The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

The Analgesic Effect of Nefopam with Fentanyl at the End of Laparoscopic Cholecystectomy

  • Lee, Ju Hwan (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University) ;
  • Kim, Jae Hong (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University) ;
  • Cheong, Yong Kwan (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University)
  • Received : 2013.06.11
  • Accepted : 2013.09.05
  • Published : 2013.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Nefopam is a centrally acting analgesic that is used to control pain. The aim of this study was to find an appropriate dose of nefopam that demonstrates an analgesic effect when administered in continuous infusion with fentanyl at the end of laparoscopic cholecystectomy. Methods: Ninety patients scheduled for laparoscopic cholecystectomy were randomly assigned to receive analgesia with fentanyl alone (50 ${\mu}g$, Group 1, n = 30), or with fentanyl in combination with nefopam 20 mg (Group 2, n = 30) or in combination with nefopam 40 mg (Group 3, n = 30) at the end of surgery. Pain and side effects were evaluated at 10 minutes, 30 minutes, 1 hour, 2 hours, 6 hours, and 12 hours after arrival in the post-anesthesia care unit (PACU). Results: Pain was statistically significantly lower in Groups 2 and 3 than in Group 1 at 10 minutes, 2 hours, and 6 hours after arrival in the PACU. Nausea was statistically significantly lower in Group 2 than in Groups 1 and 3 at 10 minutes after arrival in the PACU. Shivering was statistically significantly lower in Groups 2 and 3 than in Group 1 at 10 minutes after arrival in the PACU. Conclusions: Nefopam is a drug that can be safely used as an analgesic after surgery, and its side effects can be reduced when fentanyl 50 ${\mu}g$ is injected with nefopam 20 mg.

Keywords

References

  1. Klohs MW, Draper MD, Petracek FJ, Ginzel KH, Re ON. Benzoxazocines: a new chemical class of centrally acting skeletal muscle relaxants. Arzneimittelforschung 1972; 22: 132-3.
  2. Gassel MM, Diamantopoulos E, Petropoulos V, Hughes AC, Ballesteros ML, Ré ON. Controlled clinical trial of oral and parenteral nefopam hydrochloride. A novel and potent analgesic drug. J Clin Pharmacol 1976; 16: 34-41. https://doi.org/10.1002/j.1552-4604.1976.tb01489.x
  3. Piercey MF, Schroeder LA. Spinal and supraspinal sites for morphine and nefopam analgesia in the mouse. Eur J Pharmacol 1981; 74: 135-40. https://doi.org/10.1016/0014-2999(81)90523-9
  4. Kehlet H, Dahl JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg 1993; 77: 1048-56.
  5. Kim SH, Kim SI, Ok SY, Park SY, Kim MG, Lee SJ, et al. Opioid sparing effect of low dose ketamine in patients with intravenous patient-controlled analgesia using fentanyl after lumbar spinal fusion surgery. Korean J Anesthesiol 2013; 64: 524-8. https://doi.org/10.4097/kjae.2013.64.6.524
  6. Cheong YK, Son Y, Song YK, Kim TY. The analgesic effect of continuous intraarticular infusion of ropivacaine and fentanyl after arthroscopic shoulder surgery. Korean J Anesthesiol 2006; 50: 449-53. https://doi.org/10.4097/kjae.2006.50.4.449
  7. Moffat AC, Kenny GN, Prentice JW. Postoperative nefopam and diclofenac. Evaluation of their morphine-sparing effect after upper abdominal surgery. Anaesthesia 1990; 45: 302-5. https://doi.org/10.1111/j.1365-2044.1990.tb14737.x
  8. Parker RK, Holtmann B, Smith I, White PF. Use of ketorolac after lower abdominal surgery. Effect on analgesic requirement and surgical outcome. Anesthesiology 1994; 80: 6-12. https://doi.org/10.1097/00000542-199401000-00005
  9. Dordoni PL, Della Ventura M, Stefanelli A, Iannace E, Paparella P, Rocca B, et al. Effect of ketorolac, ketoprofen and nefopam on platelet function. Anaesthesia 1994; 49: 1046-9. https://doi.org/10.1111/j.1365-2044.1994.tb04352.x
  10. Heel RC, Brogden RN, Pakes GE, Speight TM, Avery GS. Nefopam: a review of its pharmacological properties and therapeutic efficacy. Drugs 1980; 19: 249-67. https://doi.org/10.2165/00003495-198019040-00001
  11. Sunshine A, Laska E. Nefopam and morphine in man. Clin Pharmacol Ther 1975; 18: 530-4. https://doi.org/10.1002/cpt1975185part1530
  12. Tigerstedt I, Sipponen J, Tammisto T, Turunen M. Comparison of nefopam and pethidine in postoperative pain. Br J Anaesth 1977; 49: 1133-8. https://doi.org/10.1093/bja/49.11.1133
  13. McLintock TT, Kenny GN, Howie JC, McArdle CS, Lawrie S, Aitken H. Assessment of the analgesic efficacy of nefopam hydrochloride after upper abdominal surgery: a study using patient controlled analgesia. Br J Surg 1988; 75: 779-81. https://doi.org/10.1002/bjs.1800750818
  14. Mimoz O, Incagnoli P, Josse C, Gillon MC, Kuhlman L, Mirand A, et al. Analgesic efficacy and safety of nefopam vs. propacetamol following hepatic resection. Anaesthesia 2001; 56: 520-5. https://doi.org/10.1046/j.1365-2044.2001.01980.x
  15. Beloeil H, Delage N, Nègre I, Mazoit JX, Benhamou D. The median effective dose of nefopam and morphine administered intravenously for postoperative pain after minor surgery: a prospective randomized double-blinded isobolographic study of their analgesic action. Anesth Analg 2004; 98: 395-400.
  16. Van Elstraete AC, Sitbon P. Median effective dose (ED50) of paracetamol and nefopam for postoperative pain: isobolographic analysis of their antinociceptive interaction. Minerva Anestesiol 2013; 79: 232-9.
  17. Tramoni G, Viale JP, Cazals C, Bhageerutty K. Morphinesparing effect of nefopam by continuous intravenous injection after abdominal surgery by laparotomy. Eur J Anaesthesiol 2003; 20: 990-2. https://doi.org/10.1097/00003643-200312000-00013
  18. Saghaei E, Moini Zanjani T, Sabetkasaei M, Naseri K. Enhancement of antinociception by co-administrations of nefopam, morphine, and nimesulide in a rat model of neuropathic pain. Korean J Pain 2012; 25: 7-15. https://doi.org/10.3344/kjp.2012.25.1.7
  19. Laboureyras E, Chateauraynaud J, Richebe P, Simonnet G. Long-term pain vulnerability after surgery in rats: prevention by nefopam, an analgesic with antihyperalgesic properties. Anesth Analg 2009; 109: 623-31. https://doi.org/10.1213/ane.0b013e3181aa956b
  20. Taniguchi Y, Ali SZ, Kimberger O, Zmoos S, Lauber R, Markstaller M, et al. The effects of nefopam on the gain and maximum intensity of shivering in healthy volunteers. Anesth Analg 2010; 111: 409-14. https://doi.org/10.1213/ANE.0b013e3181e332bb
  21. Alfonsi P, Adam F, Passard A, Guignard B, Sessler DI, Chauvin M. Nefopam, a nonsedative benzoxazocine analgesic, selectively reduces the shivering threshold in unanesthetized subjects. Anesthesiology 2004; 100: 37-43. https://doi.org/10.1097/00000542-200401000-00010
  22. Girard P, Coppe MC, Verniers D, Pansart Y, Gillardin JM. Role of catecholamines and serotonin receptor subtypes in nefopam-induced antinociception. Pharmacol Res 2006; 54: 195-202. https://doi.org/10.1016/j.phrs.2006.04.008
  23. Fernandez-Sanchez MT, Diaz-Trelles R, Groppetti A, Manfredi B, Brini AT, Biella G, et al. Nefopam, an analogue of orphenadrine, protects against both NMDA receptordependent and independent veratridine-induced neurotoxicity. Amino Acids 2002; 23: 31-6. https://doi.org/10.1007/s00726-001-0106-6
  24. Cheong YK, Kim TY, Lee SW. The preventive effect on postanesthetic shivering according to the dosages of ketamine. Korean J Anesthesiol 2008; 55: 277-81. https://doi.org/10.4097/kjae.2008.55.3.277

