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

Abstract

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.

Effect of Nefopam on Dysesthesia, Postoperative Pain, and Satisfaction in Patients with Lumbar Spinal Stenosis Undergoing Spine Surgery: A Double-Blind, Randomized Study

“…Previous studies investigating the effectiveness of nefopam in patients undergoing spine surgery have yielded mixed results. Some studies have reported that nefopam did not reduce PCA or opioid consumption during the first 3 d post-operation [31][32][33]. In contrast, another study found that the group treated with nefopam experienced less pain during ambulation and had a shorter hospitalization period than the control group [12].…”

Enteral nefopam for pain control at the end of life

“…There is little evidence to support the use of nefopam in a palliative care setting although trials have been done showing that it reduces the need for postoperative analgesia if given preoperatively3 and intraoperatively 4. In a recent review5 of further surgical studies, nefopam reduced morphine consumption in 8 out 10 studies and also appeared to show synergy with non-steroidal anti-inflammatory drugs or paracetamol.…”