{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T18:36:05Z","timestamp":1786559765661,"version":"build-2736575974"},"reference-count":24,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T00:00:00Z","timestamp":1718323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Immediate breast reconstruction surgery (BRS) often leads to significant postoperative pain, necessitating effective analgesia. This study aimed to compare the analgesic efficacy of patient-controlled analgesia (PCA) containing nefopam with that of PCA containing opioids alone in patients undergoing BRS. Methods: A prospective, double-blind, randomized controlled trial was conducted on 120 patients undergoing immediate BRS after mastectomy. Patients were randomly allocated to receive PCA with fentanyl alone (Group F: fentanyl 10 mcg\/kg), fentanyl and nefopam (Group FN: fentanyl 5 mcg\/kg + nefopam 1 mg\/kg), or nefopam alone (Group N: nefopam 2 mg\/kg). Pain intensity (expressed in VASr and VASm), opioid consumption, and opioid-related complications were assessed. Results: PCA with nefopam, either alone or in combination with opioids, demonstrated non-inferior analgesic efficacy compared to PCA with fentanyl alone. At 24 h postoperatively, the VASr scores were 2.9 \u00b1 1.0 in Group F, 3.1 \u00b1 1.2 in Group FN, and 2.8 \u00b1 0.9 in Group N (p = 0.501). At the same timepoint, the VASm scores were 4.1 \u00b1 1.2 in Group F, 4.5 \u00b1 1.5 in Group FN, and 3.8 \u00b1 1.4 in Group N (p = 0.129). Significant differences among the three groups were observed at all timepoints except for PACU in terms of the total opioid consumption (p &lt; 0.0001). However, there were no significant differences in opioid-related complications among the three groups. Conclusions: PCA with nefopam, whether alone or in combination with opioids, offers non-inferior analgesic efficacy compared to PCA with fentanyl alone in patients undergoing immediate BRS.<\/jats:p>","DOI":"10.3390\/jcm13123490","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T08:52:10Z","timestamp":1718355130000},"page":"3490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of Nefopam-Based Patient-Controlled Analgesia with Opioid-Based Patient-Controlled Analgesia for Postoperative Pain Management in Immediate Breast Reconstruction Surgery: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"13","author":[{"given":"Jaewon","family":"Huh","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noori","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minju","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoon","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3499-1554","authenticated-orcid":false,"given":"Deuk Young","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5165-8414","authenticated-orcid":false,"given":"Jangyoun","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2820-0322","authenticated-orcid":false,"given":"Wonjung","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1177\/000313480807400402","article-title":"Pain after mastectomy and breast reconstruction","volume":"74","author":"Vadivelu","year":"2008","journal-title":"Am. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/00000542-200301000-00011","article-title":"Difference in Risk Factors for Postoperative Nausea and Vomiting","volume":"98","author":"Stadler","year":"2003","journal-title":"Anesthesiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1097\/ALN.0000000000003298","article-title":"Persistent Postoperative Opioid Use: Perception, Progress, and Promise","volume":"132","author":"Kharasch","year":"2020","journal-title":"Anesthesiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/1440-1681.12506","article-title":"Nefopam analgesia and its role in multimodal analgesia: A review of preclinical and clinical studies","volume":"43","author":"Girard","year":"2016","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1093\/bja\/aen267","article-title":"Nefopam for the prevention of postoperative pain: Quantitative systematic review","volume":"101","author":"Evans","year":"2008","journal-title":"Br. J. Anaesth."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Lee, S., Lee, S., Kim, H., Oh, C., Park, S., Kim, Y., Hong, B., Yoon, S., Noh, C., and Ko, Y. (2021). The Analgesic Efficacy of Nefopam in Patient-Controlled Analgesia after Laparoscopic Gynecologic Surgery: A Randomized, Double-Blind, Non-Inferiority Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10051043"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Jung, K.T., So, K.Y., Kim, S.C., and Kim, S.H. (2021). Effect of Nefopam-Based Patient-Controlled Analgesia with and without Fentanyl on Postoperative Pain Intensity in Patients Following Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Non-Inferiority Trial. Medicina, 57.","DOI":"10.3390\/medicina57040316"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1177\/0300060516650783","article-title":"Opioid sparing effect and safety of nefopam in patient controlled analgesia after laparotomy: A randomized, double blind study","volume":"44","author":"Jin","year":"2016","journal-title":"J. Int. Med. