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Kanawati S, Barada MA, Naja Z, Rajab O, Sinno L, El Hasan J. Comparison of clinical effects of meperidine and sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean delivery: a randomized controlled trial. J Anesth 2022; 36:201-209. [DOI: 10.1007/s00540-021-03031-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022]
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Lin YC, Chen CY, Liao YM, Liao AHW, Lin PC, Chang CC. Preventing shivering with adjuvant low dose intrathecal meperidine: A meta-analysis of randomized controlled trials with trial sequential analysis. Sci Rep 2017; 7:15323. [PMID: 29127294 PMCID: PMC5681692 DOI: 10.1038/s41598-017-14917-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/18/2017] [Indexed: 01/07/2023] Open
Abstract
The aim of this systematic review and meta-analysis is to evaluate the pros and cons of adjuvant low dose intrathecal meperidine for spinal anaesthesia. We searched electronic databases for randomized controlled trials using trial sequential analysis (TSA) to evaluate the incidence of reduced rescue analgesics, shivering, pruritus, nausea and vomiting when applying adjuvant intrathecal meperidine. Twenty-eight trials with 2216 patients were included. Adjuvant intrathecal meperidine, 0.05-0.5 mg kg-1, significantly reduced incidence of shivering (relative risk, RR, 0.31, 95% confidence interval, CI, 0.24 to 0.40; TSA-adjusted RR, 0.32, 95% CI, 0.25 to 0.41). Intrathecal meperidine also effectively reduced need for intraoperative rescue analgesics (RR, 0.27, 95% CI, 0.12 to 0.64; TSA-adjusted RR, 0.27, 95% CI, 0.08 to 0.91) and the incidence of pruritus was unaffected (RR, 2.31, 95% CI, 0.94 to 5.70; TSA-adjusted RR, 1.42, 95% CI, 0.87 to 2.34). However, nausea and vomiting increased (RR, 1.84, 95% CI, 1.29 to 2.64; TSA-adjusted RR, 1.72, 95% CI, 1.33 to 2.23; RR, 2.23, 95% CI, 1.23 to 4.02; TSA-adjusted RR,1.96, 95% CI, 1.20 to 3.21). Under TSA, these results provided a sufficient level of evidence. In conclusion, adjuvant low dose intrathecal meperidine effectively attenuates spinal anaesthesia-associated shivering and reduces rescue analgesics with residual concerns for the nausea and vomiting.
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Affiliation(s)
- Yu-Cih Lin
- Department of Anaesthesiology, Taipei Medical University Hospital, Taipei, 110, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, 110, Taiwan
| | - Chien-Yu Chen
- Department of Anaesthesiology, Taipei Medical University Hospital, Taipei, 110, Taiwan
- Department of Anaesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, 110, Taiwan
| | - Yuan-Mei Liao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, 110, Taiwan
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei, 112, Taiwan
| | - Alan Hsi-Wen Liao
- Department of Anaesthesiology, Taipei Medical University Hospital, Taipei, 110, Taiwan
| | - Pi-Chu Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, 110, Taiwan
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, 110, Taiwan
| | - Chuen-Chau Chang
- Department of Anaesthesiology, Taipei Medical University Hospital, Taipei, 110, Taiwan.
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, 110, Taiwan.
- Department of Anaesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan.
