Doses Of Meperidine Research Articles

Comparative study of Lidocaine- Saline Versus Saline as Washout for Lumpectomy Cavity on Acute Postoperative Pain

PurposeThis study aimed to evaluate the impact of lidocaine-saline solution compared to saline alone for washing out the lumpectomy cavity, focusing on its effect on acute postoperative pain—a prevalent and significant concern among patients undergoing breast surgery. MethodsIn this comparative study, 72 patients scheduled for lumpectomy surgery were randomly assigned to either the lidocaine-saline or saline group. The lidocaine-saline group was administered a washout of the lumpectomy cavity with 2% lidocaine at a dosage of 1.75 mg/kg in 0.9% normal saline, whereas the saline group received a washout with an equivalent volume of 0.9% normal saline. We recorded the participants' basic characteristics, heart rate, blood pressure, the incidence and intensity of pain (measured by the visual analogue scale), and the usage of postoperative analgesics. ResultsThe two study groups did not differ significantly in their basic characteristics, heart rate and blood pressure. The saline group had significantly higher pain intensity than the lidocaine-saline group at 30 minutes after surgery (4.61 vs. 2.88, P<0.0001) and at all other time points (P<0.001). The saline group also took the first dose of analgesics earlier than the lidocaine-saline (46.66 Vs. 170.55 minutes, P<0.001) and used a significantly higher mean dose of meperidine (77.50mg vs 33.47mg, P<0.001). ConclusionThe use of a lidocaine-saline wash during lumpectomy procedures can significantly reduce postoperative pain and lower the necessity for analgesics in patients who have undergone breast surgery.

Erector spinae plane block as a rescue therapy in following cholecystectomy: a historical cohort study.

The aim of this study is to evaluate the effect of erector spinae plane block (ESPB) as a rescue therapy in the recovery room. This single-center historical cohort study included patients who received either ESPB or intravenous meperidine for pain management in the recovery room. Patients' numeric rating scale (NRS) scores and opoid consumptions were evaluated. One hundred and eight patients were included in the statistical analysis. Sixty-two (57%) patients received ESPB postoperatively (pESPB) and 46 (43%) patients were managed with IV meperidine boluses only (IV). The cumulative meperidine doses administered were 0 (0-40) and 30 (10-80) mg for the pESPB and IV groups, respectively (p < 0.001). NRS scores of group pESPB were significantly lower than those of Group IV on T30 and T60. ESPB reduces the frequency of opioid administration and the amount of opioids administered in the early post-operative period. When post-operative rescue therapy is required, it should be considered before opioids.

Comparison of Bilateral Ultrasound-Guided Intermediate Cervical Plexus Block vs Local Wound Infiltration for Postoperative Analgesia in Patients Undergoing Total Thyroidectomy

Abstract Background The thyroid gland surgery is a common and painful procedure demanding analgesia. Bilateral intermediate cervical plexus block (BSCPB) could be beneficial for analgesia in thyroid surgery. In this study we will evaluate the analgesic efficacy of ultrasound guided intermediate cervical plexus block vs local wound infiltration in patients undergoing elective thyroidectomy under general anaesthesia. Objective To evaluate the analgesic efficacy and possible side effects of ultrasound guided intermediate cervical plexus block vs local wound infiltration in patients undergoing elective thyroidectomy under general anaesthesia as a primary outcome. The secondary outcome is the assessment of the safety of ICPB and the total dose of meperidine used for 24 hours postoperatively. Patients and Methods 40 patients were divided into two equal groups: Group A: The patients received intermediate cervical plexus block with 10 ml of 0.25% bupivacaine. The same will be repeated on the contralateral side. Group B: Patient will receive local wound infiltration with 20 ml bupivacaine 0.25% under the skin immediately before extubation by the surgeon for pain control. Results ICPB group showed significant lower median score compared with LWI group at time 2 hrs, 4 hrs, 6 hrs, 12 hrs The time for first dose meperidine was significantly longer in ICPB group (17.2 ± 3.02 vs 10.15 ± 1.84) while Total 24 h meperidine consumption was significantly less in ICPB (26.25 ± 17.16 vs 36.25 ± 12.76) Conclusion Intermediate cervical plexus block provides another safe alternative analgesia compared to superficial blocks and local wound infiltration with better analgesic efficacy.

