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Acta Anaesthesiologica Scandinavica May 2005Intrathecal administration of meperidine, an opioid with local anesthetic activity, can induce analgesia in patients with intractable cancer pain. However, continuous...
BACKGROUND
Intrathecal administration of meperidine, an opioid with local anesthetic activity, can induce analgesia in patients with intractable cancer pain. However, continuous intrathecal administration may result in the accumulation of normeperidine, responsible for central nervous system toxicity.
METHODS
Ten patients with neuropathic cancer pain, not responding to conventional opioid therapy, were treated with continuous intrathecal administration of meperidine. In all patients, plasma concentrations of meperidine and normeperidine were measured the first days after the start of treatment. Visual analog scale scores were recorded to evaluate pain relief. Quality of life was assessed before and 3 weeks following the start of intrathecal treatment.
RESULTS
In three patients the plasma concentrations of meperidine and normeperidine increased rapidly. In one patient the plasma normeperidine concentration was higher than the meperidine concentration. One patient demonstrated transient symptoms suggestive for central nervous system excitation. Three weeks following the start of treatment, seven patients were available for evaluation of their quality of life. Pain relief and overall quality of life improved during the intrathecal treatment.
CONCLUSION
We conclude that continuous intrathecal administration of meperidine alone, or in combination with clonidine, can provide significant pain relief in patients with poor pain control despite pharmacological treatment. However, accumulation of meperidine and normeperidine resulting in central nervous system toxicity may occur during this treatment.
Topics: Aged; Analgesics, Opioid; Female; Humans; Injections, Spinal; Male; Meperidine; Middle Aged; Neoplasms; Pain, Intractable; Quality of Life
PubMed: 15836681
DOI: 10.1111/j.1399-6576.2005.00667.x -
Canadian Anaesthetists' Society Journal Sep 1985Twenty male patients of ASA physical status I or II undergoing surgery of the perineal or inguinal areas received intrathecal meperidine in a dose of 1 mg X kg-1 as the...
Twenty male patients of ASA physical status I or II undergoing surgery of the perineal or inguinal areas received intrathecal meperidine in a dose of 1 mg X kg-1 as the sole anaesthetic agent. There was sensory and motor block within ten minutes of intrathecal injection of meperidine and surgery was performed with complete analgesia. The duration of surgery was 39.7 +/- 14 (mean +/- SD) minutes. Prolonged postoperative analgesia was obtained and some patients did not require additional narcotic analgesic during the postoperative period, lasting up to seven days. Side effects included nausea and vomiting (six patients), hypotension (five patients), pruritus (five patients) and urinary retention (two patients). There was no early or late respiratory depression. It is concluded that intrathecal meperidine in a dose of 1 mg X kg-1 is effective as the sole agent for spinal anaesthesia and produces prolonged postoperative analgesia. It offers an advantage for such painful operations as haemorrhoidectomy and anal fissurectomy where its prolonged analgesic effect is desirable. It could also serve as an alternative agent for spinal anaesthesia when a local anaesthetic is not available.
Topics: Adult; Aged; Analgesia; Anesthesia, Spinal; Humans; Male; Meperidine; Middle Aged; Nausea; Postoperative Period; Time Factors; Vomiting
PubMed: 4041954
DOI: 10.1007/BF03010804 -
Clinical Pharmacy Oct 1986
Topics: Adult; Drug Interactions; Female; Humans; Meperidine; Prochlorperazine; Seizures
PubMed: 3780155
DOI: No ID Found -
Annals of Neurology Feb 1983The analgesic meperidine has been reported to produce signs of central nervous system excitation in human beings. To determine the relationship between signs and...
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).
Topics: Adolescent; Adult; Aged; Central Nervous System Diseases; Child; Emotions; Female; Humans; Male; Meperidine; Middle Aged; Neoplasms; Palliative Care; Postoperative Period; Time Factors
PubMed: 6187275
DOI: 10.1002/ana.410130213 -
Nursing Mar 2003
Topics: Cholinesterase Inhibitors; Drug-Related Side Effects and Adverse Reactions; Humans; Meperidine
PubMed: 12645582
DOI: 10.1097/00152193-200303000-00014 -
Edinburgh Medical Journal Jun 1948
Topics: Female; Humans; Labor, Obstetric; Meperidine; Pregnancy; Work
PubMed: 18875666
DOI: No ID Found -
Research Communications in Chemical... Aug 1976Gas chromatographic and gas chromatographic-mass spectrometric techniques were used to identify non-acidic metabolites of meperidine...
Gas chromatographic and gas chromatographic-mass spectrometric techniques were used to identify non-acidic metabolites of meperidine (N-methyl-4-phenyl-4-carbethoxypiperidine) excreted in human, rat, and guinea pig urine. Following enzymic hydrolysis N-hydroxynormeperidine was identified in the urine of all three species in addition to the expected metabolites normeperidine and meperidine N-oxide. In rat urine the p-hydroxyphenyl metabolite of meperidine was present in appreciable amounts. Also present in small quantity was a new phenolic metabolite of meperidine containing both hydroxyl and O-methoxyl substituents in the phenyl ring of the parent drug. The latter two metabolites were excreted as conjugates in the rat.
