scholarly journals Effects of Electrical Muscle Stimulation for Preventing Deltoid Muscle Atrophy after Rotator Cuff Repair: Preliminary Results of a Prospective, Randomized, Single-blind Trial

2019 ◽  
Vol 22 (4) ◽  
pp. 195-202
Author(s):  
Goo Joo Lee ◽  
Hangyeol Cho ◽  
Byung-Hyun Ahn ◽  
Ho-Seung Jeong
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Neuromuscular Electrical Stimulation ◽  
Cross Sectional ◽  
Post Surgery ◽  
Significant Difference ◽  
Functional Scores ◽  
Arthroscopic Rotator Cuff ◽  
Abduction Strength ◽  
Cuff Repair

Background: This study investigates the effects of neuromuscular electrical stimulation (NMES) in preventing deltoid atrophy during the first 12 weeks after arthroscopic rotator cuff repair.Methods: Eighteen patients undergoing arthroscopic repair of a medium-sized rotator cuff tear by a single surgeon, were randomized into two groups: NMES and transcutaneous electrical nerve stimulation (TENS). Each group used the respective device for 6 weeks after surgery. Pain was measured at baseline, 6, and 12 weeks postoperatively, using the visual analogue scale (VAS); range of motion (ROM), abduction strength and functional scores were measured at baseline and 12 weeks postoperatively. Deltoid thickness and cross-sectional areas were measured using magnetic resonance imaging at 12 weeks postoperatively.Results: At 12 weeks post-surgery, no statistically significant difference was observed between the NMES and TENS groups in the pain VAS, the Disabilities of the Arm, Shoulder and Hand score, ROM, and abduction strength. Postoperative decrease in the thickness of the anterior, middle, and posterior deltoid, at the level just below the coracoid, was -2.5%, -0.7%, and -6.8%, respectively, in the NMES group, and -14.0%, -2.6%, and -8.2%, respectively, in the TENS group (<i>p</i>=0.016, <i>p</i>=0.677, and <i>p</i>=0.791, respectively). At the level of the inferior glenoid tubercle, postoperative decrease in area of the deltoid was -5.4% in the NMES group and -14.0% in the TENS group, which was significantly different (<i>p</i>=0.045).Conclusions: NMES has the potential for reducing deltoid atrophy after arthroscopic rotator cuff repair, suggesting that NMES might help minimize postoperative atrophy after various shoulder surgeries.

scholarly journals ALLOGENEIC PLATELET-RICH PLASMA FOR ROTATOR CUFF REPAIR

2017 ◽  
Vol 25 (1) ◽  
pp. 38-43 ◽  
Author(s):  
CHRIS HYUNCHUL JO ◽  
JI SUN SHIN ◽  
SEUNG YEON LEE ◽  
SUE SHIN
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Platelet Rich Plasma ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Significant Difference ◽  
One Year ◽  
Arthroscopic Rotator Cuff ◽  
Retrospective Comparative Study ◽  
Cuff Repair

ABSTRACT Objective: To investigate the safety and efficacy of allogeneic platelet-rich plasma (PRP) in rotator cuff repair . Methods: Seventeen patients with a full-thickness rotator cuff tear were included. Ten patients underwent arthroscopic rotator cuff repair with allogeneic, and seven patients with autologous PRP. Three PRP gels in a volume 3 ml each were applied between the torn end and the greater tuberosity. Clinical outcomes were assessed preoperatively and at a minimum of 2 years after surgery. Structural outcomes were evaluated with the presence of retear and the change of the cross-sectional area (ACT) of the supraspinatus . Results: Allogeneic PRP did not cause any adverse events during the follow-up period. There was no significant difference in the clinical outcome measures between the two groups (all p > 0.05). The retear rate was 33.3% and 25.0% in the allogeneic group and autologous group, respectively (p = 0.764). The change between the one-year postoperative and immediately postoperative ACT was not also significantly different between the two groups (p = 0.373) . Conclusion: Allogeneic PRP in arthroscopic rotator cuff did not cause any local or general complications and that has the efficacy comparable to autologous PRP with respect to the clinical and structural outcomes. Level of Evidence III, Retrospective Comparative Study.

