end of October 2023. The study aimed to assess the postoperative pain relief efficacy and safety of intramuscular nefopam (20 mg) and intravenous methocarbamol (1 g) in 110 adults (aged 18-65) undergoing elective orthopedic surgeries. Exclusions were made for allergies to the drugs, substance abuse history, and severe hepatic or renal impairment. Participants were randomized into two groups, with pain intensity measured at one hour, six hours, and 12 hours post-operation using the visual analog scale (VAS). Side effects were also evaluated. Statistical analysis was done using SPSS 27, with a significance level set at p<0.05 and a 95% confidence interval (CI). ResultsIn this study, we conducted a rigorous comparison between two groups, methocarbamol and nefopam, to evaluate their efficacy and safety in post-operative pain management. We started by ensuring that the groups were well-matched in terms of age, gender distribution, and body mass index (BMI). The results showed remarkable similarities in mean age, gender distribution, and BMI, supported by robust p-values, affirming the effective matching of the two groups. Moving to pain management, we observed a significant advantage in favor of methocarbamol. At all-time intervals (one hour, six hours, and 12 hours postoperation), methocarbamol consistently demonstrated lower mean VAS scores compared to nefopam. These differences were highly statistically significant, underscoring the superior pain relief efficacy of methocarbamol. Exploring side effects, we found no statistically significant disparities in the occurrence of nausea and vomiting between the two groups. However, there was a noticeable trend toward higher tachycardia incidence in the nefopam group, though it did not reach statistical significance. ConclusionThe present study showed a higher efficacy of methocarbamol in post-operative pain reduction in comparison to nefopam. No serious side effects were observed with both drugs.

show abstract

“…This study did not use a weight-based dose as the recommended bolus dose is 20 mg by IV injection and then repeated every 6 hours with a maximum of 120 mg/day [11]. According to a study involving patients undergoing open spine surgeries, nefopam administered before the skin incision and at the end of surgery did not yield any difference in the amount of morphine consumption and the severity of postoperative pain [9]. Similarly, a study involving patients undergoing minimally invasive spine surgery showed that the inclusion of 24-hour nefopam infusion revealed no additional analgesic effect or improved functional outcomes postoperatively [13].…”

Section: Discussionmentioning

confidence: 99%

“…Nefopam could significantly decrease postoperative paresthesia and dysesthesia in patients who underwent endoscopic lumbar discectomy [8]. However, in another study, postoperative morphine consumption was comparable to placebo for open spine surgery [9]. Therefore, this study was designed to evaluate the effects of nefopam on postoperative pain within the first 24 hours, time to recovery, and length of hospital stay (LOS) and assess its opioid-sparing properties in patients undergoing lumbar decompression and fusion.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Intravenous Nefopam on Pain Management and Ambulation after Open Spine Surgery: A Randomized Double-Blind Controlled Study

Chalermkitpanit¹,

Yingsakmongkol²,

Limthongkul³

et al. 2023

Asian Spine J

View full text Add to dashboard Cite

Study Design: This was a randomized double-blind controlled study.Purpose: This study was designed to evaluate the effects of intravenous nefopam regarding its ability to reduce morphine consumption and postoperative pain and improve recovery in patients undergoing open spine surgery.Overview of Literature: Multimodal analgesia, including nonopioid medications, is essential for pain management in spine surgery. Evidence regarding the use of intravenous nefopam in open spine surgery as part of enhanced recovery after surgery is lacking.Methods: In this study, 100 patients undergoing lumbar decompressive laminectomy with fusion were randomized into two groups. The nefopam group received 20-mg intravenous nefopam diluted in 100-mL normal saline intraoperatively, followed by 80-mg nefopam diluted in 500-mL normal saline, administered as a continuous infusion postoperatively for 24 hours. The control group received an identical volume of normal saline. Postoperative pain was managed using intravenous morphine via patient-controlled analgesia. Morphine consumption in the first 24 hours was recorded as the primary outcome. Secondary outcomes, including postoperative pain score, postoperative function, and length of hospital stay (LOS), were assessed.Results: No statistically significant differences in the total morphine consumption and postoperative pain score in the first 24 hours postoperatively between the two groups. At the post-anesthesia care unit (PACU), the nefopam group demonstrated lower pain scores while at rest (p =0.03) and upon movement (p =0.02) than the normal saline group. However, the severity of postoperative pain between the two groups was similar from postoperative day 1 to day 3. LOS was significantly shorter in the nefopam group than in the control group (p <0.01). The time to first sitting and walking and PACU discharge between the two groups were comparable.Conclusions: Perioperative intravenous nefopam demonstrated significant pain reduction during the early postoperative period and shortened LOS. Nefopam is considered safe and effective as a part of multimodal analgesia in open spine surgery.

show abstract

Analgesic efficacy of intravenous nefopam after spine surgery: a randomized, double-blind, placebo-controlled trial

Cited by 7 publications

References 31 publications

Postoperative analgesia of intraoperative nefopam in patients undergoing anterior cervical spine surgery: A prospective randomized controlled trial

Postoperative analgesia of intraoperative nefopam in patients undergoing anterior cervical spine surgery: A prospective randomized controlled trial

Evaluating the Efficacy of Methocarbamol and Nefopam in Orthopedic Surgical Pain

Perioperative Intravenous Nefopam on Pain Management and Ambulation after Open Spine Surgery: A Randomized Double-Blind Controlled Study

Contact Info

Product

Resources

About