Nicomorphinist
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Well, I could have told them that -- the paracetamol-nefopam-ketoprofen mixture makes it possible to use less of the narcotic to get a similar effect. As time went by, I replaced ketoprofen with naproxen, and added orphenadrine (which has a structural relation to nefopam) with and these days I take that mixture q8h to potentiate Blue Velvet (morphine + tripelennamine) and have good results with compounded Scophedal (hyoscine, ephedrine & oxycodone) and the hydromorphone, oxymorphone, dihydromorphine, nicomorphine, and similar analogues of Scophedal . Novices will find PNK and its analogues to be a good pre-load for codeine, dionine, dihydrocodeine, dihydroisocodeine, nicocodeine, hydrocodone, oxycodone and the like, and certainly for the strong narcotics referenced above. The PNK pre-load also can be used with synthetics like meptazinol, tilidate/tilidine, tramadol, and other
see details: https://doi.org/10.1016/j.bja.2018.10.058
Article Info
Publication HistoryPublished online: December 29, 2018Accepted: October 22, 2018;
To view the full text, please login as a subscribed user or purchase a subscription. Click here to view the full text on ScienceDirect.
Figures
Fig 1
Flow chart. C, control; P, paracetamol; N, nefopam; K, ketoprofen; PCA, patient-controlled analgesia. No efficacy data were available for patients who did not receive the allocated intervention.
Fig 2
Morphine consumption. Box plots represent median (Q1–Q3), and whiskers represent range values for morphine consumption at different times according to treatment group. Morphine consumption was significantly different between the eight groups 24 and 48 h after surgery (P=0.001 and P<0.007, respectively). C, control; P, paracetamol; N, nefopam; K, ketoprofen.
Fig 3
Pain measured with numerical rating scale (NRS) 24 and 48 h after surgery. Box plots represent median (Q1–Q3) and whiskers represent range values for NRS at different times according to treatment group. NRS was significantly different between the eight groups 24 h after surgery (P=0.003). C, control; P, paracetamol; N, nefopam; K, ketoprofen.
Abstract
Background
Head-to-head comparisons of combinations of more than one non-opioid analgesic (NOA) with morphine alone, for postoperative analgesia, are lacking. The objective of this multicentre, randomised, double-blind controlled trial was to compare the morphine-sparing effects of different combinations of three NOAs—paracetamol (P), nefopam (N), and ketoprofen (K)—for postoperative analgesia.
Methods
Patients from 10 hospitals were randomised to one of eight groups: control (C) received saline as placebo, P, N, K, PN, PK, NK, and PNK. Treatments were given intravenously four times a day during the first 48 h after surgery, and morphine patient-controlled analgesia was used as rescue analgesia. The outcome measures were morphine consumption, pain scores, and morphine-related side-effects evaluated 24 and 48 h after surgery.
Results
Two hundred and thirty-seven patients undergoing a major surgical procedure were included between July 2013 and November 2016. Despite a failure to reach a calculated sample size, 24 h morphine consumption [median (inter-quartile range)] was significantly reduced in the PNK group [5 (1–11) mg] compared with either the C group [27 (11–42) mg; P<0.05] or the N group [21 (12–29) mg; P<0.05]. Results were similar 48 h after surgery. Patients experienced less pain in the PNK group compared with the C, N, and P groups. No difference was observed in the incidence of morphine-related side-effects.
Conclusions
Combining three NOAs with morphine allows a significant morphine sparing for 48 h after surgery associated with superior analgesia the first 24 h when compared with morphine alone.
Clinical trial registration
see details: https://doi.org/10.1016/j.bja.2018.10.058
Article InfoPublication HistoryPublished online: December 29, 2018Accepted: October 22, 2018;
To view the full text, please login as a subscribed user or purchase a subscription. Click here to view the full text on ScienceDirect.
Figures
Fig 1
Flow chart. C, control; P, paracetamol; N, nefopam; K, ketoprofen; PCA, patient-controlled analgesia. No efficacy data were available for patients who did not receive the allocated intervention.
Fig 2
Morphine consumption. Box plots represent median (Q1–Q3), and whiskers represent range values for morphine consumption at different times according to treatment group. Morphine consumption was significantly different between the eight groups 24 and 48 h after surgery (P=0.001 and P<0.007, respectively). C, control; P, paracetamol; N, nefopam; K, ketoprofen.
Fig 3
Pain measured with numerical rating scale (NRS) 24 and 48 h after surgery. Box plots represent median (Q1–Q3) and whiskers represent range values for NRS at different times according to treatment group. NRS was significantly different between the eight groups 24 h after surgery (P=0.003). C, control; P, paracetamol; N, nefopam; K, ketoprofen.
Abstract
Background
Head-to-head comparisons of combinations of more than one non-opioid analgesic (NOA) with morphine alone, for postoperative analgesia, are lacking. The objective of this multicentre, randomised, double-blind controlled trial was to compare the morphine-sparing effects of different combinations of three NOAs—paracetamol (P), nefopam (N), and ketoprofen (K)—for postoperative analgesia.
Methods
Patients from 10 hospitals were randomised to one of eight groups: control (C) received saline as placebo, P, N, K, PN, PK, NK, and PNK. Treatments were given intravenously four times a day during the first 48 h after surgery, and morphine patient-controlled analgesia was used as rescue analgesia. The outcome measures were morphine consumption, pain scores, and morphine-related side-effects evaluated 24 and 48 h after surgery.
Results
Two hundred and thirty-seven patients undergoing a major surgical procedure were included between July 2013 and November 2016. Despite a failure to reach a calculated sample size, 24 h morphine consumption [median (inter-quartile range)] was significantly reduced in the PNK group [5 (1–11) mg] compared with either the C group [27 (11–42) mg; P<0.05] or the N group [21 (12–29) mg; P<0.05]. Results were similar 48 h after surgery. Patients experienced less pain in the PNK group compared with the C, N, and P groups. No difference was observed in the incidence of morphine-related side-effects.
Conclusions
Combining three NOAs with morphine allows a significant morphine sparing for 48 h after surgery associated with superior analgesia the first 24 h when compared with morphine alone.
Clinical trial registration