scholarly journals The Incidence of Chronic Opioid Use Following Arthroscopic Rotator Cuff Repair and Patient Opioid Education

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0025
Author(s):  
Danielle G. Weekes ◽  
Jenna A. Feldman ◽  
Richard E. Campbell ◽  
Michael DeFrance ◽  
Fotios P. Tjoumakaris ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Shoulder Function ◽  
Arthroscopic Rotator Cuff Repair ◽  
Prescription Data ◽  
Opioid Use ◽  
Significant Difference ◽  
Chronic Opioid Use ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Objectives: Opioids are commonly prescribed for pain management following Arthroscopic Rotator Cuff Repair (ARCR). While their efficacy outweighs their risks in the short term, chronic opioid use is associated with significant adverse effects, such as dependence, endocrine imbalance or respiratory depression. The rate of chronic opioid use and dependence following ARCR is unknown. The purpose of this study is to determine the rate of chronic opioid use following ARCR and establish the effect of preoperative opioid education on reducing chronic consumption. A secondary aim is to determine if any correlation exists between chronic opioid use and shoulder functionality. Methods: A prospective, randomized study of 140 patients undergoing ARCR was performed with a minimum follow-up of 24 months. Patients were randomized to receive preoperative opioid education (risks of abuse, dependence, etc.) or no education. State registry database opioid prescription data monitoring software were utilized to search for all opioid prescriptions following ARCR in our patient population and this was compared to our electronic medical database for accuracy/discrepancy. The total number of opioid prescriptions and number of tablets was determined as well as time from surgery to most recent prescription. Patients were contacted to determine a shoulder Single Assessment Numeric Evaluation (SANE) score and Visual Analog Scale (VAS) pain score. Categorical data was analyzed via chi-squared tests as appropriate. Numeric data was analyzed using t-tests as appropriate. Results: Forty-five patients (32%) continued to fill opioid prescriptions chronically following ARCR. Seventeen (38%) of these patents received pre-operative opioid educated, whereas twenty-eight (62%) did not (p=0.05). Sixty percent of patients with a history of pre-operative opioid use continued to take opioids, while 23% of opioid naive patients continued (p< 0.01). There was no significant difference in SANE (p= 0.53) or VAS (p= 0.65) scores between the education and control group. Patients taking opioids prior to surgery had worse SANE scores (71.28) than the non-users (86.28), p< 0.01. Conclusion: Almost a third of patients will chronically use opioids following ARCR, including 23% of opioid naive patients. Preoperative opioid use is strongly associated with chronic opioid utilization, as well as decreased shoulder function 2 years after ARCR. Preoperative opioid education significantly decreased the rate of chronic opioid use; however, there is no effect on long-term shoulder function. [Table: see text]

What happens to the long head of the biceps tendon after arthroscopic rotator cuff repair?

2020 ◽  
Vol 102-B (9) ◽  
pp. 1194-1199
Author(s):  
Hyo-Jin Lee ◽  
Eung-Sic Kim ◽  
Yang-Soo Kim
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Biceps Brachii ◽  
Morphological Changes ◽  
Biceps Tendon ◽  
Cross Sectional ◽  
Postoperative Changes ◽  
Long Head ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Aims The purpose of this study was to identify the changes in untreated long head of the biceps brachii tendon (LHBT) after a rotator cuff tear and to evaluate the factors related to the changes. Methods A cohort of 162 patients who underwent isolated supraspinatus with the preservation of LHBT was enrolled and evaluated. The cross-sectional area (CSA) of the LHBT on MRI was measured in the bicipital groove, and preoperative to postoperative difference was calculated at least 12 months postoperatively. Second, postoperative changes in the LHBT including intratendinous signal change, rupture, dislocation, or superior labral lesions were evaluated with seeking of factors that were correlated with the changes or newly developed lesions after rotator cuff repair. Results The postoperative CSA (12.5 mm2 (SD 8.3) was significantly larger than preoperative CSA (11.5 mm2 (SD 7.5); p = 0.005). In total, 32 patients (19.8%) showed morphological changes in the untreated LHBT 24 months after rotator cuff repair. Univariate regression analysis revealed that the factor chiefly related to the change in LHBT status was an eccentric LHBT position within the groove found on preoperative MRI (p = 0.011). Multivariate analysis using logistic regression also revealed that an eccentric LHBT position was a factor related to postoperative change in untreated LHBTs (p = 0.011). Conclusion The CSA of the LHBT inside the biceps groove increased after rotator cuff repair. The preoperative presence of an eccentrically positioned LHBT was associated with further changes of the tendon itself after rotator cuff repair. Cite this article: Bone Joint J 2020;102-B(9):1194–1199.