Intra-articular remifentanil on postoperative pain in knee arthroscopic surgery; a double blind randomized clinical trial

BackgroundWe aimed to assess the efficacy of intra-articular remifentanil in relieving postoperative pain after knee arthroscopy. MethodsWe conducted a double-blind randomized clinical trial study on 60 patients. Patients were divided into two equal groups. The control group received 25 ml of intra-articular normal saline, and the intervention group received 200 μg of remifentanil dissolved in 25 ml of saline. We evaluated at rest postoperative pain at 1, 3, 6, 12, 18, and 24 h after the surgery using the Visual Analog Scale (VAS). Patients with VAS scores of 4 or more received meperidine (pethidine). The first time meperidine was requested and the total amount of meperidine consumed was recorded. ResultsOut of 60 patients, 49 were male (81.6%), and the mean age of participants was 32.71 (7.02) years. An hour after the surgery, the control group showed a mean VAS score of 8.66 (1.26), and decreased to 2.53 (1.67) at the end of 24 h. The intervention group started with a mean VAS score of 2.23 (1.81) and ended at 0.10 (0.305). All patients in the control group and 11 (36.7%) patients in the intervention group asked for analgesics during follow-up. The mean total meperidine dose in the control and intervention groups was 108.33 (23.97) mg and 13.33 (19.40) mg, respectively (P < 0.001; 95% confidence interval of the difference 83.72 to 106.27). ConclusionsIntra-articular remifentanil may decrease postoperative pain and analgesic requirements in patients undergoing knee arthroscopy.

Pulmonologist-Administered Balanced Propofol Analgosedation during Interventional Procedures: An Italian Real-Life Study on Comfort and Safety.

Propofol-based sedation provides faster recovery than midazolam-based regimens with similar safety and comfort during video flexible bronchoscope (VFB) procedures. Pulmonologist-administered propofol “balanced” analgosedation (PAP-BAS) is still debated in Italy. In this real-life study, PAP-BAS safety and comfort during VFB procedures were investigated. We analysed prospectively the subjects undergoing elective VFB procedures in the Pulmonology and RICU of Arezzo Hospital between February and July 2019. PAP-BAS combined low propofol and meperidine doses titrated to achieve an RASS score between 0 and −3. The primary end-point was the complications' rate. Secondary end-points were as follows: the relation between propofol's dose and a subject's comfort assessed with a VAS, recovery time according to a modified Aldrete score ≥9, RASS, and subjects' will of undergoing the procedure again. We collected postprocedure symptoms' intensity too. Our 158 study patients (67 years; SD ± 14; 64% males) incurred in 25% of complication, fully resolved with medical therapy. Neither recourse to ventilator support nor death was reported. Intraprocedural comfort was good (94% of VAS score ≤2). Among postprocedural symptoms, cough was the most frequently reported, in 36% of the cases. Although half of subjects remembered the procedure, 90% of them would have repeated it, if necessary. 85% of them recovered from procedures within 10 minutes. Complications, VAS, and recovery time were not correlated with propofol dose. To our knowledge, this is the first Italian study showing that PAP-BAS to perform a VFB procedure is safe, well tolerated with a quick recovery. Randomised controlled trials are warranted to confirm these preliminary results.

