The Effect of Intraoperative Nefopam Administration on Acute Postoperative Pain and Chronic Discomfort After Robotic or Endoscopic Assisted Thyroidectomy: A Randomized Clinical Trial

Kim, B. G.; Moon, Jee Youn; Choi, June Young; Park, I. S.; Oh, Ah Young; Jeon, Young Tae; Hwang, Jung Won; Ryu, Jung Hee

doi:10.1007/s00268-017-4421-9

Cited by 7 publications

(5 citation statements)

References 28 publications

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“…Fewer studies evaluated acetaminophen (two new; n = 290), 114,115 amantadine (two studies, one new; n = 82), 116,117 dexmedetomidine (one new; n = 80), 118 dextromethorphan (one study, not new; n = 50), 119 duloxetine (two new; n = 207), 120,121 etanercept (one new; n = 77), 122 fentanyl (one study, not new; n = 65), 123 magnesium (one new; n = 126), 94 memantine (one study, not new; n = 19), 124 mexiletine (two studies, not new; n = 175), 81,125 minocycline (two new; n = 231), 126,127 nefopam (four new; n = 307), 14,128–130 nitrous oxide (two studies, one new; n = 5,375), 131,132 valproic acid (one new; n = 128), 133 venlafaxine (one study, not new; n = 150), 78 and vitamin C (one new; n = 123). 134 Primary and secondary outcomes for drugs evaluated in fewer than five studies were inconclusive and shown in Supplemental Digital Content 12 (appendix L, http://links.lww.com/ALN/C639).…”

Section: Resultsmentioning

confidence: 99%

Pharmacotherapy for the Prevention of Chronic Pain after Surgery in Adults: An Updated Systematic Review and Meta-analysis

Carley¹,

Chaparro²,

Choinière³

et al. 2021

Anesthesiology

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Background Chronic postsurgical pain can severely impair patient health and quality of life. This systematic review update evaluated the effectiveness of systemic drugs to prevent chronic postsurgical pain. Methods The authors included double-blind, placebo-controlled, randomized controlled trials including adults that evaluated perioperative systemic drugs. Studies that evaluated same drug(s) administered similarly were pooled. The primary outcome was the proportion reporting any pain at 3 or more months postsurgery. Results The authors identified 70 new studies and 40 from 2013. Most evaluated ketamine, pregabalin, gabapentin, IV lidocaine, nonsteroidal anti-inflammatory drugs, and corticosteroids. Some meta-analyses showed statistically significant—but of unclear clinical relevance—reductions in chronic postsurgical pain prevalence after treatment with pregabalin, IV lidocaine, and nonsteroidal anti-inflammatory drugs. Meta-analyses with more than three studies and more than 500 participants showed no effect of ketamine on prevalence of any pain at 6 months when administered for 24 h or less (risk ratio, 0.62 [95% CI, 0.36 to 1.07]; prevalence, 0 to 88% ketamine; 0 to 94% placebo) or more than 24 h (risk ratio, 0.91 [95% CI, 0.74 to 1.12]; 6 to 71% ketamine; 5 to 78% placebo), no effect of pregabalin on prevalence of any pain at 3 months (risk ratio, 0.88 [95% CI, 0.70 to 1.10]; 4 to 88% pregabalin; 3 to 80% placebo) or 6 months (risk ratio, 0.78 [95% CI, 0.47 to 1.28]; 6 to 68% pregabalin; 4 to 69% placebo) when administered more than 24 h, and an effect of pregabalin on prevalence of moderate/severe pain at 3 months when administered more than 24 h (risk ratio, 0.47 [95% CI, 0.33 to 0.68]; 0 to 20% pregabalin; 4 to 34% placebo). However, the results should be interpreted with caution given small study sizes, variable surgical types, dosages, timing and method of outcome measurements in relation to the acute pain trajectory in question, and preoperative pain status. Conclusions Despite agreement that chronic postsurgical pain is an important topic, extremely little progress has been made since 2013, likely due to study designs being insufficient to address the complexities of this multifactorial problem. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Resultsmentioning

confidence: 99%

Pharmacotherapy for the Prevention of Chronic Pain after Surgery in Adults: An Updated Systematic Review and Meta-analysis

Carley¹,

Chaparro²,

Choinière³

et al. 2021

Anesthesiology

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“…In this study, the MMA regimen controlled postoperative pain in the PACU and at 6, 12, and 24 h after thyroidectomy as effectively as fentanyl-based PCA. Postoperative pain after thyroidectomy is generally classified as mild-to-moderate surgical pain and is most intense within 6 h postoperatively [16]. There is a risk of providing opioid analgesics in excessive amounts or for a prolonged duration as PCA regimens cannot be sufficiently The systolic pressure immediately after intubation was lower in the MMA group than in the PCA group.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Comparison of Multimodal Analgesia and Fentanyl-Based Patient-Controlled Analgesia in Women Undergoing Robot-Assisted Bilateral Axillary Breast Approach Thyroidectomy

