SRS42 - The safety and efficacy of perioperative nefopam for analgesia in spine surgery: a systematic review and meta-analysis of randomised controlled trials

Abstract Background and Objectives Moderate to severe pain is common after spine surgery. While opioids remain standard analgesia, adverse effects have prompted interest in opioid-sparing strategies. This systematic review evaluates the safety and efficacy of nefopam, a non-opioid and non-NSAID, as adjuvant perioperative analgesia in spine surgery. Methods Medline, Embase, Scopus and Cochrane databases were searched from inception to May 9, 2025. RevMan V5.4 was used to analyse mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (c.i.s) for continuous outcomes and risk ratios (RR) with 95% c.i.s for dichotomous outcomes. The GRADE framework was used to assess the certainty of evidence. Results Seven randomised controlled trials (n = 423) were included. Nefopam reduced 24-hour opioid use (MD −2.72 mg; 95% c.i.: −4.93 to −0.52 mg), but the effect disappeared after excluding the study that measured fentanyl consumption (MD −1.59 mg; 95% c.i.: −4.01 to 0.83 mg) (GRADE: moderate). Nefopam did not affect 24-hour incisional (SMD, 0.02; 95% c.i. −0.20 to 0.23) or 24-hour neuropathic pain (SMD, −0.19; 95% c.i. −0.49 to 0.10) (GRADE: high). Nefopam had no effect on the length of hospital stay (MD, 0.08 days; 95% c.i. −0.73 to 0.88 days) (GRADE: moderate). There were no significant differences in adverse effects (sedation (RR 1.30), nausea/vomiting (RR 1.11), dizziness (RR 1.14), and urinary retention (RR 2.36)), (GRADE: very low-moderate). Conclusions Nefopam may reduce opioid use when combined with fentanyl, but not morphine. Nefopam does not affect acute postoperative pain scores, adverse events, or length of hospital stay.