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Background and Objectives: Kidney transplantation (KT) is an important treatment modality for renal failure. However, moderate-to-severe pain often occurs in KT recipients. Multimodal analgesia using combined analgesic measures has been recommended to enhance postoperative recovery. This retrospective study explored the additional analgesic efficacy of paracetamol and nefopam infusions in living-donor KT recipients who received a transversus abdominis plane (TAP) block. Materials and Methods: Consecutive living-donor KT recipients at our institute between January 2020 and March 2022 were divided into groups that received a TAP block with paracetamol and nefopam infusions (Group TA) or a TAP block without analgesics (Group T) during surgery. Following propensity-score (PS) matching, 103 patients were included in each group. Postoperative pain intensity assessed using the visual analog scale (VAS), opioid consumption via patient-controlled analgesia (PCA) devices over 24 h, and postoperative outcomes were compared between the two groups. Results: VAS pain intensity at rest was lower in group TA than in group T at 1 and 6 h after surgery [1 h: 29 (15–41) vs. 41 (29–51) mm, p < 0.001; 6 h: 32 (23–43) vs. 40 (32–54) mm, p < 0.001]. The VAS pain intensity during coughing was lower in group TA [1 h: 46 (30–58) vs. 59 (48–69) mm, p < 0.001; 6 h: 51 (40–63) vs. 60 (45–71) mm, p < 0.001]. Moreover, PCA consumptions during the first 6 h and between 6–24 h post-surgery was significantly lower in group TA. Other postoperative outcomes did not differ between the two groups. Conclusions: Multimodal analgesia with intraoperative paracetamol and nefopam infusions improved postoperative pain control in living-donor KT recipients who received a preoperative TAP block. Our findings demonstrate the efficacy of paracetamol and nefopam infusions in KT recipients. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate nefopam's analgesic properties, explore caffeine's potential adjuvant effects, and examine its impact on renal and hepatic function. The study involved 56 female albino mice, divided into seven groups: Group A, as the control group, received distilled water; Group B received 0.75 mg per body weight of nefopam orally; Group C received 0.71 mg/B.W. of nefopam and 0.125 mg/B.W. of caffeine; Group D received 0.67 mg/B.W. of nefopam and 0.25 mg/B.W. of caffeine; and Group E received 0.63 mg/B.W. of nefopam and 0.37 mg/B.W. of caffeine. Group F received 0.6 mg/B.W. nefopam and 0.5 mg/B.W. caffeine orally; Group G received 0.56 mg/B.W. of nefopam and 0.62 mg/B.W. of caffeine. Several experimental models have been utilised to investigate the analgesic advantages. The hot plate test is a method used to assess the response time to thermal stimuli. Group D produced the most prolonged response duration to thermal stimuli, namely thermal pain, while the writhing test involves the injection of acetic acid, resulting in a significant decrease in the frequency of writhing observed in Group D. Inconclusion, Nefopam demonstrated analgesic properties in all experimental groups, even when augmented with caffeine, without any observed changes in renal or liver function. [ABSTRACT FROM AUTHOR]

Abstract Background Nefopam and propacetamol are the most commonly used analgesics in postoperative multimodal analgesic regimens. Distinct mechanisms are involved in each drug’s anti-nociceptive effects. No studies have compared pain relief efficacy between the two drugs in patients undergoing transplantation surgery. Here, we investigated whether the administration of nefopam or propacetamol to healthy living kidney donors who underwent rectus sheath block (RSB) for parietal pain could reduce the subsequent opioid dose necessary to produce adequate analgesia. Methods This prospective, randomized controlled trial included 72 donors undergoing elective hand-assisted living donor nephrectomy into two groups: propacetamol (n = 36) and nefopam (n = 36). Intraoperative RSB was performed in all enrolled donors. The primary outcome was the total volume of intravenous opioid-based patient-controlled analgesia (PCA) used on postoperative day 1 (POD 1). Additionally, the Numeric Rating Scale scores for flank (visceral) and umbilicus (parietal) pain at rest and during coughing were compared, and the Korean adaptation of the Quality of Recovery-15 Questionnaire (QoR-15 K) was evaluated on POD 1. Results Both groups had similar preoperative and intraoperative characteristics. On POD 1, the total amount of PCA infusion was significantly lower in the nefopam group than in the propacetamol group (44.5 ± 19.3 mL vs. 70.2 ± 29.0 mL; p