Tae,

Yi,

Jung

et al. 2024

JCM

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Opioid-free multimodal analgesia (MMA) emerges as a preferable approach for postoperative pain management compared to opioid-based patient-controlled analgesia (PCA) in robot-assisted bilateral axillary breast approach thyroidectomy, a procedure commonly undergone by young female patients. We compared the analgesic efficacy and other recovery profiles between MMA and PCA. In total, 88 female patients were administered fentanyl-based PCA or the combination of lidocaine continuous infusion and nefopam injection before recovery from general anesthesia. The visual analog scale score of postoperative pain was assessed at the post-anesthesia care unit and at 6, 12, and 24 h after the termination of surgery. Postoperative nausea and vomiting (PONV), rescue analgesic and anti-emetic agents, recovery profiles, and adverse events were also compared. The median numeric rating scores on postoperative pain at 6 h after recovery from general anesthesia were three in both groups, with no significant difference between the groups at any time point. The PONV incidence was significantly higher in the PCA group than in the MMA group. The combination of systemic lidocaine infusion and nefopam injection has an analgesic effect equivalent to that of fentanyl-based PCA without PONV.

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“…Previous studies have demonstrated the analgesic efficacy of nefopam in patients who underwent various types of robot-assisted surgeries. Patients who received nefopam during bilateral axillo-breast approach robotic or endoscopic thyroidectomy reported significantly lower postoperative pain scores and required fewer rescue analgesics compared to those receiving saline [ 27 , 28 , 29 ]. Similarly, in a study involving robotic nephrectomy, nefopam administration significantly reduced catheter-related bladder discomfort postoperatively [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Intraoperative Nefopam on Postoperative Pain, Opioid Use, and Recovery Quality with Parietal Pain Block in Single-Port Robotic Cholecystectomy: A Prospective Randomized Controlled Trial

Lee,

Kim,

Park

et al. 2024

Medicina

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Background and Objectives: This study explored how nefopam, a non-opioid analgesic in a multimodal regimen, impacts postoperative pain, opioid use, and recovery quality in single-port robot-assisted laparoscopic cholecystectomy (RALC) patients with a parietal pain block, addressing challenges in postoperative pain management. Materials and Methods: Forty patients scheduled for elective single-port RALC were enrolled and randomized to receive either nefopam or normal saline intravenously. Parietal pain relief was provided through a rectus sheath block (RSB). Postoperative pain was assessed using a numeric rating scale (NRS) in the right upper quadrant (RUQ) of the abdomen, at the umbilicus, and at the shoulder. Opioid consumption and recovery quality, measured using the QoR-15K questionnaire, were also recorded. Results: The 40 patients had a mean age of 48.3 years and an average body mass index (BMI) of 26.2 kg/m2. There were no significant differences in the pre- or intraoperative variables between groups. Patients receiving nefopam reported significantly lower RUQ pain scores compared to the controls, while the umbilicus and shoulder pain scores were similar. Rescue fentanyl requirements were lower in the nefopam group in both the PACU and ward. The QoR-15K questionnaire scores for nausea and vomiting were better in the nefopam group, but the overall recovery quality scores were comparable between the groups. Conclusions: Nefopam reduces RUQ pain and opioid use post-single-port RALC with a parietal pain block without markedly boosting RSB’s effect on umbilicus or shoulder pain. It may also better manage postoperative nausea and vomiting, underscoring its role in analgesia strategies for this surgery.

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The Effect of Intraoperative Nefopam Administration on Acute Postoperative Pain and Chronic Discomfort After Robotic or Endoscopic Assisted Thyroidectomy: A Randomized Clinical Trial

Abstract: We report that intravenous nefopam infusion during surgery decreased acute postoperative pain and the need for rescue analgesics, as well as chronic discomfort, following BABA robotic or endoscopic thyroidectomy without adverse events.

Cited by 7 publications

References 28 publications

Pharmacotherapy for the Prevention of Chronic Pain after Surgery in Adults: An Updated Systematic Review and Meta-analysis

Pharmacotherapy for the Prevention of Chronic Pain after Surgery in Adults: An Updated Systematic Review and Meta-analysis

A Randomized Comparison of Multimodal Analgesia and Fentanyl-Based Patient-Controlled Analgesia in Women Undergoing Robot-Assisted Bilateral Axillary Breast Approach Thyroidectomy

Impact of Intraoperative Nefopam on Postoperative Pain, Opioid Use, and Recovery Quality with Parietal Pain Block in Single-Port Robotic Cholecystectomy: A Prospective Randomized Controlled Trial

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