scholarly journals Factors affecting return to work following arthroscopic rotator cuff repair: A retrospective observational study in an occupational medicine clinic and single-surgeon practice

2021 ◽  
Author(s):  
Ijaz Khan ◽  
Manaal Fatima ◽  
Corey Scholes ◽  
Vikram Kandhari ◽  
K.M. Ponnanna ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Return To Work ◽  
Rotator Cuff Repair ◽  
Activity Level ◽  
Arthroscopic Rotator Cuff Repair ◽  
Factors Affecting ◽  
Significant Difference ◽  
Arthroscopic Rotator Cuff ◽  
Chi Square Analysis ◽  
Cuff Repair

Background: Return to work (RTW) following arthroscopic rotator cuff repair (aRCR) within New South Wales (NSW), Australia, under compensable schemes has not been reported. Aims: Determine factors affecting RTW status and time in patients treated with aRCR under state-based compensation schemes, compared to those outside such schemes. Methods: Patients undergoing aRCR by one surgeon with minimum 1-year follow-up were grouped into those under (CP) or outside (non-CP) workers or vehicle accident compensation schemes, matched by age and gender. RTW status and time were assessed using chi-square analysis and multivariable linear regression. Results: Of 1054 available patients, 90 CP patients were identified with 29 consented and matched to non-CP (N=29). A higher proportion of CP patients (17.2 vs 0%, P<0.001) never returned to work and a lower proportion resumed pre-injury duties at first RTW (3 vs 52%, P<0.01). Median time to first RTW did not differ between CP and non-CP groups (5.1 vs 4.4, P=0.86). Smoking (P=0.007) and post-injury activity level (P=0.004) were significantly associated with longer time to first RTW, whereas compensation status was not. Conclusions: CP patients undergoing aRCR in NSW are at risk of not returning to work. For those that return, there is no significant difference compared to non-CP in time to first RTW. Particularly, patient and management factors associated with extended time to first RTW have been identified. Interventions aimed at modifiable factors such as smoking cessation and increasing preoperative activity may improve future outcomes.

Dyslipidemia With Perioperative Statin Usage Is Not Associated With Poorer 24-Month Functional Outcomes After Arthroscopic Rotator Cuff Surgery

2020 ◽  
Vol 48 (10) ◽  
pp. 2518-2524
Author(s):  
Gerald Joseph ShengXiang Zeng ◽  
Merrill Jian Hui Lee ◽  
Jerry Yongqiang Chen ◽  
Benjamin Fu Hong Ang ◽  
Ying Hao ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Functional Outcomes ◽  
Density Lipoprotein ◽  
Rotator Cuff Disease ◽  
Significant Difference ◽  
Statin Usage ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Rotator Cuff Surgery