Background & objective: The use of fentanyl to manage postoperative pain in spinal surgery patients is common, although there have been concerns about potential of drug abuse and dependence. We investigated the effects of the combined administration of nefopam and fentanyl through intravenous (IV) patient-controlled analgesia (PCA) on early postoperative pain and possible side effects in patients undergoing spinal surgeries. Methodology: In this randomized, controlled study, 70 patients were allocated to receive either fentanyl 10 µg/mL (Group F) or fentanyl 10 µg/mL with nefopam 1.2 mg/mL (Group FN), with a total PCA volume of 100 mL per infusion bag. Patients received a background dose of 0.25 µg/kg/h and bolus dose of 0.5 mL SOS (fentanyl 5 µg). The lockout interval was set at 10 min and upper limit was set at 15 mL/4 h. The PCA parameters were set according to the body weight of each patient. Results: The cumulative postoperative fentanyl consumptions after 48 h for Group F and Group NF were reported as 744.6 ± 94.2 µg and 631 ± 62.5 µg (P < 0.05) respectively. The average number of bolus doses requested by the patients in Group F and FN were 20.8 ± 11.0, and NF 11.4± 7.6). The A/D ratio of both groups for the bolus doses were 70%. Group NF consistently scored a lower VAS and VAS-D score during the 48-hour postoperative period. However, the VAS scores significantly differ statistically between groups at 1, 6, 9, and 12 hours. Within group differences, the VAS score differed significantly statistically during the 0-1, 1-2, and 2-3 hours for Group F, while 24- 36 hours for Group NF. Conclusion: The inclusion of nefopam in patient-controlled analgesia for spine surgery patients significantly reduced total use of fentanyl within the 48 hours postoperatively after the surgery. Patients receiving fentanyl with nefopam consistently had lower VAS scores at different time points. [ABSTRACT FROM AUTHOR]

Multimodal analgesia is central to pain management after total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of adding oral nefopam to multimodal analgesia for post-TKA pain management. In this prospective, double-blind, placebo-controlled, randomized trial, 100 patients who underwent TKA at our hospital were randomized to either the nefopam or the control group. After surgery, patients in the nefopam group received 200 mg of celecoxib, 150 mg of pregabalin, and 40 mg of nefopam twice daily to control postoperative pain. Patients in the control group received 200 mg of celecoxib, 150 mg of pregabalin, and a placebo. Oxycodone hydrochloride (10 mg) was used as the rescue analgesic. If the pain remained poorly controlled, 10 mg of morphine hydrochloride was injected subcutaneously as a secondary rescue analgesic. The primary outcome was the postoperative consumption of oxycodone and morphine as rescue analgesics. Secondary outcomes were postoperative pain assessed using the visual analogue scale (VAS), functional recovery assessed by the range of knee motion and ambulation distance, time until hospital discharge, indicators of liver function, and complication rates. Patients in the nefopam group had significantly lower postoperative oxycodone and morphine consumption within 24 hours after surgery and during hospitalization, lower VAS pain scores at rest and during motion within 24 h after surgery, better functional recovery on postoperative days 1 and 2, and a shorter hospital stay. However, the absolute reduction in 0 to 24 h opioid consumption, VAS pain scores, and knee range of motion did not exceed the reported minimal clinically important difference. Both groups had similar indicators of liver function and complication rates. Adding oral nefopam to multimodal analgesia resulted in statistically significant improvements in opioid consumption, VAS pain scores, and functional recovery. However, the amount of improvement may not be clinically important. [ABSTRACT FROM AUTHOR]

Background: Nefopam and propacetamol are the most commonly used analgesics in postoperative multimodal analgesic regimens. Distinct mechanisms are involved in each drug's anti-nociceptive effects. No studies have compared pain relief efficacy between the two drugs in patients undergoing transplantation surgery. Here, we investigated whether the administration of nefopam or propacetamol to healthy living kidney donors who underwent rectus sheath block (RSB) for parietal pain could reduce the subsequent opioid dose necessary to produce adequate analgesia. Methods: This prospective, randomized controlled trial included 72 donors undergoing elective hand-assisted living donor nephrectomy into two groups: propacetamol (n = 36) and nefopam (n = 36). Intraoperative RSB was performed in all enrolled donors. The primary outcome was the total volume of intravenous opioid-based patient-controlled analgesia (PCA) used on postoperative day 1 (POD 1). Additionally, the Numeric Rating Scale scores for flank (visceral) and umbilicus (parietal) pain at rest and during coughing were compared, and the Korean adaptation of the Quality of Recovery-15 Questionnaire (QoR-15 K) was evaluated on POD 1. Results: Both groups had similar preoperative and intraoperative characteristics. On POD 1, the total amount of PCA infusion was significantly lower in the nefopam group than in the propacetamol group (44.5 ± 19.3 mL vs. 70.2 ± 29.0 mL; p < 0.001). This group also reported lower pain scores at the flank and umbilical sites and required fewer rescue doses of fentanyl in the post-anesthesia care unit. However, pain scores and fentanyl consumption in the ward were comparable between groups. The QoR-15 K scores were similar between groups; there were substantial improvements in breathing, pain severity, and anxiety/depression levels in the nefopam group. The incidences of postoperative complications, including sweating and tachycardia, were similar between groups. Conclusion: Compared with propacetamol, nefopam provides a greater analgesic effect for visceral pain and enhances the effects of blocks that reduce the opioid requirement in living kidney donors with parietal pain managed by RSB. Trial registration: The trial was registered prior to patient enrollment in the clinical trial database using the Clinical Research Information Service (registration no. KCT0007351, Date of registration 03/06/2022). [ABSTRACT FROM AUTHOR]

