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PubMed1982

Meperidine infusion for postoperative analgesia in grossly obese patients.

Postoperative analgesia was provided to nine grossly obese patients with a continuous intravenous meperidine infusion. The narcotic was infused at an initial rate of 1.3 mg . min-1 for 45 minutes, then 0.7 mg . min-1 for 30 minutes followed by 0.5 mg . min-1 for the next 24 hours. Pain was assessed at hourly intervals, serial blood samples were taken for measurement of plasma meperidine concentrations, and respiratory function was assessed by serial measurement of vital capacity and arterial blood gas analysis. Analgesia was gradual in onset and from six hours after commencement of the infusion, seven of the patients suffered little or no pain. Plasma meperidine concentrations reached a peak of 0.33 +/- 0.05 microgram . ml-1 at one hour decreased gradually after three hours. Surprisingly, there was poor correlation between analgesia and plasma meperidine concentration. All patients breathed spontaneously and maintained satisfactory blood gas tensions. However, there was a marked reduction in postoperative vital capacity. Thus meperidine administered by continuous intravenous infusion can provide good postoperative analgesia in the obese patient without producing respiratory depression. However, the lack of correlation between analgesia and plasma narcotic concentration suggests that further study is required before intravenous regimes can be prescribed by application of pharmacokinetic principles.

Adult↗
PubMed1992

Early respiratory depression during caesarean section following epidural meperidine.

A case of respiratory depression which occurred following administration of epidural meperidine during Caesarean section is described. Epidural meperidine, 75 mg (10 mg.ml-1) was given after delivery of the infant to provide postoperative analgesia. Oxygen desaturation (SaO2 90%) and a decrease in respiratory rate (4.min-1) were noted 30 min after epidural meperidine was administered. Naloxone, 0.1 mg, was given iv which resulted in prompt improvement in both respiratory rate and oxygen saturation. Vascular absorption of meperidine from the epidural venous plexus is the most probable explanation for this case of early respiratory depression. We recommend a maximum bolus dose of 50 mg of epidural meperidine for pain management after Caesarean section. It is also important to monitor oxygen saturation continuously during the intraoperative period, and to monitor the patient closely in the recovery room for at least one hour for evidence of respiratory depression.

Adult↗
PubMed1988

Intravenous meperidine for control of shivering during caesarean section under epidural anaesthesia.

To determine the efficacy of meperidine in controlling shivering during epidural anaesthesia for Caesarean section, forty-six parturients were studied. After delivery of the infant, shivering patients received either a single dose of intravenous meperidine 50 mg, or saline in a randomized double-blind fashion. Shivering was classified on a scale of 0 to 3 (grade 0 = none, grade 3 = severe shivering that was distressing to the patient and interfered with monitoring). Shivering and other variables were recorded at epidural placement, skin incision, delivery, and 2, 5, 15, 30 and 60 minutes following injection. Administration of meperidine resulted in a significant decrease in both the overall incidence of shivering (87 to 35 per cent, p less than 0.01) and severity of shivering (grade 3:57 to 0 per cent, p less than 0.01), compared with saline (incidence: 87 to 83 per cent, grade 3:57 per cent, no change). This effect was apparent within two minutes of drug injection and persisted throughout the study period. There were no differences in vital signs, oxygen saturation or temperature between groups. The incidence of nausea was similar, although patients receiving meperidine were more drowsy at two and five minutes following injection (p less than 0.01) compared with patients in the saline group. There were no differences in level of consciousness at the later intervals. The mechanism of action of meperidine on shivering remains to be elucidated.

Adult↗
PubMed1986

Pharmacokinetics of meperidine in spinal anaesthesia.

Five male patients undergoing haemorrhoidectomy received intrathecal meperidine 1 mg X kg-1 as the sole anaesthetic agent. Plasma concentration-time profiles were investigated. The peak plasma concentration of meperidine was 175 +/- 78.8 ng X ml-1 (mean +/- SD) and this occurred 90 minutes after intrathecal injection. The plasma concentrations generally were lower than those necessary for systemic analgesic effects. The terminal elimination half life of meperidine (t 1/2 beta) in the plasma was 198 minutes. Intrathecal meperidine produced good surgical anaesthesia in all patients studied. The mean duration of sensory and motor block was 77 +/- 18.8 and 47 +/- 7.4 minutes respectively. Four patients did not require any analgesic supplement during the postoperative period. No patient developed clinically evident respiratory depression or neurological sequelae. The pharmacokinetic data suggests that intrathecal meperidine provides prolonged postoperative analgesia through a regional effect on opioid receptors in the spinal cord.

