Intravenous Meperidine Research Articles

Postoperative Schmerztherapie nach totalendoprothetischen Operationen an der Hüfte mittels kontinuierlicher 3-in-1-Blockade

40 patients who had undergone total hip replacement were included in a randomised prospective study. Postoperative pain management was performed with a continuous 3-in-1 block combined with demand-adapted intravenous meperidine titration (3-in-1 catheter group; n = 20) or by demand-adapted intravenous meperidine titration alone (control group; n = 20). The 3-in-1 catheter was placed before the start of anesthesia, and the patients received 30 ml 0.5% bupivacaine via this catheter. A second dose of 30 ml 0.5% bupivacaine was injected 10 min after postanaesthetic recovery. In the control group intravenous meperidine titration was initiated if the patients required pain relief. Subjective pain intensity was evaluated over a 6-hour period by means of the visual analogue scale. Bupivacaine plasma concentrations were determined in 18 patients at 30, 60, 120, and 180 min after the first postoperative injection of bupivacaine. Good pain control was achieved in both groups. The patients in the control group required a mean of 80.8 +/- 49.9 mg meperidine. The 3-in-1 block group required significantly less meperidine (54.3 +/- 44.5 mg). Mean bupivacaine plasma levels ranged between 0.75 and 1.33 micrograms/ml. Placement of the 3-in-1 catheters was without complications. For the management of postoperative pain following total hip replacement a continuous 3-in-1 block alone was often insufficient but postoperative meperidine requirements were significantly reduced (p < 0.05). Toxic bupivacaine plasma concentrations were not measured.

Dose-Response Effects of Intravenous Meperidine on Uterine Activity

Uterine activity in the active phase of labor is evaluated in demographically similar groups of patients for the effects of the intravenous administration of 25, 50, 75, and 100 mg of meperidine. Drug effect was evaluated by quantitation of the area under the uterine contraction curve into uterine activity units (torr minutes). Unmedicated uterine activity in the active phase of labor increases by 5 uterine activity units each 10 min of labor. Although considerable individual patient variation exists, each of the four drug groups demonstrated a decrease in uterine activity as compared to expected values for unmedicated labor, and this effect was temporally dependent on dose.

Dose/Response Effects of Intravenous Meperidine on Fetal Heart Rate Variability

Active phase of labor indices of fetal heart rate (FHR) variability were studied in demograph-ically similar groups of patients receiving intravenous meperidine in varying doses of 25, 50, 75, and 100 mg. A dose/response relationship has been established for a decrease in indices of fetal heart rate (FHR) variability that is dose related to the onset of change, duration of change, point of maximal change, and return to baseline levels. There is an apparent inverse relationship between level of change and the larger doses of meperidine. Baseline (intercontractional) and total (baseline and intracontractional) data were compared for discrimination of FHR change. Baseline FHR data provided the better overall general resolution of change, whereas total FHR data generally provided an improved resolution between pre- and post-injection values.

Pharmacokinetics and pharmacodynamics of intravenous meperidine in neonates and infants.

The pharmacokinetics of meperidine (pethidine) was studied in 21 infants who received a single intravenous dose of 1 mg/kg after surgery (n = 18) or during mechanical ventilation because of respiratory distress (n = 3). Eleven patients were younger than 1 week old, 10 patients were aged from 3 weeks to 5 months, and five of the patients were premature. The pharmacokinetics of meperidine varied greatly between the subjects, with a median elimination half-life of 10.7 hours (range, 3.3 to 59.4 hours), median clearance of 8.0 ml/kg/min (range, 1.8 to 34.9 ml/kg/min), median volume of the central compartment of 2.4 L/kg (range, 0.5 to 4.8 L/kg), and median steady-state volume of distribution 7.2 L/kg (range, 3.3 to 11.0). The great interindividual variability in meperidine pharmacokinetics should be taken into consideration when meperidine is administered to neonates. Although no life-threatening or serious side effects were observed in this study, appropriate care should be exercised when prescribing meperidine for this age group.

