-
Journal of Cardiothoracic and Vascular... Apr 1995It has remained unclear whether epidural opioid analgesia permits better recovery of postthoracotomy pulmonary function than an optimal method of systemic opioid... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
It has remained unclear whether epidural opioid analgesia permits better recovery of postthoracotomy pulmonary function than an optimal method of systemic opioid administration. Lumbar epidural meperidine infusions were compared with intravenous patient-controlled analgesic (PCA) meperidine infusions in a prospective randomized unblinded study for 72 hours postthoracotomy. Before induction of general anesthesia, patients received a bolus of meperidine, 1 mg/kg, and an infusion of meperidine, 0.33 mg/kg/hr, was started via either a lumbar epidural or intravenous catheter. Postoperatively, the meperidine infusion rates were titrated as needed for analgesia. In addition, the intravenous group received meperidine, 10 mg per dose, as required, from a patient-controlled analgesia pump. No other opioid was administered during the study period. Patients were studied for recovery of spirometric tests of pulmonary function, visual analog pain scores, sedation, arterial blood gases, meperidine dose requirements, radiographic pulmonary complications, and neurologic signs and symptoms. A subgroup of 10 patients (5 from each group) had venous blood samples drawn every 24 hours for 96 hours and assayed for serum meperidine and normeperidine concentrations. Epidural meperidine analgesia was associated with improved postthoracotomy pulmonary function, better analgesia scores, and lower meperidine dose requirements than intravenous PCA meperidine. There were no differences between the epidural versus intravenous PCA subgroups with respect to serum meperidine or normeperidine levels. Normeperidine levels greater than 300 ng/mL were associated with an increased incidence of shakiness and/or tremors. Meperidine provides satisfactory postthoracotomy analgesia via a lumbar epidural infusion. This analgesia is associated with improved recovery of postoperative pulmonary function when compared with an intravenous PCA meperidine infusion.
Topics: Aged; Analgesia, Epidural; Analgesia, Patient-Controlled; Carbon Dioxide; Cholinesterase Inhibitors; Female; Forced Expiratory Volume; Humans; Infusions, Intravenous; Lung; Male; Meperidine; Middle Aged; Pain Measurement; Prospective Studies; Thoracotomy; Vital Capacity
PubMed: 7780067
DOI: 10.1016/S1053-0770(05)80182-X -
Journal of Chromatography Feb 1985A high-performance liquid chromatographic method is described for the simultaneous analysis of meperidine and normeperidine in serum and urine. A 1-ml sample aliquot is...
A high-performance liquid chromatographic method is described for the simultaneous analysis of meperidine and normeperidine in serum and urine. A 1-ml sample aliquot is extracted into hexane, then back-extracted into a small volume of dilute acid which is injected onto a cyanopropyl analytical column. Absorbance of the column effluent is monitored at 205 nm. Two internal standards are employed, diphenhydramine for meperidine and nordiphenhydramine for normeperidine. Chromatography of the four compounds takes 4 min. Serum concentration--time curves of meperidine and normeperidine are presented for eight healthy subjects following single 70-mg bolus injections of meperidine.
Topics: Adult; Cholinesterase Inhibitors; Chromatography, High Pressure Liquid; Humans; Kinetics; Male; Meperidine; Spectrophotometry, Ultraviolet
PubMed: 4019640
DOI: 10.1016/0378-4347(85)80078-5 -
Biomedical & Environmental Mass... Mar 1986A technique is described for extraction and quantitation of meperidine and normeperidine from breast milk by gas chromatography/mass spectrometry. Both compounds were...
A technique is described for extraction and quantitation of meperidine and normeperidine from breast milk by gas chromatography/mass spectrometry. Both compounds were measured in breast milk from parturients who received the drug for postpartum pain relief. The technique is sensitive to 1 ng ml-1 and standard curves were linear at 1.5-2000 ng ml-1. Levels in breast milk samples were 36.2-314 ng ml-1 and 0-333 ng ml-1 for meperidine and normeperidine, respectively. Preliminary results suggest that postpartum pain medication with meperidine results in considerable levels of both meperidine and its active metabolite, normeperidine, in breast milk.
