The effect of using nefopam in fentanyl-based intravenous patient-controlled analgesia on the incidence of postoperative nausea and vomiting in laparoscopic gynecological surgery

Currently, the regimen of intravenous patient-controlled analgesia (IV-PCA) has become lowering opioid to reduce opioid-related side effects, particularly, postoperative nausea and vomiting (PONV). Using nefopam in IV-PCA may decrease the incidence of PONV, but there is still a lack of evidence. 178 patients undergoing laparoscopic gynecological surgery were randomly assigned into two groups. The IV-PCA regimen for group F was 20 mg/kg fentanyl and for group N was 10 mg/kg fentanyl with 200 mg of nefopam. The severity of PONV and pain were assessed at both 1 hour and 24 hours after surgery. Patients’ satisfaction with recovery was evaluated by a structured questionnaire. The incidence of PONV showed no statistical difference between group N and group F (28.2% vs. 26.8% at 1 hour, p=0.839 and 32.1% vs. 43.9% at 24 hours, p=0.120, respectively). Also, postoperative pain intensity showed no statistical difference between the two groups. Patient recovery was similar between the two groups. The combined use of nefopam in IV-PCA seems to effectively decrease the fentanyl dose in laparoscopic gynecological surgery. However, it did not contribute to decreasing the incidence of PONV.