Epidural Fentanyl Does Not Influence Intravenous PCA Requirements in the Post-Caesarean Patient

Forty ASA physical status I or II patients scheduled for elective Caesarean delivery were studied to determine the effect of epidural fentanyl on post-Caesarean delivery analgesic requirements as administered by intravenous patient-controlled analgesia (PCA). Following delivery of the infant, under epidural anaesthesia with lidocaine 2% with 1/200,000 epinephrine, patients were randomly assigned to receive either 10 ml of preservative-free normal saline via the epidural catheter or 100 micrograms of fentanyl with 8 ml preservative-free normal saline in a double-blinded fashion. On arrival in the post-anesthesia recovery room (PAR), patients were provided with intravenous PCA meperidine 12.5 mg every eight minutes as needed. Patients were visited at intervals over the next 24 hr to determine if any differences in narcotic requirements, demands for narcotics, or severity of pain were noted. No differences were observed in any values between the groups. It is concluded that a single bolus of epidural fentanyl does not provide an advantage for postoperative pain relief in this patient population.

Clinical Value of Pulse Oximetry during Routine Diagnostic and Therapeutic Endoscopic Procedures

The clinical utility of transcutaneous oxygen saturation monitoring during routine diagnostic and therapeutic esophagogastroduodenoscopy and colonoscopy was assessed in 271 consecutive patients. The mean patient age was 56 years (range 14-86 years). The mean preprocedure oxygen saturation was 94% (range 81-100%). The mean dosages of intravenous meperidine, diazepam and midazolam if administered were 50 mg, 6.4 mg and 3.3 mg, respectively. The largest mean decrease in oxygen saturation of all procedures compared to the preprocedure measurement was 3.2% (p = .0001) and occurred immediately after administration of intravenous medication and endoscope intubation. Colonoscopy and esophagogastroduodenoscopy patients experienced similar decreases in oxygen saturation. The patient's age and sex, type of procedure and physician performing the procedure did not affect the degree of desaturation. The largest mean decrease in oxygen saturation observed was less than that considered normal during sleep. The clinical value of transcutaneous oxygen saturation monitoring in routine diagnostic and therapeutic esophagogastroduodenoscopy and colonoscopy is not supported by the findings of this study.

Analgesia in Anesthesia-Free Extracorporeal Shock Wave Lithotripsy: A Standardized Protocol

We treated 101 patients at our stone facility with the Dornier HM3 lithotriptor modified with the anesthesia-free design upgrade. A protocol designed by our anesthesiologists consisting of intravenous and intramuscular injections for sedation was used without any general or regional anesthesia required. Pre-medication with intramuscular meperidine and promethazine, and oral diazepam was sufficient sedation in 43 patients, while 37 required additional intravenous meperidine and/or midazolam during the procedure, 16 were treated with intraprocedural medication alone and 5 required no medication at all. Care before, during and after the procedure was rendered by the urology staff for patients in American Society of Anesthesiologists risk category I or II. Treatment was successfully completed in all patients without complications. We compared this group to the 99 patients treated consecutively before the modification. Voltage used, number of shocks and stone burden were comparable in the 2 groups but average treatment time was prolonged with the upgraded equipment (39.2 versus 27.1 minutes) to a significant degree (p <0.001).

Epidural fentanyl does not influence intravenous PCA requirements in the post-Caesarean patient

Forty ASA physical status I or II patients scheduled for elective Caesarean delivery were studied to determine the effect of epidural fentanyl on post-Caesarean delivery analgesic requirements as administered by intravenous patient-controlled analgesia (PCA). Following delivery of the infant, under epidural anaesthesia with lidocaine 2% with 1/200,000 epinephrine, patients were randomly assigned to receive either 10 ml of preservative-free normal saline via the epidural catheter or 100 micrograms of fentanyl with 8 ml preservative-free normal saline in a double-blinded fashion. On arrival in the post-anesthesia recovery room (PAR), patients were provided with intravenous PCA meperidine 12.5 mg every eight minutes as needed. Patients were visited at intervals over the next 24 hr to determine if any differences in narcotic requirements, demands for narcotics, or severity of pain were noted. No differences were observed in any values between the groups. It is concluded that a single bolus of epidural fentanyl does not provide an advantage for postoperative pain relief in this patient population.