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Chibueze CE, Nabhan AF, Sato M, Usama N, Mori Y, Elfaramawy A, Ota E. Spinal anaesthesia drugs for caesarean section. Hippokratia 2016. [DOI: 10.1002/14651858.cd012134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Chioma E Chibueze
- National Center for Child Health and Development; Department of Health Policy; 2-10-1 Okura, Setagaya-ku Tokyo Japan 157-8535
| | - Ashraf F Nabhan
- Ain Shams University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 16 Ali Fahmi Kamel Street Heliopolis Cairo Egypt 11351
| | - Masaki Sato
- National Research Institute for Child Health and Development; Division of Obstetric Anesthesia, Center for Maternal-Fetal and Neonatal Medicine; 2-10-1 Okura, Setagaya-ku Tokyo Japan 157-8535
| | - Noha Usama
- Faculty of Medicine Ain Shams University; Department of Pediatrics; Cairo Heliopolis Egypt
| | - Yumiko Mori
- National Research Institute for Child Health and Development; Division of Obstetric Anesthesia, Center for Maternal-Fetal and Neonatal Medicine; 2-10-1 Okura, Setagaya-ku Tokyo Japan 157-8535
| | - Amel Elfaramawy
- Ain Shams University; Faculty of Medicine; 15 Abou Elmahassen St Roxy, Heliopolis Cairo Cairo Egypt 11341
| | - Erika Ota
- National Center for Child Health and Development; Department of Health Policy; 2-10-1 Okura, Setagaya-ku Tokyo Japan 157-8535
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Lee JH, Chung KH, Lee JY, Chun DH, Yang HJ, Ko TK, Yun WS. Comparison of fentanyl and sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section. Korean J Anesthesiol 2011; 60:103-8. [PMID: 21390165 PMCID: PMC3049877 DOI: 10.4097/kjae.2011.60.2.103] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 08/05/2010] [Accepted: 09/12/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subarachnoid block is widely used for cesarean section due to the rapid induction, the complete analgesia, the low failure rate and the prevention of aspiration pneumonia. The addition of intrathecal opioids to local anesthetics seems to improve the quality of analgesia & prolong the duration of analgesia. Therefore we compared the effects of fentanyl 20 µg and sufentanil 2.5 µg, which were added to intrathecal hyperbaric bupivacaine. METHODS SEVENTY TWO HEALTHY TERM PARTURIENTS WERE RANDOMLY DIVIDED INTO THREE GROUPS: Group C (control), Group F (fentanyl 20 µg) and Group S (sufentanil 2.5 µg). In every group, 0.5% heavy bupivacaine was added according to the adjusted dose regimen by Harten et al. We observed the maximal level of the sensory block and motor block, the quality of intraoperative analgesia, the duration of effective analgesia and the side effects. RESULTS There were significant differences between the control and the fentanyl 20 µg and sufentanil 2.5 µg groups for the degree of muscle relaxation, the quality of intraoperative analgesia, the maximal sedation level and the duration of effective analgesia. The frequencies of side effects such as nausea and pruritis in the opioid groups were higher than those in the control group. But there were no differences between fentanyl 20 µg and sufentanil 2.5 µg for the frequencies of nausea and pruritis. CONCLUSIONS The addition of fentanyl 20 µg or sufentanil 2.5 µg for spinal anesthesia provides adequate intraoperative analgesia without significant adverse effects on the mother and neonate.
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Affiliation(s)
- Jung Hyang Lee
- Department of Anesthesiology and Pain Medicine, CHA University School of Medicine, Pocheon, Korea
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Atalay C, Aksoy M, Aksoy AN, Dogan N, Kürsad H. Combining Intrathecal Bupivacaine and Meperidine during Caesarean Section to Prevent Spinal Anaesthesia-Induced Hypotension and other Side-Effects. J Int Med Res 2010; 38:1626-36. [DOI: 10.1177/147323001003800507] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study compared intrathecal hyperbaric bupivacaine with low-dose intrathecal plain bupivacaine plus different doses of meperidine (pethidine), administered sequentially, with regard to blood pressure stability, post-operative analgesia and incidence of side-effects in 80 parturients undergoing caesarean section. Patients were randomly assigned to one of four groups ( n = 20 each group): the HB group received 10 mg hyperbaric bupivacaine intrathecally; the BM35, BM30 and BM25 groups received 5 mg plain bupivacaine plus 35, 30 or 25 mg of meperidine intrathecally, respectively. The incidence of hypotension in the BM25 group was significantly lower than in the HB group. Nausea and vomiting were less prevalent in the BM25 group than in the HB and BM35 groups. In conclusion, sequential administration of 5 mg plain bupivacaine and 25 mg meperidine intrathecally provided better blood pressure stability and a lower incidence of side-effects than bupivacaine alone, without affecting quality of anaesthesia or surgical and patient satisfaction.
