Paracetamol + Nefopam + Tramadol + Ketamine

OFA-CHU Nīmes (Opioid-Free Analgesia protocol by Centre Hospitalier Universitaire de Nīmes) is a multimodal analgesic combination therapy consisting of paracetamol, nefopam, tramadol, and ketamine. Developed for use in intensive care unit (ICU) settings, particularly for patients requiring mechanical ventilation, the protocol aims to provide effective pain management while minimizing or eliminating the requirement for potent opioids such as remifentanil. By utilizing drugs with distinct mechanisms of action—including cyclooxygenase inhibition (paracetamol), monoamine reuptake inhibition and ion channel modulation (nefopam), weak mu-opioid receptor agonism and monoamine reuptake inhibition (tramadol), and NMDA receptor antagonism (ketamine)—the protocol targets multiple pathways of pain signaling. This approach is intended to reduce opioid-associated complications such as respiratory depression, ileus, and hyperalgesia in critically ill patients.

Other names

OFA-Centre Hospitalier Universitaire de Nīmes-painOpioid-free analgesia protocolOFA-CHU Nīmes