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Anesthesiology Jan 2004The authors performed an individual patient meta-analysis of 2,703 nulliparous women who were randomized to either epidural analgesia or intravenous opioids for pain... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The authors performed an individual patient meta-analysis of 2,703 nulliparous women who were randomized to either epidural analgesia or intravenous opioids for pain relief during labor from five trials conducted at their hospital. The primary purpose in this meta-analysis was to evaluate the effects of epidural analgesia during labor on the rate of cesarean delivery.
METHODS
Between November 1, 1993, and November 3, 2000, 2,703 nulliparous women (2,188 healthy parturients and 515 women with pregnancy-induced hypertension) in spontaneous labor at term were randomized to receive either epidural analgesia or intravenous opioid analgesia in the five studies. Epidural analgesia was initiated with either epidural bupivacaine or intrathecal sufentanil and was maintained with a low-dose (0.0625% or 0.125%) mixture of bupivacaine with fentanyl. Intravenous opioid analgesia was initiated with 50 mg meperidine and 25 mg promethazine hydrochloride and was maintained with intravenous boluses of meperidine as needed.
RESULTS
A total of 1,339 nulliparous women were randomized to receive epidural analgesia, and 1,364 women were randomized to receive intravenous meperidine analgesia. There was no difference in the rate of cesarean deliveries between the two analgesia groups (epidural analgesia, 10.5% [140 of 1,339] vs. intravenous meperidine analgesia, 10.3% [141 of 1,364]; adjusted odds ratio, 1.04; 95% confidence interval, 0.81-1.34; P = 0.920). Significantly more women randomized to epidural analgesia had forceps deliveries compared to meperidine analgesia (13% [172 of 1,339] vs. 7% [101 of 1,364]; adjusted odds ratio, 1.86; 95% confidence interval, 1.43-2.40; P < 0.001). Epidural women had longer first and second stages of labor. Women who received epidural analgesia reported lower pain scores during labor and delivery compared to women who received intravenous meperidine analgesia.
CONCLUSION
Epidural analgesia compared to intravenous meperidine analgesia during labor does not increase the number of cesarean deliveries.
Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Analgesics, Opioid; Cesarean Section; Cross-Over Studies; Female; Humans; Injections, Intravenous; Meperidine; Pain Measurement; Parity; Patient Compliance; Patient Satisfaction; Pregnancy; Pregnancy, High-Risk; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 14695735
DOI: 10.1097/00000542-200401000-00023 -
Anesthesiology Jan 2000Among opioids, meperidine (pethidine) also shows local anesthetic activity when applied locally to peripheral nerve fibers and has been used for this effect in the...
BACKGROUND
Among opioids, meperidine (pethidine) also shows local anesthetic activity when applied locally to peripheral nerve fibers and has been used for this effect in the clinical setting for regional anesthesia. This study investigated the blocking effects of meperidine on different ion channels in peripheral nerves.
METHODS
Experiments were conducted using the outside-out configuration of the patch-clamp method applied to enzymatically prepared peripheral nerve fibers of Xenopus laevis. Half-maximal inhibiting concentrations were determined for Na+ channels and different K+ channels by nonlinear least-squares fitting of concentration-inhibition curves, assuming a one-to-one reaction.
RESULTS
Externally applied meperidine reversibly blocked all investigated channels in a concentration-dependent manner, i.e., voltage-activated Na+ channel (half-maximal inhibiting concentration, 164 microM), delayed rectifier K+ channels (half-maximal inhibiting concentration, 194 microM), the calcium-activated K+ channel (half-maximal inhibiting concentration, 161 microM), and the voltage-independent flicker K+ channel (half-maximal inhibiting concentration, 139 microM). Maximal block in high concentrations of meperidine reached 83% for delayed rectifier K+ channels and 100% for all other channels. Meperidine blocks the Na+ channel in the same concentration range as the local anesthetic agent lidocaine (half-maximal inhibiting concentration, 172 microM) but did not compete for the same binding site as evaluated by competition experiments. Low concentrations of meperidine (1 nM to 1 microM) showed no effects on Na+ channels. The blockade of Na+ and delayed rectifier K+ channels could not be antagonized by the addition of naloxone.
CONCLUSIONS
It is concluded that meperidine has a nonselective inhibitory action on Na+ and K+ channels of amphibian peripheral nerve. For tonic Na+ channel block, neither an opioid receptor nor the the local anesthetic agent binding site is the target site for meperidine block.