Background/Objectives: Immediate breast reconstruction surgery (BRS) often leads to significant postoperative pain, necessitating effective analgesia. This study aimed to compare the analgesic efficacy of patient-controlled analgesia (PCA) containing nefopam with that of PCA containing opioids alone in patients undergoing BRS. Methods: A prospective, double-blind, randomized controlled trial was conducted on 120 patients undergoing immediate BRS after mastectomy. Patients were randomly allocated to receive PCA with fentanyl alone (Group F: fentanyl 10 mcg/kg), fentanyl and nefopam (Group FN: fentanyl 5 mcg/kg + nefopam 1 mg/kg), or nefopam alone (Group N: nefopam 2 mg/kg). Pain intensity (expressed in VASr and VASm), opioid consumption, and opioid-related complications were assessed. Results: PCA with nefopam, either alone or in combination with opioids, demonstrated non-inferior analgesic efficacy compared to PCA with fentanyl alone. At 24 h postoperatively, the VASr scores were 2.9 ± 1.0 in Group F, 3.1 ± 1.2 in Group FN, and 2.8 ± 0.9 in Group N (p = 0.501). At the same timepoint, the VASm scores were 4.1 ± 1.2 in Group F, 4.5 ± 1.5 in Group FN, and 3.8 ± 1.4 in Group N (p = 0.129). Significant differences among the three groups were observed at all timepoints except for PACU in terms of the total opioid consumption (p < 0.0001). However, there were no significant differences in opioid-related complications among the three groups. Conclusions: PCA with nefopam, whether alone or in combination with opioids, offers non-inferior analgesic efficacy compared to PCA with fentanyl alone in patients undergoing immediate BRS. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study explored how nefopam, a non-opioid analgesic in a multimodal regimen, impacts postoperative pain, opioid use, and recovery quality in single-port robot-assisted laparoscopic cholecystectomy (RALC) patients with a parietal pain block, addressing challenges in postoperative pain management. Materials and Methods: Forty patients scheduled for elective single-port RALC were enrolled and randomized to receive either nefopam or normal saline intravenously. Parietal pain relief was provided through a rectus sheath block (RSB). Postoperative pain was assessed using a numeric rating scale (NRS) in the right upper quadrant (RUQ) of the abdomen, at the umbilicus, and at the shoulder. Opioid consumption and recovery quality, measured using the QoR-15K questionnaire, were also recorded. Results: The 40 patients had a mean age of 48.3 years and an average body mass index (BMI) of 26.2 kg/m2. There were no significant differences in the pre- or intraoperative variables between groups. Patients receiving nefopam reported significantly lower RUQ pain scores compared to the controls, while the umbilicus and shoulder pain scores were similar. Rescue fentanyl requirements were lower in the nefopam group in both the PACU and ward. The QoR-15K questionnaire scores for nausea and vomiting were better in the nefopam group, but the overall recovery quality scores were comparable between the groups. Conclusions: Nefopam reduces RUQ pain and opioid use post-single-port RALC with a parietal pain block without markedly boosting RSB's effect on umbilicus or shoulder pain. It may also better manage postoperative nausea and vomiting, underscoring its role in analgesia strategies for this surgery. [ABSTRACT FROM AUTHOR]

Abstract Background: Postoperative pain management has been found to reduce postoperative morbidity, length of hospital stays, and overall healthcare cost and increased patient satisfaction. There is currently no gold standard for pain management in the immediate postoperative period following cesarean section. The goal of this study was to assess the effectiveness of nefopam for postoperative pain management in cesarean section compared with pethidine. Materials and Methods: A total of 144 ASA II and III pregnant women scheduled for cesarean section under spinal anesthesia were recruited in the study. The two groups of patients were randomly assigned, receiving either nefopam-dexamethasone (group N) or pethidine-dexamethasone (group P). The measured outcomes were pain scores measured by the numeric rating scale (NRS), time to first analgesic request, side effects. Results: The demographic properties of the patients were comparable. No patients reported moderate or worse pain. Patients in group N reported lower NRS scores compared with group P. However, the differences were not statistically significant. Moreover, the time to first analgesic request was 315.18 ± 103.61 min in group N and 286.86 ± 101.79 min in group P (P = 0.100). No side effects were noted in this study. Conclusion: The combination of nefopam and dexamethasone is equipotent to the combination of pethidine and dexamethasone in pain control after cesarean section and can be proposed as an alternative to opioids postoperatively.