Comparing the Efficacy and Side Effects of Intravenous Ibuprofen and Acetaminophen in Pain Control Following Laparoscopic Cholecystectomy

BACKGROUNDThe importance of using effective postoperative analgesia is widely accepted. Systemic opioids are the gold standard for reducing severe pain after surgery, but the side effects have limited the use of adequate doses. We aimed to evaluate the effect of adding intravenous acetaminophen and intravenous ibuprofen to fentanyl on patient-controlled analgesia. METHODSIn this randomized clinical trial study in Ardabil city hospital at 2019, 90 patients undergoing elective laparoscopic cholecystectomy were randomly divided into three groups. The control group (n=30) received normal saline, the acetaminophen group (n=30) received 1g intravenous acetaminophen, and the ibuprofen group (n=30) received 800 mg intravenous ibuprofen. All patients received a pain control by intravenous pump containing fentanyl (15µ/ml). The drugs were injected intravenously after surgery. Shoulder and abdominal pain scores, sedation rate, nausea and vomiting, satisfaction, and the doses of fentanyl and meperidine were recorded in SPSS software within 24 h after surgery. RESULTSThe mean abdominal pain scores in ibuprofen (3.02) and acetaminophen (2.89) groups were not significantly different (P=0.719) but were significantly lower than in the control group (5.10) (P<0.001). The severity of shoulder pain, nausea and vomiting, sedation, and fentanyl intake were not significantly different in the ibuprofen and acetaminophen groups but were significantly lower than in the control group.CONCLUSIONThe use of both intravenous acetaminophen and ibuprofen in pain control after surgery can reduce the need for opioid use. Acetaminophen can also be a suitable alternative for postoperative pain control in patients that are unable to use NSAIDs.

The Effect of Pneumoperitoneum-induced Hypertension During Laparoscopic Cholecystectomy Under General Anesthesia on Postoperative Pain: A Randomized Clinical Trial.

BackgroundAcute postoperative pain is a significant cause of morbidities. This study aimed to evaluate the effect of intraoperative blood pressure during laparoscopic cholecystectomy under general anesthesia on postoperative pain in patients without underlying disorders.MethodsIn this randomized clinical trial, 72 patients undergoing general anesthesia for elective laparoscopic cholecystectomy were randomly assigned into two groups: Group A with higher than baseline preoperative blood pressure (MAP allowed to increase up to 20% higher than baseline MAP by inducing pneumoperitoneum) and group B with normal to low blood pressure (MAP deliberately controlled at a tight limit from normal baseline MAP values to 20% less than baseline by titrating TNG infusion). The Visual Analog Scale (VAS) after 2, 8, 12, and 24 hours of surgery, and the total dose of meperidine used to manage postoperative pain were recorded and compared between the two groups.ResultsThe pain scores in group A were significantly lower than group B (P = 0.001). The postoperative analgesia request time was different between the two groups (P = 0.53). During the first 24 hours, the total meperidine consumption dose in group A was significantly lower than in group B (P = 0.001).ConclusionsHigh intraoperative blood pressure may affect the postoperative pain after laparoscopic cholecystectomy and lead to less postoperative pain score and analgesic requirements.

Efficacy of Intravenous versus Intrathecal Meperidine on Post-Spinal Shivering after Knee Arthroscopy: A Randomized Controlled Study