Addition of Clonidine Enhances Postoperative Analgesia from Epidural Morphine

This study was undertaken to evaluate the analgesic effect of the combination of epidural morphine and clonidine versus epidural morphine alone in patients with postoperative pain. A randomized double-blind design was used, and 91 patients scheduled for post-operative pain relief by epidural morphine were studied. Patients received either a continuous epidural infusion of morphine and clonidine (group 1; n = 45) or morphine alone (group 2; n = 46) over the 72 h after major abdominal surgery. In the first 24 h, the dose of morphine was 6 mg per 24 h; during the second 24 h, it was decreased to 4 mg per 24 h; and in the final 24 h, it was decreased to 2 mg per 24 h in both groups. Group 1 patients received clonidine (450 micrograms) during each 24-h period. Additional epidural bolus injections of 2 mg morphine and intravenous meperidine were given on demand. The pain score, blood pressure, heart rate, respiratory rate, and relative forced vital capacity were measured at fixed times during the first 72 h after operation. Total consumption of analgesics and side effects were recorded. Although the total consumption of analgesics was significantly higher in group 2 (P less than 0.05), pain scores were lower in group 1 than group 2 during the entire observation period (P less than 0.05). Epidural clonidine produced a significant decrease (P less than 0.05) in heart rate and blood pressure, whereas the respiratory rate was not affected. Due to the better pain relief in group 1, the forced vital capacity was increased (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Exogenous Opioids in Human Breast Milk and Acute Neonatal Neurobehavior

Opioid analgesia requirements, distribution into breast milk, and influence on neonatal neurobehavior were evaluated in ten parturient-neonate pairs nursing after elective cesarean section during epidural anesthesia. Five patients received first a loading dose of intravenous meperidine after umbilical cord clamping, then patient-controlled analgesia (PCA) with intravenous meperidine, and finally meperidine tablets as needed. Five patients received morphine in the same manner. Treatment groups showed no differences with respect to neonatal Apgar scores or visual analog scale (VAS) pain or satisfaction scores at 24 and 48 h postpartum. Breast milk specimens, obtained at 12, 24, 36, 48, 72, and 96 h postpartum and analyzed for opioids and metabolites, showed persistently elevated normeperidine concentrations in the meperidine group. A blinded psychologist evaluated each infant once on the 3rd day of life with the Brazelton Neonatal Behavioral Assessment Scale (NBAS). A priori, the "alertness" and three "human orientation" outcomes of the NBAS were chosen for analysis as best measures of opioid-induced effects. On all four outcomes, neonates in the morphine group scored significantly higher (P less than 0.05) than neonates in the meperidine group. We conclude that post-cesarean delivery PCA with morphine provides equivalent maternal analgesia and overall satisfaction as that provided by PCA with meperidine, but with significantly less neurobehavioral depression among breast-fed neonates on the 3rd day of life.

Evaluation of safe, effective intravenous sedation for utilization in endoscopic procedures

The prevention of anesthetic mishaps during endoscopic procedures is of great importance to physicians in training. With the large number of such procedures performed each year, even infrequent adverse anesthetic reactions may result in a significant number of problems. To establish the safety and efficacy of an anesthetic regimen using intravenous meperidine and diazepam, all endoscopic procedures performed at one teaching institution in a 4-month period were retrospectively analyzed with regard to: (1) type and dosage of sedation/anesthesia, (2) endoscopic procedure involved, (3) effect of any underlying disease state, (4) side effects, (5) endoscopic complications, and (6) overall patient acceptance. A total of 716 patients underwent 913 endoscopic procedures with 876 separate anesthetic/intravenous sedations. General anesthesia was utilized in 44% of the 155 pediatric procedures. In the adult patients, intravenous sedation was administered by a physician-in-training under supervision except in 9% of cases (66 patients) when intravenous sedation utilizing alternative agents was given by the anesthesia department. The dose of sedation used (per body weight) declined with increasing age in the pediatric group (0-19 years). The adult dose remained constant for the next eight decades of life (meperidine 0.76 +/- 0.33 mg/kg: diazepam 0.12 +/- 0.08 mg/kg). In the adult group, 758 procedures were performed: 371 patients underwent esophago-gastroduodenoscopy, 258 colonoscopy, 36 endoscopic retrograde cholangiopancreatography, 40 flexible sigmoidoscopy, and 51 percutaneous endoscopic gastrostomy. Anesthetic-related complications (transient apnea and itching), were noted in two patients, and naloxone was utilized to reverse oversedation in a further 17 (2.56%).(ABSTRACT TRUNCATED AT 250 WORDS)

Intravenous Meperidine During Labor

Rayburn, W.; Leuschen, P.; Earl, R.; Woods, M.; Lorkovic, M.; Gaston-Johansson, F.; Morgan, Randall J. M.D.Author Information

Efficacy and Safety of a Diazepam and Meperidine Combination for Pediatric Gastrointestinal Procedures

