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| 22KS-008 |
Effects of nefopam on acute and chronic postoperative pain after video assisted thoracoscopic surgery for lung cancer
Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, CHA University, Goyang, South Korea1
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea2
Background: Nefopam is a non-opioid, non-steroidal, centrally acting analgesic and its efficacy on multimodal analgesia has been reported. This prospective, single-blinded, randomized controlled trial evaluated analgesic effects of intraoperative nefopam on acute and chronic postoperative pain after video-assisted thoracoscopic surgery (VATS) for lung cancer.
Methods: Adult patients undergoing elective VAT lung lobectomy were randomly assigned to either nefopam group or control group. Nefopam group received 20 mg of nefopam immediately after anesthesia induction and 15 min before the end of surgery. Control group received saline in the same manner. The primary outcome was cumulative opioid consumption during the 6 h postoperatively. The secondary outcomes were pain intensities using a numerical rating scale (NRS) and adverse events related to nefopam or opioids. The incidence of chronic pain was evaluated 3 months after surgery.
Results: Ninety nine patients were included in the analysis (nefopam group [n=50] vs. control group [n=49]). Total opioid consumption (median [interquartile range]) during the 6 h postoperatively was similar between the groups (nefopam group vs. control group, 19.8[13.5-25.3] mg vs. 20.3 [13.9-27.0] mg; 95% CI: -6.6393 to 3.6901; p =0.356). Total opioid consumption and pain intensities during the 72 h postoperatively were also comparable between the groups. Intraoperative remifentanil infusion dose was higher in the nefopam group than the control group (450 [300-550] μg vs. 300 [250-450] μg, p=0.013). The incidence of nausea/vomiting, respiratory depression and change in aspartate aminotransferase(AST), alanine aminotransferase(ALT) were not statistically different between the groups. The presence of chronic pain at 3 months were 55.3% and 64.9% in the nefopam and control group, respectively. It was not significantly different between the groups (Odd ratio: 0.669, 95% CI: 0.264 to 1.695, p =0.482).
Conclusion: Intraoperative nefopam did not decrease opioid consumption and pain intensities during acute postoperative period and could not reduce the incidence of chronic post-surgical pain after VATS of lung cancer.
Methods: Adult patients undergoing elective VAT lung lobectomy were randomly assigned to either nefopam group or control group. Nefopam group received 20 mg of nefopam immediately after anesthesia induction and 15 min before the end of surgery. Control group received saline in the same manner. The primary outcome was cumulative opioid consumption during the 6 h postoperatively. The secondary outcomes were pain intensities using a numerical rating scale (NRS) and adverse events related to nefopam or opioids. The incidence of chronic pain was evaluated 3 months after surgery.
Results: Ninety nine patients were included in the analysis (nefopam group [n=50] vs. control group [n=49]). Total opioid consumption (median [interquartile range]) during the 6 h postoperatively was similar between the groups (nefopam group vs. control group, 19.8[13.5-25.3] mg vs. 20.3 [13.9-27.0] mg; 95% CI: -6.6393 to 3.6901; p =0.356). Total opioid consumption and pain intensities during the 72 h postoperatively were also comparable between the groups. Intraoperative remifentanil infusion dose was higher in the nefopam group than the control group (450 [300-550] μg vs. 300 [250-450] μg, p=0.013). The incidence of nausea/vomiting, respiratory depression and change in aspartate aminotransferase(AST), alanine aminotransferase(ALT) were not statistically different between the groups. The presence of chronic pain at 3 months were 55.3% and 64.9% in the nefopam and control group, respectively. It was not significantly different between the groups (Odd ratio: 0.669, 95% CI: 0.264 to 1.695, p =0.482).
Conclusion: Intraoperative nefopam did not decrease opioid consumption and pain intensities during acute postoperative period and could not reduce the incidence of chronic post-surgical pain after VATS of lung cancer.