Administration Of Meperidine Research Articles

Lower-body warming and postoperative temperature in cesarean delivery under spinal anesthesia: a randomized controlled trial

Study objective: Intraoperative warming techniques after spinal anesthesia in cesarean delivery have conflicting results. Lower body warming has not been investigated, and may be beneficial to counteract heat loss from vasodilation. We investigated a combination of intraoperative lower body forced-air warming and warmed intravenous (IV) fluids versus only warmed IV fluids alone for the primary outcome of maternal temperature in the post-anesthesia care unit (PACU) after elective cesarean delivery.Design: A single-center, single-blinded, randomized, superiority trial.Setting: Obstetric operating room and post-anesthesia care unit in a university hospital.Patients: Sixty-six healthy women undergoing elective cesarean delivery under spinal anesthesia.Interventions: After written informed consent, recruited women received intravenous (IV) co-loading of 1000 mL lactated Ringer’s solution warmed to 42°C during performance of spinal anesthesia. They were then randomized to receive intra-operative lower-body forced-air warming (warming group) or no forced-air warming (control group).Measurements: The primary outcome was maternal oral temperature upon arrival at PACU. Secondary outcome measures included the incidence of hypothermia (<36.0°C), shivering and thermal comfort scores, and the incidence of meperidine administration. In addition, umbilical cord blood gases, Apgar scores, and newborns' rectal temperature were measured after delivery. ResultsIn total, 66 women were recruited. After exclusion of 3 participants (1 missing crucial data, 2 converted to general anesthesia), 63 women remained available for analysis. The mean (Standard deviation) core temperature on arrival to PACU was 36.6°C (0.4°C) in the warming group and 36.5°C (0.3°C) in the control group (P = 0.67). There were no significant differences in shivering intensity between the groups at any time; thermal comfort scores were significantly higher for the air-warming group 30 minutes after arrival to PACU (P = 0.03), but not at any other time. There were no differences in meperidine administration or neonatal outcomes. ConclusionIn healthy women having cesarean delivery under spinal anesthesia, addition of lower body forced air warming conveyed no additional benefit beyond standard management with warmed IV fluids.

The Effect of Superficial Cervical Plexus Blockage With Ultrasound Guidance on Pain After Thyroidectomy

The main complaint after thyroidectomy is pain upon swallowing. It has been proven that postoperative uncontrolled pain can lead to chronic pain. We investigated the effectiveness of superficial cervical plexus block with ultrasound guidance on pain after thyroidectomy. This is a prospective, double-blind clinical trial study on patients aged 18-60 years who are candidates for thyroidectomy. Patients were randomly divided into two groups. The treatment group underwent superficial cervical plexus block under ultrasound guidance with an injection of 10 ml of ropivacaine 0.2%, and the control group received 10 ml of normal saline after sedation and before general anesthesia. The hemodynamic variables, amount of remifentanil used for hemodynamic stability, the severity of perioperative pain, postoperative nausea and vomiting, and the need for analgesics were compared between the two groups. The severity of pain in the treatment group at the time of discharge from recovery, 2, 6, 12, and 24 hours after surgery was 1.36, 1.76, 1.46, 1.24, and 0.44, respectively and in the control group was 3.12, 3.30, 3.82, 2.96 and 2.02 (P&lt;0.001). The average dose of meperidine administration for pain relief during recovery in the treatment group was 2.8 (±7.84) mg, and in the control group was 9.2 (±11.92) mg (P&lt;0.002). The need for diclofenac for analgesia during 24hours after surgery in the block group was 4 (±19.79) mg and in the control group was 64 (±69.28) mg, (P&lt;0.001). Superficial cervical plexus block can significantly reduce perioperative pain and need analgesic administration during and after thyroidectomy.

Serotonin Syndrome after PACU Administration of Tramadol and Meperidine.

Serotonin syndrome, malignant hyperthermia, and neuroleptic malignant syndrome are life-threatening conditions with similar clinical presentations, all of which may occur in post-operative patients. The rarity of these conditions has limited their research as well as the ability to recognise and treat them effectively. We present the case of a 61-year-old male who developed altered mental status, respiratory distress, fever, and haemodynamic instability following post-operative administration of tramadol and meperidine. The differential diagnosis process and process of elimination were used to diagnose this patient with serotonin syndrome. Chart review was used to review the details of the case to write this report. Serotonin syndrome was eventually diagnosed in the context of the symptoms following the administration of 2 serotonergic agents. The patient’s symptoms improved with supportive care and did not recur. This case is one of the first published reports of serotonin syndrome resulting from an interaction between tramadol and meperidine, highlighting the importance of constant vigilance in the perioperative period when serotonergic agents are involved. The increased usage of serotonergic antidepressants and Enhanced Recovery After Surgery protocols calling for serotonergic analgesics represent a significant and underrecognised potential for serotonergic multidrug interactions to occur.

