Effects of Intraoperative Nefopam on Catheter-Related Bladder Discomfort in Patients Undergoing Robotic Nephrectomy: A Randomized Double-Blind Study

Abstract

Catheter-related bladder discomfort (CRBD) is one of the most difficult symptoms during the postoperative period. Nefopam is a non-narcotic analgesic agent, which also has anticholinergic action. This study was performed to evaluate the effects of nefopam on CRBD in male patients undergoing robotic nephrectomy. A total of 109 male patients were randomly divided into two groups: the control group (n = 55) received 20 mL of normal saline, and the nefopam group (n = 54) received 20 mg of nefopam 1 h before the end of the operation. At postoperative times of 20 min, 1 h, 2 h, and 6 h, the severity of CRBD was measured using an 11-point numeric rating scale, respectively. The severity of CRBD in the nefopam group was significantly lower than that in the control group at 20 min (4.8 ± 1.3 vs. 2.3 ± 1.0, respectively, p = 0.012) and at 1, 2, and 6 h (3.5 ± 1.2, 2.7 ± 0.9, and 2.5 ± 1.0 vs. 4.1 ± 0.8, 1.6 ± 0.8, and 1.3 ± 0.6, respectively, p < 0001). Intraoperative nefopam administration reduced the severity of CRBD in patients undergoing robotic nephrectomy.

The systematic review and meta-analysis evaluated the efficacy and safety of nefopam for catheter-related bladder discomfort based on randomized controlled trials

“…Several studies have been conducted to evaluate the effectiveness of nefopam in alleviating postoperative catheter-related bladder discomfort. These studies have shown promising results, indicating that nefopam can significantly reduce the intensity and frequency of bladder discomfort, improve patient satisfaction, and enhance overall postoperative recovery (Cheon et al, 2018;Park et al, 2018;In et al, 2019;Gad et al, 2022;Charoenpol et al, 2023). This is also in line with the philosophy of Enhanced Recovery After Surgery (ERAS).…”

“…After thoroughly examining the complete texts of these studies, we excluded 24 of them based on the reasons provided in Figure 1. Finally, the meta-analysis included five RCTs with 405 patients (202 in the nefopam group and 203 in the control group) (Cheon et al, 2018;Park et al, 2018;In et al, 2019;Gad et al, 2022;Charoenpol et al, 2023).…”

Impact of Intraoperative Nefopam on Postoperative Pain, Opioid Use, and Recovery Quality with Parietal Pain Block in Single-Port Robotic Cholecystectomy: A Prospective Randomized Controlled Trial

“…Previous studies have demonstrated the analgesic efficacy of nefopam in patients who underwent various types of robot-assisted surgeries. Patients who received nefopam during bilateral axillo-breast approach robotic or endoscopic thyroidectomy reported significantly lower postoperative pain scores and required fewer rescue analgesics compared to those receiving saline [ 27 , 28 , 29 ]. Similarly, in a study involving robotic nephrectomy, nefopam administration significantly reduced catheter-related bladder discomfort postoperatively [ 28 ].…”

“…Patients who received nefopam during bilateral axillo-breast approach robotic or endoscopic thyroidectomy reported significantly lower postoperative pain scores and required fewer rescue analgesics compared to those receiving saline [ 27 , 28 , 29 ]. Similarly, in a study involving robotic nephrectomy, nefopam administration significantly reduced catheter-related bladder discomfort postoperatively [ 28 ]. Another study comparing continuous lidocaine infusion and nefopam injection to fentanyl-based patient-controlled analgesia (PCA) found comparable pain relief but with a lower incidence of PONV in the nefopam group [ 27 ].…”

Effects of Chlorpheniramine Maleate on Catheter-Related Bladder Discomfort in Patients Undergoing Ureteroscopic Stone Removal: A Randomized Double-Blind Study

“…In previous studies, antimuscarinic agents such as tolterodine [4] and oxybutynin [6] have been reported to be effective for preventing and treating CRBD. In addition, several types of agents, including the anticholinergics (glycopyrrolate [17] and butylscopolamine [1]), the antiepileptics (gabapentin [7] and pregabalin [18]), the anesthetics/sedatives (ketamine [8] and dexmedetomidine [2]), and the analgesics (tramadol [9] and nefopam [19]), decrease CRBD. They seem to have a preventive effect on CRBD via antimuscarinic effects, whereas side effects such as dry mouth, tachycardia, and sedation occur due to the nature of each agent.…”