J Dent Anesth Pain Med.  2019 Feb;19(1):55-66. 10.17245/jdapm.2019.19.1.55.

Effects on postoperative nausea and vomiting of nefopam versus fentanyl following bimaxillary orthognathic surgery: a prospective double-blind randomized controlled trial

Affiliations
  • 1Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea. stone90@snu.ac.kr
  • 2Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea.
  • 3Department of Anesthesiology, School of Dentistry, Dankook University, Cheonan, Republic of Korea.
  • 4Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
  • 5Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul, Republic of Korea.

Abstract

BACKGROUND
Postoperative nausea and vomiting (PONV) frequently occurs following bimaxillary orthognathic surgeries. Compared to opioids, Nefopam is associated with lower incidences of PONV, and does not induce gastrointestinal tract injury, coagulopathy, nephrotoxicity, or fracture healing dysfunction, which are common side effects of Nonsteroidal anti-inflammatory drugs. We compared nefopam- and fentanyl-induced incidence of PONV in patients with access to patient-controlled analgesia (PCA) following bimaxillary orthognathic surgeries.
METHODS
Patients undergoing bimaxillary orthognathic surgeries were randomly divided into nefopam and fentanyl groups. Nefopam 120 mg or fentanyl 700 µg was mixed with normal saline to a final volume of 120 mL. Patients were given access to nefopam or fentanyl via PCA. Postoperative pain intensity and PONV were measured at 30 minutes and 1 hour after surgery in the recovery room and at 8, 24, 48, and 72 hours after surgery in the ward. The frequency of bolus delivery was compared at each time point.
RESULTS
Eighty-nine patients were enrolled in this study, with 48 in the nefopam (N) group and 41 in the fentanyl (F) group. PONV occurred in 13 patients (27.7%) in the N group and 7 patients (17.1%) in the F group at 8 hours post-surgery (P = 0.568), and there were no significant differences between the two groups at any of the time points. VAS scores were 4.4 ± 2.0 and 3.7 ± 1.9 in the N and F groups, respectively, at 8 hours after surgery (P = 0.122), and cumulative bolus delivery was 10.7 ± 13.7 and 8.6 ± 8.5, respectively (P = 0.408). There were no significant differences in pain or bolus delivery at any of the remaining time points.
CONCLUSION
Patients who underwent bimaxillary orthognathic surgery and were given nefopam via PCA did not experience a lower rate of PONV compared to those that received fentanyl via PCA. Furthermore, nefopam and fentanyl did not provide significantly different postoperative pain control.

Keyword

Fentanyl; Nefopam; Patient-Controlled Analgesia; Postoperative Nausea And Vomiting

MeSH Terms

Analgesia, Patient-Controlled
Analgesics, Opioid
Fentanyl*
Fracture Healing
Gastrointestinal Tract
Humans
Incidence
Nefopam*
Orthognathic Surgery*
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Postoperative Nausea and Vomiting*
Prospective Studies*
Recovery Room
Analgesics, Opioid
Fentanyl
Nefopam
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