Intraoperative and Postoperative Nefopam Administration for Video-assisted Thoracoscopic Lobectomy Pain: A Multicenter, Randomized, Controlled Trial

Abstract

Objective: Intraoperative nefopam infusion was documented as safe and viable for supplemental pain management, alongside opioids following surgery. Postoperative pain control with nefopam after video-assisted thoracoscopic surgery (VATS) is not well understood. This study assessed the effects of nefopam towards postoperative morphine requirements and pain intensity 24 hours after VATS lobectomies. Materials and Methods: This multicenter, double-blind, randomized, controlled trial enrolled 18-70-year-old elective VATS lobectomy patients. Patients were randomized 1:1, receiving nefopam or normal saline solution (NSS) administered during the maintenance of anesthesia and 24-hour postoperative period. All received multimodal analgesia, including paracetamol, ibuprofen, and intercostal nerve blocks. Postoperative morphine was administered via patient-controlled analgesia (PCA) devices and recorded at 10 and 30 minutes, and 1, 2, 6, 12, 18 and 24 hours. Postoperative pain was graded at rest and during deep breathing using numeric rating scale (NRS) scores 1, 2, 12, and 24 hours. Results: Of 72 enrolled patients, 70.8% were female, with a mean (± standard deviation) age of 56.5 ± 10.4 years. No significant postoperative difference was observed between groups for: total median (P<inf>25</inf>, P<inf>75</inf>) morphine amounts administered over 24 hours (nefopam, 14 [8, 24] mg; control, 8 [4.5, 19] mg; p = 0.17); NRS pain scores during rest (p = 0.98) or deep breathing (p = 0.82) 1, 2, 12, and 24 hours Conclusion: Intraoperative and postoperative nefopam infusion, including multimodal analgesia, did not reduce morphine consumption or NRS pain scores in VATS lobectomy, but may have prolonged the duration of pain relief.