Postoperative Analgesic Efficacy of Nefopam after Anorectal Surgery: A Retrospective Observational Study

Haruethaivijitchock, Phantila; Cha-arong, Tasneem; Jungprasert, Suwapit; Rattananupong, Thanapoom; Lohsoonthorn, Vitool

doi:10.1055/s-0043-1776887

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Journal of Coloproctology (Rio de Janeiro)

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Original Article • J Coloproctol 43 (4) • Dec 2023 • https://doi.org/10.1055/s-0043-1776887 copy

Postoperative Analgesic Efficacy of Nefopam after Anorectal Surgery: A Retrospective Observational Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To examine the effectiveness of nefopam on postoperative pain control after anorectal surgeries.

Methods

We retrospectively reviewed the electronic medical records of patients who underwent anorectal surgeries from January 2019 to March 2022 at two medical centers. The data were divided into nefopam and conventional groups. The primary outcome was the number of patients who requested additional opioids in the 24-h postoperative period. The secondary outcomes were numeric rating pain scores (NRPS) within a 24-h postoperative period and analgesic drugs-related side effects.

Results

Eighty-seven patients in the conventional group and 60 in the nefopam group were recruited. The nefopam group reported less additional opioid consumption than the conventional group in all dimensions of analysis, including overall, adjusted to anesthetic techniques and types of surgery. However, these did not reach statistical significance (P = 0.093). Only patients in the nefopam group who underwent hemorrhoidectomy under TIVA or spinal anesthesia significantly required fewer additional opioids (P = 0.016, 60% mean difference). Similarly, the 24-h postoperative morphine consumption was lower in the nefopam group (mean difference = −3.4, 95%CI: 0.72,6.08). Furthermore, significantly lower NRPS were reported in the nefopam group during the 12-18 h postoperative period (P = 0.009). On the other hand, analgesic drugs related side effects were similar in both groups.

Conclusions

The administration of nefopam after major anorectal surgery is beneficially evident in reducing postoperative opioid requirements.

Keywords
anorectal surgery; hemorrhoidectomy; nefopam; postoperative pain; opioid requirements

Patient characteristics	Nefopam (n= 60) n (%)	Conventional (n= 87) n (%)	P-value^† ‡ Independent t-test.
- Age (years) ^a † Exact probability test.	46.50 ± 11.65	44.46 ± 11.79	0.302^‡ † Exact probability test.
- Sex			0.388
Male Female	40 (66.7)	51 (58.6)	-
Male Female	20 (33.3)	36 (41.4)	-
- BMI (Kg/m²)			0.096
Underweight (BMI ≤ 18) Normal (BMI 18-24.9) Overweight (BMI 25-29.9) Obese (BMI ≥ 30)	3 (5.0)	2 (2.3)	-
	33 (55.0)	47 (54.0)	-
	20 (33.3)	21 (24.1)	-
	4 (6.7)	17 (19.5)	-
- ASA physical status			0.557
I II III	43 (71.7)	60 (69.0)	-
	14 (23.3)	25 (28.7)	-
	3 (5.0)	2 (2.3)	-
- Type of surgery			0.057
LIFT/Fistulotomy Hemorrhoidectomy Strictulotomy/Anoplasty LIS/Sphincterotomy Combined (>1 operation)	30 (50.0)	50 (57.5)	-
	23 (38.3)	20 (23.0)	-
	0 (0)	2 (2.3)	-
	0 (0)	6 (6.9)	-
	7 (11.7)	9 (10.3)	-
- Operation time (min) ^a † Exact probability test.	60.38 ± 28.13	71.72 ± 30.89	0.023^‡ † Exact probability test.
- Anesthetic technique			0.009
Spinal anesthesia Total intravenous anesthesia (TIVA) Local anesthesia	29 (48.3)	48 (55.2)	-
	16 (26.7)	7 (8.1)	-
	15 (25.0)	32 (36.8)	-
- Intraoperative morphine use (mg) ^a † Exact probability test.	2.65 ± 3.24	2.55 ± 2.75	0.843^‡ † Exact probability test.

