Nefopam as an adjunct to intravenous patient-controlled analgesia after renal transplantation: a randomised trial.
Kim SY, et al.Acta anaesthesiologica Scandinavica 2015 Sep;59(8):1068-75
Aims
To investigate the efficacy of nefopam as an adjunct to fentanyl-based intravenous patient-controlled analgesia (IV PCA) on post-operative pain relief in patients undergoing renal transplantation.
Interventions
Patients were randomly assigned to receive either nefopam (160 mg in 200 ml at a rate of 4 ml/h) versus volume matched normal saline infusion as placebo, in the first 48 h after reperfusion of grafted kidney.
Participants
98 patients aged 20-64 years undergoing elective living donor renal transplantation
Outcomes
The primary outcome was cumulative fentanyl consumption during the first 48 h after operation. Secondary outcomes measured were pain intensity, adverse events and the need for additional analgesics. Quantitative data (age, height, weight and operation details) were also analysed along with categorical data (sex, history of motion sickness or post-operative nausea and vomiting, smoking, pre-operative dialysis, coexisting disease and pethidine administration).
Follow-up
7 days
CET Conclusions
This is a small but well conducted study in which nefopam was used as an adjuvant to opioid analgesia after elective living related renal transplantation. The nefopam group received nefopam for 48 hours, while the control group received saline as a placebo. Both groups received opioid based intravenous patient controlled analgesia (IV PCA) with fentanyl. The primary end point was cumulative fentanyl consumption and this was significantly less in the 48 hours after surgery in the nefopam group, as was the pain intensity scores at the same time. Adverse events and early graft function were similar between the two groups, but there was less drowsiness in the nefopam group. The authors conclude that the addition of nefopam to fentanyl PCA does spare the amount of opioid required in the first 48 hours of surgery and there are no significant side effects. Thus nefopam is a suitable non opioid analgesic after renal transplantation.
Data analysis
Modified intention-to-treat analysis
Trial registration
Clinicaltrials.gov - NCT01622881