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| 22KS-001 |
Effect of Continuous Infusion of IV Nefopam after VATS under ERAS Protocol
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
2Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
Background: Although nefopam has been reported to have opioid-sparing and analgesic effects in postsurgical patients, its effectiveness in video-assisted thoracoscopic surgery (VATS) is unknown. This study aimed to investigate the opioid-sparing and analgesic effects of perioperative nefopam infusion in video-assisted thoracoscopic surgery (VATS) for lung resection.
Methods: Ninety patients scheduled for elective VATS for lung resection were randomized to either the nefopam (group N) or control group (group C). Group N received 20 mg nefopam over 30 min immediately after the induction of anesthesia, and nefopam was administered continuously for 24 h postoperatively, using a dual-channel elastomeric infusion pump combined with fentanyl-based intravenous patient-controlled analgesia. Group C received the same volume of normal saline as nefopam solution administered in the same manner. The primary outcome measure was fentanyl consumption for the first 24 h postoperatively. The secondary outcome measures were the cumulative fentanyl consumption during the 48 h postoperatively, pain intensity at rest and during coughing evaluated using an 11-point numeric rating scale, quality of recovery at 24 h and 48 h postoperatively, and the occurrence of analgesic-related side effects during the first 24 h and 24les related to chronic postsurgical pain (CPSP) were also investigated by telephone interviews with participants at 3 months postoperatively.
Results: A total of 83 patients were enrolled. Group N showed significantly lower fentanyl consumption during the first 24 h and 48 h postoperatively (24 h: median difference: -270 μg [95% confidence interval (CI), -400 to -150 μg], P < 0.001; 48 h: median difference: -365 μg [95% CI: -610 to -140 μg], P < 0.001). Group N also showed a significantly lower pain score during coughing at 24 h postoperatively (median difference, -1 [corrected 95% CI: -2.5 to 0], adjusted P = 0.040). However, there were no significant between-group differences in the postoperative quality of recovery, occurrence of analgesic -related side effects, length of hospital stay, and occurrence of CPSP.
Conclusion: Perioperative nefopam infusion using a dual-channel elastomeric infusion pump has a significant opioid-sparing effect in patients undergoing VATS for lung resection. Therefore, it could be a feasible option for multimodal analgesia in these patients.
Methods: Ninety patients scheduled for elective VATS for lung resection were randomized to either the nefopam (group N) or control group (group C). Group N received 20 mg nefopam over 30 min immediately after the induction of anesthesia, and nefopam was administered continuously for 24 h postoperatively, using a dual-channel elastomeric infusion pump combined with fentanyl-based intravenous patient-controlled analgesia. Group C received the same volume of normal saline as nefopam solution administered in the same manner. The primary outcome measure was fentanyl consumption for the first 24 h postoperatively. The secondary outcome measures were the cumulative fentanyl consumption during the 48 h postoperatively, pain intensity at rest and during coughing evaluated using an 11-point numeric rating scale, quality of recovery at 24 h and 48 h postoperatively, and the occurrence of analgesic-related side effects during the first 24 h and 24les related to chronic postsurgical pain (CPSP) were also investigated by telephone interviews with participants at 3 months postoperatively.
Results: A total of 83 patients were enrolled. Group N showed significantly lower fentanyl consumption during the first 24 h and 48 h postoperatively (24 h: median difference: -270 μg [95% confidence interval (CI), -400 to -150 μg], P < 0.001; 48 h: median difference: -365 μg [95% CI: -610 to -140 μg], P < 0.001). Group N also showed a significantly lower pain score during coughing at 24 h postoperatively (median difference, -1 [corrected 95% CI: -2.5 to 0], adjusted P = 0.040). However, there were no significant between-group differences in the postoperative quality of recovery, occurrence of analgesic -related side effects, length of hospital stay, and occurrence of CPSP.
Conclusion: Perioperative nefopam infusion using a dual-channel elastomeric infusion pump has a significant opioid-sparing effect in patients undergoing VATS for lung resection. Therefore, it could be a feasible option for multimodal analgesia in these patients.
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