Background: Current literature suggests a higher rate of rotator cuff disease development in patients with dyslipidemia (DL). Moderate to high levels of DL are associated with higher rates of retear and revision surgery after arthroscopic rotator cuff repair. Statins protect against development of rotator cuff disease and mitigate the need for rotator cuff repair. Purpose: We aimed to investigate the influence of DL and statin use on postoperative functional outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2010 and 2016, 266 patients underwent arthroscopic double-row rotator cuff repair for atraumatic full-thickness tears. Evaluation was conducted preoperatively and at 3, 6, 12, and 24 months postoperatively. Three functional outcome measures were used (Constant Shoulder Score [CSS], Oxford Shoulder Score [OXF], and University of California, Los Angeles, Shoulder Rating Scale [UCLASS]), as well as a visual analog scale (VAS) for pain. DL and non-DL were classified through screening of health and assessment of lipid levels within 6 months of surgery (triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein). Patients with DL were divided into statin users and nonusers. Types and dosages of statins were recorded, and intensity and equivalency charts were employed for standardization. Mann-Whitney U test and Pearson chi-square test were used for analysis. Generalized estimating equations and linear mixed models were used to examine the influence of DL and statin dosage, respectively on percentage change of postoperative outcome scores. Results: Increased age was associated with a higher incidence of DL ( P < .001), and 86% of the DL group was taking statins. The DL group also exhibited poorer scores preoperatively (CSS, P = .001; OXF, P = .032). No significant difference in scores was elicited between the DL and non-DL groups at 24 months. However, patients with DL experienced greater percentage improvement of CSS and OXF from preoperative baseline than did patients without DL ( P = .008 and P = .034, respectively) at 24 months. There was no significant difference in 24-month functional outcomes between statin users and nonusers. No statistically significant change of CSS; OXF; UCLASS; or VAS was noted with increasing statin doses at 24 months. Conclusion: Patients with DL with perioperative statin usage did not have poorer 24-month functional outcomes after arthroscopic rotator cuff surgery compared with those in patients without DL.

Biceps Tenodesis Combined With Rotator Cuff Repair Increases Functional Status And Elbow Strength In Both Operated And Contralateral Arms

2020 ◽  
Author(s):  
Ali Ihsan KILIC ◽  
Onur HAPA ◽  
Ramadan OZMANEVRA ◽  
Nihat Demirhan DEMIRKIRAN ◽  
Onur GURSAN
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Constant Score ◽  
Elbow Flexion ◽  
Arthroscopic Rotator Cuff Repair ◽  
Biceps Tenodesis ◽  
Significant Difference ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Abstract Purpose: Aim of the present study was to prospectively evaluate the elbow flexion and supination strengths, and the functional outcomes of patients after arthroscopic rotator cuff repair combined with simultaneous biceps tenodesis.Methods: Nineteen patients who underwent arthroscopic rotator cuff repair and biceps tenodesis with at least 24 months follow-up were included. Patients were evaluated using a visual analogue scale (VAS) for bicipital groove pain, American Shoulder and Elbow Surgeons (ASES), and constant scores(CS), biceps apex distance (BAD), elbow flexion and supination strengths.Results: VAS for biceps groove measurement averages of postoperative 6th, 12th and 24th month were lower in comparison to pre-operative data and were considered to be statistically significant (p<0.05). Constant score, an average of all post-operative measurements and scores were found higher than pre-operative values and was considered to be statistically significant (p<0,01). There was a significant difference in the comparison of operated and contralateral forearm supination and elbow flexion muscle strength measurements at postoperative 3rd and 6th-month follow-up (p<0.01).Conclusion: Arthroscopic biceps tenodesis into the anchors of lateral row combined rotator cuff repair provides an increase in strength of elbow flexion and forearm supination, while decreases pain. Level of Evidence: Level IV

Effects of a Thermosensitive Antiadhesive Agent on Single-Row Arthroscopic Rotator Cuff Repair

