Effects of nefopam with fentanyl in intravenous patient-controlled analgesia after arthroscopic orthopedic surgery: a prospective double-blind randomized trial

Abstract

Background/aim: We performed this prospective randomized double-blind study to compare the effects of nefopam versus ketorolac in intravenous fentanyl-based patient-controlled analgesia (PCA) after shoulder arthroscopic orthopedic surgery.Materials and methods: Ninety-two patients were randomly divided into two groups to receive intravenous PCA. Patients were assigned to either the nefopam group (nefopam 120 mg and fentanyl 20 µg/kg) or the ketorolac group (ketorolac 2 mg/kg and fentanyl 20 µg/kg). Pain was assessed on a visual analogue scale (VAS) and a numeric rating scale (NRS). Additionally, patient satisfaction, adverse events, and vital signs were monitored.Results: There were no significant differences in VAS score (P = 0.48) or NRS score (P = 0.15) between the two groups. Similarly, patient satisfaction did not differ between the two groups [8.5(0.8) vs. 8.2(1.0), P = 0.14]. There were no statistically significant differences in the incidence of nausea (P = 0.72), vomiting (P = 0.46), urinary retention (P = 0.82), sweating (P = 0.49), or dizziness (P = 0.45) between the two groups. Likewise, there were no differences in heart rate [78.2(7.7) vs. 75.2(6.5), P = 0.18] or SpO2 [98.4(1.8) vs. 98.5(1.9), P = 0.83]. Conclusion:Nefopam is an appropriate alternative for co-administration with fentanyl-based PCA in patients who have difficulty using nonsteroidal antiinflammatory drugs.

Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review

“… 74 2018 Low Low High Low Low Low Oh et al. 75 2018 Low Low High Low Low Low Premkumar et al 76 2016 Low Low High Low Low Low Purcell et al. 77 2019 High Low Low High Low Low Reda et al.…”

“…D2 < D1 from 18 to 24 hours. Control = D1 and D2, at 6 hours D1: Dexamethasone Intravenous dexamethasone .11 mg/kg with interscalene nerve block, prior to surgery 22 46.1 ± 17.0 D2: Dexamethasone + dexmedetomidine Coadministered intravenous dexamethasone .11 mg/kg + intravenous dexmedetomidine, with interscalene nerve block, prior to surgery 22 47.4 ± 13.5 Bjørnholdt et al, 2014 36 2 Subacromial decompression and/or acromioclavicular joint resection Intravenous medication D40: 40 mg Dexamethasone 40 mg dexamethasone intravenously, preoperatively 25 53 ± 10 NRS: D40 = D8 = Placebo, from surgery until day 3 Total analgesic consumption: D40 = D8 = Placebo, from surgery until day 3 D8: 8 mg dexamethasone 8 mg dexamethasone intravenously, preoperatively 26 55 ± 11 Placebo Placebo infused, preoperatively 22 49 ± 11 Oh et al., 2018 75 1 Shoulder Arthroscopy Intravenous Patient-Controlled Analgesia (PCA) Nefopam PCA provided once awake, of 120 mg nefopam, 20 μg/kg fentanyl, and 16 mg ondansetron 46 53.3 ± 12.8 VAS and NRS: Nepofam = Ketorolac, from 10 min to 48 hours Total PCA: Nepofam = Ketorolac, from 10 min to 24 hours Ketorolac PCA provided once awake, of 2 mg/kg ketorolac, 20 μg/kg fentanyl, and 16 mg ondansetron 46 51.9 ± 11.5 Yun et al., 2012 89 1 Rotator cuff repair, with SLAP lesion in 62% and biceps tear in 17% ...…”

“…Ten studies evaluated interventions for postoperative pain management protocols, six in shoulder arthroscopy, 61 , 66 , 71 , 75 , 83 four in knee arthroscopy, 29 , 85 , 91 , 94 and none in hip arthroscopy. Notable in shoulder arthroscopy, Yun et al.…”

“…Notable in shoulder arthroscopy, Yun et al 89 found that subacromial patientcontrolled analgesia (PCA) provided postoperatively for 48 hours to rotator cuff repair patients provided better pain relief at 1 hour postoperatively compared to IV PCA, while opioid consumption was similar. Merivirta et al 71 and Oh et al 75 found that a 72-hour postoperative fentanyl batch provided similar outcomes to a bupivacaine infusion and that Nefopam IV PCA provided similar outcomes to a Ketorolac IV PCA, respectively. For knee arthroscopy, Tompkins et al 85 found that providing the sleep aid Zolpidem (10 mg) to ACL reconstruction patients for days 0-7 postoperatively decreased opioid consumption, while not affecting pain relief.…”

“…Postoperative Interventions for Pain Management Ten studies evaluated interventions for postoperative pain management protocols, six in shoulder arthroscopy, 61,66,71,75,83 four in knee arthroscopy, 29,85,91,94 and none in hip arthroscopy. Notable in shoulder arthroscopy, Yun et al 89 found that subacromial patientcontrolled analgesia (PCA) provided postoperatively for 48 hours to rotator cuff repair patients provided better pain relief at 1 hour postoperatively compared to IV PCA, while opioid consumption was similar.…”