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Combination of nefopam and remifentanil is more effective to reduce rocuronium-induced withdrawal response compared with remifentanil alone: a prospective, double-blinded, randomized control study
Anesth Pain Med 2018;13(1):53-60
Published online January 31, 2018
© 2018 Korean Society of Anesthesiologists.

Ki Tae Jung1,2, Sang Hun Kim1,2 , Keum Young So1,2, and Hyun Mae Moon1
1Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 2Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea
Correspondence to: Sang Hun Kim, M.D., Ph.D.
Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, 309 Pilmundaero, Dong-gu, Gwangju 61453, Korea
Tel: 82-62-220-3223
Fax: 82-62-223-2333
E-mail: ksh3223@chosun.ac.kr
ORCID
http://orcid.org/0000-0003-3869-9470
Received April 27, 2017; Revised July 21, 2017; Accepted September 1, 2017.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: We investigated the effect of combination of nefopam and remifentanil under the hypothesis that nefopam would effectively prevent rocuronium-induced withdrawal response by blocking serotonin receptors and providing a synergistic or additional effect with remifentanil.
Methods: After receiving Institutional Review Board approval, 76 patients aged between 20 and 65 years with American Society of Anesthesiologists physical statuses of I or II were randomly allocated to the control group and nefopam group. In the control group, 102 ml of 0.9% sodium chloride solution was infused one hour before surgery at 100 ml/h. In the nefopam group, 20 mg nefopam (2 ml) in 100 ml of a 0.9% sodium chloride solution was infused one hour before surgery at 100 ml/h. Rocuronium (0.6 mg/kg) was injected after the induction of anesthesia with remifentanil and propofol at target concentrations of 2.0 ng/ml and 3.0 µg/ml, respectively. The grades of rocuronium-induced withdrawal response were evaluated using a four-point scale. The hemodynamics and respiratory rates were recorded upon operating room arrival, after anesthesia induction, and one minute post-injection of rocuronium.
Results: Two patients (nefopam group) were excluded due to incomplete infusion and side effects; thus, 74 patients were finally analyzed. The overall incidence of rocuronium-induced withdrawal response was significantly lower in nefopam group (27.8%, n = 36) than in control group (60.5%, n = 38) (P = 0.005).
Conclusions: The combination of nefopam (20 mg) and remifentanil is more effective at reducing rocuronium-induced withdrawal response than remifentanil infusion alone with stable hemodynamics.
Key Words : Injection site reaction, Nefopam, Remifentanil, Rocuronium.


January 2018, 13 (1)
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