Adult↗
PubMed1986

Epidural meperidine analgesia after cardiac surgery.

Epidural meperidine (1 mg X kg-1) was administered for relief of sternal pain to ten patients, at a mean of 24.8 hours after infusion of high dose fentanyl for cardiac surgery. Lung function, cough, pain score, somnolence, respiratory rate, PaCO2, pulse and blood pressure were studied before and for six hours after analgesic administration. Following epidural meperidine, four of ten patients were pain-free, and three had only minimal pain. Duration of analgesia was 8.8 +/- 4.9 hours. Cough score was significantly improved for five hours. Postoperatively vital capacity was approximately 40 per cent, and FEV1 was approximately 55 per cent of the preoperative value. There was no significant change in FEV1 or vital capacity, following analgesia with epidural meperidine. The somnolence score increased in seven patients. In the first two hours after epidural meperidine, three patients exhibited a fall in their respiratory rate, one had a PaCO2 greater than 45, and two of these patients had marked hypotension. These side effects are easily treated without mechanical or pharmacological support, and do not preclude the use of epidural meperidine after a high dose fentanyl anaesthetic.

Blood Pressure↗
PubMed1987

A comparison of nalbuphine and meperidine in treatment of postoperative pain.

The analgesic efficacy and side effect profile of nalbuphine 20 mg IV and of nalbuphine 40 mg IV were compared to those of meperidine 75 mg IM in the immediate postoperative period. Pain intensity, pain relief, additional analgesic requirements and the overall acceptability of the treatment were recorded for 150 patients. No significant differences were found between the groups for any of the efficacy variables. Peak analgesic effects occurred at 15 minutes in both nalbuphine groups and at 30 minutes in the meperidine group. The mean time to additional analgesic medication was approximately 207 minutes in each group. The incidence of nausea and vomiting with meperidine was 22 per cent (95 per cent confidence interval 10 to 34 per cent) and with nalbuphine 20 mg the incidence was two per cent (95%CI -2 to 6 per cent). This difference was significant (p less than 0.01). The difference between nalbuphine 40 mg (10 per cent, 95%CI 1 to 19 per cent) and meperidine, was not considered statistically significant (p = 0.17). The analgesic efficacy of nalbuphine 20 mg was indistinguishable from that of nalbuphine 40 mg and from that of meperidine 75 mg. The significantly lower incidence of nausea and vomiting with nalbuphine is a major advantage for a recovery room analgesic.

Abdomen↗
PubMed1995

Failure of meperidine wound infiltration to reduce pain after laparoscopic tubal ligation.

Many women experience considerable pain and delay in return to regular activity after laparoscopic tubal ligation. We performed a prospective randomized double-blind study to evaluate pain and recovery after laparoscopic tubal ligation and the influence of meperidine wound infiltration. After approval by the Ethics Committee, informed consent was obtained from 60 patients. All patients received naproxen 500 mg po one hour before surgery. Patients were randomized into three groups. All patients received a standard general anaesthetic. Group C patients (n = 18) received normal saline (NS) in the deltoid and NS in the wound. Group S patients (n = 21) received 50 mg of meperidine in the deltoid and NS in the wound. Group W patients (n = 21) received 50 mg meperidine in the wound and NS in the deltoid. After surgery, pain and nausea were treated with morphine and metoclopramide as needed. Following hospital discharge, patients were contacted by telephone daily until they returned to regular activities. The mean maximum pain score of Group S patients was lower than that of Group C patients (P < 0.05). Group S patients required less morphine in the Postanaesthesia Care Unit than the Group C patients (P < 0.05). One Group C patient was readmitted to hospital due to inadequate analgesia with oral medications. Group S patients returned to regular activity earlier than the Group C patients (P < 0.05). It is concluded that wound infiltration with meperidine did not affect postoperative pain or recovery. Intramuscular administration of the same amount of meperidine resulted in less postoperative pain and earlier return to regular activity.

