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Annals of Emergency Medicine Dec 2008Despite guidelines recommending against opioids as first-line treatment for acute migraine, meperidine is the agent used most commonly in North American emergency... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
Despite guidelines recommending against opioids as first-line treatment for acute migraine, meperidine is the agent used most commonly in North American emergency departments. Clinical trials performed to date have been small and have not arrived at consistent conclusions about the efficacy of meperidine. We performed a systematic review and meta-analysis to determine the relative efficacy and adverse effect profile of opioids compared with nonopioid active comparators for the treatment of acute migraine.
METHODS
We searched multiple sources (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and LILACS, emergency and headache medicine conference proceedings) for randomized controlled trials comparing parenteral opioid and nonopioid active comparators for the treatment of acute migraine headache. Our primary outcome was relief of headache. If this was unavailable, we accepted rescue medication use or we transformed visual analog scale change scores by using an established procedure. We grouped studies by comparator: a regimen containing dihydroergotamine, antiemetic alone, or ketorolac. For each study, we calculated an odds ratio (OR) of headache relief and then assessed clinical and statistical heterogeneity for the group of studies. We then pooled the ORs of headache relief with a random-effects model.
RESULTS
From 899 citations, 19 clinical trials were identified, of which 11 were appropriate and had available data. Four trials involving 254 patients compared meperidine to dihydroergotamine, 4 trials involving 248 patients compared meperidine to an antiemetic, and 3 trials involving 123 patients compared meperidine to ketorolac. Meperidine was less effective than dihydroergotamine at providing headache relief (OR=0.30; 95% confidence interval [CI] 0.09 to 0.97) and trended toward less efficacy than the antiemetics (OR=0.46; 95% CI 0.19 to 1.11); however, the efficacy of meperidine was similar to that of ketorolac (OR=1.75; 95% CI 0.84 to 3.61). Compared to dihydroergotamine, meperidine caused more sedation (OR=3.52; 95% CI 0.87 to 14.19) and dizziness (OR=8.67; 95% CI 2.66 to 28.23). Compared to the antiemetics, meperidine caused less akathisia (OR=0.10; 95% CI 0.02 to 0.57). Meperidine and ketorolac use resulted in similar rates of gastrointestinal adverse effects (OR=1.27; 95% CI 0.31 to 5.15) and sedation (OR=1.70; 95% CI 0.23 to 12.72).
CONCLUSION
Clinicians should consider alternatives to meperidine when treating acute migraine with injectable agents.
Topics: Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Dihydroergotamine; Humans; Ketorolac; Meperidine; Migraine Disorders; Randomized Controlled Trials as Topic
PubMed: 18632186
DOI: 10.1016/j.annemergmed.2008.05.036 -
British Medical Journal Apr 1947
Topics: Meperidine
PubMed: 20343513
DOI: 10.1136/bmj.1.4503.579-b -
Anesthesiology May 2005Systemic opioids are commonly administered during labor, but their efficacy has been recently questioned. In addition, laboratory and clinical studies provide a strong... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
BACKGROUND
Systemic opioids are commonly administered during labor, but their efficacy has been recently questioned. In addition, laboratory and clinical studies provide a strong rationale for combining mu- and kappa-opioid receptor agonists for analgesia. The authors therefore studied, using validated intensity and affective scales and definitions of effective pain relief, the efficacy of intravenous meperidine, butorphanol, and their combination for labor analgesia.
METHODS
Healthy women with singleton term pregnancy requesting analgesia during active labor were studied. Women were randomly assigned to receive 50 mg meperidine, 1 mg butorphanol, or 25 mg meperidine plus 0.5 mg butorphanol (n = 15/group). Pain intensity was assessed using a 0-10 numerical rating scale, and affective magnitude was assessed using a ratiometric descriptive scale before drug administration and between the sixth and seventh uterine contractions after drug administration.
RESULTS
All three treatments reduced pain intensity equally. Butorphanol alone did not reduce pain affective magnitude, whereas the other treatments did. There was a significant correlation between reduction in pain intensity and affective magnitude in all groups, with greater reductions in affective magnitude than intensity. Overall, 29% of women exhibited clinically meaningful pain relief, with no difference among groups. Groups did not differ in incidence of opioid-induced adverse effects.
CONCLUSIONS
These doses of meperidine and butorphanol do reduce pain intensity and affective magnitude, although a minority of patients achieve meaningful pain relief as defined in multiple patient populations, including laboring women. Combination of these drugs did not improve their therapeutic benefit.
