Korean J Health Promot > Volume 24(2); 2024 > Article |
|
AUTHOR CONTRIBUTIONS
Dr. Seung-Kwon MYUNG had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors reviewed this manuscript and agreed to individual contributions.
Conceptualization: YJ and SKM. Methodology: YJ and SKM. Software: YJ and SKM. Validation: SKM. Formal analysis: YJ and SKM. Investigation: YJ, WE, and DK. Data curation: YJ and SKM. Writing-original draft: YJ and SKM. Writing-review & editing: all authors.
No. | Source | No. of patient (E/C) | Type of surgery | Anesthesia | Nefopam regimen | Postoperative analgesic | Assessment of pain scores | Finding |
---|---|---|---|---|---|---|---|---|
1 | Tramoni et al. [7] (2003) | 31/31 | Laparotomy | Thiopental, remifentanil, isoflurane | 80 mg IV postoperatively, day-1 during 2 day, started in PACU | IV morphine PCA for 48 hr+propacetamol 2 g every 6 hr | 10, 20, 30 min, 1, 2 hr in PACU, every 4 hr in ward | At 48 hr, cumulative-morphine consumption was 58±28 mg in the placebo group and 39±28 mg in the nefopam group (P<0.01) |
2 | Du Manoir et al. [8] (2003) | 93/90 | Hip arthroplasty | Thiopental or propofol, sufentanil, isoflurane, nitrous oxide | 20 mg IV diluted in dextrose 5%, started at wound closure every 4 hr ended 24 hr | IV morphine PCA | PACU, 1, 4, 8, 12, 16, 20, 24 hr | PCA-administered morphine over 24 hr was significantly less for the nefopam group than the control group (21.2±15.3 and 27.3±19.2 mg, respectively, P=0.02) |
3 | Merle et al. [9] (2005) | 20/20/20 | Urologic laparotomy | Propofol, sufentanil, desflurane, nitrous oxide | 20 mg bolus at the end of surgery+80 mg (Group 1) or 120 mg (Group 2) IV over 24 hr | IV morphine PCA | PACU, 12, 24, 36, 48 hr | In the placebo group, the median (IQR) morphine consumption reached 29 mg (13–53 mg), whereas in patients receiving 80 and 120 mg nefopam, it levelled to 44 mg (11–54 mg) and 35 mg (9–82 mg) (P>0.05) |
4 | Aveline et al. [10] (2009) | 24/24/25 | Total knee replacement | Propofol, remifentanil, sevoflurane, nitrous oxide | 0.2 mg kg–1 over 20-min after anesthetic induction+120 µg kg–1 hr–1 5 min until the end of surgery+60 µg kg–1 hr–1 until POD2 | IV 0.15 mg/kg morphine 20 min before skin closure, IV morphine PCA for 48 hr+IV 3 mg morphine rescue | PACU, 2, 6, 12, 24, 48 hr | At 48 hr, cumulative morphine dose was higher in the placebo group than in nefopam group (72.1±8.7 mg vs. 52.2±7.5 mg, P<0.0001). When compared to placebo, patients in the nefopam groups had lower VAS scores at rest, only in the recovery and at 2 hr (P<0.0001 and P=0.003, respectively) |
5 | Park et al. [11] (2015) | 33/33 | Laparoscopic gastrectomy | Propofol, remifentanil | Mixed with IV PCA | IV fentanyl PCA | 30 min, 24 hr | Analgesic demand for 24 hr after PCA administration was 1.6±0.8 time in the control group, 1.1±0.6 time in the nefopam group (P < 0.05) |
(nefopam 100 mg, fentanyl 30 µg/kg diluted in 100 mL N/S) started after 90 min from anesthesia induction | ||||||||
6 | Kim et al. [12] (2015) | 47/48 | Renal transplantation | Propofol, remifentanil, desflurane | Continuous infusion of 160 mg diluted with 200 ml N/S at a rate of 4 mL/hr after reperfusion over 48 hr | IV fentanyl PCA, IV 50 μg fentanyl 10 min before the end of the operation | 1, 6, 12, 24, 48 hr | Continuous IV administration of nefopam 160 mg for the first 48 hr after reperfusion of the graft kidney demonstrated 19% fentanyl-sparing effect with concomitant improvement of post-operative analgesia. |