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Affiliation(s)
- C Atalay
- Department of Anaesthesia and Reanimation, Medical Faculty, Atatürk University, Erzurum, Turkey
| | - M Aksoy
- Department of Anaesthesia and Reanimation, Medical Faculty, Atatürk University, Erzurum, Turkey
| | - AN Aksoy
- Department of Obstetrics and Gynaecology, Nenehatun Hospital, Erzurum, Turkey
| | - N Dogan
- Department of Anaesthesia and Reanimation, Medical Faculty, Atatürk University, Erzurum, Turkey
| | - H Kürsad
- Department of Anaesthesia and Reanimation, Medical Faculty, Atatürk University, Erzurum, Turkey
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Abstract
Spinal anaesthesia in the outpatient is characterized by rapid onset and offset, easy administration, minimal expense, and minimal side effects or complications. Spinal anaesthesia offers advantages for outpatient lower extremity, perineal, and many abdominal and gynaecological procedures. Development of small-gauge, pencil-point needles are responsible for the success of outpatient spinal anaesthesia with acceptable rates (0-2%) of postdural puncture headache (PDPH). Compared with peripheral nerve blocks, spinal anaesthesia has a more predictable offset. There are many possible choices of local anaesthetics for outpatient spinal anaesthesia. These include lidocaine, prilocaine, mepivacaine and small doses of bupivacaine. Meperidine has local anaesthetic properties in addition to its opiate properties. It has been used as the sole intrathecal agent for spinal anaesthesia but has no real advantages over lidocaine. Mepivacaine and lidocaine have each been associated with transient neurological symptoms (TNS) following intrathecal administration. This has stimulated development of alternative agents, including combinations of local anaesthetics and opioids. Lidocaine remains the most useful agent for outpatient spinal anaesthesia. For longer procedures, mepivacaine is an excellent spinal anaesthetic agent. Attention to technique, reduction of dose and addition of fentanyl to lidocaine result in effective spinal anaesthesia with rapid recovery and a low incidence of significant side effects or complications.
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Affiliation(s)
- William F Urmey
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 100021, USA.
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Krames E. Implantable devices for pain control: spinal cord stimulation and intrathecal therapies. Best Pract Res Clin Anaesthesiol 2002; 16:619-49. [PMID: 12516895 DOI: 10.1053/bean.2002.0263] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Untreated chronic pain is costly to society and to the individual suffering from it. The treatment of chronic pain, a multidimensional disease, should rely on the expertise of varying health care providers and should focus not only on the neurobiological mechanisms of the process but also on the psychosocial aspects of the disease. Implantable devices are costly and invasive, and such efficacious therapies should be used only when more conservative and less costly therapies have failed to provide relief of pain and suffering. Spinal cord stimulation provides neuromodulation of neuropathic, but not nociceptive, pain signals and when used for appropriate indications in the right individuals provides approximately 60-80% long-term pain relief in 60-80% of patients trialled for efficacy. Intrathecal therapies with opioids such as morphine, fentanyl, sufentanil or meperidine--or non-opioids such as clonidine or bupivacaine--provide analgesia in patients with nociceptive or neuropathic pain syndromes. Baclofen, intrathecally, provides profound relief of muscle spasticity due to multiple sclerosis, spinal cord injuries, brain injuries or cerebral palsy.
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Affiliation(s)
- Elliot Krames
- Pacific Pain Treatment Centers and Neuromodulation, Journal of the International Neuromodulation Society, San Francisco, California 94109, USA
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Murto K, Lui AC, Cicutti N. Adding low dose meperidine to spinal lidocaine prolongs postoperative analgesia. Can J Anaesth 1999; 46:327-34. [PMID: 10232715 DOI: 10.1007/bf03013223] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To investigate the effects of the addition of low dose meperidine to spinal lidocaine on the sensory and motor blockade profile, and the quality and duration of postoperative analgesia. METHODS In a randomized double blind prospective dose finding study 40 patients undergoing transurethral prostatectomy with spinal anesthetic were allocated to receive 75 mg lidocaine 5% intrathecally as the sole agent (group A), or co-administered with 0.15 mg x kg(-1) meperidine (group B) or 0.30 mg x kg(-1) meperidine (group C). Sensory and motor blockade profiles were documented. Postoperatively, the amount of analgesics required, time to first analgesic, visual analogue scores and adverse events were recorded. RESULTS Sensory blocks at or above T10 was maintained for 128, 156 and 145 minutes in groups A, B and C respectively. There was no difference in the latency or duration of the motor block among the three groups. Patients in group C had lower visual analogue pain scores (VAPS) over time than did those in groups A and B (P < 0.05). Time to first analgesia was longer (429 +/- 197 minutes) in group C than in group A (254 +/- 157 minutes) (P < 0.05). Fewer patients in group C required parenteral opioid postoperatively than in group A (P < 0.05). The incidence of bradycardia was higher in the groups receiving meperidine. No symptoms of transient radicular irritation (TRI) were reported in the groups receiving meperidine. CONCLUSION The addition of 0.3 mg x kg(-1) of meperidine to spinal lidocaine prolongs postoperative analgesia without delaying discharge from post anesthetic care unit (Table II) and reduces the requirement for parenteral analgesics (Table III).
