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At least 199 records · Page 11Linked to original sources
PubMed1984

Submucous paracervical blockade compared with intramuscular meperidine as analgesia during labor: a double-blind study.

A double-blind study was carried out to compare the effect of submucous paracervical blockade using 12 mL 0.25% bupivacaine (55 women) to the effect of intramuscular injection of 75 mg meperidine (62 women) during the first stage of labor. All 117 were normal primiparous pregnancies. Seventy-eight percent of the women in the paracervical blockade group achieved full or acceptable pain relief against 31% in the meperidine group (P less than .01). Transient fetal bradycardia occurred in two cases in the paracervical blockade group and one in the meperidine group; all infants were born in good condition. Fetal distress, defined as an umbilical artery pH of 7.15 or less and/or a one-minute Apgar score of 7 or less was more frequent in the meperidine group (16 infants) than in the paracervical blockade group (six infants) (P less than .05). Submucous paracervical blockade is superior to intramuscular meperidine as pain relief during labor. Furthermore, meperidine results in more infants with asphyxia as compared with paracervical blockade.

Anesthesia, Obstetrical↗
PubMed1981

Generalized cardiovascular and regional hemodynamic effects of meperidine in conscious dogs.

Changes in both total cardiovascular function and regional hemodynamics associated with large doses of intravenous meperidine were studied in conscious dogs in the absence of other drugs or recent surgery. The animals had previously been surgically prepared by placement of aortic catheters and implantation of chronic indwelling electro-magnetic and Doppler ultrasonic flow probes on the aorta and on mesenteric, renal, and iliac arteries. Meperidine, 2 mg/kg, produced mild renal vascular dilation (10% maximum decreases in resistances and 5% increases in blood flow), but did not alter the resistances and flows in the mesenteric or iliac vascular beds. Meperidine, 6 mg/kg, again resulted in renal dilation (maximum 22% decreases in resistance and 18% increase in blood flow). The iliac vasculature also dilated (maximum 39% decreases in resistance and 40% increases in blood flow). However, the mesenteric vasculature constricted (89% increases in resistance and 40% decreases in blood flow). Following 2 mg/kg of meperidine cardiac output and aortic pressure decreased significantly while total peripheral resistance increased significantly. Heart rate remained unchanged. Following 6 mg/kg of meperidine total peripheral resistance and aortic pressure decreased significantly while heart rate increased. Cardiac output increased during the first part of the observation period then subsequently decreased significantly. It is concluded that in unmedicated dogs meperidine has significant effects on total cardiovascular function and on regional blood flow.

Animals↗
PubMed1982

Meperidine metabolism in the parturient.

A study of meperidine metabolism was undertaken in 21 normal parturients at term. Meperidine, 50 mg intravenously, was the sole analgesic agent used during the intrapartum period. Maternal and cord blood assessment for meperidine and normeperidine was done by gas chromatography-mass spectrophotometry. Most maternal sera showed a typical meperidine elimination curve. A secondary rise in maternal meperidine 30 to 180 minutes after injection was found in 4 patients. One patient showed a significant alteration in normeperidine appearance. These data add further validity to the hypothesis that the pregnant woman can metabolize meperidine by several pathways.

Adolescent↗
PubMed1981

Peridural meperidine in humans: analgesic response, pharmacokinetics, and transmission into CSF.

Effective analgesia resulted from the injection of peridural meperidine in two groups of cancer patients, eight with postoperative pain and eight with intractable pain. Peridural meperidine HCl, 100 mg (n = 8), in 10 ml saline administered to patients following surgery was followed by a median duration of analgesia of 6 hours (range 4-20 hours) over periods ranging from 1-4 days. Peridural meperidine HCl, 30-100 mg (n = 8), in 10 ml saline administered to patients with intractable pain gave a median duration of analgesia of 8 hours (range 4-20 hours) over periods ranging from 1-9 days. There was no obvious tendency towards tolerance. In all patients, the onset of analgesia was within 5 min and was complete within 30 min. This analgesia paralleled the rise in CSF meperidine concentrations following peridural administration. Systemic absorption of peridurally administered meperidine occurred with a half-life of 15-30 min and produced blood concentrations high enough to contribute to analgesia after approximately 20 min in the majority of patients. There was no objective evidence in any neurological change nor sympathetic blockade after peridural meperidine. From this evidence the dorsal horn of the spinal cord may be the major site of action as distinct from the axonal blockade produced by local anesthetics, indicating 'selective' spinal analgesia.

