The Effect of Nefopam on Postoperative Fentanyl Consumption: A Randomized, Double-blind Study

Moon, Jee Youn; Choi, Sang Sik; Lee, Shin Young; Lee, Mi Kyung; Kim, Jung Eun; Lee, Ji Eun; Lee, So Hyun

doi:10.3344/kjp.2016.29.2.110

Cited by 29 publications

(31 citation statements)

References 35 publications

(53 reference statements)

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“…27 Several studies have demonstrated the anti-nociceptive effects of nefopam using a variety of routes of administration and for various indications. [9][10][11][28][29][30] Nefopam reduced thermal hypersensitivity after acute and postoperative pain in rats. 31 Intraperitoneal nefopam showed an antiallodynic effect mediated by adenosine triphosphate-sensitive potassium channel in rats with spinal nerve ligation-induced neuropathy.…”

Section: Discussionmentioning

confidence: 99%

<p>The Antiallodynic Effect of Nefopam on Vincristine-Induced Neuropathy in Mice</p>

Lee

Sim

Cho

et al. 2020

JPR

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Background: Chemotherapy-induced neuropathic pain is a disabling condition following cancer treatment. Vincristine has more neurotoxicity than other vinca alkaloid agents. This study evaluated the correlation of different doses of nefopam with antiallodynic effects in a mouse vincristine neuropathy model. Methods: A peripheral neuropathic mouse model was made by intraperitoneal injection of vincristine (0.1 mg/kg/day; 5-day-on, 2-day-off schedule over 12 days). After the development of allodynia, mice were injected intraperitoneally with 0.9% normal saline (NS group) or various doses (10, 30, 60 mg/kg) of nefopam (Nefopam group). We examined allodynia using von Frey hairs pre-administration and at 30, 60, 90, 120, 180, 240 mins, and 24 hrs after drug administration. We also measured the neurokinin-1 receptor concentrations in the spinal cord to confirm the antiallodynic effect of nefopam after drug administration. Results: The peripheral neuropathic mouse model showed prominent mechanical allodynia. Intraperitoneal nefopam produced a clear dose-dependent increase in paw withdrawal threshold compared with pre-administration values and versus the NS group. The concentration of neurokinin-1 receptor was significantly decreased in the Nefopam group (P<0.05). Conclusion: Intraperitoneally administered nefopam yielded a dose-dependent attenuation of mechanical allodynia and decreased neurokinin-1 receptor concentration, suggesting that the neurokinin-1 receptor is involved in the antiallodynic effects of nefopam in vincristine neuropathy.

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Section: Discussionmentioning

confidence: 99%

<p>The Antiallodynic Effect of Nefopam on Vincristine-Induced Neuropathy in Mice</p>

Lee

Sim

Cho

et al. 2020

JPR

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“…[ 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%

“…Moon et al found that the combined use of nefopam and fentanyl in IV PCA significantly reduced fentanyl consumption after laparoscopic hysterectomy, but pain scores and the incidence of PONV was not significantly decreased in the nefopam group. [ 14 ] Jin et al also showed that total PCA fentanyl consumption was reduced by the combined use of nefopam in PCA after laparotomy; however, the incidence of PONV showed no significant difference between the fentanyl and nefopam-fentanyl combination groups. [ 13 ] Our cohort study also showed that the combined use of nefopam with fentanyl in IV PCA after gynecological surgery resulted in comparable pain scores and no increase in the incidence of PONV compared with the ketorolac-fentanyl combination.…”

Section: Discussionmentioning

confidence: 99%

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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“…Moon and colleagues18 investigated the opioid-sparing effects of either 200 mg or 400 mg nefopam when added to a fentanyl intravenous PCA over the first 48 postoperative hours. Cumulative on-demand fentanyl consumption during the first 48 hours postoperatively was 236±128 μg vs 107±105 μg for the fentanyl-only versus the fentanyl-nefopam group, while pain scores, side effects, and patient satisfaction were not different 18…”

Section: Resultsmentioning

confidence: 99%

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Lirk

Thiry

Bonnet

et al. 2019

Reg Anesth Pain Med

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Background and objectivesLaparoscopic hysterectomy is increasingly performed because it is associated with less postoperative pain and earlier recovery as compared with open abdominal hysterectomy. The aim of this systematic review was to evaluate the available literature regarding the management of pain after laparoscopic hysterectomy.Strategy and selection criteriaRandomized controlled trials evaluating postoperative pain after laparoscopic hysterectomy published between January 1996 and May 2018 were retrieved, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, from the EMBASE and MEDLINE databases and the Cochrane Register of Controlled Trials. Efficacy and adverse effects of analgesic techniques were assessed.ResultsOf the 281 studies initially identified, 56 were included. Of these, 31 assessed analgesic or anesthetic interventions and 25 assessed surgical interventions. Acetaminophen, non-steroidal anti-inflammatory drugs, and dexamethasone reduced opioid consumption. Limited evidence hindered recommendations on alpha-2-agonists. Inconsistent evidence was found in the studies investigating pregabalin and transversus abdominis plane block, and no evidence was found for intraperitoneal local anesthetics, port site infiltration, or single-port laparoscopy. Measures to lower peritoneal insufflation pressure or humidify or heat insufflated gas seem to reduce the incidence of shoulder pain, but not abdominal pain.ConclusionsThe baseline analgesic regimen for laparoscopic hysterectomy should include acetaminophen, a non-steroidal anti-inflammatory drug, dexamethasone, and opioids as rescue analgesics.

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The Effect of Nefopam on Postoperative Fentanyl Consumption: A Randomized, Double-blind Study

Cited by 29 publications

References 35 publications

<p>The Antiallodynic Effect of Nefopam on Vincristine-Induced Neuropathy in Mice</p>

<p>The Antiallodynic Effect of Nefopam on Vincristine-Induced Neuropathy in Mice</p>

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

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

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