Comparison Between Preoperative and Intraoperative Administration of Nefopam for Acute and Chronic Postoperative Pain in Colon Cancer Patients: A Prospective, Randomized, Double‐Blind Study

Abstract

Background The present study was designed as a prospective, randomized, double‐blind clinical trial to evaluate the effects of preoperatively administered nefopam on postoperative acute hyperalgesia and the long‐term painful sequelae compared to intraoperative administration. Methods One hundred and fifty patients undergoing elective laparoscopic colectomy were enrolled. Group 1 (post‐incisional nefopam) patients received saline at 30 min before skin incision followed by intraoperative administration of 20 mg nefopam at 1 h after incision. Group 2 (pre‐incisional nefopam) patients were administered 20 mg nefopam before skin incision and received saline after skin incision. At postoperative 2, 6, 24, 48, and 72 h, fentanyl consumption and pain intensities at rest and during deep breathing were evaluated by visual analog scale (VAS). The incidence of the long‐term painful sequelae after surgery was evaluated more than one year after surgery. Results Cumulative fentanyl consumption during postoperative 72 h was similar between Group 1 and Group 2 (1534 ± 698 μg, 95% CI 1367–1702 μg vs. 1442 ± 721 μg, 95% CI 1266–1618 μg, P = 0.197). VAS pain scores at rest were comparable between the two groups, but VAS scores during deep breathing were significantly lower in Group 2 than in Group 1. Six and five patients complained of mild pain (pain rating 1) at the surgical site in Group 1 and 2, respectively. Conclusions Preoperatively administered nefopam reduced exertional pain compared to intraoperative administration although postoperative analgesic consumption was similar between two groups. It may be helpful to conduct early ambulation and deep breathing during the acute postoperative period in patients undergoing intestinal surgery. Trial registration No: KCT0001656.

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

“…Several studies have reported on the timing of nefopam administration for postoperative analgesia. Preoperative administration of 20 mg of nefopam reduced exertional pain during 2 to 72 h of follow-up after colon cancer surgery, although it did not reduce postoperative fentanyl consumption [15]. Furthermore, intraoperative administration of 40 mg of nefopam decreased pain at 6 h after laparoscopic gastrectomy, although it did not decrease pain after 6 h [17].…”

“…It has been suggested that the analgesic effect results from reduction in the neurokinin-1 receptor, which may inhibit substance P and neurokinin-1 signaling and subsequently lead to decreased nociceptive responses [12]. Nefopam has been used in several surgical procedures as an analgesic and as a component of multimodal analgesia for enhanced recovery after surgery (ERAS) [15][16][17][18][19]. However, protocols that consider the efficacy and safety, appropriate dose, administration time, administration methods (continuous or bolus injection), and combination with other drugs have not yet been identified.…”

The Lack of Analgesic Efficacy of Nefopam after Video-Assisted Thoracoscopic Surgery for Lung Cancer: A Randomized, Single-Blinded, Controlled Trial

“…This result could reflect an inadequate dose of nefopam. One study in laparoscopic colectomy also reported that 20 mg of nefopam did not reduce acute or chronic postoperative pain [ 38 ]. Those authors suggested that a low dose of nefopam caused negative preemptive analgesic results, which might not be enough to prevent nociceptive transmission and central sensitization for moderate to severe pain [ 38 ].…”

“…One study in laparoscopic colectomy also reported that 20 mg of nefopam did not reduce acute or chronic postoperative pain [ 38 ]. Those authors suggested that a low dose of nefopam caused negative preemptive analgesic results, which might not be enough to prevent nociceptive transmission and central sensitization for moderate to severe pain [ 38 ]. On the other hand, a study in breast surgery reported that 20 mg of nefopam administered before surgical incision reduced the use of rescue analgesics and lowered the incidence of chronic postoperative pain [ 30 ].…”

Changes in spinal alignment one month post abdominal surgery: A prospective cohort study

“…[2] The most common complication following abdominal procedures is pain centered around the surgical wound, and many reports regarding its intensity, changes, associations with cancer site, [3,4] surgical technique, [5] and long-term duration have been published. [6] Various treatment strategies for postoperative pain have been investigated including reducing the release of inflammatory cytokines through preoperative nutritional therapy, [7] intraoperative anesthetic administration, [8] and application of postoperative analgesics, [9,10] among others. One simple, noninvasive, and low-cost method that patients can perform independently to protect their postoperative wounds is to adopt an anterior tilt posture.…”