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Abstract
Background and Aims Evidence regarding intravenous nefopam in open spine surgery is lacking as part of enhanced recovery after surgery (ERAS). This study aimed to evaluate intravenous nefopam’s effect on reducing morphine consumption, postoperative pain, and functional outcomes.
Methods One hundred patients undergoing lumbar decompressive laminectomy with fusion were randomized into two groups. The nefopam group received 20 mg of intravenous nefopam diluted in 100 ml normal saline intraoperatively, followed by nefopam 80 mg diluted in 500 ml 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 with patient-controlled analgesia (PCA) intravenous morphine. Morphine consumption in the first 24 hours was recorded as a primary outcome.
Results No statistically significant difference in total morphine consumption and postoperative pain score in the first 24 hours postoperatively between the two groups. At the PACU, patients in the nefopam group demonstrated lower pain scores while at rest (p=0.03) and upon movement (p=0.02) compared to the normal saline group. However, the severity of postoperative pain between the two study groups was similar from postoperative day 1 to day 3. LOS in patients who received nefopam was significantly shorter than patients in the control group (p<0.01). The two groups’ time to first sitting and walking and PACU discharge were comparable.
A CONSORT flow diagram of the study was shown
Primary and secondary outcomes between the two study groups
Postoperative pain score: resting pain (left) and upon movement (right). *P < 0.05
Conclusions Perioperative intravenous nefopam demonstrated significant pain reduction during the early postoperative period and shortened LOS. Nefopam is considered effective as a part of multimodal analgesia in open spine surgery.