Korean J Pain.  2018 Apr;31(2):102-108. 10.3344/kjp.2018.31.2.102.

Effects of warmed carrier fluid on nefopam injection-induced pain

• Cho HR
• Kim SH
• Kim JA
• Min JH
• Lee YK

• KMID: 2410832
• DOI: http://doi.org/10.3344/kjp.2018.31.2.102

Abstract

BACKGROUND
Nefopam is a non-opioid, non-steroidal analgesic drug with fewer adverse effects than narcotic analgesics and nonsteroidal anti-inflammatory drugs, and is widely used for postoperative pain control. Because nefopam sometimes causes side effects such as nausea, vomiting, somnolence, hyperhidrosis and injection-related pain, manufacturers are advised to infuse it slowly, over a duration of 15 minutes. Nevertheless, pain at the injection site is very common. Therefore, we investigated the effect of warmed carrier fluid on nefopam injection-induced pain.
METHODS
A total of 48 patients were randomly selected and allocated to either a control or a warming group. Warming was performed by diluting 40 mg of nefopam in 100 ml of normal saline heated to 31-32℃ using two fluid warmers. The control group was administered 40 mg of nefopam dissolved in 100 ml of normal saline stored at room temperature (21-22℃) through the fluid warmers, but the fluid warmers were not activated.
RESULTS
The pain intensity was lower in the warming group than in the control group (P < 0.001). The pain severity and tolerance measurements also showed statistically significant differences between groups (P < 0.001). In the analysis of vital signs before and after the injection, the mean blood pressure after the injection differed significantly between the groups (P = 0.005), but the heart rate did not. The incidence of hypertension also showed a significant difference between groups (P = 0.017).
CONCLUSIONS
Use of warmed carrier fluid for nefopam injection decreased injection-induced pain compared to mildly cool carrier fluid.

Keyword

Cold temperature; Heating; Nefopam; Pain; Vasoconstriction; Vasodilation

MeSH Terms

Blood Pressure
Cold Temperature
Heart Rate
Heating
Hot Temperature
Humans
Hyperhidrosis
Hypertension
Incidence
Narcotics
Nausea
Nefopam*
Pain, Postoperative
Vasoconstriction
Vasodilation
Vital Signs
Vomiting
Narcotics
Nefopam

Figure

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  Fig. 1 Insertion site of the catheter based on the inclusion criteria.

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  Fig. 2 Flowchart of patient recruitment, randomization and allocation.

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  Fig. 3 Fluid warming devices used in this study. Fluid warmer device 1: Ranger™ Model 245 Blood/Fluid Warming Unit, Augustine Medical Inc., USA. Fluid warmer device 2: ANIMEC AM-2S-5A, ELLTEC, Japan.

• 

  Fig. 4 Measurement of vein diameter using ultrasonography.

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  Fig. 5 Illustration of a fluid warmer and measurement of infusion fluid temperature using an infrared thermometer. This picture is from a pilot study. In the study itself, the power indicator of the ANIMEC warmer was covered with black tape.

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  Fig. 6 Diagram illustrating hypothesis concerning linkage between platelet activation and vascular pain.

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