Background and Aims: Hypothermia is considered a common problem with anesthesia. Spinal anesthesia, affects the process of temperature regulation. The aim of this study was to compare the prophylactic effect of intravenous (IV) meperidine with intrathecal (IT) meperidine on the prevention of shivering during spinal anesthesia in patients underwent knee arthroscopy. Aim of the Study: The aim of this work is to study the effect of meperidine either intravenous (IV) vs intrathecal (IT) on controlling postoperative shriving after knee arthroscopy. Materials and Methods: This study will be conducted in accordance with the principles of the ethics committee Benha University hospitals. Full written informed consent will be obtained from all patients before inclusion in the study, and a prospective randomized double-blinded study was conducted in adult patients undergoing knee arthroscopy under spinal anesthesia. Cases are divided into three equal groups (20 patients in each). Group IT: will receive spinal anesthesia (12.5 mg heavy bupivacaine) with intrathecal meperidine (25 mg). Group IV: will receive spinal anesthesia (12.5 mg heavy bupivacaine) with intravenous meperidine (25 mg). Group C: will receive spinal anesthesia (12.5 mg heavy bupivacaine) only postoperatively. Incidence and degree of shivering (SS), sedation score (RSS), pain score (VAS), hemodynamics, and PONV will be measured at the following intervals: 0 min (once arrived at PACU), 20 min later, 40 min later, 80 min later. Results: Shivering was observed in 0%, 0%, and 10.5% of patients in Groups IT, IV, and C, respectively. There was a significant difference between Group IT and IV compared to Group C (P Conclusion: We concluded that IT meperidine and IV meperidine comparably can decrease intensity and incidence of shivering compared to control group as well as decrease the requirement for additional doses of meperidine for shivering control without any hemodynamic side effect. And intrathecal meperidine showed better postoperative pain control and less postoperative nausea and vomiting (PONV).

Intramuscular meperidine analgesia at the beginning of active phase shortens labor duration without adverse effects on obstetric lacerations

The primary objectives of this study were to evaluate the impact of intramuscular meperidine on shortening of the active phase of labor, the neonatal outcome and the rate and severity of perineal lacerations in term pregnant women in the first stage of labor. A total of 571 primiparous term pregnant women delivered vaginally were included into this retrospective study. In 437 of them, meperidine (100 mg IM) at the beginning of the active phase was administered and 134 women did not receive any meperidine dose. The length of labor phases, obstetric lacerations, and neonatal outcomes were recorded. The results of this study showed that meperidine could be used safely as an obstetric analgesic with its additional benefit of shortening the active phase of the first stage and second stage of labor without increased risk of obstetric lacerations and perinatal adverse outcomes. In case of limited use of neuraxial analgesia in a busy state maternity hospital, intramuscular meperidine administration as obstetric analgesia seems beneficial in reducing the length of the active phase of the first stage of labor and the second stage of labor without adversely affecting obstetric lacerations and neonatal outcomes.

Effect of Meperidine on Equine Blood Histamine, Tryptase, and Immunoglobulin-E Concentrations.

Objectives: To evaluate changes in immunological parameters following subcutaneous (SC) and intramuscular (IM) administration of meperidine in horses through quantitative analysis of plasma tryptase, histamine, and IgE levels.Methods: Six adult horses were enrolled in a prospective randomized crossover design. Horses were administered one treatment per day, with a seven day washout period: (a) meperidine 1 mg/kg IM, saline 6 mL SC; (b) saline 6 mL IM, meperidine 1 mg/kg SC; (c) saline 6 mL SC, saline 6 mL IM. Blood samples were obtained for plasmatic histamine (baseline, 5, 10, 15, 30, and 60 min) via LC-MS/MS and plasmatic tryptase (baseline, 15, 30, 60, 120, and 240 min) quantification with enzyme-linked immunoabsorbent assays. Serum immunoglobulin E (IgE) concentrations prior to any meperidine treatment and 7–14 days following the first meperidine treatment were evaluated with enzyme-linked immunoabsorbent assays. Histamine and tryptase concentrations were evaluated with a mixed-effect analysis of variance. The levels of IgE at baseline (before the administration of the first dose of meperidine) were compared with the IgE values at 60 min following the second meperidine administration with the Paired t test. Biopsies of localized injection site reactions from subcutaneous meperidine administration were collected from two horses.Results: No statistically significant elevations from baseline in histamine (p = 0.595), tryptase (p = 0.836), or IgE (p = 0.844) were found in any of the horses in this study. There were no differences between treatment groups. Administration of SC meperidine caused a localized vasculitis and thrombosis with regional edema and hemorrhage.Conclusion: No evidence of anaphylactoid or anaphylactic type reactions occurred following IM or SC meperidine administration.

