Nefopam for Analgesia Following Cardiac Surgery: A Randomized Placebo-Controlled Double-Blind Clinical Trial

Area of Science:

• Anesthesiology
• Pharmacology
• Cardiovascular Surgery

Background:

• Postoperative pain management after cardiac surgery often relies on opioids, which carry risks.
• Nefopam is a non-opioid analgesic with potential opioid-sparing effects.

Purpose of the Study:

• To assess the analgesic efficacy of nefopam compared to placebo.
• To evaluate the opioid-sparing effects of nefopam.
• To determine the safety profile of nefopam in patients undergoing cardiac surgery.

Main Methods:

• A randomized, double-blind, placebo-controlled trial involving 103 adults undergoing elective cardiac surgery.
• Patients received either intravenous nefopam or placebo, alongside patient-controlled analgesia with fentanyl.
• Outcomes included fentanyl consumption, pain scores, intubation duration, and length of stay.

Main Results:

• Nefopam group showed a 25% reduction in 48-hour fentanyl consumption (p=0.014).
• Modest reductions in pain scores were observed at specific time points, particularly during movement.
• Adverse events, intubation duration, and hospital length of stay were similar between groups.

Conclusions:

• Nefopam is well-tolerated in cardiac surgery patients.
• It provides statistically significant but clinically modest reductions in opioid use and pain.
• Nefopam can be considered a safe adjunct in multimodal analgesia for cardiac surgery.