Cited by

  1. Medications in Treatment of Postherpetic Neuralgia vol.27, pp.1, 2014, https://doi.org/10.3344/kjp.2014.27.1.1
  2. The Effect of Nefopam on Postoperative Fentanyl Consumption: A Randomized, Double-blind Study vol.29, pp.2, 2016, https://doi.org/10.3344/kjp.2016.29.2.110
  3. Use of Nefopam in Perioperative Pain Management; Keeping Nefopam in between vol.29, pp.2, 2016, https://doi.org/10.3344/kjp.2016.29.2.71
  4. approach vol.35, pp.10, 2017, https://doi.org/10.1080/07391102.2016.1216895
  5. The efficacy and safety of nefopam for pain relief during laparoscopic cholecystectomy vol.97, pp.10, 2018, https://doi.org/10.1097/MD.0000000000010089
  6. Terapêutica anestésica para o alívio da dor aguda pós-colecistectomia videolaparoscópica: revisão sistemática. vol.45, pp.4, 2018, https://doi.org/10.1590/0100-6991e-20181885
  7. Postoperative Pain and Intravenous Patient-Controlled Analgesia-Related Adverse Effects in Young and Elderly Patients : A Retrospective Analysis of 10,575 Patients vol.94, pp.45, 2015, https://doi.org/10.1097/md.0000000000002008
  8. A Comparison of Oxycodone and Alfentanil in Intravenous Patient-Controlled Analgesia with a Time-Scheduled Decremental Infusion after Laparoscopic Cholecystectomy vol.2016, pp.None, 2013, https://doi.org/10.1155/2016/7868152
  9. Effects on postoperative nausea and vomiting of nefopam versus fentanyl following bimaxillary orthognathic surgery: a prospective double-blind randomized controlled trial vol.19, pp.1, 2013, https://doi.org/10.17245/jdapm.2019.19.1.55
  10. Analgesic efficacy of intravenous nefopam after spine surgery: a randomized, double-blind, placebo-controlled trial vol.9, pp.None, 2013, https://doi.org/10.12688/f1000research.22909.2