Comprehensive Prospective Analysis of the Factors Contributing to Aspiration Pneumonia Following Endoscopic Submucosal Dissection in Patients with Early Gastric Neoplasms.

Endoscopic submucosal dissection (ESD) has become the first-line treatment for early gastric neoplasms; however, a subset of patients treated by this method develop aspiration pneumonia. We conducted a comprehensive prospective analysis of the factors contributing to post-ESD aspiration pneumonia in early gastric neoplasms in this study, with special focus on whether pre-treatment oral care can prevent aspiration pneumonia. Sixty-one patients who underwent ESD for gastric neoplasms were randomly assigned to the oral care or control groups. ESD was performed under deep sedation. Of 60 patients whose data were available for analysis, 5 (8.3%) experienced pneumonia confirmed either by chest radiography or computed tomography. Although no difference in the rate of pneumonia was found between the control and oral care groups, the post-oral care bacteria count was significantly higher in the saliva of patients who developed pneumonia compared to those without pneumonia. In addition, the presence of vascular brain diseases and the dose of meperidine were also significantly associated with the occurrence of pneumonia. These results suggest that the number of oral bacteria as well as pre-existing vascular brain diseases and high-dose narcotics can affect the incidence of post-ESD pneumonia.

The Effect of Intrathecal Meperidine on Maternal and Newborn Outcomes After Cesarean Section: A Systematic Review and Meta-Analysis Study.

ContextSpinal anesthesia is the most preferred method for cesarean section. This meta-analysis was performed to determine the effect of minimum and maximum intrathecal doses of meperidine (pethidine) [5 to 40 mg] on the maternal and newborn outcomes after cesarean section.Evidence AcquisitionThe data were collected through the systematic search in the ISI, PubMed, Scopus, Google Scholar, Barakat, MagIran, SID, Irandoc, and EMBASE medical databases. Eighteen clinical trial studies with 1,494 patients were included.ResultsPatients who had received intrathecal meperidine had experienced lower shivering, relative risk [RR] = 0.34 (95% CI = 0.23, 0.48) and longer analgesia, [standard mean difference (SMD)] = 7.67 (95% CI = 1.85, 13.49) after the surgery. Moreover, RR of nausea = 1.37 (95% CI = 1.13, 1.66), vomiting RR = 2.02 (95% CI = 1.28, 3.20), and pruritus RR = 9.26 (95% CI = 4.17, 20.58) was higher in the pethidine group than in the control group. There was no statistically significant difference in the Apgar score at one-minute RR = 0.99 (95% CI = 0.9, 1.09), at five-minute RR = 0.93 (95% CI = 0.87, 1.08), maternal hypotension RR = 1.00 (95% CI = 0.87, 1.15), and maternal sensory and motor blockade durations, SMD = -1.72 (95% CI = -3.78.0.34) and SMD = -4.38 (95% CI = -9.19, 0.44), respectively in the two pethidine and control groups.ConclusionsIntrathecal meperidine can reduce shivering and increase the duration of postoperative analgesia, though it increases the relative risk of nausea, vomiting, and pruritus. No significant difference was found both in the Apgar score, maternal hypotension, and duration of the motor and sensory block.

The efficacy of bilateral sphenopalatine ganglion block under general anesthesia in trans-sphenoidal endoscopic hypophysectomy