Topics: Female; Gas Chromatography-Mass Spectrometry; Humans; Meperidine; Milk, Human
PubMed: 2938653
DOI: 10.1002/bms.1200130307 -
Annals of Internal Medicine Jun 1977Concentrations of meperidine and its active metabolite, normeperidine, were measured in plasma of patients receiving the drug for analgesia. Meperidine levels in cancer...
Concentrations of meperidine and its active metabolite, normeperidine, were measured in plasma of patients receiving the drug for analgesia. Meperidine levels in cancer patients were 0.10 to 0.55 microng/ml 1 h after a dose and were 0.05 to 0.14 in patients in the oliguric period after renal transplantation. Normeperidine levels were 0.05 to 0.28 microng/ml in the cancer patients and 0.13 to 0.36 in the renal failure patients. The ratio of normeperidine to meperidine levels was always higher in the renal failure patients than in the cancer patients. Additionally, two patients receiving multiple doses of meperidine had high normeperidine levels and very high normeperidine/meperidine ratios when they showed signs of central nervous system excitation. These data indicate that normeperidine can contribute to the excitatory effects seen after multiple doses of meperidine and suggest that patients with renal failure are particularly susceptible to this problem.
Topics: Acute Kidney Injury; Adult; Aged; Analgesia; Female; Humans; Male; Meperidine; Middle Aged; Neoplasms; Seizures
PubMed: 869353
DOI: 10.7326/0003-4819-86-6-738 -
Canadian Journal of Anaesthesia =... Feb 2000Meperidine has local anesthetic properties and, therefore, when given epidurally it has the potential to cause hemodynamic changes. Our objective was to study the...
PURPOSE
Meperidine has local anesthetic properties and, therefore, when given epidurally it has the potential to cause hemodynamic changes. Our objective was to study the hemodynamic effects of an analgesic dose of epidural meperidine (50 mg) in 34 ASA 1-2 term parturients scheduled for elective Cesarean section under epidural anesthesia.
METHODS
A lumbar epidural catheter was inserted and patients lay in the supine left wedge position. Intravenous fluid preload was withheld, and hemodynamic measurements comprising of mean arterial pressure, cardiac output and heart rate were made using automatic oscillotonometry (Dinamap 1486SX) and transthoracic electrical bioimpedance (Bomed NCCOM3). Following baseline measurements, the hemodynamic effects of sequential epidural injection of first, 10 ml saline, and 20 min thereafter, 50 mg meperidine diluted to 10 ml with saline, were recorded. Sensory blockade was assessed following each injection using loss of temperature discrimination to ice. Paired Student t tests were used to compare changes in hemodynamic variables.
RESULTS
Epidural meperidine produced a small increase from the saline values in the mean (SD) cardiac output of 5.81 +/-1.44 to 6.04+/-1.54 L x min(-1) (P<0.05), and mean arterial pressure of 77.1+/-8.8 to 79.3+/-9.9 mm Hg (P<0.05). Sensory changes, the upper level of which ranged from L1 to T1, were detected in 94% of patients given epidural meperidine. Epidural saline injection had no such hemodynamic effects, but produced a detectable sensory level in two patients.
CONCLUSION
Epidural meperidine, 50 mg, caused minimal hemodynamic changes in term parturients.
Topics: Analgesics, Opioid; Cesarean Section; Female; Hemodynamics; Humans; Injections, Spinal; Labor, Obstetric; Meperidine; Pregnancy
PubMed: 10674510
DOI: 10.1007/BF03018852 -
Anesthesiology Nov 1981Effective analgesia resulted from the injection of peridural meperidine in two groups of cancer patients, eight with postoperative pain and eight with intractable pain....
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.