SummaryLittle has been published about outpatient sedation for pediatric patients. We designed a study to evaluate the efficacy and adverse effects of diazepam and meperidine in combination for sedation in ambulatory pediatric patients undergoing endoscopy, colonoscopy, or liver biopsy. Thirty patients (7 months‐20 years) were observed. Each patient received a single combined dose of intravenous diazepam and meperidine. The standard dose was 0.1 mg/kg for diazepam and 2.0 mg/kg for meperidine. In patients weighing &gt;100 lb, set doses of meperidine (100 mg) and diazepam (5 mg) were used. The time to achieve sedation and the vital signs were measured; cooperation, emotional state, and drowsiness were rated before, during, and after procedures. The amnesic effect was noted, as were any adverse effects. Diazepam and meperidine were effective in 26 of 30 patients, with sedation generally produced within 2–3 min. Cooperation and emotional state improved significantly following drug administration (p &lt; 0.05). When a prospective 24‐h telephone follow‐up study was instituted in 40 consecutive patients receiving diazepam and meperidine no significant adverse effects were noted. Only 20% of patients old enough to be questioned remembered the procedure. Diazepam and meperidine in combination appear to be effective and safe in pediatric patients undergoing gastrointestinal procedures. Prolonged monitoring of patients does not appear necessary in this patient population.

Efficacy and Safety of a Diazepam and Meperidine Combination for Pediatric Gastrointestinal Procedures

Little has been published about outpatient sedation for pediatric patients. We designed a study to evaluate the efficacy and adverse effects of diazepam and meperidine in combination for sedation in ambulatory pediatric patients undergoing endoscopy, colonoscopy, or liver biopsy. Thirty patients (7 months-20 years) were observed. Each patient received a single combined dose of intravenous diazepam and meperidine. The standard dose was 0.1 mg/kg for diazepam and 2.0 mg/kg for meperidine. In patients weighing greater than 100 lb, set doses of meperidine (100 mg) and diazepam (5 mg) were used. The time to achieve sedation and the vital signs were measured; cooperation, emotional state, and drowsiness were rated before, during, and after procedures. The amnesic effect was noted, as were any adverse effects. Diazepam and meperidine were effective in 26 of 30 patients, with sedation generally produced within 2-3 min. Cooperation and emotional state improved significantly following drug administration (p less than 0.05). When a prospective 24-h telephone follow-up study was instituted in 40 consecutive patients receiving diazepam and meperidine no significant adverse effects were noted. Only 20% of patients old enough to be questioned remembered the procedure. Diazepam and meperidine in combination appear to be effective and safe in pediatric patients undergoing gastrointestinal procedures. Prolonged monitoring of patients does not appear necessary in this patient population.

Nasal oxygen alleviates hypoxemia in colonoscopy patients sedated with midazolam and meperidine

A randomized study was carried out to determine whether the administration of oxygen (3 liter/min) via nasal prongs significantly affects arterial oxygenation during colonoscopy in patients sedated with intravenous midazolam (2.6 +/- 0.2 mg, means +/- SE) and meperidine (48 +/- 3 mg). Patients who received supplemental oxygen were less likely to become hypoxic (pulse oximeter reading, SpO2 less than 90%) than those who breathed room air (10 of 28 vs. 22 of 28, p less than 0.005). Similarly, the total time during which SpO2 was below 90% was significantly less in patients receiving nasal oxygen (0.7 +/- 0.3 min) than in patients breathing room air (9.7 +/- 1.9 min, p less than 0.001). Minimum oxygen saturations were significantly higher in patients receiving oxygen (90.6 +/- 0.8%) than in patients breathing air (86.5 +/- 0.8%, p less than 0.001). In patients breathing air, there was a significant negative correlation between the dose of meperidine and the minimum observed oxygen saturation; conversely, midazolam dose did not correlate with indices of hypoxemia. The authors conclude that administration of oxygen via nasal prongs can reduce the risk of hypoxemia during colonoscopy. However, since hypoxemia may occur even when nasal oxygen is given, continuous monitoring of arterial oxygenation is recommended.