Adult↗
PubMed1995

Analgesic and urodynamic effects of epidural meperidine and pentazocine--a comparative study.

Meperidine 1 mg kg-1 and pentazocine 0.3 mg kg-1 were administered epidurally to investigate their effect on vesical function in twenty American Society of Anesthesiologists Classification I (ASA-1) adult males. Cystometry was performed before and 45 minutes following epidural administration of meperidine and pentazocine. There was no significant change in maximum cystometric capacity, detrusor pressure at which detrusor reflex occurred and in vesical compliance following epidural administration of meperidine in ten patients and also in ten patients who received epidural pentazocine. The mean onset of analgesia after epidural administration of meperidine was 8 minutes which lasted for more than 360 minutes whereas mean onset of analgesia after epidural administration of pentazocine was 4 minutes which lasted for more than 360 minutes. There was no significant change in heart rate, blood pressure and respiratory rate after epidural administration of either meperidine or pentazocine. None of the subjects in either of the groups experienced any difficulty in passing urine, frequency or urgency of micturition. Side-effects like nausea, vomiting, pruritus and respiratory depression were not observed. It is concluded that epidural administration of meperidine 1 mg kg-1 or pentazocine 0.3 mg kg-1 produces significant analgesia of faster onset without altering vesical function as documented, both subjectively by voiding symptoms and objectively by cystometry.

Adult↗
PubMed1994

Spinal anesthesia with meperidine: will epinephrine prolong its duration?

Meperidine (Demerol) has local anesthetic properties separate from its opioid receptor agonist effect. Unlike morphine, meperidine is structurally similar to local anesthetics. Therefore, it is not surprising that it possesses some characteristics of local anesthetics. If meperidine acts like a local anesthetic, binding to the same receptor sites and inhibiting nerve conduction, then drugs that alter the action and duration of local anesthetics may have a similar effect on it. This double-blinded investigation used low-dose meperidine as the sole intrathecal agent to determine the effect of epinephrine on the duration of sensory blockade. Thirty male ASA physical status I through III patients between the ages of 58-81 years who were scheduled for transurethral resection of the prostate or of bladder tumors were randomly assigned to receive meperidine with or without epinephrine. A continuous spinal technique was utilized, and meperidine 0.5 mg/kg was administered after ascertaining the proper position of the catheter. Fourteen of the patients received epinephrine, and 16 patients did not. There were no statistically significant differences between the two groups in terms of age, height, weight, and ASA physical status. No statistically significant prolongation of the sensory blockade was observed with the addition of epinephrine. There were no statistically significant differences between the two groups with regard to onset time or the incidence of complications. The occurrence of a full motor block in the group that did not receive epinephrine was statistically significant.

Aged↗
PubMed1994

[Analysis of meperidine and its metabolites in urine of an addict by GC/FID and GC/MS].

Analytical methods of GC/FID and GC/MS for identification and determination of meperidine, an analgesic drug, and its metabolites were established. The determination of meperidine spiked in urine was shown to have a good linear relationship in the range of 0.1-8.0 micrograms/ml urine (Y = 0.4995X + 0.1201, r = 0.9996). The detection limit was 20 ng/ml urine. With the developed methods, meperidine and its metabolites in urine collected from a meperidine addict were identified and determined. Meperidine, normeperidine, meperidinic acid in free and conjugate forms, normeperidine acid in free and conjugate forms, and acetyl-normeperidine were detected. Among these metabolites, acetyl-normeperidine was reported for the first time.

Cholinesterase Inhibitors↗
PubMedDate not supplied

Comparison of ketorolac and meperidine in patients with postoperative pain--impact on health care utilization.

