The use of centrally acting analgesics in the postoperative analgesia in patients with the consequences of a severe mine-explosive injury of the lower extremities


  • Maksym Shostak KNP "Kyiv City Clinical Hospital No. 6"
  • Oleksii Domoratskyi National University of Health Care of Ukraine named after P. L. Shupyka



Blast injury, multimodal analgesia, nefopam


In this article, the authors discuss the place of modern analgesics of central action (nefopam hydrochloride) in the analgesia of patients with explosive injuries of the lower extremities. Currently, there is no information in global practice regarding the use of centrally acting analgesics for analgesia in patients with combat trauma. An example was the analgesia of patients in the p/o period with a severe explosive injury of the lower extremities. Attention is drawn to the need for effective analgesia for patients with a combo injury not only in the acute period. A feature of the treatment of such patients is the need for major restorative and reconstructive surgical interventions, which in turn are accompanied by a pronounced pain syndrome. In our experience, the addition of non-narcotic analgesics of central action (nefopam hydrochloride) to the scheme of multimodal analgesia is appropriate to improve analgesia in this category of patients. The addition of nefopam hydrochloride to a multimodal analgesia regimen at 20 mg IV every 6 hours was effective in the treatment of severe acute postoperative pain.


Download data is not yet available.


Eiamcharoenwit J, Chotisukarat H, Tainil K, Attanath N, Akavipat P. Analgesic efficacy of intravenous nefopam after spine surgery: a randomized, double-blind, placebo-controlled trial. F1000Research [Internet]. 2020 Aug 26;9:516. Available from: DOI:

Oh CS, Jung E, Lee SJ, Kim SH. Effect of nefopam versus fentanyl-based patient-controlled analgesia on postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery: a prospective double-blind randomized controlled trial. Current Medical Research and Opinion [Internet]. 2015 Jul 6;31(8):1599–607. Available from: DOI:

Aveline C, Gautier JF, Vautier P, Cognet F, Hetet HL, Attali JY, et al. Postoperative analgesia and early rehabilitation after total knee replacement: A comparison of continuous low-dose intravenous ketamine versus nefopam. European Journal of Pain [Internet]. 2009 Jul;13(6):613–9. Available from: DOI:

Smith JE, Garner J. Pathophysiology of primary blast injury. Journal of the Royal Army Medical Corps [Internet]. 2018 Oct 12;165(1):57–

Available from: DOI:

Tovar MA, Bell RS, Neal CJ. Epidemiology of Blast Neurotrauma: A Meta-analysis of Blast Injury Patterns in the Military and Civilian Populations. World Neurosurgery [Internet]. 2021 Feb;146:308-314. e3. Available from: DOI:

Mayhew E, Henson D, Reavley P. Pain management in paediatric blast injury. The Lancet Child & Adolescent Health [Internet]. 2021 Jan;5(1):e1. Available from: DOI:

Spurrier E, Singleton JAG, Masouros S, Gibb I, Clasper J. Blast Injury in the Spine: Dynamic Response Index Is Not an Appropriate Model for Predicting Injury. Clinical Orthopaedics & Related Research [Internet]. 2015 Sep;473(9):2929–35. Available from: DOI:

Smith JE. Blast lung injury. Journal of The Royal Naval Medical Service [Internet]. 2011 Dec;97(3):99–104. Available from: DOI:

Mathews ZR, Koyfman A. Blast Injuries. The Journal of Emergency Medicine [Internet]. 2015 Oct;49(4):573–87. Available from: DOI:

Webster CE, Clasper J, Stinner DJ, Eliahoo J, Masouros SD. Characterization of Lower Extremity Blast Injury. Military Medicine [Internet]. 2018 Mar 14;183(9–10):e448–53. Available from: DOI:

Matviychuk MV, Fishchuk VV, Saliy RL. Mine-explosive injury [Minno-vybukhova travma] In: XV scientific and practical conference "Actual issues of medical care in conditions of war in eastern Ukraine, civilian conditions. Psychological rehabilitation" [XV naukovo-praktychna konferentsiya "Aktualʹni pytannya medychnoyi dopomohy v umovakh viyny na skhodi Ukrayiny, tsyvilʹnykh umovakh. Psykholo-hichna reabilitatsiya"]. Proceedings; 2017 Apr 27–28; Vinnytsia. Vinnytsia; 2017 [cited 2022 Aug 18]; P. 100–104. Available from: [In Ukrainian]

Застосування анальгетиків центральної дії в післяопераційному знеболенні пацієнтів з наслідками тяжкої мінно-вибухової травми нижніх кінцівок



How to Cite

Shostak M, Domoratskyi O. The use of centrally acting analgesics in the postoperative analgesia in patients with the consequences of a severe mine-explosive injury of the lower extremities. prmd [Internet]. 2023 Jan. 29 [cited 2023 Jun. 1];5(2):27-31. Available from:



Original article