Chalermkitpanit Pornpan, Yingsakmongkol Wicharn, Limthongkul Worawat, Tanasansomboon Teerachat, Pannangpetch Patt, Tangchitcharoen Nattapat, Singhatanadgige Weerasak
Pain Management Research Unit, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Asian Spine J. 2023 Aug;17(4):632-638. doi: 10.31616/asj.2022.0358. Epub 2023 Jul 6.
This was a randomized double-blind controlled study.
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.
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.
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.
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.
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.
这是一项随机双盲对照研究。
本研究旨在评估静脉注射奈福泮在减少接受开放性脊柱手术患者的吗啡用量、术后疼痛及改善恢复情况方面的效果。
多模式镇痛，包括非阿片类药物，对于脊柱手术的疼痛管理至关重要。缺乏关于静脉注射奈福泮作为手术强化康复一部分用于开放性脊柱手术的证据。
在本研究中，100例行腰椎减压椎板切除融合术的患者被随机分为两组。奈福泮组术中接受20毫克静脉注射奈福泮稀释于100毫升生理盐水中，术后接受80毫克奈福泮稀释于500毫升生理盐水中持续输注24小时。对照组接受相同体积的生理盐水。术后疼痛通过患者自控镇痛使用静脉注射吗啡进行管理。记录前24小时的吗啡用量作为主要结局。评估次要结局，包括术后疼痛评分、术后功能及住院时间（LOS）。
两组术后24小时内的总吗啡用量及术后疼痛评分无统计学显著差异。在麻醉后恢复室（PACU），奈福泮组静息时（p = 0.03）及活动时（p = 0.02）的疼痛评分低于生理盐水组。然而，两组术后第1天至第3天的术后疼痛严重程度相似。奈福泮组的住院时间显著短于对照组（p < 0.01）。两组首次坐起和行走时间及PACU出院时间相当。
围手术期静脉注射奈福泮在术后早期显示出显著的疼痛减轻且缩短了住院时间。奈福泮作为开放性脊柱手术多模式镇痛的一部分被认为是安全有效的。