Adult↗
PubMed1994

Respiratory depression associated with meperidine spinal anaesthesia.

Intrathecal meperidine administration can provide surgical anaesthesia and postoperative analgesia for about two to six hours. We have observed two cases of respiratory depression associated with meperidine spinal anaesthesia. An 81-yr-old woman received 50 mg intrathecal meperidine for inguinal hernia repair. Supplemental oxygen was administered at 3 L.min-1 by nasal prongs. About 40 min later, the patient's oxygen saturation decreased from 97% to 87% and she was asked to take big breaths. She responded immediately and oxygen saturation returned to 97%. Two more similar episodes followed in the next five minutes. Naloxone 0.1 mg iv was administered and the oxygen saturation remained at 96-97% until completion of surgery about 15 min later. She had an uneventful recovery. A 24-yr-old healthy woman presented for tubal ligation eight hours after vaginal delivery of an infant. The surgical procedure was performed under spinal anaesthesia produced by 50 mg meperidine. During surgery, midazolam 2 mg iv was given for anxiolysis. About five minutes after admission to the postanaesthesia care unit, the patient's respiratory rate decreased to ten breaths per minute and oxygen saturation decreased to 89%. Supplemental oxygen at 3 L.min-1 was administered by nasal prongs. The patient was encouraged to take big breaths and the arterial oxygen saturation rapidly increased to 98-99%. Forty minutes later, nasal oxygen was discontinued. The patient maintained her oxygen saturation while breathing room air. She was then discharged to the ward and had an uneventful recovery course. We recommend that a patient's respiratory variables and oxygenation be closely monitored for at least one hour after intrathecal meperidine administration.

Adult↗
PubMed1994

Epidural opioid analgesia after caesarean section: a comparison of patient-controlled analgesia with meperidine and single bolus injection of morphine.

The quality of analgesia, patient satisfaction and incidence of side effects following a single bolus of epidural morphine were compared with patient-controlled epidural analgesia (PCEA) with meperidine during the first 24 hr after elective Caesarean section. Seventy-five women were randomly assigned to three equal groups. Group I received 30 mg epidural meperidine after delivery and PCEA with meperidine; Group 2 received 3 mg epidural morphine after delivery and PCEA with saline in a double-blind fashion. Group 3 received 3 mg epidural morphine after delivery without saline PCEA. Visual analogue pain scores (VAS) were higher with PCEA meperidine from 8-16 hr post-operatively (P < 0.05) than in both epidural morphine groups. Two patients in Group 1 and one in Group 3 required supplemental parental analgesia. The incidence of nausea was 16% in Group 1, compared with 52% in Group 2 and 56% in Group 3 (P < 0.01). Pruritus occurred in 24% of Group 1 patients, 84% of patients in Group 2 and 68% of patients in Group 3 (P < 0.001). Forty-six percent of patients in Group 1 were very satisfied with pain management, compared with 77% in Group 2 and 79% in Group 3. Nurse workload was higher in the PCEA study groups than in Group 3 (P < 0.05). A single bolus of epidural morphine provides superior analgesia and satisfaction at low cost, but with a higher incidence of nausea and pruritus than PCEA with meperidine.

Adult↗
PubMed1976

Metabolites of meperidine in the fetal and maternal serum.

Although meperidine appears to be the safest obstetric analgesic agent, it has been associated with infant respiratory depression in certain situations. It would appear that the incidence of fetal depression related to meperidine is dependent on the time of injection prior to delivery, the quantity of drug administered, and the rate of maternal metabolism of the analgesic. Previous work showed that meperidine is metabolized in the maternal system by one of three patterns. The present study demonstrates that the particular maternal serum pattern is characteristic for the individual, regardless of whether the patient is pregnant or not, and that the fetal depression, although usually mild, can be correlated with fetal pH data as well as Apgar scores. In addition, this study supports indirectly the contention that metabolites of meperidine rather than the parent compound cause fetal depression. It would appear, therefore, that in certain obstetric cases with a higher probability for infant depression, other analgesic agents might be considered, especially if the serum pattern indicates meperidine is being metabolized.

Apgar Score↗
PubMed1984

Meperidine and normeperidine metabolism in the rhesus monkey.