Background and Objectives: Kidney transplantation (KT) is an important treatment modality for renal failure. However, moderate-to-severe pain often occurs in KT recipients. Multimodal analgesia using combined analgesic measures has been recommended to enhance postoperative recovery. This retrospective study explored the additional analgesic efficacy of paracetamol and nefopam infusions in living-donor KT recipients who received a transversus abdominis plane (TAP) block. Materials and Methods: Consecutive living-donor KT recipients at our institute between January 2020 and March 2022 were divided into groups that received a TAP block with paracetamol and nefopam infusions (Group TA) or a TAP block without analgesics (Group T) during surgery. Following propensity-score (PS) matching, 103 patients were included in each group. Postoperative pain intensity assessed using the visual analog scale (VAS), opioid consumption via patient-controlled analgesia (PCA) devices over 24 h, and postoperative outcomes were compared between the two groups. Results: VAS pain intensity at rest was lower in group TA than in group T at 1 and 6 h after surgery [1 h: 29 (15–41) vs. 41 (29–51) mm, p < 0.001; 6 h: 32 (23–43) vs. 40 (32–54) mm, p < 0.001]. The VAS pain intensity during coughing was lower in group TA [1 h: 46 (30–58) vs. 59 (48–69) mm, p < 0.001; 6 h: 51 (40–63) vs. 60 (45–71) mm, p < 0.001]. Moreover, PCA consumptions during the first 6 h and between 6–24 h post-surgery was significantly lower in group TA. Other postoperative outcomes did not differ between the two groups. Conclusions: Multimodal analgesia with intraoperative paracetamol and nefopam infusions improved postoperative pain control in living-donor KT recipients who received a preoperative TAP block. Our findings demonstrate the efficacy of paracetamol and nefopam infusions in KT recipients.

This study aimed to evaluate the analgesic properties of nefopam and the adjuvant effects of caffeine. It also investigated the anti-inflammatory effect of co-administering nefopam and caffeine on Prostaglandin E2 level (PGE2). The study involved 56 female albino mice (Mus musculus), divided into seven groups, eight mice per each group. Group A which served as the control group received distilled water; Group B received 30 mg/kg BW of nefopam orally; Group C received 28.5 mg/BW of nefopam and 5 mg/BW of caffeine orally; Group D received 27 mg/BW of nefopam and 10 mg/BW of caffeine orally; Group E received 25.5 mg/BW of nefopam and 15 mg/BW of caffeine orally; Group F received 24 mg/BW of nefopam and 20 mg/BW of caffeine orally; Group G received 22.5 mg/BW of nefopam and 25 mg/BW of caffeine orally. The nociceptive response was assessed using the formalin test, showing a significant (P

AbstractBackground: Acute renal colic is a severe and sudden form of loin pain that usually radiates from the flank towards the groin. Acute renal colic is one of the common causes of emergency department admission worldwide. Nefopam has a unique analgesic effect, that differs pharmacologically from nonsteroidal anti-inflammatory drugs, opioids, or paracetamol and has a potential role in multimodal analgesia. Furthermore, studies have found that nefopam has opioid-sparing effects postoperatively following urological surgery, making it a suitable option for urologists and emergency physicians. Aim: This review aims to survey the literature regarding the efficacy of nefopam in treating acute renal colic. Conclusion: This review revealed that the efficacy of nefopam in treating acute renal colic has not been established in any clinical trial, nor has it been included in any international guidelines. Nonsteroidal anti-inflammatory drugs and intravenous paracetamol are first-line agents in the management of acute renal colic.

