The effect of pre-incision nefopam on postoperative pain after major upper abdomonal surgery

ABSTRACT

Background: Nefopam a powerful painkiller has been put into clinical use since 1976, effects preemptive analgesia. Objectives: To assess the effect of presurgical IV Nefopam on postoperative pain after major upper abdomonal surgery. Subjects and method: A double-blind randomized controlled trial. 62 patients were divided into 2 groups Nefopam (N, n = 31) and placebo group (PG, n = 31). Presurgical IV 20 mg Nefopam was used in N.PCA was used for both groups. Postoperative non-painful time (PNPT); VAS/48 hours at rest and on cough; IV Morphine rescue with PCA was measured during postsurgical 48 hour period.Results: PNPT was longer in N 42 \xb1 8,9 vs. 22 \xb1 4,8, p<0,01. Titration dose of morphine, Morphine consumption of first 24 hours, and of another 24 hours were lower in N 5,6 \xb1 1,7; 25,2 \xb1 4,9; 10,1 \xb1 3,6 mg vs. 7,1 \xb1 1,5; 30,1 \xb1 4,5; 13,3 \xb1 2,1, p<0,05 and < 0,01, respectively. VASs under tested conditions during first 16 hours were significant lower in N. Conclusion: Presurgical Nefopam had the effect of pre-emptive analgesia as evidence by a significant VAS decrease during the first 16 hours with lower Morphine consumption of 48 hours .