Woratanat KachacheewaThitima WattanavijitkulSiwadol WongsakTheerawat Chalacheewa2025-05-132025-05-132025-05-132024Ramathibodi Medical Journal. Vol. 47, No. 3 (Jul - Jun 2024), 12-210125-3611 (Print)2651-0561 (Online)https://repository.li.mahidol.ac.th/handle/20.500.14594/110056Background: 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.application/pdfengผลงานนี้เป็นลิขสิทธิ์ของมหาวิทยาลัยมหิดล ขอสงวนไว้สำหรับเพื่อการศึกษาเท่านั้น ต้องอ้างอิงแหล่งที่มา ห้ามดัดแปลงเนื้อหา และห้ามนำไปใช้เพื่อการค้าNefopamMorphine-sparing effectTotal knee arthroplastyIntravenous infusionMultimodal analgesiaOriginal ArticlePharmacy Division Faculty of Medicine Ramathibodi Hospital Mahidol UniversityDepartment of of Pharmacy Practice Faculty of Pharmaceutical Sciences Chulalongkorn UniversityDepartment of Orthopaedics Faculty of Medicine Ramathibodi Hospital Mahidol UniversityDepartment of Anesthesiology Faculty of Medicine Ramathibodi Hospital Mahidol University