Background:The most important goal in endoscopic pituitary surgery is bloodless field with better visualization under hemodynamic stability and good analgesia to improve the outcome, the current study was performed to evaluate the intraoperative anesthetic and postoperative analgesic effects of bilateral sphenopalatine ganglion block(SPGB)as adjuvant to general anesthesia in endoscopic transsphenoidal resection of pituitary adenoma. Patients and methods:thirty patients(ASA I-II)aged 22–55 years, randomly assigned into two equal groups. After stabilization of general anesthesia, the patients received bilateral sphenopalatine ganglion block with 2ml of either2% lidocaine: 1:200000 epinephrine(SPGB group)or sterile normal saline(control group). Mean arterial blood pressure was maintained at 60–70mmHg by using nitroglycerine. Intraoperative MAP and heart rate, Nitroglycerine and propranolol consumption, blood loss, average category scale, emergence time were recorded. Also, pre and postoperative plasma B-endorphin, VAS and time of first request for analgesia, total dose of meperidine consumption in the first 24hours postoperatively, patient’s satisfaction and post-operative complication were recorded. Results: Sphenopalatine ganglion block group showed decrease in blood loss(P<0.001), ACS(P<0.01), nitroglycerine consumption(P<0.0001)and emergence time(P< 0.001). At PACU, visual analogue pain score were lower in SPGB at 0,1,6(P<0.001), there were a high difference between two groups in B-endorphin levels(P<0.001)and also in dose of meperidine, % of patients needs analgesia and patients satisfaction(P<0.002), Conclusion:Use of sphenopalatine ganglion block with general anesthesia is a safe and effective technique, it contributes in adequate intra and postoperative analgesia needed for stabilization of hemodynamics with less blood loss, improving the quality of surgical field instead of controlled hypotensive technique during endoscopic endo-nasal trans-sphenoidal hypophysectomy.

What is the optimal dose of intrathecal meperidine in open prostate surgery? A prospective double-blind randomized study.

This study was an analysis of the effect of different dosages of intrathecal meperidine (40 mg, 50 mg, 60 mg, and 70 mg) on hemodynamic parameters, the duration of neural blockade, and the incidence of meperidine-related side effects in patients who underwent an open prostatectomy. Sixty patients who underwent an open prostatectomy with combined spinal-epidural anesthesia were included. The patients were allocated to receive 1 of 4 different dosages of intrathecal meperidine (n=15 for each group): Group I: 40 mg, Group II: 50 mg, Group III: 60 mg, and Group IV: 70 mg. The duration of the block procedure, surgery duration, highest sensory block level, and anesthetic complications were recorded and analyzed. At 20 minutes after the spinal injection, the maximum sensory block level was T6 in Group I and II, and it was T5 in Group III and IV. The mean motor block scores at 20 minutes after the spinal injection were lower in Group I compared with the other groups (p<0.001 for all). The motor block duration was significantly shorter in Group I and II than in Group III and IV (p<0.001 for all). Surgeon satisfaction was greater in Group II, III, and IV compared with Group I (p<0.001 for all). Patient satisfaction was better in Group III and IV compared with Groups I and II (p<0.001 for all). Intrathecal meperidine at a dose of 60 mg exerted a sufficient analgesic effect with minimum side effects in patients undergoing open prostatectomy.

Comparison of Effects of Hemostatic Gelatin Sponge Impregnated with Ropivacaine versus Normal Saline Applied on the Transverse Process of the Operated Vertebrae on Postoperative Pain in Patients Undergoing Spinal Instrumentation Surgery: A Randomized Clinical Trial

Protocols for effective postoperative pain control in patients undergoing spinal surgery are not standardized. In our study, we compared the effects of hemostatic absorbable gelatin sponge impregnated with ropivacaine versus normal saline when applied to the transverse process of the operated vertebrae on the postoperative pain following instrumentation spine surgery. A prospective double-blind randomized study was conducted on 30 patients undergoing spine surgery. At the end of surgery, the hemostatic gelatin sponge was applied by the surgeon on the transverse process of the operated vertebra containing either ropivacaine 0.5% or normal saline NaCl 0.9. Pain was assessed using the visual analog scale (VAS) every 4 hours for 48 hours postoperatively in the 2 groups (ropivacaine vs. normal saline). The total amount of postoperative opioid use was also recorded. The VAS score was significantly lower in patients receiving hemostatic gelatin sponge impregnated with local anesthetics as compared with patients receiving gelatin sponge impregnated with normal saline 48 hours postoperatively; the mean total dose of meperidine given in the first 48 hours postoperatively was significantly lower (53.5 ± 51.0 mg) in patients receiving gelatin sponge impregnated with local anesthetics as compared with patients receiving hemostatic gelatin sponge impregnated with normal saline (140.5 ± 102 mg). Use of intraoperative hemostatic gelatin sponge impregnated with ropivacaine applied on the transverse process of the operated vertebrae intraoperatively resulted in decreasing the postoperative pain in patients undergoing lumbar instrumentation surgery as manifested by the decrease in the VAS score and the total dose of opioids.