Topics: Adult; Animals; Chromatography, Gas; Chromatography, Thin Layer; Female; Guinea Pigs; Humans; Hydroxylation; In Vitro Techniques; Male; Mass Spectrometry; Meperidine; Methods; Rats
PubMed: 986679
DOI: No ID Found -
Anesthesia and Analgesia Apr 1999The intrathecal injection of 0.7-1 mg/kg meperidine provides spinal anesthesia of only short duration. In this study, we investigated the effects of three different... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
UNLABELLED
The intrathecal injection of 0.7-1 mg/kg meperidine provides spinal anesthesia of only short duration. In this study, we investigated the effects of three different doses of meperidine for spinal anesthesia on the duration and level of sensory block and the incidence of side effects. Forty-five African men were randomly allocated to receive one of three doses of intrathecal meperidine: Group A = 1.2 mg/kg, Group B = 1.5 mg/kg, and Group C = 1.8 mg/kg. The duration of sensory block was significantly longer after 1.5 mg/kg compared with 1.2 mg/kg meperidine (112 +/- 19 vs 79 +/- 27 min; P = 0.001). Increasing the dose to 1.8 mg/kg did not further increase the duration of block. The level and the onset of the block were not affected by the dose. Common side effects were fatigue (27%), pruritus (20%), and nausea (7%). Seven patients had respiratory depression and seven had a decrease of systolic arterial blood pressure (SAP) >30% from baseline. There was no difference in the incidence of any side effect among groups. Respiratory depression and decreases in SAP were observed 5-50 min after meperidine injection. Twenty-two patients had no pain after the sensory block had terminated. We conclude that increasing the dose of meperidine from 1.2 to 1.5 mg/kg increased the duration, but not the level, of sensory block without an increase in side effects.
IMPLICATIONS
Intrathecal meperidine 1 mg/kg provides surgical anesthesia for only 40-90 min. We investigated the effects of three larger doses of meperidine in 45 African men. The 1.5 and 1.8 mg/kg doses provide a longer duration of anesthesia compared with 1.2 mg/kg. Nausea, pruritus, and respiratory depression were common in all dose groups. We conclude that increasing the dose of meperidine from 1.2 to 1.5 mg/kg increased the duration, but not the level, of sensory block without an increase in side effects.
Topics: Analgesics, Opioid; Anesthesia, Spinal; Black People; Dose-Response Relationship, Drug; Hemorrhoids; Herniorrhaphy; Humans; Injections, Spinal; Male; Meperidine; Middle Aged; Prospective Studies; Prostatectomy; Single-Blind Method; Time Factors
PubMed: 10195532
DOI: 10.1097/00000539-199904000-00027 -
The Journal of Pharmacology and... Apr 1976Meperidinic acid was converted to O-meperidinyl-glycollic acid and covalently attached to bovine serum albumin. Rabbits injected with this conjugate produced antibodies...
Meperidinic acid was converted to O-meperidinyl-glycollic acid and covalently attached to bovine serum albumin. Rabbits injected with this conjugate produced antibodies reactive with meperidine which were measured by the ammonium sulfate method. The specificities of these antisera were studied by competitive inhibition of the binding of 100 pmol/ml of 3H-meperidine to antibody by the prior addition of increasing concentrations of various unlabeled compounds. The concentrations in nanomoles per milliliter of various unlabeled opiods required to inhibit 3H-meperidine binding by 50% (I50) were: meperidine, 0.08; O-meperidinyl-glycollic acid, 1.7; methadone, 580; heroin, 1750; codeine, 2600; and morphine, 4200. Several psychopharmacologically active compounds were found to have I50 values comparable to the nonmeperidine opioids: hydroxyzine. HCl, 460; propoxyphene, 4,500; diazepam, 6,500; and cocaine, 10,800. The metabolites of meperidine exhibited the following I50 values: normeperidine, 0.7; meperidinic acid and normeperidinic acid, 210. A radioimmunoassay for meperidine which employs this antiserum was shown to be approximately 100 times more sensitive than the spectrophotometric method of Burns et al. (J. Pharmacol. Exp Ther. 114: 289-293, 1955). In this assay only normeperidine and some of the meperidine congeners might be expected to interfere with the measurement of meperidine. The degree of normeperidine interference was shown to be comparable to that present in the existing assay method.
Topics: Animals; Antibodies; Antibody Formation; Antibody Specificity; Binding, Competitive; Cattle; Meperidine; Morphine Derivatives; Rabbits; Radioimmunoassay; Serum Albumin, Bovine
PubMed: 944261
DOI: No ID Found -
The Journal of Pharmacology and... May 1980We have determined the renal clearance of meperidine and inulin simultaneously under steady-state conditions by using the chronic fetal lamb preparation. Meperidine was...
We have determined the renal clearance of meperidine and inulin simultaneously under steady-state conditions by using the chronic fetal lamb preparation. Meperidine was infused at a constant rate of 3.2 mg/min into the maternal vena cava, and [14C]inulin was infused at a constant rate of 0.22 muCi/min into the fetal vena cava. Total fetal urine output was collected for three consecutive 15-min intervals, and fetal blood was sampled at the midpoint of each urine collection. The mean meperidine clearance in 12 studies was 12.04 +/- 2.90 (S.E.) ml/min, whereas mean inulin clearance was 2.48 +/- 0.35 (S.E.) ml/min. In all but one animal, the ratio of meperidine clearance to inulin clearance is greater than one, indicating tubular secretion of meperidine. The results show that there is a negative relationship between meperidine clearance and urine pH, but there is no relationship between meperidine clearance and gestational age or urine flow rate. These results suggest that meperidine is secreted across the renal tubules by "ion trapping."
Topics: Animals; Blood Proteins; Diuresis; Female; Fetus; Hydrogen-Ion Concentration; Inulin; Kidney Tubules; Maternal-Fetal Exchange; Meperidine; Metabolic Clearance Rate; Pregnancy; Protein Binding; Sheep
PubMed: 7365693
DOI: No ID Found