Analgesic Efficacy of Nefopam as an Adjuvant in Patient-Controlled Analgesia for Acute Postoperative Pain After Laparoscopic Colorectal Cancer Surgery.

Eun Jung Oh,Jin Young Lee,Won Gook Wi,Woo Seog Sim,Woo Jin Kim,Jeayoun Kim

doi:10.3390/jcm10020270

Abstract

Despite rapid advancements in laparoscopic surgical techniques and perioperative management, postoperative pain remains a significant clinical issue. We examined the analgesic efficacy of nefopam as an adjuvant in patient-controlled analgesia (PCA) for acute postoperative pain in patients undergoing laparoscopic colorectal cancer surgery. We retrospectively analyzed the medical records of 120 patients who did or did not receive 80 mg of nefopam as an adjuvant in fentanyl PCA; they were allocated to the nefopam (n = 60) or non-nefopam group (n = 60). The demographic, clinical, and anesthetic data, with data on pain severity and opioid administration at the postoperative anesthesia care unit (PACU) on postoperative days (PODs) 1, 3, and 5, were compared between the groups. The pain score and opioid administration did not differ at the PACU or on PODs 1, 3, or 5. The day of PCA discontinuation, time to pass flatus, length of the hospital stay, and incidence of nausea/vomiting, dizziness, and headache also did not differ between the groups. Fentanyl PCA with 80 mg of nefopam as an adjuvant did not have a superior analgesic effect after laparoscopic colorectal cancer surgery.

Highlights

The day of Patient-controlled analgesia (PCA) discontinuation, time to pass flatus, length of the hospital stay, and incidence of nausea/vomiting, dizziness, and headache did not differ between the groups
Opioid agonists are used as a matrix in combination with non-opioid analgesics; the goal is to reduce the adverse effects caused by a single class of analgesics while enhancing the analgesic effects [11]
We evaluated the analgesic efficacy of nefopam as an adjuvant in fentanyl PCA in patients undergoing laparoscopic surgery for colorectal cancer

Summary

Introduction

The day of PCA discontinuation, time to pass flatus, length of the hospital stay, and incidence of nausea/vomiting, dizziness, and headache did not differ between the groups. Fentanyl PCA with 80 mg of nefopam as an adjuvant did not have a superior analgesic effect after laparoscopic colorectal cancer surgery. Patient-controlled analgesia (PCA) is commonly used for postoperative pain management. PCA are based on both opioid and non-opioid analgesics [8]. In a study assessing 39 frequently used drugs for PCA, fentanyl, morphine, and dexmedetomidine are reported to be used most often [8]. The advantages of fentanyl include a rapid onset and maintenance of cardiovascular stability, while adverse effects include sedation, orthostatic hypotension, nausea, vomiting, bradycardia, as well as central nervous system and respiratory depression [9,10]. Several analgesic adjuncts to opioid agonists have been studied, including alpha-2 agonist, non-steroidal anti-inflammatory drugs (NSAIDs), and ketamine, it is unclear which combinations are effective [10].

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