Topics: Adult; Analgesia, Obstetrical; Analgesics, Opioid; Butorphanol; Drug Combinations; Female; Heart Rate, Fetal; Humans; Injections, Intravenous; Meperidine; Pain Measurement; Pregnancy; Receptors, Opioid, kappa; Receptors, Opioid, mu; Regression Analysis; Stress, Physiological; Uterine Contraction
PubMed: 15851889
DOI: 10.1097/00000542-200505000-00021 -
Journal of Medicine and Life Jul 2023Postoperative shivering is a common complication that can lead to increased postoperative complications. This study aimed to compare the effectiveness of intravenous... (Randomized Controlled Trial)
Randomized Controlled Trial
Postoperative shivering is a common complication that can lead to increased postoperative complications. This study aimed to compare the effectiveness of intravenous ibuprofen and meperidine in preventing shivering following laparoscopic cholecystectomy. A total of 120 patients, aged 20-70 and classified as ASA I-II, were enrolled in this triple-blind clinical trial. The participants were randomly assigned to one of three groups: ibuprofen (800mg IV), meperidine (30 mg), or placebo (normal saline 2 ml), administered 30 minutes before the end of surgery. The occurrence of postoperative shivering was assessed and recorded at regular intervals (0, 5, 10, 15, 30, and 60 minutes after surgery). Additionally, postoperative pain levels were measured using a visual analog scale (VAS), sedation levels were evaluated using the Ramsay Sedation Scale (RSS), and the incidence of postoperative nausea and vomiting was documented. The prevalence and severity of postoperative shivering were not statistically significant between groups. The VAS was significantly lower in the meperidine group than the ibuprofen group throughout the study (p <0.001). The VAS was significantly lower in the ibuprofen group than the placebo group at 0 and 15 minutes after surgery. Although the incidence of nausea was slightly higher in the meperidine group, the difference was not statistically significant (p=0.75). Sedation scores were consistently lower in the ibuprofen group and higher in the meperidine group compared to the other groups (p<0.0001) The meperidine group had a significantly higher sedation score indicative of deep sleepiness (score of 4) than the other groups. Intravenous ibuprofen demonstrated comparable efficacy to meperidine in controlling shivering. Additionally, the incidence of nausea, vomiting, and sleepiness was lower in the intravenous ibuprofen group, suggesting it is a potential alternative to meperidine.
Topics: Humans; Meperidine; Ibuprofen; Shivering; Cholecystectomy, Laparoscopic; Sleepiness; Anesthesia, General; Nausea
PubMed: 37900063
DOI: 10.25122/jml-2022-0040 -
Iranian Journal of Medical Sciences Jul 2023Several adjuvants, added to local anesthetics, were suggested to induce an ideal regional block with high-quality analgesia. The purpose of this study was to evaluate... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Several adjuvants, added to local anesthetics, were suggested to induce an ideal regional block with high-quality analgesia. The purpose of this study was to evaluate the particular blocking properties of low-dose bupivacaine in combination with meperidine and fentanyl in spinal anesthesia during Cesarean sections.
METHODS
A randomized, double-blind clinical trial was conducted at Hafez Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from February 2015 to February 2016. A total of 120 pregnant women, who underwent spinal anesthesia during elective Cesarean section were enrolled in the study. Based on block-wise randomization, the patients were randomly assigned to three groups, namely "B" group received 2 mL bupivacaine 0.5% (10 mg), "BM" group received 8 mg bupivacaine and 10 mg meperidine, and "BF" group received 8 mg bupivacaine and 15 µg fentanyl intrathecally. The block onset, the duration of analgesia, and the time of discharge from the post-anesthesia care unit (PACU) were all assessed. Data were analyzed using SPSS software version 21, and P<0.05 were considered statistically significant.
RESULTS
The mean duration of motor blocks in the B group (150 min) were significantly higher than the BM (102 min) and BF (105 min) groups (P<0.0001). In both the BM and BF groups, the duration of sensory and motor blocks was the same. The length of stay in the PACU was significantly longer in the B group (P<0.001) than the BM and BF groups. When meperidine or fentanyl was added to bupivacaine, the duration of the analgesia lengthened (P<0.001).