The efficacy of transversus abdominis plane block for post-operative analgesia after the cesarean section performed under general anesthesia.

OBJECTIVE:Several methods are used to control the pain after cesarean operations. Recently, the transverse abdominis plane block (TAP) has been proposed to compensate for the problems developed by preexisting methods. In the present study, we compared the analgesic efficacy of the TAP block after caesarean section in a prospective, randomized, double-blinded controlled trial.METHODS:In this study, thirty patients undergoing cesarean sections under general anesthesia were divided into two groups. Patients in Group T (n=15) on whom TAP Block with USG guidance was performed using 0.25% bupivacaine totally 60 ml. The patients in Group C were administered (n=15), 0.9% NaCl totally 60 ml (30 ml at each side) with USG guidance. Post-operative demand of meperidine using a patient-controlled analgesia device was recorded.RESULTS:First time on the need for analgesia were significantly higher in the control group (Group C). The total dose of meperidine, tenoxicam, paracetamol used for analgesia was significantly higher in the Group C. The outset times of breastfeeding and mobilization did not change between the groups.CONCLUSION:The USG-TAP block with 0.25% bupivacaine 60 ml (30 ml on each side) significantly reduced post-operative pain in patients undergoing the cesarean section. We think that TAP block is a comfortable and feasible method which reduces post-operative analgesia need and does not lead any serious complications.

The effects of preoperative pregabalin administration on postoperative pain on Libyan patients undergoing laparoscopic cholecystectomy

Abstract Objective: The present prospective study was carried out in Surgical Department of Tripoli Central Hospital with the aim to evaluate the effect of preoperative single dose of 150 mg pregabalin in reducing postoperative pain and analgesic consumption after laparoscopic cholecystectomy. Patients and Methods: Sixty patients of both sexes in the age of 18–60 years undergoing laparoscopic cholecystectomy were randomly allocated into two equal groups of 30 patients each. The pregabalin group received 150 mg oral pregabalin 1 h before induction of anesthesia and a placebo group received a matching placebo orally. Variables measured included age, sex, body mass index (BMI), duration of surgery, time to first dose and total dose of meperidine after recovery, and the visual analog scale (VAS – static and dynamic). The occurrence of nausea and vomiting during the first 24 h postoperative was also recorded. Results: No significant difference was found between the meperidine and the placebo groups regarding age, sex, BMI, or duration of surgery. The time of first meperidine dose required to alleviate pain after surgery was significantly four times longer in the pregabalin group as compared to the placebo group. The total dose of meperidine required for pregabalin group was significantly lower than that required for placebo group. Moreover, VAS was significantly decreased in the pregabalin group compared to placebo group both at static and dynamic states only 1 h after recovery. Conclusion: This study validates the preoperative use of a single dose of pregabalin in attenuating pain intensity postoperatively and reducing total analgesic consumption.

