A randomized trial of nefopam for postoperative pain management in obstructive sleep apnea patients undergoing uvulopalatopharyngoplasty
In brief
Nefopam does not lower 24-hour morphine use after uvulopalatopharyngoplasty
In a triple-blinded trial of 51 sleep-apnea patients undergoing UPPP, intravenous nefopam (20 mg loading then 80 mg/24 h) resulted in a median morphine consumption of 7 mg versus 5 mg with placebo, a difference that was not statistically significant. Pain scores, recovery milestones and satisfaction were unchanged, and mild side effects such as tachycardia occurred only in the nefopam group.
- Journal
- European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Q1)
- Published
- 16 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Saowapark Chumpathong, Peerachatra Mangmeesri, Sriwimon Panyamee, Wish Banhiran, Maythad Uataya
- PMID
- 42747527
- DOI
- 10.1007/s00405-026-10472-w
Why clinicians should know about it
- Picked for Otorhinolaryngology (top studies of the week, 20 September 2026): Nefopam trial for postoperative pain after uvulopalatopharyngoplasty
- Picked for Surgery (top studies of the week, 20 September 2026): Nefopam trial for UPPP pain, not within general surgery scope
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.