Meperidine and its principle metabolite, normeperidine, were given intravenously to four non-human primates prior to cesarean delivery in an equivalent dose for human parturients. The status of the infants regarding neonatal depression was assessed at delivery. Repeated blood samples from both the mother and the neonate were obtained over a period of 4 days. The levels of meperidine and normeperidine were analyzed. The results showed that the metabolism of meperidine and normeperidine in the non-human primate was essentially the same as that observed in the human parturient. In addition, normeperidine appeared to be more toxic than meperidine to the neonate. Finally, there does not appear to be an evidence for neonatal metabolism of meperidine to normeperidine.

Animals↗
PubMed1982

Meperidine-induced hypothermia in the rat.

A dose of 40 mg/kg of meperidine (pethidine) caused a marked lowering of rectal temperature in restrained female rats at room temperature (22 degrees C). This decrease was not antagonized by injection of 1 mg/kg of naloxone, whereas hypothermia of equal magnitude induced by 20 mg/kg of morphine was reversed by 1 mg/kg of naloxone. Pretreatment with the serotonin reuptake blocker, fluoxetine (10 mg/kg), or a non-hypothermic dose of meperidine (20 mg/kg) significantly potentiated the hypothermia induced by 100 mg/kg of l-5-hydroxytryptophan. The hypothermic effect of 40 mg/kg of meperidine was significantly greater than that of 10 mg/kg of fluoxetine. Finally, 40 mg/kg of meperidine produced a significantly greater hypothermic effect in restrained rats than in unrestrained rats. The results indicate that the hypothermic effect of meperidine is not a result of an opioid action, and that although it may be mediated through serotonergic systems, inhibition of serotonin reuptake is probably not the primary mechanism.

5-Hydroxytryptophan↗
PubMed2004

Meperidine for dystocia during the first stage of labor: A randomized controlled trial.

OBJECTIVE: This study was undertaken to evaluate whether the administration of meperidine decreases the length of labor in patients with a diagnosis of dystocia during the first stage of labor. STUDY DESIGN: Women with term singleton pregnancies who received a diagnosis of dystocia and required an active management of labor were randomly assigned to receive either 100 mg of meperidine or placebo. The primary outcome measure was length of labor. RESULTS: Four hundred seven pregnant women were included. There were no significant statistical differences between meperidine and placebo groups in length of labor and operative delivery rates such as forceps and cesarean section by intention-to-treat analysis. Low Apgar scores, umbilical artery acidosis, and admission to neonatal care units were increased in the meperidine group. CONCLUSION: Because of the absence of any benefits in patients with dystocia in labor and the presence of harmful effects on neonatal outcomes, meperidine should not be used during labor for this specific indication.

Analgesics, Opioid↗
PubMed2004

Morphine induces less nausea than meperidine when administered parenterally.

The objective of our study is to identify and compare the prevalence of nausea after parenteral administration of opioids in the Emergency Department (ED). This prospective study utilized a convenience sample at a community-based ED with a volume of 60,000 annual visits. Patients who were in acute pain or had an exacerbation of chronic pain requiring treatment with an opioid analgesic agent were eligible. Demographic and historical features were recorded on a standardized closed data collection form. The main study endpoint was the occurrence of nausea. The prevalence of nausea and vomiting was compared between morphine and meperidine. There were 37 patients in the morphine group and 156 in the meperidine group. The two groups were similar with respect to mean age, gender, and weight. The reported nausea was 0 of 37 in the morphine group and 20 of 156 (12.8%) in the meperidine group. This difference between morphine and meperidine groups of 12.8% (95% confidence intervals 2-24%) was statistically significant. In our patient population, morphine caused significantly less nausea then meperidine when it was used as an analgesic in the ED.

Adult↗
PubMed1986

Serum concentrations of meperidine in patients with sickle cell crisis.

We compared mean serum concentrations of meperidine in sickle cell patients in crisis and control patients receiving meperidine prior to incision and drainage of abscesses. Eight sickle cell and five control patients without confounding illnesses consented to participate and received 100 mg meperidine in the deltoid or gluteal muscle for pain. Blood samples were drawn at baseline, 0.25, 0.50, 0.75, 1.0, 1.5, and 2.0 hours postinjection. In the sickle cell group, mean peak concentration of meperidine was 0.32 +/- 0.08 micrograms/mL at an average of 0.5 +/- 0.07 hours postinjection. Among controls mean peak concentration was 0.72 +/- 0.37 micrograms/mL at an average of 0.6 +/- 0.11 hours. The difference in peak concentrations was significant at all time intervals (P less than .01); the difference in times to peak was not significant. We conclude that, given a standard dose, serum concentrations of meperidine differ between sickle cell and control patients, which may suggest reasons for the relatively poor pain control often noted in sickle cell patients.

