Nefopam as an adjunct to intravenous patient‐controlled analgesia after renal transplantation: a randomised trial

Background Nefopam has been used as an adjuvant to opioid analgesia after operation. We investigated the efficacy of nefopam as an adjunct to fentanyl‐based intravenous patient‐controlled analgesia ( IV PCA ) on post‐operative pain relief in patients undergoing renal transplantation. Methods Ninety‐eight patients undergoing elective renal transplantation were randomised into two groups: nefopam or control groups. The former received nefopam (160 mg in 200 ml at a rate of 4 ml/h) whereas the latter received normal saline during the first 48 h after reperfusion of grafted kidney. Pain intensity scores, cumulative dose of fentanyl, and the incidence of adverse events were assessed at 1, 6, 12, 24, and 48 h post‐operatively. Serum creatinine and estimated glomerular filtration rate were evaluated on post‐operative days 1, 2, 4, and 7. Results The cumulative fentanyl consumption during the first 48 h after operation was 19% less in the nefopam group than that in the control group (1005 ± 344 μg vs. 1246 ± 486 μg, mean ±  SD ; P  = 0.006). Pain intensity scores at rest and on coughing were significantly lower in the nefopam group throughout the first 12 and 48 h after operation, respectively. Adverse events and early graft function were comparable between the groups, except a significantly lower incidence of drowsiness observed in the nefopam group (4% vs. 21%, P  = 0.027). Conclusion In combination with fentanyl PCA , nefopam reduced post‐operative fentanyl consumption with superior analgesia after renal transplantation.