7 | Choi et al. [13] (2016) | 18/18/18 | Laparoscopic cholecystectomy | Propofol, remifentanil, sevoflurane | 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 0.065 mg/kg/hr | IV morphine 20 mg in PACU for rescue | 5, 15, 30, 45, 60 min | In control group, there were higher request of morphine in regard to the proportion (78% vs. 22%) |
8 | Jin et al. [14] (2016) | 35/36 | Laparotomy | Propofol, sevoflurane | Mixed with IV PCA | IV fentanyl PCA | 1, 2, 6, 12, 24 hr | PCA fentanyl consumption (496.4±287.0, 767.4±370.1) and total fentanyl consumption (533.5±288.0, 811.6±377.6) remained significantly lower in the nefopam group than the control group (P=0.005 and P=0.005, respectively) |
(25 µg/mL fentanyl and 2.4 mg/mL nefopam) over 24 hr | ||||||||
9 | Li et al. [15] (2016) | 16/15/17 | Abdominal surgery | Fentanyl, thiopental, isoflurane, nitrous oxide, sufentanil | Continuous infusion of 3 mg/kg/hr in PACU | IV morphine PCA | 0.5, 1, 2, 6, 12, 24 hr | The mean cumulative dose of morphine administered during the 24 hr period was 33.4±2.5 mg and 26.94±3.5 mg in the control and nefopam (P<0.05) groups. The VRS and VAS scores were significantly higher in the control group than in nefopam groups at 1, 2, 6, and 12 hr postoperatively. |
10 | Moon et al. [16] (2016) | 28/27 | Laparoscopic total hysterectomy | Thiopental, desflurane, nitrogen oxide | A single bolus of 10 mg fentanyl and 4 mg nefopam was injected at skin closure+fentanyl 2.5 mg/mL nefopam via PCA without continuous basal infusion | IV fentanyl PCA+30 mg of IV ketorolac rescue | 1, 2, 6, 12, 24, 48 hr | Total fentanyl consumption at 48 hr was 236.1±12.81 mg in Group A (fentanyl 1,000 µg), 107.5±74.0 mg in Group B (fentanyl 500 µg+nefopam 200 mg), and 120.7±91.1 mg in Group C (fentanyl 500 µg+nefopam 400 mg) (P<0.001 for Group A vs. Group B and P<0.001) |
11 | Park et al. [17] (2016) | 20/21 | Bimaxillary osteotomy | Propofol, remifentanil, sevoflurane | 20 mg with 50 mL of N/S 30 min before induction+24 hr IV infusion of 5 mg/10 mL/hr beginning postoperatively | IV fentanyl 50 µg in PACU, IM diclofenac sodium 75 mg in ward for rescue | 0.5, 1, 6, 24 hr | In PACU, pain was significantly lower in the nefopam group than in the control (median [IQR] 4.6 [3.0–6.0] vs. 6.0 [5.5–7.0], P=0.002). On ward, the difference was statistically significant 6 and 24 hr postoperatively (P<0.005). |
12 | Na et al. [18] (2016) | 41/42 | Breast cancer surgery | Propofol, alfentanil, sevoflurane | 20 mg IV preoperatively | IV fentanyl 0.5 µg/kg rescue in PACU, ketorolac, meloxicam | PACU, 6, 24 hr | The NRS of postoperative pain was significantly lower in the nefopam than in the control group in the PACU (4.5±2.2 vs. 5.7±1.5, P=0.01), at 6 hr (3.0±1.6 vs. 4.5±1.3, respectively, P<0.001), and at 24 hr (3.1±1.1 vs. 3.8±1.5, P=0.01). |
13 | Cuvillon et al. [19] (2017) | 37/32 | Abdominal surgery | Propofol, sufentanil, sevoflurane, nitrous oxide | 5 mg/hr continuous IV infusion up to 120 mg, started at the end of the surgery until 48 hr | IV morphine PCA, IV 2 mg morphine rescue, IV paracetamol 1 g/6 hr | PACU, 6, 12, 24, 36, 48 hr | The cumulative morphine consumption in PACU to 48 hr was not different between the nefopam and control groups, with 53±37 mg and 54±34 mg (P=0.85). |