Analgesic requirement	Nefopam (n= 60) n (%)	Conventional (n= 87) n (%)	P-value^† * Significance < 0.05.
- Opioid requirement	26 (43.3)	51 (58.6)	0.093
- Anesthetic technique
Spinal anesthesia	12 (41.1)	26 (54.2)	0.349
Total intravenous anesthesia (TIVA)	6 (37.5)	5 (71.4)	0.193
Local anesthesia	8 (53.3)	20 (62.5)	0.751
- Type of surgery
LIFT/Fistulotomy	13 (43.3)	27 (54.0)	0.356
Hemorrhoidectomy (Overall)	9 (39.1)	13 (65.0)	0.090
Hemorrhoidectomy (Spinal anesthesia or TIVA)	3 (23.1)	5 (83.3)	0.016
Strictulotomy/Anoplasty	0 (0)	2 (100.0)	-
LIS/Sphincterotomy	3 (50.0)	3 (50.0)	-
Combined (>1 operation)	4 (57.1)	6 (66.7)	0.696

Analgesic requirement	Nefopam (n= 60)	Conventional (n= 87)	Mean difference	95% CI of mean difference
Overall of anorectal surgery^a a Data expressed as mean ± standard deviation.	1.83 ± 2.65	2.32 ± 2.38	−0.48	−0.34, 1.31
Hemorrhoidectomy (Spinal anesthesia or TIVA)^a a Data expressed as mean ± standard deviation.	0.85 ± 1.72	4.25 ± 3.92	−3.40	0.72, 6.08^* † Exact probability test.

Analgesic requirement	NSAIDs (n= 107) n (%)	No NSAIDs (n= 40) n (%)	P-value
Opioid requirement	57 (53.3)	20 (50.0)	0.853^† † Exact probability test.
Morphine consumption^a a Data expressed as mean ± standard deviation.	2.11 ± 2.55	2.15 ± 2.38	0.927

Mean pain scores	Nefopam (n= 60)	Conventional (n= 87)	P-value	Mean difference	95% CI
- At 6-12 h ^a a Data expressed as mean ± standard deviation.	2.68 ± 2.61	3.21 ± 2.14	0.185	0.524	−0.25, 1.30
Spinal anesthesia	2.97 ± 3.06	3.46 ± 2.44	0.439	0.493	−0.77, 1.75
Total intravenous anesthesia (TIVA)	1.44 ± 1.26	3.14 ± 1.68	0.013	1.705	0.39, 3.02
Local anesthesia	3.46 ± 2.39	2.84 ± 1.69	0.308	−0.623	−1.84, 0.59
- At 12-18 h ^a a Data expressed as mean ± standard deviation.	1.45 ± 1.59	2.33 ± 2.23	0.009	0.883	0.22, 1.54
Spinal anesthesia	1.48 ± 1.86	2.52 ± 2.69	0.072	1.038	−0.93, 2.17
Total intravenous anesthesia (TIVA)	0.88 ± 1.02	1.43 ± 0.98	0.240	0.554	−0.40, 1.51
Local anesthesia	2.00 ± 1.36	2.25 ± 1.55	0.595	0.250	−0.69, 1.19
- At 18 -24 h ^a a Data expressed as mean ± standard deviation.	1.37 ± 1.81	1.52 ± 1.80	0.620	0.151	−0.45, 0.75
Spinal anesthesia	1.17 ± 1.47	1.38 ± 1.79	0.609	0.203	−0.58, 0.99
Total intravenous anesthesia (TIVA)	1.44 ± 2.71	1.43 ± 1.62	0.994	−0.089	−2.31, 2.30
Local anesthesia	1.67 ± 1.23	1.75 ± 1.88	0.877	0.083	−0.99, 1.16

Side effect	Nefopam (n= 60) n (%)	Conventional (n= 87) n (%)	P-value^† † Exact probability test.
- Nausea and vomiting	4 (6.7)	4 (4.6)	0.716
- Rash	1 (1.7)	0 (0)	0.408

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[1] Address for correspondence Phantila Haruethaivijitchock, MD, FRCA, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand (e-mail: cphantila@gmail.com).