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1111\/aas.12519","article-title":"Nefopam as an adjunct to intravenous patient-controlled analgesia after renal transplantation: A randomised trial","volume":"59","author":"Kim","year":"2015","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1177\/0300060514525351","article-title":"The analgesic efficacy and safety of nefopam in patient-controlled analgesia after cardiac surgery: A randomized, double-blind, prospective study","volume":"42","author":"Kim","year":"2014","journal-title":"J. Int. Med. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1093\/bja\/49.11.1133","article-title":"Comparison of nefopam and pethidine in postoperative pain","volume":"49","author":"Tigerstedt","year":"1977","journal-title":"Br. J. Anaesth."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1002\/cpt1975185part1530","article-title":"Nefopam and morphine in man","volume":"18","author":"Sunshine","year":"1975","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"55","DOI":"10.17245\/jdapm.2019.19.1.55","article-title":"Effects on postoperative nausea and vomiting of nefopam versus fentanyl following bimaxillary orthognathic surgery: A prospective double-blind randomized controlled trial","volume":"19","author":"Choi","year":"2019","journal-title":"J. Dent. Anesth. Pain Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"249","DOI":"10.2165\/00003495-198019040-00001","article-title":"Nefopam: A review of its pharmacological properties and therapeutic efficacy","volume":"19","author":"Heel","year":"1980","journal-title":"Drugs"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"612","DOI":"10.4097\/kjae.2017.70.6.612","article-title":"A comparison between ketorolac and nefopam as adjuvant analgesics for postoperative patient-controlled analgesia: A randomized, double-blind, prospective study","volume":"70","author":"Son","year":"2017","journal-title":"Korean J. Anesthesiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e115","DOI":"10.1016\/j.anclin.2017.01.018","article-title":"Essential Elements of Multimodal Analgesia in Enhanced Recovery after Surgery (ERAS) Guidelines","volume":"35","author":"Beverly","year":"2017","journal-title":"Anesthesiol. Clin."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chiu, C., Aleshi, P., Esserman, L.J., Inglis-Arkell, C., Yap, E., Whitlock, E.L., and Harbell, M.W. (2018). Improved analgesia and reduced post-operative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) pathway for total mastectomy. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0505-9"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S133","DOI":"10.36076\/ppj.2008\/11\/S133","article-title":"Opioid pharmacology","volume":"11","author":"Trescot","year":"2008","journal-title":"Pain Physician"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/00000542-200401000-00010","article-title":"Nefopam, a nonsedative benzoxazocine analgesic, selectively reduces the shivering threshold in unanesthetized subjects","volume":"100","author":"Alfonsi","year":"2004","journal-title":"Anesthesiology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1111\/j.1399-6576.1979.tb01486.x","article-title":"Comparison of the analgesic dose-effect relationships of nefopam and oxycodone in postoperative pain","volume":"23","author":"Tigerstedt","year":"1979","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_21","first-page":"27","article-title":"Comparison of analgesic efficacy of acetaminophen monotherapy versus acetaminophen combinations with either pethidine or parecoxib in patients undergoing laparoscopic cholecystectomy: A randomized prospective study","volume":"18","author":"Mulita","year":"2021","journal-title":"Med. Glas."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1016\/j.jpainsymman.2010.08.016","article-title":"Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: A systematic literature review","volume":"41","author":"Hjermstad","year":"2011","journal-title":"J. Pain Symptom Manag."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jemermed.2014.07.039","article-title":"A comparison of three self-report pain scales in adults with acute pain","volume":"48","author":"Bahreini","year":"2015","journal-title":"J. Emerg. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/bja\/aen103","article-title":"Assessment of pain","volume":"101","author":"Breivik","year":"2008","journal-title":"Br. J. Anaesth."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3490\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:58:57Z","timestamp":1760108337000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,14]]},"references-count":24,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["jcm13123490"],"URL":"https:\/\/doi.org\/10.3390\/jcm13123490","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,14]]}}}