A double-blind, randomized study was conducted to compare the effects of intramuscular ketorolac tromethamine and meperidine hydrochloride, and subsequent oral pain medication, on health care utilization and postoperative recovery. Following abdominal hysterectomy or cholecystectomy, 210 patients (aged 18 to 70 years; 189 women, 21 men) were randomly assigned to therapy and evaluated for efficacy, safety, nursing care requirements, functional independence, recovery milestones, and quality of life. The patients received 30 mg of ketorolac intramuscularly every 3 to 6 hours as needed, followed by 10 mg of ketorolac every 4 to 6 hours, or 100 mg of meperidine intramuscularly every 3 to 6 hours as needed, followed by acetaminophen/codeine (600 mg/60 mg) orally every 4 to 6 hours. Patients receiving ketorolac had lower nursing utilization scores and achieved a higher level of functioning than patients receiving meperidine during the first 3 postoperative days. Times to first bowel movement, walking without assistance, and first oral fluids were significantly shorter after ketorolac than meperidine. Mean pain intensity difference (from baseline) scores and pain relief scores when adjusted for baseline pain severity were comparable between ketorolac and meperidine. Most adverse events reported by the patients were mild to moderate; 12 patients in each group withdrew from treatment because of adverse events (nausea, rash, or headache). It is concluded that ketorolac is an effective alternative to meperidine in the management of postoperative pain.

Administration, Oral↗
PubMedDate not supplied

A comparison of meperidine and lidocaine for spinal anesthesia for postpartum tubal ligation.

BACKGROUND AND OBJECTIVES: This study compares the anesthetic potency, duration, and side effects of subarachnoid meperidine and lidocaine for postpartum tubal ligation. METHOD: Twenty healthy, unpremedicated postpartum women gave written informed consent to participate in this randomized double-blind study. After intravenous infusion of 200 mL physiologic salt solution, patients received subarachnoid injections from either lidocaine 70 mg in 7.5% glucose or meperidine 60 mg in saline while lying in the right lateral position. Heart rate, blood pressure, sensory and motor block, pain, nausea, and pruritus were recorded at intervals for up to 12 hours after injection. The time to first postoperative analgesic was also recorded. RESULTS: There were no differences between the groups in demographics, heart rate, or blood pressure at any time. Sensory or motor block developed slightly faster in the lidocaine group. One patient in each group required general anesthesia owing to inadequate sensory block. Beginning at 60 minutes, meperidine patients experienced more pruritus (P < .05). Lidocaine patients had more postoperative pain (P < .01) and required supplemental analgesia 83.3 +/- 32.7 minutes after induction versus 447.6 +/- 184.0 minutes in the meperidine group. No patient's oxygen saturation fell below 95%. Patients expressed equal satisfaction with both agents. CONCLUSION: Subarachnoid meperidine and lidocaine both provide adequate anesthesia for postpartum tubal ligation. Meperidine provided longer postoperative analgesia.

Adult↗
PubMedDate not supplied

Meperidine analgesia and delirium in aged hip fracture patients.

Delirium is quite frequent in elderly patients who sustain hip fractures. The use of Meperidine by physicians, unaware of the possible emergence of delirium in elderly patients, is very popular. We have retrospectively examined the incidence of delirium in 181 consecutive patients admitted to the orthogeriatric ward with hip fractures. We used the confusion assessment method to establish the presence of delirium in all patients. A database search was conducted to identify which patients were treated by Meperidine, or Morphine, prior to delirium onset. We identified 92 cases, 44 of whom were treated by Meperidine alone, and the other 48 treated by Morphine alone. Delirium was diagnosed in 13 (27.1%) Morphine treated patients as compared with 19 (43.2%) treated by Meperidine (P<0.001). Age, cognitive status and opiate use were associated with perioperative delirium. A subset regression analysis showed that exposure to Meperidine was significantly associated with delirium (odds ratio 2.5, P<0.01), in contrast with Morphine. Our results confirm the association between exposure to Meperidine and delirium, suggesting that this drug should be withdrawn in elderly hip fractured patients undergoing surgery, and substituted by low dose Morphine analgesia. Reducing the incidence of delirium, by adopting such an approach, may result in a significant potential of savings in direct costs, related to treatment of delirium in this population.

