Girard Philippe, Chauvin Marcel, Verleye Marc
Pharmacology Department, Biocodex, Compiègne, France.
Department of Anaesthesia, Hôpital Ambroise Paré, Boulogne, France.
Clin Exp Pharmacol Physiol. 2016 Jan;43(1):3-12. doi: 10.1111/1440-1681.12506.
Nefopam is a non-opioid, non-steroidal, centrally acting analgesic drug used to prevent postoperative pain, primarily in the context of multimodal analgesia. This paper reviews preclinical and clinical studies in which nefopam has been combined with opioids, non-steroidal anti-inflammatory compounds, and paracetamol. This report focuses on the literature during the last decade and discusses the translational efforts between animal and clinical studies in the context of multimodal or balanced analgesia. In preclinical rodent models of acute and inflammatory pain, nefopam combinations including opioids revealed a synergistic interaction or enhanced morphine analgesia in six out of seven studies. Nefopam combinations including non-steroidal anti-inflammatory drugs (NSAIDs) (aspirin, ketoprofen or nimesulide) or paracetamol likewise showed enhanced analgesic effects for the associated compound in all instances. Clinical studies have been performed in various types of surgeries involving different pain intensities. Nefopam combinations including opioids resulted in a reduction in morphine consumption in 8 out of 10 studies of severe or moderate pain. Nefopam combinations including NSAIDs (ketoprofen or tenoxicam) or paracetamol also demonstrated a synergic interaction or an enhancement of the analgesic effect of the associated compound. In conclusion, this review of nefopam combinations including various analgesic drugs (opioids, NSAIDs and paracetamol) reveals that enhanced analgesia was demonstrated in most preclinical and clinical studies, suggesting a role for nefopam in multimodal analgesia based on its distinct characteristics as an analgesic. Further clinical studies are needed to evaluate the analgesic effects of nefopam combinations including NSAIDs or paracetamol.
奈福泮是一种非阿片类、非甾体类、中枢性镇痛药，主要用于多模式镇痛中预防术后疼痛。本文综述了奈福泮与阿片类药物、非甾体类抗炎化合物及对乙酰氨基酚联合应用的临床前和临床研究。本报告重点关注过去十年的文献，并讨论在多模式或平衡镇痛背景下动物研究与临床研究之间的转化研究成果。在急性和炎性疼痛的临床前啮齿动物模型中，七项研究中有六项显示，含阿片类药物的奈福泮联合用药呈现协同作用或增强了吗啡的镇痛效果。含非甾体类抗炎药（阿司匹林、酮洛芬或尼美舒利）或对乙酰氨基酚的奈福泮联合用药在所有情况下同样显示增强了相关化合物的镇痛效果。针对不同疼痛强度的各类手术开展了临床研究。在十项关于重度或中度疼痛的研究中，十项里有八项显示，含阿片类药物的奈福泮联合用药使吗啡用量减少。含非甾体类抗炎药（酮洛芬或替诺昔康）或对乙酰氨基酚的奈福泮联合用药也显示出协同作用或增强了相关化合物的镇痛效果。总之，本综述对含各类镇痛药（阿片类药物、非甾体类抗炎药和对乙酰氨基酚）的奈福泮联合用药进行了研究，结果显示，大多数临床前和临床研究都证明联合用药增强了镇痛效果，这表明奈福泮凭借其独特的镇痛特性在多模式镇痛中发挥了作用。需要进一步开展临床研究来评估含非甾体类抗炎药或对乙酰氨基酚的奈福泮联合用药的镇痛效果。