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MESH Headings
- Adjuvants, Anesthesia/administration & dosage
- Adjuvants, Anesthesia/adverse effects
- Adjuvants, Anesthesia/therapeutic use
- Aged
- Aged, 80 and over
- Analgesia/methods
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Analgesics, Opioid/therapeutic use
- Analysis of Variance
- Anesthesia, Spinal/methods
- Anesthetics, Local/administration & dosage
- Arrhythmia, Sinus/chemically induced
- Bradycardia/chemically induced
- Double-Blind Method
- Humans
- Hypotension/chemically induced
- Incidence
- Lidocaine/administration & dosage
- Male
- Meperidine/administration & dosage
- Meperidine/adverse effects
- Meperidine/therapeutic use
- Middle Aged
- Motor Neurons/drug effects
- Nerve Block/methods
- Neurons, Afferent/drug effects
- Pain Measurement
- Pain, Postoperative/prevention & control
- Prospective Studies
- Prostatectomy
- Time Factors
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Affiliation(s)
- K Murto
- Department of Anesthesia, Ottawa Hospital, Ontario, Canada
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Reuben SS, Steinberg RB, Lurie SD, Gibson CS. A dose-response study of intravenous regional anesthesia with meperidine. Anesth Analg 1999; 88:831-5. [PMID: 10195533 DOI: 10.1097/00000539-199904000-00028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Intravenous regional anesthesia (IVRA) with meperidine in doses > or = 100 mg provides effective postoperative analgesia. However, this technique is associated with excessive opioid-related side effects, which limit its clinical usefulness. The minimal dose of meperidine that is effective for IVRA has yet to be established. We added 0, 10, 20, 30, 40, or 50 mg of meperidine to 0.5% lidocaine IVRA for either carpal tunnel or tenolysis surgery. Pain and sedation scores and the incidence of side effects were assessed in the postanesthesia care unit. The duration of analgesia, defined as the time to first request for pain medications, and use of acetaminophen/codeine (T3) tablets were measured. The duration of analgesia increased, in a dose-dependent manner, in the groups that received 0, 10, 20, and 30 mg of meperidine. There was no significant difference in the duration of analgesia for patients receiving > or = 30 mg of meperidine. T3 use was similar in the groups that received 0, 10, and 20 mg of meperidine and in the groups that received 30, 40, and 50 mg. T3 use was significantly lower in the larger dose groups. The incidence of sedation and of all other side effects was significantly higher in the groups that received 30-50 mg of meperidine compared with those that received smaller doses. We conclude that doses of meperidine large enough to produce the most effective postoperative analgesia with IVRA lidocaine causes a significant incidence of side effects, thus limiting its clinical usefulness. IMPLICATIONS Meperidine may be a useful addition to 0.5% lidocaine for i.v. regional anesthesia. We showed that 30 mg is the optimal dose of meperidine with respect to postoperative analgesia. However, this dose caused a significant incidence of sedation, dizziness, and postoperative nausea and vomiting.