Topics: Analgesics, Opioid; Anesthetics, Local; Animals; Binding Sites; Dose-Response Relationship, Drug; Lidocaine; Membrane Potentials; Meperidine; Patch-Clamp Techniques; Peripheral Nerves; Potassium Channels; Sodium Channels; Xenopus laevis
PubMed: 10638911
DOI: 10.1097/00000542-200001000-00026 -
PloS One 2014Many studies have demonstrated that the pharmacokinetics and pharmacodynamics of analgesic drugs vary according to the circadian time of drug administration. This study...
BACKGROUND
Many studies have demonstrated that the pharmacokinetics and pharmacodynamics of analgesic drugs vary according to the circadian time of drug administration. This study aims at determining whether the analgesic effect and pharmacokinetics of pethidine in male BALB/c mice are influenced by administration time.
METHODS
A hot-plate test was used to evaluate the analgesic effect after pethidine (20 mg/kg) or saline injection at different dosing times. Mouse blood samples were collected at different intervals after dosing at 9:00 am and 9:00 pm, and were determined via liquid chromatography-tandem mass spectrometry (LC-MS/MS).
RESULTS
A significant 24-h rhythm was observed in the latency to thermal response at 30 min after dosing, with the peak during the dark phase and the nadir during the light phase. Tolerance to analgesic effect was produced after chronic pethidine injection at 9:00 am or 9:00 pm, and the recovery from tolerance was faster during the dark phase. The peak concentration (Cmax) and area under the concentration-time curve (AUC) of pethidine and its metabolite norpethidine were significantly higher during the dark phase than during the light phase, but the total serum clearance (CL/F) exhibited the opposite trend. The rhythm of drug plasma concentration was positively correlated with the analgesic effect.
CONCLUSION
These results suggest that the pharmacodynamics and pharmacokinetics of pethidine in mice vary significantly according to the dosing time, which implies that the time of administration should be considered in the rational clinical use of pethidine to maximise analgesia and minimise the adverse effects.
Topics: Administration, Metronomic; Analgesics, Opioid; Animals; Drug Chronotherapy; Male; Meperidine; Mice
PubMed: 25025283
DOI: 10.1371/journal.pone.0102054 -
British Journal of Anaesthesia Dec 1993We have studied the effects of electroacupuncture at classical acupuncture points, applied before and during surgery in patients undergoing hysterectomy, on... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
We have studied the effects of electroacupuncture at classical acupuncture points, applied before and during surgery in patients undergoing hysterectomy, on postoperative pain and metabolic stress responses in a prospective, randomized and patient-blinded manner. Fifty otherwise healthy women were allocated randomly to receive or not receive electroacupuncture. Electroacupuncture was begun 20 min before skin incision and continued to the end of surgery. All patients received similar general anaesthesia and all received patient-controlled analgesia (PCA) after operation. Postoperative pain in the two groups was evaluated by recording analgesic requirements by PCA and by pain-rating performed by patients and nursing staff. There were no significant differences between the two groups in postoperative analgesic requirements, pain-rating or metabolic stress responses.
Topics: Adult; Aged; Analgesia, Patient-Controlled; Drug Administration Schedule; Electroacupuncture; Female; Humans; Hysterectomy; Meperidine; Middle Aged; Pain, Postoperative; Prospective Studies; Single-Blind Method; Stress, Physiological
PubMed: 8280549
DOI: 10.1093/bja/71.6.835 -
Anesthesiology Jan 1998Postanesthetic shivering develops in as many as one half of patients recovering from isoflurane anesthesia. Cholinergic stimulation of the hypothalamic-pituitary-adrenal... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Postanesthetic shivering develops in as many as one half of patients recovering from isoflurane anesthesia. Cholinergic stimulation of the hypothalamic-pituitary-adrenal axis and adrenal medulla by physostigmine enhances secretion of arginine vasopressin, epinephrine, and norepinephrine. Because the hypothalamus is the dominant thermoregulatory controller in mammals, and these neurotransmitters may be involved in body temperature control, physostigmine administration may influence the incidence of shivering. Accordingly, the authors tested the hypothesis that physostigmine administration inhibits postanesthetic shivering. Its efficacy was compared with that of saline (negative control) and meperidine and clonidine (positive controls).
METHODS
Sixty patients having surgery of the ear or nose were tested. General anesthesia was induced with 2 mg/kg propofol, 0.1 mg/kg vecuronium, and 1.5 microg/kg fentanyl and maintained with isoflurane (1.5 +/- 0.4%) in 70% nitrous oxide. At the end of surgery, the patients were randomly assigned to receive an intravenous bolus of 0.04 mg/kg physostigmine, isotonic saline, 0.5 mg/kg meperidine, or 1.5 microg/kg clonidine. Heart rate, mean arterial blood pressure, oxygen saturation, visual analog pain score, temperature, and postanesthetic shivering were measured during recovery.
