Nalmefene Mitigates Opioid‐Induced Nausea and Vomiting in Postoperative Analgesia but Not Resting Pain

BACKGROUND: Patient-controlled analgesia (PCA) pumps have emerged as the prevalent modality for managing postoperative pain. Opioids, although widely utilized as analgesic agents in these pumps, are often accompanied by undesirable side effects that can compromise patient comfort and hinder the widespread adoption of PCA therapy. METHODS: We conducted a retrospective study involving 392 patients undergoing lumbar spine surgery who were prescribed PCA pumps for pain relief. Over the initial 1-3 days postsurgery, comprehensive data encompassing resting and activity-related pain levels, Ramsay sedation scores, activity status, and flatus passage were carefully recorded and analyzed. RESULTS: Interestingly, patients who received a supplemental dose of nalmefene in their PCA pumps exhibited a notable increase in resting pain intensity on the second postoperative day. However, the incidence of postoperative nausea and vomiting (PONV) was notably reduced (15.5% in the sufentanil + nalmefene group vs 25.5% in the sufentanil group). Notably, no statistically significant variations were discerned between the two groups in Ramsay sedation scores, postoperative activity capabilities, flatus passage, or inflammatory biomarker levels. CONCLUSION: The integration of nalmefene into PCA pumps presents a promising strategy for mitigating the occurrence of PONV, albeit with the caveat of potentially compromising opioid-mediated analgesia, necessitating further research and exploration. The delicate balance between enhancing patient comfort and preserving effective pain control remains a critical area of investigation in the field of postoperative pain management.