Journal Article↗
PubMed1983

Central nervous system excitatory effects of meperidine in cancer patients.

The analgesic meperidine has been reported to produce signs of central nervous system excitation in human beings. To determine the relationship between signs and symptoms of central nervous system excitation and plasma levels of meperidine and normeperidine, we studied 67 patients receiving meperidine for the relief of postoperative or chronic pain. In 48 patients, excitatory effects ranging from mild nervousness to tremors, twitches, multifocal myoclonus, and seizures were directly correlated with accumulation of normeperidine in plasma. Evidence of compromised renal function occurred in only 14 of the 48 symptomatic patients, suggesting that renal dysfunction may contribute to but is not the sole factor in the accumulation of normeperidine or its relation to adverse neurological signs. In a second study we surveyed mood alterations in 47 patients receiving meperidine and 29 receiving other narcotic analgesics for postoperative pain. The repeated administration of meperidine was associated with adverse alterations in various elements of mood (e.g., apprehension, sadness, restlessness).

Adolescent↗
PubMed1978

Disposition of meperidine in pregnancy.

Plasma concentration-time profiles of meperidine after intravenous administration to 7 pregnant women during labor were investigated. There was considerable interpatient variation in initial plasma concentrations of meperidine and its volume of distribution. When the data in the literature on the disposition of meperidine in nonpregnant subjects were used for comparison, it was found that the initial dilution volume (V1), the volume of distribution at steady-state (Vss), and the apparent volume of distribution during the terminal exponential phase of drug elimination (Vbeta) were less (p less than 0.05) in pregnant subjects than in healthy nonpregnant control subjects but were not significantly different in pregnant subjects and nonpregnant surgical patients. Mean total systemic blood clearance was also significantly less in the pregnant subjects (843 ml/min) than previously reported for healthy nonpregnant control subjects (1,465 ml/min). The blood/plasma concentration ratio of meperidine in pregnant women (0.940) was higher than that in control subjects (0.768; p less than 0.01). Placental transfer of meperidine was investigated in 4 of the patients; in 2 the concentration of the drug was greater in cord plasma than in maternal plasma. Further study is indicated.

Adolescent↗
PubMed1980

A comparison of alphaprodine and meperidine pharmacokinetics.

We have developed a gas-liquid chromatographic analysis for measuring plasma alphaprodine. The analysis is sufficiently sensitive for studying therapeutic-dose pharmacokinetics in man. Single intravenous bolus injections of either alphaprodine or meperidine were given to volunteer subjects. Plasma concentration data were fitted to a biexpoential equation and pharmacokinetic parameters were calculated. Consistent with alphaprodine's shorter clinical duration compared to meperidine, we found that plasma levels of alphaprodine decline at a more rapid rate. Plasma clearances for the two narcotics are nearly identical (1.04 l./kg/min for alphaprodine and 1.01 l./kg/min for meperidine). The apparent volume of distribution for alphaprodine is smaller than for meperidine (1.90 l./kg for alphaprodine and 3.37 l./kg for meperidine).

Adult↗
PubMed1996

Pharmacokinetics of meperidine in healthy volunteers after short- and long-term exposure to high altitude.

Increased numbers of erythrocytes have been shown ex vivo to increase meperidine uptake, and one of the major physiologic changes that occurs at high altitude is an increase in hematocrit and erythrocytes. A study was therefore conducted to evaluate the effects of high altitude on the pharmacokinetics of meperidine. Intramuscular doses (0.75 mg/kg) of meperidine were given to three groups of healthy volunteers (age range, 18-20 years): participants living at sea level (group L), those same participants the day after arrival at high altitude (4,360 m; group HA), and participants who had lived at high altitude for > or = 10 months (group HC). Blood samples were collected for 12 hours after drug administration. Meperidine was measured in whole blood, plasma, and plasma water. Elimination rate constant (lambda z) and clearance uncorrected for bioavailability (Cl/F) were significantly lower at high altitudes than at sea level in plasma (HA and HC) and in whole blood (HA only). Mean residence time (MRT) was significantly higher at high altitudes than at sea level in plasma (HA and HC) and in whole blood (HA only). Hematocrit was significantly increased at both time points at high altitude in comparison to values at sea level, and was also higher after a long-term stay at high altitude than after arrival at high altitude. Erythrocyte binding increased significantly from 41.3% at sea level to 43.8% at arrival at high altitude to 50.9% after a long-term stay at high altitude. The extent of protein binding tended to decrease with high altitude, but this decrease was not significant. Free concentrations of meperidine in plasma water measured 1, 2, and 4 hours after administration were significantly increased after 2 and 4 hours.