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Background: Catheter-related bladder discomfort (CRBD) is a frequent occurrence following urinary catheterization during surgical procedures, as well as a commonly experienced bladder pain syndrome after surgery. There have been various studies on drugs and interventions to manage CRBD, but their comparative efficacy and safety are still a topic of debate. We conducted a meta-analysis to assess the efficacy and safety of nefopam for managing postoperative CRBD.Methods: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to find randomized controlled trials (RCTs) on using nefopam in postoperative CRBD. The study employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data analysis was performed using RevMan version 5.4.1.Results: Five RCTs with 405 patients were analyzed to evaluate the efficacy of nefopam on postoperative CRBD. Short-term and long-term periods were defined as within 6 h and longer than 12 h after surgery, respectively. The incidence and severity of CRBD were compared between the two groups during these time periods. The analysis proved that nefopam reduced the short-term incidence of postoperative CRBD (RR 0.36; 95% CI, 0.18–0.70; p = 0.003, I² = 78%) and the long-term incidence (RR 0.49; 95% CI, 0.32–0.74; p = 0.0007, I² = 0%) significantly. We compared the incidence of moderate-to-severe CRBD between groups based on the scaling system (none, mild, moderate, and severe). This was used to assess the severity of postoperative CRBD. The results showed that patients in the nefopam group had a significantly lower incidence of moderate-to-severe CRBD compared to those in the placebo group in the short-term (RR 0.19; 95% CI, 0.10–0.34; p < 0.00001; I² = 0%). However, there were no significant differences between the two groups in the incidence of moderate-to-severe CRBD in the long-term (RR 0.61; 95% CI, 0.21–1.76; p = 0.36; I² = 0%). There were no significant variations in the occurrence of adverse events between the nefopam and control groups, mainly including postoperative nausea and vomiting (PONV) (RR 1.14; 95% CI, 0.40–3.21; p = 0.81), and tachycardia (RR 0.25; 95% CI, 0.03–2.11, p = 0.20).Conclusion: The findings of this meta-analysis indicate that nefopam significantly reduced the incidence of short or long-term postoperative CRBD. Nefopam decreased the severity of postoperative CRBD, particularly significantly reducing the occurrence of moderate to severe CRBD in the short-term. Overall, patients have good tolerance and no apparent side effects. [ABSTRACT FROM AUTHOR]

Postoperative residual pain and dysesthesia in patients with lumbar spinal stenosis (LSS) can reduce patient satisfaction. We investigated the effects of nefopam on dysesthesia, postoperative pain, and satisfaction in patients with LSS who underwent spine surgery. A total of 73 patients were randomly assigned to two groups: the nefopam group (n = 35), receiving a 20 mL normal saline-based solution containing nefopam 20 mg, and the control group (n = 38), which received 20 mL of normal saline 1 h before the end of the operation. Postoperative incisional pain, dysesthesia scores, and overall satisfaction with postoperative pain management were evaluated. The severity of dysesthesia within 12 and 24 h in the nefopam group was significantly lower than that in the control group (2.3 ± 1.9 and 1.7 ± 1.6 vs. 3.3 ± 2.1, and 2.6 ± 1.9, respectively; p = 0.029 and p = 0.048). Satisfaction scores for postoperative pain management were significantly higher in the nefopam group (3.7 ± 0.6 vs. 3.1 ± 1.0, respectively; p = 0.006). The administration of nefopam effectively reduced the severity of dysesthesia within 24 h of surgery in geriatric patients undergoing spine surgery and increased patient satisfaction with postoperative pain management. [ABSTRACT FROM AUTHOR]

Study Design This was a randomized double-blind controlled study. Purpose This study was designed to evaluate the effects of intravenous nefopam regarding its ability to reduce morphine consumption and postoperative pain and improve recovery in patients undergoing open spine surgery. Overview of Literature Multimodal analgesia, including nonopioid medications, is essential for pain management in spine surgery. Evidence regarding the use of intravenous nefopam in open spine surgery as part of enhanced recovery after surgery is lacking. Methods In this study, 100 patients undergoing lumbar decompressive laminectomy with fusion were randomized into two groups. The nefopam group received 20-mg intravenous nefopam diluted in 100-mL normal saline intraoperatively, followed by 80-mg nefopam diluted in 500-mL normal saline, administered as a continuous infusion postoperatively for 24 hours. The control group received an identical volume of normal saline. Postoperative pain was managed using intravenous morphine via patient-controlled analgesia. Morphine consumption in the first 24 hours was recorded as the primary outcome. Secondary outcomes, including postoperative pain score, postoperative function, and length of hospital stay (LOS), were assessed. Results No statistically significant differences in the total morphine consumption and postoperative pain score in the first 24 hours postoperatively between the two groups. At the post-anesthesia care unit (PACU), the nefopam group demonstrated lower pain scores while at rest (p=0.03) and upon movement (p=0.02) than the normal saline group. However, the severity of postoperative pain between the two groups was similar from postoperative day 1 to day 3. LOS was significantly shorter in the nefopam group than in the control group (p

Anesthesia is used in animals to relieve pain during surgical interference or other procedures which were likely causing pain. Safe, effective, and reversible anesthesia requires selecting proper anesthetic agents. This study aimed to evaluate the qualitative and quantitative aspects of total intravenous anesthesia (TIVA) induced by using nefopam/xylazine/ ketamine and propofol combination in local breed donkeys. Nefopam/xylazine/ ketamine and propofol anesthetic combination was evaluated for pain management by using nefopam to provide the maintenance of the anesthetic stage. The onset and duration of anesthetic induction, time of maintenance, and period of recovery were recorded. Furthermore, heart rate, respiratory rate, body temperature, and blood picture were analyzed before and after administration of the combination. Our findings revealed that administration of Nefopam/ xylazine/ ketamine and propofol combination led to a smooth induction with rapid onset within one minute. The anesthetic effect was maintained for approximately 31 minutes after continuous infusion of propofol for standard deviation (19±2 minutes). This was followed by a smooth recovery within approximately 48 minutes after induction of anesthesia. It concluded that nefopam/xylazine/ketamine and propofol infusion is considered satisfactory for pain management and provide satisfactory anesthesia for short surgical procedures in donkeys.

