A randomized trial of nefopam for postoperative pain management in obstructive sleep apnea patients undergoing uvulopalatopharyngoplasty

Abstract Objective Uvulopalatopharyngoplasty (UPPP) is a surgical treatment for obstructive sleep apnea that often results in significant postoperative pain. Given the risks associated with opioid use in patients with obstructive sleep apnea, multimodal analgesia is preferred. This study evaluated whether nefopam, a non-opioid analgesic, without respiratory depressive effects, could reduce morphine consumption and improve postoperative recovery in patients undergoing UPPP. Methods This prospective, exploratory, randomized, triple-blinded trial enrolled patients scheduled for elective UPPP. Participants were randomly assigned to receive either nefopam or a placebo (normal saline). The nefopam group received a 20 mg intravenous loading dose over 1 h, followed by a continuous infusion of 80 mg over 24 h. Both groups received standard multimodal analgesia. The primary outcome was total morphine consumption within 24 h postoperatively. The secondary outcomes were postoperative pain scores, time to first oral intake, patient satisfaction, quality-of-life scores, and adverse events. Results Fifty-one patients were analyzed (nefopam: 26, control: 25). The median 24-hour morphine consumption was 7 mg in the nefopam group and 5 mg in the control group ( P = 0.56). No significant differences were found between groups in postoperative pain scores, time to first oral intake, patient satisfaction, or quality-of-life scores. Adverse event rates were similar, although tachycardia (11.5%) and sweating (3.8%) were observed only in the nefopam group. Subgroup analysis in UPPP alone and extended UPPP surgery likewise revealed no significant differences between groups. Conclusion Nefopam is not recommended for pain management following UPPP as it did not significantly reduce morphine consumption or improve pain-related outcomes.