The effect of diclofenac and nefopam on postoperative dental pain

Goucke, C. Roger; Keaveny, J.; Healy, T.E.J.; Ryan, Michael

doi:10.1111/j.1365-2044.1990.tb14745.x

Cited by 14 publications

(5 citation statements)

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“…Based on this analysis, we recommend that further studies should focus on the early postoperative analgesic effect of nefopam. Similar to previous studies [18], our results support the conclusion that this preoperative oral analgesic lacks demonstrated drug efficacy. In addition, considering that most operative durations were less than 90 min, this surgery was too short for the identification of a postoperative anti-hyperalgesic effect.…”

Section: Discussionsupporting

confidence: 92%

Analgesic Effect of Low Dose Nefopam Hydrochloride after Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Koh

Joo

Kim

et al. 2019

JCM

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Arthroscopic rotator cuff repair causes acute postoperative hyperalgesia. Multimodal analgesia is preferable to opioid-based intravenous patient-controlled analgesia (IV-PCA) due to postoperative nausea and vomiting (PONV). We evaluated the effect of nefopam as a postoperative non-opioid analgesic after shoulder surgeries. A total of 180 adult patients were enrolled for arthroscopic rotator cuff repair. They were randomly assigned to nefopam (N) or control (C) groups and each group was reclassified according to the interscalene block (B) into NB, CB and NX, CX. Nefopam was applied at a constant dose intravenously during recovery. Pain scores were measured with a Visual Analogue Scale (VAS) before (T0), immediately after (T1), 30 min (T2) and 12 h (T3), 24 h (T4) and 48 h (T5) after surgery. There was no significant difference in demographic data. The overall VAS scores did not differ with regard to nefopam use, except for the NB group at T4 in intention to treat (ITT) analysis (p < 0.05). PONV occurred more frequently in the N group than in the C group (p < 0.05). Neither individual nor all risk factors were associated with PONV occurrence (p > 0.10). In conclusion, nefopam alone did not show a definite decrease in postoperative pain. It instead increased PONV regardless of risk factors.

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Section: Discussionsupporting

confidence: 92%

Analgesic Effect of Low Dose Nefopam Hydrochloride after Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Koh

Joo

Kim

et al. 2019

JCM

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“…in relieving pain in outpatients who received general anaesthesia for surgical removal of third molars. 12 Postoperative morphine requirements were similar with nefopam 20 mg i.v. and ketamine 10 mg i.v.…”

Section: Data From Active Controlled Trialsmentioning

confidence: 72%

Nefopam for the prevention of postoperative pain: quantitative systematic review

Evans

Lysakowski

Tramèr

2008

British Journal of Anaesthesia

118

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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.

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“…Nefopam is a non‐opioid analgesic drug usually administered by intravenous infusion or intramuscular injection for postoperative pain (Calmi et al 1985; Pandit et al 1989; Goucke et al 1990; Guirimand et al 1990; Moffat et al 1990). Previous studies in man have shown that 20 mg nefopam reduces daily morphine consumption by 30 % after upper abdominal surgery (McLintock et al 1988) and by 50% after elective hepatic resection (Mimoz et al 2001).…”

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confidence: 99%

Comparative Pharmacokinetics and Pharmacodynamics of Intravenous and Oral Nefopam in Healthy Volunteers*

Aymard

Warot

Démolis

et al. 2003

Pharmacology & Toxicology

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To determine the pharmacokinetic, subjective effects of a single 20 mg dose of nefopam administered either intravenously or orally in healthy volunteers, twenty-four healthy Caucasian men received 20 mg nefopam orallyπplacebo intravenous infusion and placebo orallyπintravenous infusion of 20 mg nefopam with one week interval, in a doubleblind, double-dummy cross-over study. Nefopam and desmethyl-nefopam plasma concentrations were measured by HPLC with UV detection up to 48 hr after drug administration. Self-rating questionnaires (Mood and vigilance Visual Analogue Scales, Addiction Research Centre Inventory) and drug safety were investigated. The F value (bioavailability) of the parent drug was 0.36∫0.13. The AUC oral /AUC iv ratio of nefopamπdesmethyl-nefopam was 0.62∫0.23. The half-life of nefopam was similar whether administered orally (5.1∫1.3 hr) or intravenously (5.1∫0.6 hr). The half-life of desmethyl-nefopam was two to three times longer than that of the parent molecule (orally: 10.6∫3.0 versus 5.1∫1.3 hr, PϽ10ª4 and intravenously: 15.0∫2.4 versus 5.1∫0.6 hr, PϽ10 ª4 ). As assessed by the Addiction Research Centre Inventory, no evidence of abuse liability in healthy, drug-naive volunteers was observed. On visual analogue scales, volunteers rated themselves as more drowsy, less alert, less energetic and less anxious after oral compared to intravenous administration. The AUC 0»24 hr of anxiety and energy parameters were not different after oral and intravenous administration: 90∫142 versus 35∫84 (PΩ0.27) and 66∫74 versus 46∫54 mm.hr (PΩ0.36), respectively. The AUC 0»24 hr of drowsiness and alertness parameters were significantly greater after oral than after intravenous administration: 68∫65 versus 27∫30 (PΩ0.005) and 54∫63 versus 28∫48 mm.hr (PΩ0.03), respectively. A clockwise hysteresis loop was observed for drowsiness in 16 out of 24 volunteers after oral administration. The results suggest that in healthy volunteers desmethyl-nefopam may contribute to the pharmacodynamic effects of single dose nefopam solution administered orally. This study shows a rather low bioavailability of nefopam given in intravenous solution when administered orally. Nevertheless, when the main metabolite desmethyl-nefopam is taken into account, the ratio of the areas under the curves is almost doubled.Nefopam is a non-opioid analgesic drug usually administered by intravenous infusion or intramuscular injection for postoperative pain (Calmi et al. 1985;Pandit et al. 1989; Goucke et al. 1990;Guirimand et al. 1990;Moffat et al. 1990). Previous studies in man have shown that 20 mg nefopam reduces daily morphine consumption by 30 % after upper abdominal surgery (McLintock et al. 1988) and by 50% after elective hepatic resection (Mimoz et al. 2001). Results obtained in man on the nociceptive R III reflex suggest that nefopam probably exerts its analgesic action through central (spinal and/or supraspinal) mechanisms. An oral formulation of nefopam is not available in France. Oral administration of intravenous solution of n...

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The effect of diclofenac and nefopam on postoperative dental pain

Cited by 14 publications

References 1 publication

Analgesic Effect of Low Dose Nefopam Hydrochloride after Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Analgesic Effect of Low Dose Nefopam Hydrochloride after Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Nefopam for the prevention of postoperative pain: quantitative systematic review

Comparative Pharmacokinetics and Pharmacodynamics of Intravenous and Oral Nefopam in Healthy Volunteers*

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