Optimization of acute postoperative pain management in trauma and orthopedic patients

Background. The modern approach to multimodal postoperative analgesia involves the administration of two or more analgesic agents that exert a polymodal effect on the pathogenetic mechanisms of pain. Nefopam hydrochloride can prevent opioid-induced hyperalgesia, relieve pain without respiratory depression and without affecting platelet aggregation, the state of the gastrointestinal mucosa and intestinal motility, which differentiates it from traditional non-opioid analgesics. Objective: to assess the impact of nefopam hydrochloride as a component of multimodal analgesia on pain intensity and stress response markers in trauma and orthopedic patients during postoperative pain management. Materials and methods. A prospective randomized open-label controlled clinical study was conducted in 120 patients (47 men, 73 women) aged 19 to 94 years (mean (M ± σ) of 55.97 ± 19.78 years) who underwent lower limb surgeries under spinal anesthesia. Patients were divided into two groups: the controls (n = 60) received standard multimodal analgesia (ketorolac, acetaminophen), while people in the main group (n = 60) additionally received 20 mg of nefopam hydrochloride intramuscularly 4 times per day. Pain intensity was evaluated using the Numeric Rating Scale, narcotic analgesic consumption, and cortisol levels in blood serum were assessed as well. Data analysis was performed using SPSS 20 (SPSS Inc.), version 21.0.0 for Windows. Results. It was found that the use of nefopam hydrochloride as a component of multimodal postoperative analgesia in patients undergoing trauma and orthopedic surgeries significantly reduces score on the Numeric Rating Scale: by 23.6 % during the first 6 hours after surgery (p < 0.001), and by 1.5, 2.3, and 3.6 times at 12, 18, and 24 hours postoperatively, respectively (p < 0.001). It was also associated with lower mean serum cortisol concentrations — 5.20 ± 4.43 vs. 8.51 ± 3.48 µg/dL in the control group 6 hours after surgery, and 2.08 ± 1.63 vs. 4.11 ± 1.70 µg/dL in 12 hours (p < 0.001). Additio-nally, it reduced the average cumulative morphine dose by 1.5 times during the first 24 hours postoperatively (p < 0.001). The opioid-reducing effect of multimodal analgesia with nefopam hydrochloride reached 61.7 %. Conclusions. Nefopam hydrochloride is an effective component of multimodal postoperative analgesia in trauma and orthopedic patients, improving the quality of postoperative pain management and reducing stress response intensity.