14 | Kim et al. [20] (2017) | 20/20/20 | Laparoscopic cholecystectomy | Propofol, remifentanil, sevoflurane | 0.3 mg/kg during anesthesia induction+65 µg/kg/hr was infused continuously during surgery | IV fentanyl 50 µg+IV fentanyl 25 µg for follow-up dose rescue | 1, 5, 15, 30, 45, 60 min | Nefopam group (36.3±37.6 μg, P=0.001) has less fentanyl requirements after surgery than control group (76.3±31.9 μg, P=0.042). They also had lower Vas scores than control group at the 1, 5, and 45 min time points in the PACU (P=0.001, 0.026, and <0.001) |
15 | Na et al. [21] (2018) | 28/32 | Laparoscopic gastrectomy | Propofol, remifentanil | 20 mg diluted in 100 mL N/S after anesthesia induction and at the end of the operation | IV fentanyl PCA+tramadol (37.5 mg)/acetaminophen (325 mg) TID | PACU, 6, 24, 48, 72 hr, 5 day | Patients in the nefopam group required less fentanyl via IV PCA than did those in the control group during the first 6 hr (323.8±119.3 μg vs. 421.2±151.6 μg, P=0.009) |
16 | Yeo et al. [22] (2022) | 49/50 | Video-assisted thoracoscopic surgery | Propofol, remifentanil, sevoflurane | 20 mg diluted in 100 mL N/S after induction and 15 min before the end of surgery | IV fentanyl PCA, IV 0.01 mg/kg of hydromorphone and 1 g of acetaminophen 20 min before the end of surgery | PACU, 6, 12, 24, 72 hr | Intraoperative nefopam administration did not decrease total opioid consumption or postoperative pain intensity during the first 72 hr after VATS for lung cancer. |
17 | Chalermkitpanit et al. [23] (2022) | 49/45 | Minimally invasive spine surgery | Propofol, desflurane, fentanyl | 20 mg diluted in 100 mL N/S intraoperatively, followed by continuous infusion of 80 mg of nefopam diluted in 500 mL of N/S postoperatively for 24 hr | 1,000 mg of paracetamol orally every 6 hr+daily 90 mg of etoricoxib+daily 75 mg of pregabalin | PACU, 24, 48, 72 hr | The addition of 24-hr IV nefopam in a multimodal analgesic regimen provided no beneficial effects on morphine consumption, postoperative pain, or functional outcomes. |
Source | Random sequence generation | Allocation concealment | Blinding of participants, and personnel | Blinding of outcome assessment | Incomplete outcome data | Selective reporting | Other bias | No. of low risk of bias |
---|---|---|---|---|---|---|---|---|
Tramoni et al. [7] (2003) | Unclear | Unclear | Unclear | Unclear | Low | Low | Unclear | 2 |
Du Manoir et al. [8] (2003) | Unclear | Unclear | Low | Unclear | Low | Low | Unclear | 3 |
Merle et al. [9] (2005) | Unclear | Unclear | High | Unclear | Low | Low | Unclear | 2 |
Aveline et al. [10] (2009) | Low | Low | Low | Low | Low | Unclear | Unclear | 5 |
Park et al. [11] (2015) | Unclear | Unclear | High | High | Low | Low | Unclear | 2 |
Kim et al. [12] (2015) | Low | Low | Low | Low | Low | Low | Unclear | 6 |
Choi et al. [13] (2016) | Low | Low | Low | Low | Low | Low | Unclear | 6 |
Jin et al. [14] (2016) | Low | Unclear | Low | Low | Low | Low | Unclear | 5 |
Li et al. [15] (2016) | Low | High | High | Low | Low | Unclear | Unclear | 3 |
Moon et al. [16] (2016) | Low | High | Low | Low | Low | Low | Unclear | 5 |
Park et al. [17] (2016) | Low | Low | Low | Low | Low | Low | Unclear | 6 |
Na et al. [18] (2016) | Low | High | Low | Low | Low | Low | Unclear | 5 |
Cuvillon et al. [19] (2017) | Low | High | Low | Low | High | Low | Unclear | 4 |
Kim et al. [20] (2017) | Low | High | Low | Low | Low | Low | Unclear | 5 |
Na et al. [21] (2018) | Low | High | Low | High | Low | Low | Unclear | 4 |
Yeo et al. [22] (2022) | Low | Low | High | High | Low | Low | Unclear | 4 |
Chalermkitpanit et al. [23] (2022) | Low | Low | Low | High | Low | Low | Unclear | 5 |