Objective To examine the effectiveness of nefopam on postoperative pain control after anorectal surgeries.

Abstract Background Catheter-related bladder discomfort (CRBD) is a common postoperative bladder pain syndrome. Many drugs and interventions for managing CRBD have been studied, but their comparative effectiveness remains controversial. We made a study to assess the comparative effectiveness of interventions included Ketorolac, Lidocaine, Chlorpheniramine, Gabapentin, Magnesium, Nefopam, Oxycodone, Parecoxib, Solifenacin, Tolterodine, Bupivancaine, Dexmedetomidine, Hyoscine N-butyl bromide, Ketamine, Penile nerve block on urological postoperative CRBD. Methods We performed a network meta-analysis via Aggregate Data Drug Inormation System software included 18 studies with 1816 patients and assessed the risk of bias by Cochrane Collaboration tool. The incidence of moderate to severe CRBD at 0, 1, and 6 h after surgery and the incidence severe CRBD at 1 h after surgery were compared. Result The number of best rank is 0.48(Nefopam) and 0.22(Nefopam) in the incidence of moderate to severe CRBD at 1 h and incidence severe CRBD at 1 h. More than half of studies at unclear or high risk of bias. Conclusion Nefopam reduced the incidence of CRBD and prevented severe events, but limited by the small number of studies for each intervention and heterogeneous patients.

Study Design: This was a randomized double-blind controlled study. Purpose: This study was designed to evaluate the effects of intravenous nefopam regarding its ability to reduce morphine consumption and postoperative pain and improve recovery in patients undergoing open spine surgery. Overview of Literature: Multimodal analgesia, including nonopioid medications, is essential for pain management in spine surgery. Evidence regarding the use of intravenous nefopam in open spine surgery as part of enhanced recovery after surgery is lacking. Methods: In this study, 100 patients undergoing lumbar decompressive laminectomy with fusion were randomized into two groups. The nefopam group received 20-mg intravenous nefopam diluted in 100-mL normal saline intraoperatively, followed by 80-mg nefopam diluted in 500-mL normal saline, administered as a continuous infusion postoperatively for 24 hours. The control group received an identical volume of normal saline. Postoperative pain was managed using intravenous morphine via patient-controlled analgesia. Morphine consumption in the first 24 hours was recorded as the primary outcome. Secondary outcomes, including postoperative pain score, postoperative function, and length of hospital stay (LOS), were assessed. Results: No statistically significant differences in the total morphine consumption and postoperative pain score in the first 24 hours postoperatively between the two groups. At the post-anesthesia care unit (PACU), the nefopam group demonstrated lower pain scores while at rest (p =0.03) and upon movement (p =0.02) than the normal saline group. However, the severity of postoperative pain between the two groups was similar from postoperative day 1 to day 3. LOS was significantly shorter in the nefopam group than in the control group (p <0.01). The time to first sitting and walking and PACU discharge between the two groups were comparable. Conclusions: Perioperative intravenous nefopam demonstrated significant pain reduction during the early postoperative period and shortened LOS. Nefopam is considered safe and effective as a part of multimodal analgesia in open spine surgery. [ABSTRACT FROM AUTHOR]