2020 ◽  
Vol 48 (11) ◽  
pp. 2669-2676
Author(s):  
Jangwoo Kim ◽  
Yuna Kim ◽  
Whanik Jung ◽  
Ji Hoon Nam ◽  
Sae Hoon Kim
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Functional Score ◽  
Control Group ◽  
Injection Group ◽  
Functional Scores ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Postoperative stiffness after rotator cuff repair is a common complication that can lead to poor outcomes and patient discomfort. The application of an antiadhesive agent at the time of repair recently became an option for clinicians, but little information is available on its effects. Purpose: To evaluate and compare retear rates, the incidence of postoperative stiffness, and the clinical outcomes of patients who underwent cuff repair with or without the application of an antiadhesive agent. Study Design: Cohort study; Level of evidence, 3. Methods: Among 296 patients who underwent arthroscopic rotator cuff repair surgery, we compared the outcomes of those injected with a thermosensitive gel antiadhesive agent into the subacromial space (112 cases) versus noninjected controls (184 cases). Retear rates in the 2 groups were determined by magnetic resonance imaging at 1 year after surgery. Shoulder joint range of motion and functional scores were evaluated serially. Results: The rate of retear was significantly lower in the injection group (20/112 cases; 17.9%) than the control group (53/184 cases; 28.8%) ( P = .034). Postoperative stiffness was not significantly different between the 2 groups ( P = .710). Among the data regarding range of motion, only forward flexion at 6 months after surgery showed superior results in the injection group. Functional scores showed conflicting results: The control group had better visual analog scale scores for pain (injection vs control: 2.17 vs 1.68 at 6 months; 1.82 vs 1.28 at 12 months), American Shoulder and Elbow Surgeons scores (79.89 vs 89.64 at 12 months), and simple shoulder test scores (8.70 vs 10.06 at 12 months), whereas the injection group had better Constant-Murley scores (injection vs control: 59.49 vs 55.60 at 3 months; 77.35 vs 71.98 at 6 months; 87.28 vs 81.56 at 12 months). Conclusion: The tendon healing rate was significantly higher in the group receiving an antiadhesive agent than in the control group. No intergroup difference was seen in the occurrence of postoperative stiffness. However, the pain-related functional score showed inferior results in the injection group at 12 months. The biological action of antiadhesive agents in rotator cuff repair should be further evaluated.

scholarly journals EFFECT OF SUBSCAPULARIS TEARS ON FUNCTIONAL SCORES OF PATIENTS UNDERGOING ROTATOR CUFF REPAIR

2019 ◽  
Vol 27 (2) ◽  
pp. 116-119 ◽  
Author(s):  
Eduardo Angeli Malavolta ◽  
Verônica Yulin Prieto Chang ◽  
Marcello TraballiBozzi Pinto de Castro ◽  
Fernando Brandao Andrade-Silva ◽  
Jorge Henrique Assunção ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Subscapularis Tendon ◽  
Full Thickness ◽  
Functional Scores ◽  
Tendon Tears ◽  
Arthroscopic Rotator Cuff ◽  
Upper Third ◽  
Cuff Repair

ABSTRACT Objective: To evaluate the influence of partial- and full-thickness upper third subscapularis tendon tears on the functional scores of patients undergoing arthroscopic rotator cuff repair. Methods: Patients who underwent arthroscopic rotator cuff repair were divided into three groups according to the subscapularis tendon condition: intact, partial-thickness tear, or full-thickness upper third tear. Functional scores were compared among groups. Second, the influence of biceps and infraspinatus tears on the scores was tested using multivariate regression analysis. Results: We evaluated 307 shoulders in 297 patients. Full-thickness upper third subscapularis tears presented significantly worse scores than intact tendons. Partial-thickness tears had scores that did not differ significantly from those of the other groups. Patients with full-thickness upper third tears presented a greater rate of injured and unstable biceps tendons. The multivariate analysis showed that biceps and infraspinatus tendon tears did not influence the scores or the intergroup comparison. Conclusion: Full-thickness upper third subscapularis tendon tears presented worse functional scores than intact subscapularis tendons among patients undergoing posterosuperior rotator cuff repair. Patients with full-thickness subscapularis tears were more likely to suffer biceps tears, but this fact did not influence functional scores. Level of Evidence I; Clinical randomized trial

Do Selective COX-2 Inhibitors Affect Pain Control and Healing After Arthroscopic Rotator Cuff Repair? A Preliminary Study