Percutaneous Endoscopic Gastrostomy and Jejunostomy for Long‐Term Feeding in Patients with Cancer of the Head and Neck

Enteral feeding is often required in patients with cancer of the head and neck. Percutaneous endoscopic gastrostomies (PEGs) and jejunostomies (PEJs) can facilitate enteral feeding in patients who require this treatment. The endoscopic technique allows for the placement of feeding gastrostomies and jejunostomies without a surgical procedure and eliminates the need for nasal tubes for long-term enteral feeding. Forty-two patients with head and neck tumors were referred for placement of PEGs because of severe dysphagia induced by tumors, surgery, radiation, or chemotherapy. The procedure was performed in the gastroenterology suite. Patients were sedated with intravenous meperidine and diazepam, and local anesthetic with lidocaine was applied to the area of incision. Average procedure time was approximately 20 minutes. The procedure was successful in 39 patients in whom tubes were placed ranging in diameter from 15F to 22F. PEGs were placed in 36 patients with intact stomachs and PEJs in three patients with previous gastrectomies. The remaining three procedures were unsuccessful because of technical reasons. There were three localized skin infections, and all responded to antibiotic therapy. Neither peritonitis nor any other immediate complication occurred. In 16 nonhospitalized patients, the procedure was performed on an outpatient basis. After a mean followup of 4.5 +/- 6 months of enteral feeding in the home, there was only one case of aspiration and subsequent pneumonia, and this case responded to antibiotics. No other long-term complications were noted. Thus feeding gastrostomies and jejunostomies can be placed safely and easily in patients with cancers of the head and neck by endoscopic methods without abdominal surgery. These tubes can be used for enteral feeding and eliminate the need for nasogastric tubes. They are better tolerated, are of a wider diameter, and have a reduced risk for migration, clogging, and aspiration-related complications.

Intravenous Meperidine for Control of Shivering During Caesarean Section Under Epidural Anaesthesia

Meperidine has been employed to control shivering in a variety of clinical circumstances, including general anesthesia. Since shivering may occur during epidural anesthesia, the current study was designed to assess the efficacy of meperidine in control of shivering during cesarean section.

Human fetal oxygenation (tcPo2), heart rate variability and uterine activity following maternal administration of meperidine.

Fetal tcPo2 levels were measured in 10 patients following maternal administration of 50 mg of meperidine by intravenous route. About 3 minutes following injection of meperidine, tcPo2 values started to decline to reach the lowest value of 37 +/- 25% by 7 mins of injection. tcPo2 values recovered by about 15 mins following injection. These changes in fetal tcPo2 levels preceded transient minimal increase in FHR variability. The increase in FHR variability was followed immediately by a decrease in the indices of the FHR variability. The uterine activity began to decline below the predicted positive slope values shortly following injection of meperidine. This decline was maximum 15 mins post-injection, subsequently establishing a trajectory toward the positive values expected for unmedicated labor. Two patients receiving 25 mg intravenous meperidine demonstrated no decline in tcPo2 levels; however, in the patient receiving 75 mg of intravenous meperidine, the changes noted were similar to those observed following 50 mg of meperidine.

Premedication with meperidine and diazepam for upper gastrointestinal endoscopy precludes the need for topical anesthesia

The authors conducted a prospective study in 90 patients undergoing upper endoscopic examination under sedation to determine whether there was any beneficial effect in anesthetizing the pharynx with topical anesthesia. These patients were divided into three groups of 30 patients. Group A received 39 ml of viscous lidocaine gargle (2%) diluted with 15 ml of tap water. Group B received the placebo. Group C received neither viscous lidocaine nor placebo. All patients received intravenous meperidine and diazepam titrated to produce adequate sedation for upper endoscopy. It was demonstrated that the undesirable effects of upper endoscopy, that is, gagging, sore throat, and dysphagia, did not differ significantly in any of the three study groups as evaluated by either the patients or the endoscopist. Only two patients complained that the procedure was mildly unpleasant. The authors conclude that the practice of anesthetizing the pharynx in patients receiving sedation for upper endoscopy should be abandoned since anesthesia of the pharynx is not exempt from morbidity and mortality as well as being time-consuming and expensive.

Minor Complication of Thyroid Cyst Sclerosis With Tetracycline

To the Editor. —In a previous issue of theArchives, Treece et al1reported the successful use of tetracycline hydrochloride for sclerosis of recurrent thyroid cysts with uniformly successful results.1One of us wrote an accompanying editorial.2Subsequently, it has been reported3that the first known use of an agent (tincture of iodine) to sclerose a thyroid cyst was in 1861.4 We have since used tetracycline for thyroid cyst sclerosis with salutary results in approximately 20 patients. However, on two occasions, we have each noted a patient who experienced extreme pain almost immediately in the area of injection that was relieved only by the administration of intravenous morphine sulfate or intramuscular meperidine hydrochloride. One patient had had several aspirations performed elsewhere with fluid reaccumulation. After she experienced the pain, she was examined almost immediately by ultrasound, which showed no residual cyst. Presumably, the tetracycline extravasated