Nefopam as an alternative to nonsteroidal anti-inflammatory drugs in perioperative pain management: a narrative review

Nonsteroidal anti-inflammatory drugs (NSAIDs) constitute the foundation of contemporary perioperative pain management regimens. However, their use is often limited by a broad range of serious adverse effects and contraindications. This review, based on an analysis of the scientific sources, aims to evaluate the analgesic efficacy and safety of nefopam, a centrally acting non-opioid analgesic, as an alternative to NSAIDs in perioperative pain management regimens. A search of medical databases, including PubMed (MEDLINE), the Cochrane Library, and eLibrary (RSCI), was conducted from July 1 to December 30, 2024. Nefopam has demonstrated consistent analgesic and opioid-sparing effects in laparoscopic surgery, spinal surgery, cardiac surgery, and transplantation, as well as in patients in intensive care units. Additional beneficial effects include prevention and treatment of postoperative shivering and reduction of discomfort and pain associated with urinary catheterization. The most commonly reported adverse effects of nefopam include excessive sweating, tachycardia following intravenous administration, and dry mouth. Overall, nefopam appears to have a more favorable safety profile compared with NSAIDs.