Lekprasert Varinee, Yapanan Lapuskorn, Ittichaikulthol Wichai, Buachai Rungrawan, Soisod Phimol, Sophonsritsuk Areepan
Department of Anesthesiology, Faculty of Medicine Ramathidodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathidodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Anesthesiol Res Pract. 2021 Feb 12;2021:5461890. doi: 10.1155/2021/5461890. eCollection 2021.
Nefopam is a non-NSAIDs and opioid sparing centrally acting drug which is effective for a multimodal postoperative analgesia. The present study aimed to evaluate the analgesic efficacy of nefopam combined with parecoxib for gynecologic surgery.
This randomized double-blinded control trial recruited participants ( = 72) who underwent gynecologic surgeries and divided them into either a nefopam or control group. The study group received parecoxib 40 mg plus nefopam 20 mg, while the control group received parecoxib 40 mg plus normal saline solution intravenously during open abdominal gynecological surgery. Both groups then received either nefopam or normal saline every 6 hours postoperatively for 24 hours. Intravenous patient-controlled analgesia with morphine was given for breakthrough pain within 24 h. The participants were evaluated for morphine consumption within 24 hours and postoperative pain using a verbal numerical rating scale (VNRS) at a postanesthetic care unit, at 6-, 12-, and 24-hour postoperative periods. Adverse effects were recorded.
Morphine consumption within 24 hours and adverse effects were not significantly different between both groups. Mean difference and 95% confident interval of morphine consumption between both groups was 1.00 (-4.56, 4.76), =0.97. The VNRS on movement at 6 hours after surgery of the nefopam group was significantly different from that of the control group [mean (SD), 4.14 (2.11) vs. 5.14 (1.80), =0.04]. The VNRS of the nefopam group at 12 hours after operation during resting and on movement was significantly different from that of the control group ([mean (SD), 1.47 (1.80) vs. 2.54 (2.15), =0.03], [mean (SD), 3.22 (1.84) vs 4.17 (1.74), =0.03]), respectively.
The combined administration of nefopam and parecoxib during gynecologic surgery slightly reduced the VNRS at 6 and 12 hours postoperatively more than treatment with parecoxib.
奈福泮是一种非甾体抗炎药和阿片类药物节省型中枢作用药物，对多模式术后镇痛有效。本研究旨在评估奈福泮联合帕瑞昔布用于妇科手术的镇痛效果。
本随机双盲对照试验招募了接受妇科手术的参与者（n = 72），并将他们分为奈福泮组或对照组。研究组在开腹妇科手术期间静脉注射帕瑞昔布40mg加奈福泮20mg，而对照组静脉注射帕瑞昔布40mg加生理盐水。两组术后每6小时接受一次奈福泮或生理盐水，共24小时。术后24小时内，对于爆发性疼痛给予静脉自控吗啡镇痛。在麻醉后护理单元、术后6小时、12小时和24小时，使用言语数字评定量表（VNRS）评估参与者24小时内的吗啡消耗量和术后疼痛情况。记录不良反应。
两组24小时内的吗啡消耗量和不良反应无显著差异。两组间吗啡消耗量的平均差异和95%置信区间为1.00（-4.56，4.76），P = 0.97。奈福泮组术后6小时运动时的VNRS与对照组有显著差异[平均值（标准差），4.14（2.11）对5.14（1.80），P = 0.04]。奈福泮组术后12小时休息时和运动时的VNRS与对照组有显著差异（[平均值（标准差），1.47（1.80）对2.54（2.15），P = 0.03]，[平均值（标准差），3.22（1.84）对4.17（1.74），P = 0.03]）。
妇科手术期间联合使用奈福泮和帕瑞昔布比单独使用帕瑞昔布在术后6小时和12小时能稍微降低VNRS。