CONCLUSION
Intrathecal low-dose spinal anesthesia induced by bupivacaine (8 mg) in combination with meperidine and/or fentanyl for Cesarean section increased maternal hemodynamic stability, while ensuring effective anesthetic conditions, extending effective analgesia, and reducing the length of stay in PACU. IRCT2015013119470N14.
Topics: Humans; Female; Pregnancy; Bupivacaine; Cesarean Section; Fentanyl; Anesthesia, Spinal; Analgesia; Meperidine
PubMed: 37456203
DOI: 10.30476/IJMS.2022.95205.2653 -
Anaesthesia May 2000
Topics: Analgesia, Obstetrical; Analgesics, Opioid; Female; Fentanyl; Humans; Meperidine; Morphine; Pregnancy
PubMed: 10792130
DOI: 10.1046/j.1365-2044.2000.01477.x -
Medical Science Monitor : International... Oct 2023BACKGROUND Caudal block is widely regarded as the top choice for multimodal analgesia in children undergoing urological surgeries, particularly circumcision. This study... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND Caudal block is widely regarded as the top choice for multimodal analgesia in children undergoing urological surgeries, particularly circumcision. This study investigates the efficacy of caudal block and the necessity of rescue analgesia in circumcision surgeries. MATERIAL AND METHODS A prospective, single-blind study was conducted at Ordu University Training and Research Hospital from December 1, 2022, to July 1, 2023. The study randomly divided ASA class I-II children aged 1-12 years into 3 groups for circumcision surgery. Group C received only caudal block. Group CP received caudal block with 10 mg/kg intravenous paracetamol. Group CM received caudal block with 1 mg/kg intravenous meperidine. In each case, a caudal block was administered using 0.5 ml/kg of 0.125% bupivacaine under ultrasound guidance. The primary outcome of the study was total analgesic consumption; the secondary outcomes were pain scores and time to first analgesic administration. Pain severity was evaluated using FLACC and Wong-Baker scores at 0, 1, 4, and 24 h. RESULTS A total of 120 patients, 40 patients in each group, were included in the study. A significant difference was detected among all 3 groups in the Wong-Baker pain score (24th hour) (P<0.001). The FLACC and Wong-Baker pain scores did not differ significantly in the other time frames. The time of the first rescue analgesia and the total amount of analgesic taken in the first 24 h were the same for both groups (P=0.408 and P=0.238). CONCLUSIONS The addition of paracetamol or meperidine to caudal block does not enhance the quality of analgesia.
Topics: Child; Humans; Male; Acetaminophen; Analgesics; Anesthetics, Local; Bupivacaine; Meperidine; Nerve Block; Pain, Postoperative; Prospective Studies; Single-Blind Method
PubMed: 37904341
DOI: 10.12659/MSM.942557 -
Anesthesiology Apr 1998Thermoregulatory shivering can be characterized by its threshold (triggering core temperature), gain (incremental intensity increase with further core temperature... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
BACKGROUND
Thermoregulatory shivering can be characterized by its threshold (triggering core temperature), gain (incremental intensity increase with further core temperature deviation), and maximum intensity. Meperidine (a combined mu- and kappa-agonist) treats shivering better than equianalgesic doses of pure mu-opioid agonists. Meperidine's special antishivering action is mediated, at least in part, by a disproportionate decrease in the shivering threshold. That is, meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold, whereas alfentanil (a pure mu-agonist) decreases the vasoconstriction and shivering thresholds comparably. However, reductions in the gain or maximum shivering intensity might also contribute to the clinical efficacy of meperidine. Accordingly, we tested the hypothesis that meperidine reduces the gain and maximum intensity of shivering much more than alfentanil does.
METHODS
Ten volunteers were each studied on three separate days: (1) control (no drug); (2) a target total plasma meperidine concentration of 1.2 microg/ml; and (3) a target plasma alfentanil concentration of 0.2 microg/ml. Skin temperatures were maintained near 31 degrees C, and core temperatures were decreased by central-venous infusion of cold lactated Ringer's solution until maximum shivering intensity was observed. Shivering was evaluated using oxygen consumption and electromyography. A sustained increase in oxygen consumption identified the shivering threshold. The gain of shivering was calculated as the slope of the oxygen consumption versus core temperature regression, and as the slope of electromyographic intensity versus core temperature regression.
RESULTS
Meperidine and alfentanil administration significantly decreased the shivering thresholds. However, neither meperidine nor alfentanil reduced the gain of shivering, as determined by either oxygen consumption or electromyography. Opioid administration also failed to significantly decrease the maximum intensity of shivering.
