Experience of Multimodal Non Opioid Analgesia after Highly Traumatic after Cancer Surgery in the Head and Neck

V.V. Balandin, E.S. Gorobets

FGBU «Russian Cancer Research Center. n.a. N.N. Blokhin», Moscow

For citation: Balandin VV, Gorobets ES. Experience of Multimodal Non Opioid Analgesia after Highly Traumatic Cancer Surgery in the Head and Neck. Intensive Care Herald. 2016;2:70–73.

Introduction. 80 clinical observations of the adult patients who underwent high-traumatic operations for tumors of the head and neck. Materials and methods. Anesthesia: an admixture of a Nefopam of 1 % 12 ml (120 mg), Lidocainum of 1 % 284 ml (2840 mg) and a Tenoksikam of 1 % 4 ml (40 mg) intravenously with the help of disposable elastomeric infusional pump (volume 300 ml) within 2 days after operation with rate of 6–8 ml/h are presented. Efficiency of anesthesia was estimated by 10-point visual- analog score system (VAS). Intensity of pain didn’t exceed 2.8 ± 0.84 points on the first, and 2.3 ± 0.68 on the second postoperative day. Additional anesthesia was required to 21 % of patients during the first 24 hours and for 12.5 % of patients at the second postoperative day. It was necessary to add narcotic analgetics only at 8.5 % of patients on the first and 3.5 % on the second day after operation. Results. Side effects were revealed in 8 % of patients and include: tachycardia, nausea and a sweating. Conclusions. The presented results demonstrate strong analgetic effect of the developed scheme of anesthesia and its safety. The technique provided early activization of patients, excluding or minimizing use of narcotic analgetics during the postoperative period.

Keywords: postoperative pain, multimodal analgesia, head and neck tumors, nefopam, lidocaine, NSAIDS

Received: 26.04.2016


  1. Bilotta F., Pietropaoli P., Sanita R. Nefopam and tramadol for the prevention of shivering during neuroaxial anesthesia. Reg. Anesth. Pain. Med. 2002; 27: 380–384.
  2. Delage N., Maaliki H., Beloeil H. Median effective dose (ED50) of nefopam and ketoprofen in postoperative patients. Anesthesiol 2005; 102: 1211–1216.
  3. Fernandez-Sanchez М., Diaz-Trelles R., Groppetti A. Nefopam, an analogue of or-phenadrine, protects against both NMDA receptor-dependent and independent vera-tridine-induced neurotoxicity. Amino Acids. 2002; 23: 31–36.
  4. Girard P., Verniers D., Coppe M.-C. Nefopam and ketoprofen synergy in rodent models of antinociception. Eur. J. Pharm. 2008; 584: 263–271.
  5. Herminghaus A., Wachowiak M., Wilhelm W. Intravenous administration of lidocaine for perioperative analgesia. Rewiew and recommendations for practical usage. Anesthesist. 2011; 60(2): 152–
  6. Herroeder S., Pecher S., Schonherr M.E. et al. Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology. 2007; 106: 11–86.
  7. Kehlet H., Dahl J.B. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth. Analg. 1993; 77: 1048–1056.
  8. Kehlet H. Labat Lecture 2005. Surgical stress and postoperative outcome — from here to where? Anesth. Pain Med. 2006; 31: 47–52.
  9. Marret E., Rolin M., Beaussier M., Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br. J. Surg. 2008; 95(11): 1331–1338.
  10. Piper S., Rohm K., Suttner S. A comparison of nefopam and clonidine for the prevention of postanaesthetic shivering: a comparative, double-blind and placebo-controlled dose-ranging study. 2004; 59: 559–564.
  11. Verleye M., Andre N., Heulard I., Gillardin J. Nefopam blocks voltagesensitive sodium channels and modulates glutamatergic transmission in rodents. Brain Res. 2004; 1013: 249–2
  12. Баландин В.В., Горобец Е.С. Послеоперационное обезболивания нефопамом и НПВП у больных, оперированных по поводу опухолей области головы и шеи. Анестезиология и реаниматология. 2014; 1: 40–43.
  13. Баландин В.В., Горобец Е.С. Безопиоидная анестезия, анальгезии и седация в хирургии опухолей головы и шеи. Анестезиология и реаниматология. 2015; 60(6): 39–42.
  14. Овечкин А.М., Свиридов С.В. Послеоперационная боль и обезболивание: современное состояние проблемы. Медицина критических состояний. 2011; 6(37): 20–31.