Absorption↗
PubMed2003

Efficacy of tramadol versus meperidine for pain relief and safe recovery after adenotonsillectomy.

BACKGROUND AND OBJECTIVE: Adequate relief of pain after tonsillectomy is a common problem. We compared meperidine and tramadol when given at induction of anaesthesia with respect to their effects on postoperative pain relief and emergence characteristics after adenotonsillectomy in children. METHODS: Fifty children aged 4-7 yr undergoing tonsillectomy were randomly assigned to receive either tramadol 1 mg kg(-1) (n = 25) or meperidine 1 mg kg(-1) (n = 25) before commencement of the surgical procedure. Anaesthesia was induced with propofol (with cis-atracurium for muscle relaxation) and maintained with sevoflurane in oxygen and nitrous oxide. Postoperative pain was scored by a blinded observer using a facial pain scale in the recovery room at 0 (at arrival of the patient in the postoperative care unit) and at 10, 20 and 45 min thereafter. Agitation scores were also assessed by the same observer at 0 min. Heart rate and mean arterial pressure were recorded at regular intervals. The time to recovery to spontaneous respiration and the incidence of postoperative nausea and vomiting were noted. RESULTS: Facial pain scale scores were increased in the tramadol group at 0, 10 and 20 min (P < 0.05). No difference was observed in scores at the 45th min postoperation. Agitation scores were higher in the tramadol group than in the meperidine group. No statistical difference was found between the two groups. Heart rates and mean arterial pressures were similar in both groups. The time to recovery to spontaneous respiration was delayed with meperidine compared with tramadol (P < 0.05). The incidence of nausea and vomiting was not statistically different between groups. CONCLUSIONS: Meperidine was more effective for pain relief and provides better emergence characteristics than tramadol after tonsillectomy in children.

Adenoidectomy↗
PubMed1992

Pharmacokinetics and pharmacodynamics of intravenous meperidine in neonates and infants.

The pharmacokinetics of meperidine (pethidine) was studied in 21 infants who received a single intravenous dose of 1 mg/kg after surgery (n = 18) or during mechanical ventilation because of respiratory distress (n = 3). Eleven patients were younger than 1 week old, 10 patients were aged from 3 weeks to 5 months, and five of the patients were premature. The pharmacokinetics of meperidine varied greatly between the subjects, with a median elimination half-life of 10.7 hours (range, 3.3 to 59.4 hours), median clearance of 8.0 ml/kg/min (range, 1.8 to 34.9 ml/kg/min), median volume of the central compartment of 2.4 L/kg (range, 0.5 to 4.8 L/kg), and median steady-state volume of distribution 7.2 L/kg (range, 3.3 to 11.0). The great interindividual variability in meperidine pharmacokinetics should be taken into consideration when meperidine is administered to neonates. Although no life-threatening or serious side effects were observed in this study, appropriate care should be exercised when prescribing meperidine for this age group.

Aging↗
PubMed1994

Objectively measured perinatal exposure to meperidine and benzodiazepines in Finland.

We measured concentrations of meperidine and benzodiazepines in the umbilical serum of all live neonates born in Finland during a single week. Of the neonates, 31.1% were exposed to meperidine or benzodiazepines or both. One hundred twenty-one mothers of the 261 neonates exposed to meperidine were not recorded in the Finnish Medical Birth Registry as having received analgesic drugs. Infants born to primiparous mothers were more likely to be exposed. The exposures were associated with the type of delivery: vacuum extraction with a high proportion of neonates exposed to meperidine and elective caesarean section with a high proportion of neonates exposed to benzodiazepines. The exposures were influenced by the method of obstetric analgesia: epidural blockade was associated with more frequent exposure to meperidine. No significant circadian variation in exposures was detected. Validation of birth registry data is imperative before they are used for pharmacoepidemiologic studies.

Adult↗