CONCLUSIONS
The authors could not confirm the hypothesis that meperidine reduces the gain or maximum intensity of shivering more than alfentanil does. These results suggest that meperidine's special antishivering effect is primarily mediated by a disproportionate reduction in the shivering threshold.
Topics: Adjuvants, Anesthesia; Adult; Alfentanil; Anesthetics, Intravenous; Body Temperature Regulation; Cholinesterase Inhibitors; Hemodynamics; Humans; Infusions, Intravenous; Male; Meperidine; Oxygen Consumption; Shivering
PubMed: 9579492
DOI: 10.1097/00000542-199804000-00003 -
Journal of Ayub Medical College,... 2023Shivering is one of the most common adverse outcomes associated with the administration of spinal anaesthesia, which, when clinically relevant, leads to numerous...
BACKGROUND
Shivering is one of the most common adverse outcomes associated with the administration of spinal anaesthesia, which, when clinically relevant, leads to numerous detrimental effects on the human body. Hence, its management becomes imperative. Meperidine, an opioid analgesic, is the drug of choice for this condition. However, the use of meperidine is controversial, as it carries the devastating adverse effect of respiratory depression. We explored the role of granisetron, a 5HT3 antagonist and a commonly used antiemetic premedication, in minimising the incidence of post-spinal shivering and decreasing the use of meperidine as a rescue drug.
METHODS
Overall, 160 parturient patients, between the ages 18-50, undergoing uncomplicated, elective caesarean section, were enrolled in the study, and randomized into two groups with 80 participants each: Group A received 3ml of normal saline, and Group B was administered 3 mg granisetron,15 minutes before spinal anaesthesia institution. Incidence of clinically relevant shivering (score of 3 or more) was noted, and it was recorded whether meperidine was used or not.
RESULTS
67.5% of participants in Group A, and 32.5% of patients in Group B, experienced clinically relevant shivering, with 62.5% of patients in Group A and 28.75% in Group B warranting the use of meperidine. There was a statistically significant difference between the two groups in terms of incidence of clinically relevant shivering, and meperidine consumption (p-value <0.001).
CONCLUSIONS
Premedication with 3 mg granisetron effectively attenuates the occurrence of post-spinal shivering and, hence, lowers the requirement of meperidine as rescue medication.
Topics: Humans; Pregnancy; Female; Adolescent; Young Adult; Adult; Middle Aged; Meperidine; Granisetron; Shivering; Pharmaceutical Preparations; Cesarean Section; Anesthesia, Spinal
PubMed: 38406929
DOI: 10.55519/JAMC-04-11651 -
Journal de Gynecologie, Obstetrique Et... Feb 2008Continuous electronic fetal heart rate (FHR) monitoring is part of routine care for laboring patients under either systemic or locoregional analgesia. Opioid systemic... (Comparative Study)
Comparative Study Review
Continuous electronic fetal heart rate (FHR) monitoring is part of routine care for laboring patients under either systemic or locoregional analgesia. Opioid systemic analgesia (mainly meperidine in early labor), yet less frequently used in our country, is associated with a decrease in FHR-variability and worse acid-base and neonatal status compared to epidural or combined spinal epidural analgesia. Although epidural analgesia may cause maternal hypotension and fever, longer second stage of labour and more instrumental vaginal deliveries, these potentially adverse factors appear to be outweighed by benefits on clinical and neonatal acid-base status when compared with maternal opioid systemic analgesia. The mechanisms by which epidural or spinal analgesia may affect fetal well-being include maternal hypotension and/or uterine hyperactivity. All these undesirable side effects which may induce severe intrapartum fetal distress must be adequately detected and treated with intrauterine resuscitation techniques, including correction of maternal hypotension and/or the use of tocolytics agents. Reinstallation of electronic fetal monitoring at arrival in the operating room before cesarean section for suspected fetal hypoxia may be helpful to choose better anesthetic technique and try to avoid general anesthesia associated with increased maternal morbidity and mortality.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Anesthesia, Obstetrical; Female; Fetal Diseases; Fetal Distress; Fetal Hypoxia; Fetal Monitoring; Heart Rate, Fetal; Humans; Infant, Newborn; Meperidine; Pregnancy
PubMed: 18191340
DOI: 10.1016/j.jgyn.2007.11.010