Nefopam for the prevention of postoperative pain: quantitative systematic review

Abstract

Nefopam, a centrally acting analgesic, has been used in the surgical setting in many countries since the mid-1970s. However, clinical trials provide contflicting results for its analgesic potency. We performed a systematic search (multiple databases, bibliographies, any language, to January 2008) for randomized, placebo-controlled trials of nefopam for the prevention of postoperative pain. Data were combined using classic methods of meta-analyses and were expressed as weighted mean difference (WMD), relative risk (RR), and number needed to treat/harm (NNT/H) with 95% confidence interval (CI). Nine trials (847 adult patients, 359 received nefopam) were included. Nefopam (cumulative doses, 20 -160 mg) was given orally or i.v., as single or multiple doses, or as a continuous infusion. Compared with placebo, cumulative 24 h morphine consumption was decreased with nefopam: WMD 213 mg (95% CI 217.9 to 28.15). Pain intensity at 24 h was also decreased: on a 100 mm visual analogue scale, WMD 211.5 mm (95% CI 215.1 to 27.85). The incidence of tachycardia was increased with nefopam (RR 3.12, 95% CI 1.11 -8.79; NNH 7), as was the incidence of sweating (RR 4.92, 95% CI 2.0 -12.1; NNH 13). There is limited evidence from the published literature that nefopam may be a useful non-opioid analgesic in surgical patients. The analgesic potency seems to be similar to non-steroidal anti-inflammatory drugs. However, dose responsiveness and adverse effect profile remain unclear, and the role of nefopam as part of multimodal analgesia needs to be established. Data in children are lacking.

Nefopam as an adjunct to intravenous patient‐controlled analgesia after renal transplantation: a randomised trial

“…10 In adult patients undergoing various types of operations, nefopam has provided opioid-sparing effect with concomitant improvement of post-operative analgesia quality. [11][12][13][14][15] The pharmacokinetics of nefopam is characterised by primary elimination by hepatic biotransformation with less than 5% of unchanged substance in urine. 16,17 Therefore, in contrast to NSAIDs, nefopam can be safely used as an analgesic adjuvant with opioid-based IV PCA in patients with impaired renal function.…”

Enhanced analgesic effects of nefopam in combination with acetaminophen in rodents

“…Nefopam is a novel type of analgesic drug that exerts non-narcotic effects (1), and thus differs from typical opioids and anti-inflammatory drugs (2). Nevertheless, it effectively elicits antinociception in the majority of noxious and thermal models in rodents (3,4).…”

The analgesic efficacy and safety of nefopam in patient-controlled analgesia after cardiac surgery: A randomized, double-blind, prospective study

“…2 Open cardiac surgery causes severe pain that can affect a patient's vital signs and prognosis. Postoperative analgesia is required to achieve patient comfort, stable haemodynamics and postoperative rehabilitation.…”