Ketamine for acute and subacute pain in opioid-tolerant patients

Prolonged acute pain, especially that of oncologic neurological origin, is at times difficult to control; it is seldom entirely alleviated by opioids. We report eight patients with severe pain, three of whom suffered from new onset oncologic metastatic bone pain, others had previous pain syndromes and presented with exacerbation of pain. Pain was associated with hyperalgesia and allodynia phenomena in two patients and with phantom pain in a third one. Tolerance to opioids had developed, and high IV doses of morphine, meperidine or fentanyl, and patient-controlled intravenous and epidural analgesia were insufficient. Several patients became dependent on opioids and could not be weaned from assisted ventilation. Pain was controlled with decreasing adjunct doses of ketamine. Within 5-10 days of ketamine and opioid protocols, pain was controlled and after an additional 5-7 days, ketamine could be stopped and pain controlled on oral regimens compatible with outpatient care. Ketamine is an efficient adjuvant analgesic for intractable severe pain, caused by metastasis, trauma, chronic ischemia, or central neuropathic pain. It is effective even when mega doses of IV, epidural, or oral opioids prove ineffective and when signs of tolerance have developed.

Comparison of preemptive effect of intravenous ketorolac versus meperidine on postoperative shivering and pain in patients undergoing cesarean section under spinal anesthesia: A prospective, randomized, double-blind study.

Background:Pain and shivering are two unpleasant problems in postoperative period. Various techniques are used to alleviate the postoperative shivering and pain. We compared the preemptive prescription of a single dose of intravenous meperidine and ketorolac on postoperative pain and shivering in patients undergoing cesarean section with spinal anesthesia.Methods:One hundred and fifty patients who were scheduled for elective cesarean section under spinal anesthesia were randomly allocated to one of three study groups to receive intravenous ketorolac (group K), meperidine (group M) or normal saline (group P). Time to first analgesic request, analgesic requirement in the first 24 hours after surgery, body tympanic temperature, hemodynamic variables and incidence of shivering were assessed as outcome variables.Results:There was no significant difference between meperidine and ketorolac groups in terms of prevalence of shivering, although both groups were different from the placebo group (p<0.04). The mean time to first analgesic request was longer in group k (3.8±1.4) and groups M (3.3±1.2) than in group P (2.1±0.8) hours (p<0.001).Conclusions:The preemptive prescription of a single dose of intravenous meperidine and ketorolac can provide a satisfying analgesia immediately after surgery and decrease shivering prevalence without any serious side effects.

Simultaneous quantitation of meperidine, normeperidine, tramadol, propoxyphene and norpropoxyphene in human plasma using solid-phase extraction and gas chromatography/mass spectrometry: Method validation and application to cardiovascular safety of therapeutic doses.

RATIONALE Several opioid analgesics have been related to the prolongation of cardiac repolarization, a condition which can be fatal. In order to establish a correct estimation of the risk/benefit balance of therapeutic doses of meperidine, normeperidine, tramadol, propoxyphene and norpropoxyphene, it was necessary to develop an analytical method to determinate plasma concentrations of these opioids. METHODS Here we describe a method which incorporates strong alkaline treatment to obtain norpropoxyphene amide followed by a one-elution step solid-phase extraction, and without further derivatization. Separation and quantification were achieved by gas chromatography/electron ionization mass spectrometry (GC/EI-MS) in selected-ion monitoring mode. Quantification was performed with 500 μL of plasma by the addition of deuterated analogues as internal standards. RESULTS The proposed method has been validated in the linearity range of 25-1000 ng/mL for all the analytes, with correlation coefficients higher than 0.990. The lower limit of quantification was 25 ng/mL. The intra- and inter-day precision, calculated in terms of relative standard deviation, were 2.0-12.0% and 6.0-15.0%, respectively. The accuracy, in terms of relative error, was within a ± 10% interval. The absolute recovery and extraction efficiency ranged from 81.0 to 111.0% and 81.0 to 105.0%, respectively. CONCLUSIONS A GC/MS method for the rapid and simultaneous determination of meperidine, normeperidine, tramadol, propoxyphene and norpropoxyphene in human plasma was developed, optimized and validated. This procedure was shown to be sensitive and specific using small specimen amounts, suitable for application in routine analysis for forensic purposes and therapeutic monitoring. To our knowledge, this is the first full validation of the simultaneous determination of these opioids and their metabolites in plasma samples.