Introduction: Pain is a disturbing condition that may increase postoperative patient complains. Moderate to severe postoperative pain require the use of more potent analgesics such as Nefopam, a centrally acting non-opioid analgesic. Despite its common use, the effect of nefopam on the histology of lung, kidney and heart is not well documented. Aim of the Work: The goal of this work is to explore the changes induced by nefopam on the lung, kidney, and heart tissues and investigate the protective role of black seed oil (Nigella sativa oil) on these tissues. Material and Methods: Eighteen adult healthy albino rats of both sexes were randomly divided into three groups, 6 rats in each. Group I considered as a control group. Group II received intraperitoneal Nefopam (10 mg/kg body weight) for one month. Group III received black seed oil orally (0.2 ml/kg) through oral gavage one day preceding each intraperitoneal injection of Nefopam for one month period. Lung, kidney and heart of the three groups were removed and prepared for histological examination by light microscope. Morphometric measurements were done to compare some parameters among the groups. Results: Compared to control, several pathological changes were seen in Nefopam treated rats. Sections of lungs revealed inflammatory cell infiltration as well as emphysematous dilatation of the alveoli. Shrinkage of the glomerular tuft with widening of the urinary spaces was seen in kidney sections. On the other hand, heart section showed sever congestion and haemorrhage of the blood vessels and oedema in between the cardiac muscle fibers. Pretreatment with black seed oil efficiently alleviate the changes induced by Nefopam on the lung, kidney and heart tissue and reverts the abnormal structure to become near normal. Conclusion: Nefopam induces marked structural changes in the lung, kidney and heart of albino rats. These changes were effectively reversed by pretreatment with black seed oil. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study explored how nefopam, a non-opioid analgesic in a multimodal regimen, impacts postoperative pain, opioid use, and recovery quality in single-port robot-assisted laparoscopic cholecystectomy (RALC) patients with a parietal pain block, addressing challenges in postoperative pain management. Materials and Methods: Forty patients scheduled for elective single-port RALC were enrolled and randomized to receive either nefopam or normal saline intravenously. Parietal pain relief was provided through a rectus sheath block (RSB). Postoperative pain was assessed using a numeric rating scale (NRS) in the right upper quadrant (RUQ) of the abdomen, at the umbilicus, and at the shoulder. Opioid consumption and recovery quality, measured using the QoR-15K questionnaire, were also recorded. Results: The 40 patients had a mean age of 48.3 years and an average body mass index (BMI) of 26.2 kg/m2. There were no significant differences in the pre- or intraoperative variables between groups. Patients receiving nefopam reported significantly lower RUQ pain scores compared to the controls, while the umbilicus and shoulder pain scores were similar. Rescue fentanyl requirements were lower in the nefopam group in both the PACU and ward. The QoR-15K questionnaire scores for nausea and vomiting were better in the nefopam group, but the overall recovery quality scores were comparable between the groups. Conclusions: Nefopam reduces RUQ pain and opioid use post-single-port RALC with a parietal pain block without markedly boosting RSB’s effect on umbilicus or shoulder pain. It may also better manage postoperative nausea and vomiting, underscoring its role in analgesia strategies for this surgery.

Study Design Randomized double-blind control study. Purpose To evaluate the effects of nefopam on reducing morphine consumption and postoperative pain in patients undergoing minimally invasive spine surgery (MISS) and to evaluate its effects on enhanced recovery after spine surgery. Overview of Literature Enhanced recovery after surgery (ERAS) has become a major goal for spine surgery. Multimodal pain management combining non-opioid analgesics is a key element of this. However, there is little evidence regarding the use of nefopam in spine surgery as part of an ERAS protocol. Methods One hundred patients undergoing MISS were randomized into two groups. Patients in the nefopam group received 20 mg of intravenous nefopam diluted in 100 mL of normal saline intraoperatively, followed by 80 mg of nefopam diluted in 500 mL of normal saline, given as a continuous infusion postoperatively for 24 hours. The control group received an identical volume of normal saline. Postoperative pain was managed by patient-controlled analgesia in the form of intravenous morphine. Morphine consumption in the first 24 hours was recorded as a primary outcome. Secondary outcomes regarding ERAS were also collected. Results There were no significant differences in either total morphine consumption or postoperative pain score in the first 24 hours postoperatively between patients receiving nefopam and the control group. Morphine consumption in patients receiving nefopam was 13.54±10.64 mg compared with 15.86±16.2 mg in the control group (p=0.41). Time to postanesthetic care unit discharge, times to first sitting and walking, length of hospital stay, as well as duration of Foley catheter use and time until drain removal were also similar. There were no serious adverse effects of nefopam compared with normal saline. Conclusions Nefopam did not significantly reduce opioid consumption or postoperative pain score. Adding nefopam as part of multimodal analgesia did not show beneficial effects for enhancing recovery after spine surgery.

Background: Catheter-related bladder discomfort (CRBD) is a common postoperative bladder pain syndrome. Many drugs and interventions for managing CRBD have been studied, but their comparative effectiveness remains controversial. We made a study to assess the comparative effectiveness of interventions included Ketorolac, Lidocaine, Chlorpheniramine, Gabapentin, Magnesium, Nefopam, Oxycodone, Parecoxib, Solifenacin, Tolterodine, Bupivancaine, Dexmedetomidine, Hyoscine N-butyl bromide, Ketamine, Penile nerve block on urological postoperative CRBD. Methods: We performed a network meta-analysis via Aggregate Data Drug Inormation System software included 18 studies with 1816 patients and assessed the risk of bias by Cochrane Collaboration tool. The incidence of moderate to severe CRBD at 0, 1, and 6 h after surgery and the incidence severe CRBD at 1 h after surgery were compared. Result: The number of best rank is 0.48(Nefopam) and 0.22(Nefopam) in the incidence of moderate to severe CRBD at 1 h and incidence severe CRBD at 1 h. More than half of studies at unclear or high risk of bias. Conclusion: Nefopam reduced the incidence of CRBD and prevented severe events, but limited by the small number of studies for each intervention and heterogeneous patients. [ABSTRACT FROM AUTHOR]

