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

Abstract

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.

The Analgesic Efficacy of Nefopam in Patient-Controlled Analgesia after Laparoscopic Gynecologic Surgery: A Randomized, Double-Blind, Non-Inferiority Study

“…Opioids are known to induce PONV in 20–40% of patients [ 17 , 18 ], while nefopam is known to induce PONV in 15–30% of the patients [ 13 ]. In addition, according to the study by Oh et al [ 19 ], the PONV incidence was 31.9% in the group using nefopam and 57.4% in the group using fentanyl for post-gynecological pain control [ 19 ], but this study did not show a significant difference among the three groups.…”

“…In this study, an NRS pain score difference of 1 was considered as the non-inferiority margin. Based on a previous study [ 13 ], a standard deviation of 1.6 was assumed for the NRS distribution of laparoscopic gynecological surgery. To achieve a power of 80% with a risk of 0.025 for type 1 errors, the minimum number of patients required in each group was 41.…”

The effect of using nefopam in fentanyl-based intravenous patient-controlled analgesia on the incidence of postoperative nausea and vomiting in laparoscopic gynecological surgery

“…Although previous reports compared the analgesic or adverse effect between nefopam and opioids, each study showed an incoherency in their methods, particularly in the study population, anesthetic setting, the type of surgery, etc. [23].…”

Predicted Versus Non-Predicted Opioid Administration Using Preoperative Pain Sensitivity in Patients Undergoing Gynecological Surgery: A Randomized-Controlled Trial

“…Although opioids remain a cornerstone for postoperative pain management [ 1 , 3 , 5 , 6 ], opioid use is associated with undesirable effects including postoperative nausea and vomiting (PONV) [ 4 , 6 , 7 , 8 , 9 , 10 ]. In particular, gynecological surgery is associated with an increased risk of PONV, of which the incidence was reported in 26–57% of women [ 11 , 12 , 13 , 14 ].…”