Effect of nefopam for patient-controlled analgesia after laparoscopic gastrectomy

ABSTRACT

BACKGROUND: Nefopam is a central acting, non-opioid analgesic used for control of postoperative pain. However, there are limited studies on the analgesic effect of nefopam for patient-controlled analgesia (PCA). We investigated the analgesic effect of nefopam mixed in fentanyl PCA following laparoscopic gastrectomy. METHODS: Sixty-six patients between the ages of 20 and 70 years, of American Society of Anesthesiologists physical status I, II or III, who were scheduled to undergo elective laparoscopic gastrectomy, were enrolled in the study. Patients were randomly assigned to the nefopam (N) or saline (S) group. Anesthesia was maintained with target controlled infusion of propofol and remifentanil. For PCA, patients in the N group received 100 mg nefopam and 30 microg/kg fentanyl. Patients in the S group received fentanyl 30 microg/kg. PCA infusion was started after 90 minutes from anesthesia induction. Pain by verbal rating scale at rest or on cough, shivering and postoperative nausea and vomiting were assessed immediately and after 30 minutes in the recovery room. Pain by verbal rating scale at rest or on cough, total volume of PCA, bolus button count, and additional analgesic requirements were assessed after 24 hour of PCA infusion. RESULTS: Shivering scores were statistically different between groups immediately and after 30 minutes in the recovery room. Pain by verbal rating scale at rest and additional analgesic requirements after 24 hour of PCA infusion were statistically different between groups. CONCLUSIONS: Addition of nefopam to patients on the fentanyl PCA regimen after laparoscopic gastrectomy resulted in effective postoperative pain control and reduced incidence of postoperative shivering.