RESULTS
Postanesthetic shivering occurred in 6 of 15 (40%) patients given saline. In contrast, postanesthetic shivering was significantly reduced in physostigmine-treated patients (1 of 15, or 7%) and was absent in patients given clonidine or meperidine.
CONCLUSIONS
Physostigmine inhibited shivering as well as did two established treatments, meperidine and clonidine. These data suggest that cholinergic systems contribute to the genesis and control of postanesthetic shivering.
Topics: Adult; Aged; Anesthesia; Blood Pressure; Clonidine; Female; Heart Rate; Humans; Male; Meperidine; Middle Aged; Physostigmine; Shivering
PubMed: 9447863
DOI: 10.1097/00000542-199801000-00018 -
Journal of Korean Medical Science Dec 1987Intraspinal narcotic anesthesia was performed in 180 open heart surgery patients. 0.1 mg/Kg of morphine or 1.5 mg/Kg of meperidine was administered as the primary...
Intraspinal narcotic anesthesia was performed in 180 open heart surgery patients. 0.1 mg/Kg of morphine or 1.5 mg/Kg of meperidine was administered as the primary anesthetic in the subarachnoid space using the barbotage technique. Of the 180 patients scheduled for open heart surgery, morphine was administered to 95 patients, meperidine to 55 and a mixture of morphine and meperidine to 30 patients. From a clinical point of view, there were no significant cardiovascular problems, however, respiratory depression seemed to be most serious after morphine administration. Mild complications such as pruritus (11.1%), voiding difficulty (10.6%), intraoperative awareness (4.4%) and spinal headache were observed, however these were mild, not major clinical problems and were acceptable. Postoperative analgesic effect and respiratory controllability were excellent.
Topics: Anesthesia, Spinal; Cardiac Surgical Procedures; Humans; Meperidine; Morphine; Respiratory Insufficiency
PubMed: 3268179
DOI: 10.3346/jkms.1987.2.4.225 -
Anesthesiology Jun 1994Although meperidine has been used for patient-controlled analgesia both intravenously (PCIA) and epidurally (PCEA), these routes have not been compared, and many studies... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Although meperidine has been used for patient-controlled analgesia both intravenously (PCIA) and epidurally (PCEA), these routes have not been compared, and many studies have suggested that there is no advantage to the epidural route for administration of lipophilic opioids.
METHODS
A randomized, double-blind, crossover study was conducted for 24 h after cesarean section to compare the analgesic efficacy, side effects, patient satisfaction, drug use, and plasma drug concentrations with meperidine administered either as PCIA or as PCEA. Two groups, stratified for time of cesarean section during epidural anesthesia, postoperatively received either PCEA (group 1) or PCIA (group 2) with identical variables for 12 h before crossing to the other route for an additional 12 h.
RESULTS
Results from 45 patients showed a similar speed of analgesic onset but, subsequently, significantly lower pain scores both at rest and with coughing in those receiving PCEA (P = 0.0001). Nausea and pruritus scores did not differ between the groups in the first 12 h postoperatively, but sedation scores were significantly higher with PCIA (P = 0.0001). Patient satisfaction scores and preference significantly favored PCEA (P = 0.0001), with almost 90% of participants preferring the epidural route. Meperidine use was reduced approximately 50% with PCEA (P = 0.0001), and plasma meperidine and normeperidine concentrations were significantly lower (P = 0.0001).
CONCLUSIONS
We conclude that after cesarean section, PCEA with meperidine produces high-quality pain relief with few side effects and has significant advantages over PCIA meperidine. With the caveat that neonatal effects in breast-feeding mothers have yet to be evaluated, it can be highly recommended in this population.
Topics: Adult; Analgesia, Obstetrical; Analgesia, Patient-Controlled; Cesarean Section; Double-Blind Method; Drug Eruptions; Female; Humans; Injections, Epidural; Injections, Intravenous; Meperidine; Pain, Postoperative; Patient Satisfaction; Pregnancy; Pruritus
PubMed: 8010473
DOI: 10.1097/00000542-199406000-00014 -
Revista Brasileira de Ginecologia E... Dec 2017To verify if pethidine is safe for the conceptus when used during labor. Systematic review in the Capes Periodicals/PubMed and MEDLINE/Virtual Health Library (BVS,...
