Morphine-Sparing Effect of Intermittent Versus Continuous Intravenous Infusion of Nefopam in Patients After Total Knee Arthroplasty: A Randomized Trial

Woratanat Kachacheewa; Thitima Wattanavijitkul; Siwadol  Wongsak; Theerawat  Chalacheewa

doi:10.33165/rmj.2024.47.3.268540

Authors

Woratanat Kachacheewa Pharmacy Division, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Thitima Wattanavijitkul Department of of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
Siwadol Wongsak Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Theerawat Chalacheewa Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33165/rmj.2024.47.3.268540

Keywords:

Nefopam, Morphine-sparing effect, Total knee arthroplasty, Intravenous infusion, Multimodal analgesia

Abstract

Background: Nefopam, a nonopioid analgesic, is recommended to improve pain control and minimize opioid-related side effects following total knee arthroplasty (TKA).

Objective: To compare cumulative morphine consumption between intermittent infusion (II) and continuous infusion (CI) of nefopam, combined with other multimodal analgesics, in TKA patients.

Methods: Fifty-eight patients were randomly assigned to receive either intermittent nefopam infusion (II group) (20 mg IV every 6 hours) or continuous infusion (CI group) (80 mg/day). The primary outcome was cumulative morphine consumption via patient-controlled analgesia, with secondary outcomes including pain scores every 4 hours and adverse drug reactions (ADRs).

Results: No significant difference was found in cumulative morphine consumption (median [range], 4 [0 -12] mg in II and 6 [0 - 18] mg in CI; P = .579) and the ADRs over 48 hours between groups. At 4 hours, the II group had significantly lower pain scores compared to the CI group (median [range], 0 [0 - 4] and 0 [0 - 8]; P = .008). However, by 24 and 36 hours, the CI group reported significantly lower pain scores compared to the II group; median (range), 0 (0 - 5) vs 2 (0 - 9) at 24 hours (P = .020) and 0 (0 - 4) vs 2 (0 - 8) at 36 hours (P = .014).

Conclusions: Both intermittent and continuous nefopam infusion in primary TKA showed no significant difference in morphine-sparing or occurrence of ADRs within the 48-hour follow-up period. These findings suggest that both infusion methods are comparable in managing post-operative pain in TKA patients.

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