No former studies are dealing with the pharmacological (pharmacodynamics and pharmacokinetics) interaction between nefopam and tramadol in the chicks' model. The median effective doses (ED50s) for nefopam and tramadol produces analgesia has been estimated each alone as 9.24 and 0.83 mg/kg, IP, respectively. The interaction concerning nefopam and tramadol combination was estimated by isobolographic analysis to be 2.91 and 0.25 mg/kg, IP. The kind of interaction between nefopam and tramadol was synergistic as indicated by the interaction index 0.61. The analgesic efficacy of the combination was significantly different from nefopam and tramadol administered alone. Nefopam plasma concentration 18.48 mg/kg, IP for different measured times 0.5, 1, 2, 4, and 24 hours 33.25, 27.10, 15.05, 13.61, and 2.45 µg/ml while the concentration was increased once coadministered with tramadol 1.66 mg/kg, IP by 22, 26, 43, 45, and 81% been 40.72, 34.27, 21.53, 19.76, and 4.43 µg/ml, respectively. Nefopam pharmacokinetic profile comprised of area-under-curve (AUC), area-under-moment-curve (AUMC), mean-residence-time (MRT), half-life (t1/2β), maximal concentration (Cmax) amplified after tramadol is coadministered with nefopam by 52, 260, 23, 15, and 22%. The elimination constant (Kel), distribution volume (VD), clearance (Cl) were diminished 13, 25, and 29%, similarly. The sum results suggested a synergistic interaction between nefopam and tramadol along with a modification in nefopam pharmacokinetic parameters which improve the therapeutic efficacy of nefopam in the chickens besides, advocate using these two drugs as preanesthetics in veterinary medicine.

Purpose: Transurethral resection of prostate (TURP) with postoperative catheter traction can lead to significant catheter-related bladder discomfort (CRBD). This condition causes many postoperative complications and low patient satisfaction. This study aimed to evaluate the effectiveness of preoperative single-dose intravenous nefopam on the incidence and severity of CRBD and its adverse effects. Methods: This randomized, controlled, double-blind study included patients who underwent TURP under spinal anesthesia with postoperative urinary catheter traction. Patients were allocated into nefopam (NF) and normal saline (NS) groups. Twenty mg of nefopam in normal saline solution (NSS) 100 mL or NSS 100 mL were given intravenously before TURP. The primary outcome was the incidence of CRBD. Results: Seventy-three patients were randomized into NF (n = 37) and NS (n = 36) groups. There were 35 and 33 patients in the NF and NS groups, respectively, in the final analysis. The incidences of CRBD were 45.71% and 84.85% in the NF and NS groups at 6 h after operation, respectively, OR 0.54 (95% CI 0.36, 0.73), while before the end of catheter traction, the corresponding incidences were 37.14% and 75.76%, respectively, OR 0.49 (95% CI 0.28, 0.84). The CRBD scores were statistically significantly lower in the NF group at both time points. Morphine consumptions and adverse effects were not different between groups. Patient satisfaction was higher in the NF group. Conclusions: Single-dose nefopam significantly reduced the incidence and severity of CRBD in patients undergoing TURP with urinary catheter traction at 6 h after the procedure and before the end of catheter traction without increasing the adverse effects. [ABSTRACT FROM AUTHOR]

The objective designated to discover the analgesic effect of nefopam in the normal (non-stressed) chickens and its possible alteration due to hydrogen peroxide (H2O2)-induced oxidative stress (OS) in 7-14 day old chickens. The analgesia of nefopam has been increased by 47% in the stressed chickens by measuring the analgesic Median Effective Dose (ED50) value. This value was 9.10 mg/kg, IM in the normal chickens where it became 4.80 mg/kg, IM in stressed chickens. There is a significant rise in the antinociceptive action of nefopam 18 mg/kg, IM by 88% in the stressed group of chickens in comparison with the normal one elicited by an electro-stimulation and formaldehyde 0.05 ml of 0.1% tests for induction of nociception. The observations showed several significant stimulatory modifications in the neurobehaviour when nefopam treated with a subtle dosage 1 mg/kg, IM in the stressed chickens concerning the latency to move, squares crossed and time of the tonic immobility response test. Significant damage was detected in the liver function when nefopam injected at 18 mg/kg, IM in stress chickens in comparison to normal one by 28, 33 and 65% as estimated through Alkaline phosphatase (ALP), Aspartate trans-aminase (AST) and Alanine trans-aminase (ALT) concentrations in the serum, respectively. The sum of data findings indicated that H2O2-inducedOS increased the analgesic activity of nefopam in the chickens; despite the changes occur on the neurobehaviour and liver function. The dose of nefopam should be reduced when preparing the therapeutic regimen in the stressed animals.