Adolescent↗
PubMed1997

Clinical significance of methohexital, meperidine, and diazepam in breast milk.

Concentrations in breast milk of medications used during general anesthesia were measured to determine whether interruption of breast-feeding was indicated. Breast milk and maternal blood samples were obtained from nine women undergoing tubal sterilization under general anesthesia. Concentrations of methohexital, meperidine, diazepam, and nordiazepam were determined for each sample by gas chromatography. Methohexital levels declined rapidly after the first hour and were undetectable at 24 hours. Meperidine was present in both milk and blood during the recovery period but not at 24 hours. Infant-exposure indices for methohexital were less than 1% and ranged from 1.2% to 3.5% for meperidine. The maximum doses of methohexital and meperidine to an infant, in a 100 mL feeding 1 hour after induction of anesthesia were estimated to be 0.04 mg and 0.06 mg, respectively. Diazepam and nordiazepam were not detectable in any sample of milk or blood. The maximum possible infant-exposure index for diazepam would be 3%. The amounts of methohexital, meperidine and diazepam excreted into breast milk do not warrant interruption of breast-feeding.

Adult↗
PubMed1978

GLC determination of meperidinic and normeperidinic acids in urine.

A GLC procedure for the determination of meperidinic and normeperidinic acids in human urine is described. After the extraction of any interfering meperidine or normeperidine, the urine samples are dried and the acids are reesterified using ethanol-sulfuric acid. The resulting meperidine and normeperidine are then extracted and quantified. With this method, the urinary excretion of these metabolites was followed in five subjects who received a single meperidine dose of 36 mg/m2 im. This method represents an improvement over the previously described methods for meperidinic and normeperidinic acids and can be applied to clinical situations.

Chromatography, Gas↗
PubMed1978

Potent reduction of basal acid output produced by meperidine.

Meperidine is a potent narcotic related chemically and pharmacologically to morphine and atropine. To examine its gastric antisecretory activity a study designed to test the effect of meperidine on basal acid secretion was carried out: 100 mg of meperidine given intramuscularly reduced basal acid output (BAO) by 66.3% at 1 hr (P less than 0.001), 64.9% at 2 hr (P less than 0.001), and 44.9% at 3 hr (P = 0.005). This degree of reduction of BAO by this dose of meperidine did not differ from that produced by 30 mg of propantheline intramuscularly. These results demonstrate that meperidine in standard classical doses is a potent inhibitor of BAO in man.

Adolescent↗
PubMedDate not supplied

Comparison of meperidine plus midazolam and fentanyl plus midazolam in procedural sedation: a double-blind, randomized controlled trial.

This double-blind, randomized, prospective study was conducted to compare the analgesic and sedative efficacy of fentanyl and meperidine in orthopedic closed reduction of fractures and dislocations undertaken in the emergency department. Seventy consecutive adult patients with fractures or dislocations suitable for reduction were randomized to receive fentanyl (1 mcg/kg; n = 36) or meperidine (0.5 mg/kg; n = 34) in combination with midazolam (0.02 mg/kg). Vital signs and alertness scale scores of the patients were monitored. The Visual Analog Scale (VAS) was used to determine the degree of pain. There was no statistically significant difference between the VAS mean scores of the fentanyl and meperidine groups (t test, P = .772). The need for additional analgesic drugs was significantly more frequent in patients receiving meperidine (P = .018). No adverse events, such as hypotension or respiratory depression, were noted. Euphoria occurred in one patient in the fentanyl group. Although dose requirements differ, fentanyl and meperidine provide effective and reliable analgesia in closed reduction of fractures and dislocations.

Adult↗