Topics: Adult; Aged; Catheterization; Epidural Space; Female; Humans; Kinetics; Male; Meperidine; Middle Aged; Models, Biological; Neoplasms; Pain; Pain, Postoperative; Spinal Cord; Time Factors
PubMed: 7294405
DOI: No ID Found -
The Journal of Clinical Pharmacology... 1968
Clinical Trial Comparative Study
Topics: Adolescent; Adult; Aged; Blood Pressure; Clinical Trials as Topic; Female; Fentanyl; Humans; Intubation, Intratracheal; Male; Meperidine; Middle Aged; Pulse
PubMed: 4886316
DOI: 10.1002/j.1552-4604.1968.tb00114.x -
Cancer Investigation 1983As part of a study to evaluate the analgesic efficacy of meperidine and hydroxyzine, alone and in combination, a double-blind complete crossover study of meperidine (50... (Comparative Study)
Comparative Study
As part of a study to evaluate the analgesic efficacy of meperidine and hydroxyzine, alone and in combination, a double-blind complete crossover study of meperidine (50 mg IM), hydroxyzine (100 mg IM), meperidine (50 mg IM) plus hydroxyzine (100 mg IM), and saline placebo was conducted. Thirty patients with chronic moderate to severe pain due to metastatic cancer were evaluated as to pain relief following administration of all four study medications. All of the treatment groups showed statistically significant analgesic activity as compared to placebo. Hydroxyzine provided sustained pain relief to six hours, whereas meperidine produced analgesia up to two hours. The combination produced additive analgesia only during the first 2 hr. The pharmacokinetics of meperidine and hydroxyzine were compared to observed analgesia. Significant correlation between serum drug levels of meperidine and hydroxyzine and pain relief resulted and the serum levels of meperidine and hydroxyzine necessary for analgesia were calculated to be 0.10-0.15 mg/ml and 60-70 ng/ml; respectively. The observed analgesia of the meperidine/hydroxyzine combination was correlated with the analgesia of the individual agents and the limited additive analgesia observed with the addition of meperidine to hydroxyzine does not justify the added toxicity of the narcotic.
Topics: Aged; Analysis of Variance; Antineoplastic Combined Chemotherapy Protocols; Double-Blind Method; Drug Evaluation; Humans; Hydroxyzine; Kinetics; Meperidine; Middle Aged; Neoplasms; Pain; Palliative Care; Time Factors
PubMed: 6199095
DOI: 10.3109/07357908309042413 -
Bioorganic & Medicinal Chemistry Letters Dec 1999A series of meperidine analogues was synthesized and the binding affinities for the dopamine and serotonin transporters were determined. The substituents on the phenyl...
A series of meperidine analogues was synthesized and the binding affinities for the dopamine and serotonin transporters were determined. The substituents on the phenyl ring greatly influenced the potency and selectivity of these compounds for the transporter binding sites. In general, meperidine (3) and its analogues were more selective for serotonin transporter binding sites and the esters 9 were more potent than the corresponding nitriles 8. The 3,4-dichloro derivative 9e was the most potent ligand of the series for dopamine transporter binding sites while the 2-naphthyl derivative 9g exhibited the most potent binding affinity and was highly selective for serotonin transporter binding sites.
Topics: Carrier Proteins; Dopamine; Dopamine Plasma Membrane Transport Proteins; Membrane Glycoproteins; Membrane Transport Proteins; Meperidine; Nerve Tissue Proteins; Protein Binding; Serotonin; Serotonin Plasma Membrane Transport Proteins
PubMed: 10612583
DOI: 10.1016/s0960-894x(99)00606-x -
Journal of Clinical Pharmacology Apr 1975The results of a two-way crossover trial of two commercial preparations of meperidine hydrochloride in 24 healthy volunteers is reported. The urinary excretion patterns... (Clinical Trial)
Clinical Trial
The results of a two-way crossover trial of two commercial preparations of meperidine hydrochloride in 24 healthy volunteers is reported. The urinary excretion patterns resulting from dosing with the two preparations were followed for 48 hours, and the urine concentrations of meperidine and a major metabolite, normeperidine, were determined by gas liquid chromatography. Statistical analysis of the data showed no significant difference between the urine concentrations of meperidine and normeperidine produced by either preparation, and the preparations are of comparable bioavailability. The use of the urinary excretion pattern and concentrations represents a rapid, accurate, and quantitative method for determining the bioavailability of different preparations of meperidine hydrochloride.
Topics: Adult; Analysis of Variance; Biological Availability; Clinical Trials as Topic; Female; Humans; Male; Meperidine; Time Factors
PubMed: 1092724
DOI: 10.1002/j.1552-4604.1975.tb01447.x