Nefopam as an adjunct to intravenous patient-controlled analgesia after renal transplantation: a randomised trial.

Abstract

Nefopam has been used as an adjuvant to opioid analgesia after operation. We investigated the efficacy of nefopam as an adjunct to fentanyl-based intravenous patient-controlled analgesia (IV PCA) on post-operative pain relief in patients undergoing renal transplantation. Ninety-eight patients undergoing elective renal transplantation were randomised into two groups: nefopam or control groups. The former received nefopam (160mg in 200ml at a rate of 4ml/h) whereas the latter received normal saline during the first 48h after reperfusion of grafted kidney. Pain intensity scores, cumulative dose of fentanyl, and the incidence of adverse events were assessed at 1, 6, 12, 24, and 48h post-operatively. Serum creatinine and estimated glomerular filtration rate were evaluated on post-operative days 1, 2, 4, and 7. The cumulative fentanyl consumption during the first 48h after operation was 19% less in the nefopam group than that in the control group (1005±344μg vs. 1246±486μg, mean±SD; P=0.006). Pain intensity scores at rest and on coughing were significantly lower in the nefopam group throughout the first 12 and 48h after operation, respectively. Adverse events and early graft function were comparable between the groups, except a significantly lower incidence of drowsiness observed in the nefopam group (4% vs. 21%, P=0.027). In combination with fentanyl PCA, nefopam reduced post-operative fentanyl consumption with superior analgesia after renal transplantation.