Combination found to be more effective than monotherapy for post-operative pain management

A recent study published in The Journal of Pain has proved that the combination of propacetamol and nefopam have more effect rather than using these analgesics alone immediately after the surgery.

Postoperative pain is associated with thyroidectomy which can be prevented by analgesics. Propacetamol and intravenous (IV) acetaminophen, are the most commonly used analgesics for moderate to severe postoperative pain and nefopam is a centrally-acting analgesic drug. The present study was conducted to find out the efficacy through a comparative analysis of propacetamol-nefopam combination and these medications as a monotherapy for acute and chronic pain after the surgery.

In this study, about 84 patients were randomly allocated in three groups as propacetamol group, nefopam group, and combination (propacetamol with nefopam) group. After allocation, an analgesic treatment was given after 30 minutes, before the end of the surgery and then every 6 hours during the postoperative 24 hours. If the pain persisted, tramadol 50 mg was administered as a rescue medicine. The intensity of the pain on the wound site and posterior neck area was measured using a numeric rating scale (0 to 10) at the admission of post-anesthetic care unit (PACU) on the post-operative day 1 and 3 months after the surgery. After measurement of pain intensity, the results were recorded.

The results indicated that the pain scores on the wound site were significantly lower for the combination group as compared to the propacetamol or nefopam alone groups at the admission of PACU [median (range): 3 (0-8), 5 (3-8), and 4 (0-9), respectively, p<0.05] but no significant differences were found with the pain scores among the three groups at the postoperative day 1 and 3 months after the surgery. No significant differences were indicated for the incidences of neuropathic pain, rescue pain medication and adverse effects such as sedation, nausea, vomiting, dry mouth, tachycardia, sweating, and dizziness.

It was inferred from the study that the combination of propacetamol and nefopam proved to generate a more effective analgesic effect rather than using these analgesics alone immediately after the surgery. The differences were dismissed at post-operative day 1 and 3 months after the surgery.