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Affiliation(s)
- S S Reuben
- Department of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
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Reuben SS, Steinberg RB, Lurie SD, Gibson CS. A Dose-Response Study of Intravenous Regional Anesthesia with Meperidine. Anesth Analg 1999. [DOI: 10.1213/00000539-199904000-00028] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Pethidine is the only member of the opioid family that has clinically important local anaesthetic activity in the dose range normally used for analgesia. Pethidine is unique as the only opioid in current use that is effective as the sole agent for spinal anaesthesia. In lower doses, intrathecal pethidine is also an effective analgesic for treating pain in labour. This paper reviews the pharmacology of intrathecal pethidine and clinical experience reported to date. Articles reviewed include those identified by a Medline search using keywords "intrathecal" or "spinal anaesthesia/ anesthesia" and "pethidine" or "meperidine". Reference lists from identified papers were scrutinized to identify further relevant articles.
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Affiliation(s)
- W D Ngan Kee
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital
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Harvey SC, O'Neil MG, Pope CA, Cuddy BG, Duc TA. Continuous intrathecal meperidine via an implantable infusion pump for chronic, nonmalignant pain. Ann Pharmacother 1997; 31:1306-8. [PMID: 9391683 DOI: 10.1177/106002809703101105] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To report a continuous infusion of intrathecal meperidine via an implanted infusion pump for nonmalignant, chronic pain. CASE SUMMARY A 69-year-old white woman had chronic, nonmalignant low-back pain and bilateral leg pain. Multiple drug therapies and other interventional techniques had failed. The patient achieved significant pain relief by a continuous infusion of intrathecal meperidine via an implanted infusion pump. DISCUSSION To our knowledge, this is the first report of meperidine administered intrathecally by continuous infusion. Continuous infusion of intrathecal and epidural opiates by implanted infusion pumps is becoming more widely recognized as an alternative treatment for patients with chronic, benign pain. Epidural and intrathecal meperidine is an effective analgesic for short-term surgical procedures. Data reporting effective relief and safety with continuous intrathecal meperidine remain limited. CONCLUSIONS Continuous intrathecal meperidine via an implantable infusion pump may be an effective alternative in the treatment of chronic pain.
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Affiliation(s)
- S C Harvey
- Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, USA
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Conway F, Critchley LA, Stuart JC, Freebairn RC. A comparison of the haemodynamic effects of intrathecal meperidine, meperidine-bupivacaine mixture and hyperbaric bupivacaine. Can J Anaesth 1996; 43:23-9. [PMID: 8665630 DOI: 10.1007/bf03015953] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To study the haemodynamic effects of intrathecal meperidine, administered either alone or mixed with bupivacaine. METHODS We studied 42 Chinese patients, aged 59-87 yr, scheduled for transurethral bladder or prostate surgery, randomized into three equals groups, that received either meperidine 0.8 mg.kg-1, meperidine 0.4 mg.kg-1 plus 1.5 ml of 0.5% heavy bupivacaine or 3 ml of heavy bupivacaine 0.5%. Non-invasive systolic (SAP) and mean (MAP) arterial pressures, central venous pressure and cardiac index, stroke index and heart rate (HR) measured by the BoMed NCCOM3-R7S bioimpedance device, were recorded over the first 25 min. Systemic vascular resistance index (SVRI) was derived. Onset of sensory and motor block was also measured. Decreases in MAP of 25% were treated with colloid and metaraminol. RESULTS The onset of block was slower in the meperidine group (P < 0.05). Decreases in SAP, MAP and SVRI (all; P < 0.001) occurred within five minutes in all three groups. The HR was increased in the bupivacaine group (P = 0.03), but bradycardias treated with atropine occurred in six patients receiving meperidine and four patients receiving the mixture. Six patients receiving meperidine and two patients receiving the mixture required general anaesthesia for inadequate block. The incidence of nausea and vomiting was higher in the patients receiving meperidine (P < 0.05). No other complications were encountered. CONCLUSIONS Intrathecal meperidine used alone or mixed with bupivacaine has no intra-operative advantage over heavy bupivacaine 0.5%.
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Affiliation(s)
- F Conway
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
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Ong B, Segstro R. Respiratory depression associated with meperidine spinal anaesthesia. Can J Anaesth 1994; 41:725-7. [PMID: 7923521 DOI: 10.1007/bf03015628] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
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.
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Affiliation(s)
- B Ong
- Department of Anaesthesia, University of Manitoba, Winnipeg, Canada
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