2017 ◽  
Vol 46 (3) ◽  
pp. 679-686 ◽  
Author(s):  
Joo Han Oh ◽  
Hyuk Jun Seo ◽  
Ye-Hyun Lee ◽  
Hye-Yeon Choi ◽  
Ho Yun Joung ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Adverse Effects ◽  
Rotator Cuff Repair ◽  
Pain Control ◽  
Arthroscopic Rotator Cuff Repair ◽  
Functional Scores ◽  
Cox 2 ◽  
Arthroscopic Rotator Cuff ◽  
Cox 2 Inhibitors ◽  
Cuff Repair

Background: Selective cyclooxygenase (COX)–2 inhibitors are commonly used analgesics that provide similar analgesia as that of other analgesics but with fewer adverse effects. However, few prospective studies have performed comparative analyses in this regard. Purpose: To evaluate the efficacy of a selective COX-2 inhibitor in early postoperative pain control, satisfaction with pain management, and incidence of systemic adverse effects in patients undergoing arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This study included 180 patients who underwent arthroscopic rotator cuff repair between September 2011 and August 2012. The patients were randomly assigned to receive celecoxib, ibuprofen, or tramadol (n = 60 each). Visual analog scale (VAS) scores for pain intensity and satisfaction with medication, incidence of adverse effects, and use of rescue medication were recorded and compared between the 3 groups at 3 days and 2 weeks after surgery. Magnetic resonance and ultrasonography images of 82 patients were retrospectively reviewed at least 24 months after surgery, along with the range of motion and pain VAS and functional scores. Results: There were no significant differences among the 3 groups in terms of pain intensity, incidence of adverse effects, or dosage of rescue medication at 3 days or 2 weeks after surgery. Pain VAS and functional scores at the final follow-up were also comparable among the 3 groups. However, the retear rate in the celecoxib group (11/30 [37%]) was significantly higher than those in the ibuprofen (2/27 [7%]) and tramadol (1/25 [4%]) groups ( P = .009). Conclusion: Despite having similar postoperative analgesic effects as other nonsteroidal anti-inflammatory drugs and opioids, selective COX-2 inhibitors should not be used for postoperative analgesia because they might negatively affect tendon-to-bone healing after surgical repair. Registration: NCT02850211 ( ClinicalTrials.gov identifier)

scholarly journals Analgesic Effect of Low Dose Nefopam Hydrochloride after Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

2019 ◽  
Vol 8 (4) ◽  
pp. 553 ◽  
Author(s):  
Hyun Jung Koh ◽  
Jin Joo ◽  
Yang-Soo Kim ◽  
Yu Jung Lee ◽  
Woojoo Yoo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Controlled Trial ◽  
Demographic Data ◽  
Opioid Analgesic ◽  
Arthroscopic Rotator Cuff Repair ◽  
Significant Difference ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Arthroscopic rotator cuff repair causes acute postoperative hyperalgesia. Multimodal analgesia is preferable to opioid-based intravenous patient-controlled analgesia (IV-PCA) due to postoperative nausea and vomiting (PONV). We evaluated the effect of nefopam as a postoperative non-opioid analgesic after shoulder surgeries. A total of 180 adult patients were enrolled for arthroscopic rotator cuff repair. They were randomly assigned to nefopam (N) or control (C) groups and each group was reclassified according to the interscalene block (B) into NB, CB and NX, CX. Nefopam was applied at a constant dose intravenously during recovery. Pain scores were measured with a Visual Analogue Scale (VAS) before (T0), immediately after (T1), 30 min (T2) and 12 h (T3), 24 h (T4) and 48 h (T5) after surgery. There was no significant difference in demographic data. The overall VAS scores did not differ with regard to nefopam use, except for the NB group at T4 in intention to treat (ITT) analysis (p < 0.05). PONV occurred more frequently in the N group than in the C group (p < 0.05). Neither individual nor all risk factors were associated with PONV occurrence (p > 0.10). In conclusion, nefopam alone did not show a definite decrease in postoperative pain. It instead increased PONV regardless of risk factors.

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