To verify if pethidine is safe for the conceptus when used during labor. Systematic review in the Capes Periodicals/PubMed and MEDLINE/Virtual Health Library (BVS, in the Portuguese acronym) databases. A total of 17 studies published from January 1st, 2000, to September 2nd, 2016, with a total of 1,688 participants involved were included in the present review. There was no record of conceptus vitality decrease associated with low doses of pethidine being administered to mothers during labor. Intramuscular (IM) or intravenous (IV) pethidine at low doses, of up to 50 mg, is safe to administer during labor.
Topics: Analgesia, Obstetrical; Analgesics, Opioid; Female; Humans; Labor Pain; Meperidine; Pregnancy
PubMed: 28666300
DOI: 10.1055/s-0037-1604065 -
The Canadian Veterinary Journal = La... Jan 2004Epidural administration of bupivacaine and meperidine produces analgesia in several animal species and in humans. A prospective randomized study was conducted in 18...
Epidural administration of bupivacaine and meperidine produces analgesia in several animal species and in humans. A prospective randomized study was conducted in 18 healthy horses to compare the effect of these 2 drugs administered by the epidural route. Animals were divided into 3 treatment groups of 6 animals each. All drugs were injected by the epidural route in all animals between the 1st and 2nd coccygeal vertebrae. Treatment 1 (BUP)--0.06 mg/kg of body weight of 0.5% hyperbaric bupivacaine; treatment 2 (MEP)--0.6 mg/kg of body weight of 5% meperidine; treatment 3 (SS)--0.9% saline solution (control group). Heart rate, arterial pressure, respiratory rate, rectal temperature, analgesia, sedation, and motor-blocking were determined before drug administration (baseline values); at 5, 10, 15, and 30 minutes after drug administration, and then at 30-minute intervals thereafter. Both hyperbaric bupivacaine and meperidine administered epidurally produced complete bilateral perineal analgesia in all horses. The onset of analgesia was 6, s = 2.6 minutes after injection of bupivacaine, as opposed to 9, s = 2 minutes after meperidine. The duration of analgesia was 240, s = 57 minutes for meperidine and 320, s = 30 minutes for bupivacaine. Heart and respiratory rates, arterial pressure, and rectal temperature did not change (P < 0.05) significantly from basal values after the epidural administration of bupivacaine, meperidine, or saline solution. To conclude, both bupivacaine and meperidine induced long-lasting perineal analgesia, with minimal cardiovascular effects. Analgesia was induced faster and lasted longer with bupivacaine.
Topics: Analgesia, Epidural; Analgesics, Opioid; Anesthetics, Local; Animals; Blood Pressure; Bupivacaine; Dose-Response Relationship, Drug; Heart Rate; Horses; Injections, Epidural; Kinetics; Meperidine; Pain Measurement; Random Allocation; Respiration
PubMed: 14992253
DOI: No ID Found -
Anesthesia Progress 1997Narcotic sedation is commonly accomplished with nitrous oxide (N2O) coadministration. Concerns regarding respiratory morbidity and mortality with drug combinations have...
Narcotic sedation is commonly accomplished with nitrous oxide (N2O) coadministration. Concerns regarding respiratory morbidity and mortality with drug combinations have been reported in the literature, particularly in patients not receiving supplemental oxygen (O2). The purpose of this investigation was to determine the effect of meperidine alone and in combination with N2O on respiration in laboratory rats by evaluating cardiovascular and arterial blood gas data. Fifty-four Sprague-Dawley rats were assigned to one of six groups (nine per group). Groups were allocated based upon the dosage of meperidine administered (0, 4.0, or 8.0 mg/kg intraperitoneally [i.p.]) and exposure to N2O (50% with oxygen) or O2 (100%). Following meperidine administration, animals were placed into a sealed chamber through which flowed either N2O or O2. Arterial blood was obtained, at baseline and at 15-min intervals, from a femoral artery catheter and pH, O2, CO2 (mm Hg), and oxygen saturation (%) were determined. Plasma samples were analyzed using a System 1306 pH/blood gas analyzer. Group comparisons demonstrated that: (a) N2O coadministration, in animals pretreated with meperidine, did not result in increased arterial CO2 levels, and (b) as expected, arterial O2 levels in all groups increased significantly from preexposure baseline values (P < 0.05). This investigation demonstrated that the coadministration of N2O to meperidine-sedated animals did not enhance respiratory depression.
Topics: Analgesics, Opioid; Anesthetics, Inhalation; Animals; Blood Gas Analysis; Blood Pressure; Dose-Response Relationship, Drug; Male; Meperidine; Nitrous Oxide; Rats; Rats, Sprague-Dawley; Respiration; Respiratory Insufficiency; Time Factors
PubMed: 9481959
DOI: No ID Found