Nefopam, a non-narcotic, nonsteroidal, centrally acting analgesic, is commonly used for the treatment of nociceptive pain and prevention of postoperative shivering and hiccups [1,2]. Most studies on nefopam have focused on its analgesic potency compared to that of opioids or non-steroidal antiinflammatory drugs. Nefopam was reported to be an effective alternative to opioids without significant changes in the Richmond Agitation Sedation Scale score, ventilatory frequency, and oxygen saturation [3]. Therefore, we can frequently encounter patients with many kinds of analgesic taken via infusions or single bolus injections, in the clinical setting requiring the control of preoperative pain such as disease-related pain and drug injection pain.In general, neuromuscular blockers (NMBs) may interact with several drugs, including anticonvulsants, steroids, calcium channel blockers, antidepressants, antibiotics, and anti-arrhythmic drugs, resulting in potentiation of action or rapid recovery of blockade [4][5][6][7][8]. Hence, monitoring of neu-
Rocuronium has generally been used in anesthetic practice by bolus injection for muscle relaxation during tracheal intubation or by continuous infusion [1]. However, rocuronium may induce a withdrawal response due to intense injection This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: We investigated the effect of combination of nefopam and remifentanil under the hypothesis that nefopam would effectively prevent rocuronium-induced withdrawal response by blocking serotonin receptors and providing a synergistic or additional effect with remifentanil.Methods: After receiving Institutional Review Board approval, 76 patients aged between 20 and 65 years with American Society of Anesthesiologists physical statuses of I or II were randomly allocated to the control group and nefopam group. In the control group, 102 ml of 0.9% sodium chloride solution was infused one hour before surgery at 100 ml/h. In the nefopam group, 20 mg nefopam (2 ml) in 100 ml of a 0.9% sodium chloride solution was infused one hour before surgery at 100 ml/h. Rocuronium (0.6 mg/kg) was injected after the induction of anesthesia with remifentanil and propofol at target concentrations of 2.0 ng/ml and 3.0 mg/ml, respectively. The grades of rocuronium-induced withdrawal response were evaluated using a four-point scale. The hemodynamics and respiratory rates were recorded upon operating room arrival, after anesthesia induction, and one minute post-injection of rocuronium.Results: Two patients (nefopam group) were excluded due to incomplete infusion and side effects; thus, 74 patients were finally analyzed. The overall incidence of rocuroniuminduced withdrawal response was significantly lower in nefopam group (27.8%, n = 36) than in control group (60.5%, n = 38) (P = 0.005).
Conclusions:The combination of nefopam (20 mg) and remifentanil is more effective at reducing rocuronium-induced withdrawal response than remifentanil infusion alone with stable hemodynamics.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.