Na, H.S., Oh, A.Y., Koo, B.W., Lim, D.J., Ryu, J.H., & Han, J.W. (2016). Preventive analgesic efficacy of nefopam in acute and chronic pain after breast cancer surgery: A prospective, double-blind, and randomized trial. Medicine, 95(20), e3705.

To evaluate the efficacy of nefopam on acute and chronic postoperative pain from breast surgery

Women were randomized to either nefopam or normal saline placebo control. All patients received 0.05mg/kg of midazolam preoperatively, and all patients received the same anesthetic regimen. At the end of surgery, 30 mg of IV ketorolac was given and, postoperatively, patients were given 0.5 mcg fentanyl if pain rating was 5 or higher. After discharge from PACU, ketorolac was given according to pain ratings, and meloxicam daily was begun as soon as patients started eating. Pain was assessed at 6 and 24 hours postop and at 10 days and at three months.

• N = 83   
• MEAN AGE = 53.2 years
• FEMALES: 100%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: All had breast cancer.
• OTHER KEY SAMPLE CHARACTERISTICS: All were scheduled to undergo lumpectomy.

• SITE: Single site   
• SETTING TYPE: Multiple settings    
• LOCATION: Republic of Korea

• PHASE OF CARE: Active antitumor treatment

• Double-blind, randomized, controlled trial

• Numeric rating scale for pain

Pain scores were significantly lower in the nefopam group immediately after surgery, and at 6 and 24 hours postoperatively (p < 0.01). No differences existed in pain rating at 10 days and three months. Analgesic consumption during the initial postoperative period was also lower in the nefopam group (p = 0.03). Some differences in pain were seen between groups when stratified according to postoperative radiation or nonradiation.

Prophylactic use of nefopam was associated with reduced pain in the first three days postoperatively among women undergoing surgery for breast cancer.

• Small sample (< 100)

Nefopam is a strong central-acting nonopioid analgesic that was shown to be of benefit for management of acute pain. This medication is more commonly used in European countries, and may be a useful alternative to opioids in patients with cancer. Further research is needed to explore its utility for management of various types of cancer-related pain and comparative effectiveness with other common approaches for pain management.