Femoral 3-in-1 Nerve Block for Total Knee Replacement, an Analgesic Approach Not to Be Neglected. Single Center Experience and Literature Review.

Total Knee Replacement Surgery (TKR) is one of the most common elective orthopedic operations. Postoperative pain after total knee replacement, remains a challenge. In this retrospective observational study, we evaluated the effectiveness of 3-in-1 nerve block in patients after total knee arthroplasty compared to standard opioid treatment, and we state the reasons why this approach should still be considered. To evaluate the effectiveness of the 3-in-1 nerve block, we assessed the acute pain service archive and compared the values of the visual analog scale, by separating patients into two groups according to the analgesic regimen they received as per local protocols. In group A, patients received 0.25% bupivacaine through a 3 in 1 block catheter and additional meperidine IM if needed, while in group B they received meperidine every six hours. Our analysis showed the statistically significant better effectiveness of 3-in-1 nerve block with bupivacaine administration in postoperative TKR pain control compared to repeated administration of meperidine. The results of our study suggest that 3-in-1 nerve block with bupivacaine is an option that must always be considered in order to alleviate post-operative pain after TKR.

Relationship between molar incisor hypomineralization, intrapartium medication and illnesses in the first year of life

Molar incisor hypomineralization (MIH) affects the first permanent molars and permanent incisors whose formative embryological process develops around birth and the first year of life. This study’s main objective is to assess the relationship between MIH, on the one hand, with the administration during childbirth of epidural bupivacaine, intramuscular meperidine with haloperidol, synthetic intravenous oxytocin, and prostaglandins such as dinoprostone vaginally, and on the other hand, with suffered pathologies during the first year of life. Cross-sectional retrospective study was carried out on 111 children who attended dental check-ups. Oral examination was carried out to determine MIH involvement. Data on the administration of medications during delivery and the illnesses suffered by the children in the first year of life were taken from the hospital records. Significant relationship with Pearson's chi-square was found between the presence of MIH and the administration of meperidine with haloperidol intramuscularly and the vaginal administration of dinoprostone during labour. Also in children who have suffered serious infections and those who have received antibiotics in early childhood. In recent years there has been a growing trend in many countries to medicalize childbirth even above what the World Health Organization recommends. Some of the drugs used in these protocols could be involved in the appearance of dental mineralization alterations of the MIH type and this would help to explain the increase in its prevalence.

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.

Meperidine pharmacokinetics and effects on physiologic parameters and thermal threshold following intravenous administration of three doses to horses

BackgroundMeperidine is a synthetic opioid that belongs to the phenylpiperidine class and is a weak mu receptor agonist. In horses there are a limited number of published studies describing the analgesic effects of systemically administered meperidine in horses. The objective of this study was to describe the pharmacokinetics, behavioral and physiologic effects and effect on thermal threshold of three doses of intravenously administered meperidine to horses. Eight University owned horses (four mares and four geldings, aged 3–8 years were studied using a randomized balanced 4-way cross-over design. Horses received a single intravenous dose of saline, 0.25, 0.5 and 1.0 mg/kg meperidine. Blood was collected before administration and at various time points until 96 hours post administration. Plasma and urine samples were analyzed for meperidine and normeperidine by liquid chromatography-mass spectrometry and plasma pharmacokinetics determined. Behavioral and physiologic data (continuous heart rate, step counts, packed cell volume, total plasma protein and gastrointestinal sounds) were collected at baseline through 6 hours post administration. The effect of meperidine administration on thermal nociception was determined and thermal excursion calculated.ResultsMeperidine was rapidly converted to the metabolite normeperidine. The volume of distribution at steady state and systemic clearance (mean ± SD) ranged from 0.829 ± 0.138–1.58 ± 0.280 L/kg and 18.0 ± 1.4–22.8 ± 3.60 mL/min/kg, respectively for 0.5–1.0 mg/kg doses. Adverse effects included increased dose-dependent central nervous excitation, heart rate and cutaneous reactions. Significant effects on thermal nociception were short lived (up to 45 minutes at 0.5 mg/kg and 15 minutes at 1.0 mg/kg).ConclusionsResults of the current study do not support routine clinical use of IV meperidine at a dose of 1 mg/kg to horses. Administration of 0.5 mg/kg may provide short-term analgesia, however, the associated inconsistent and/or short-term adverse effects suggest that its use as a sole agent at this dose, at best, must be cautiously considered.

Analgesic Efficacy and Adverse Effects of Meperidine in Managing Postoperative or Labor Pain: A Narrative Review of Randomized Controlled Trials

Meperidine, a synthetic opioid, has a rapid onset and short duration of action. Mounting evidence has challenged meperidine's analgesic benefits, and concerns have been raised about its safety profile. Despite recommendations to restrict the prescription of meperidine, the drug remains frequently used. The aim of this study was to evaluate the evidence regarding the efficacy and safety of meperidine for acute postoperative and labor pain. This was a narrative review of the analgesic efficacy and side effects of meperidine compared to other analgesic drugs for acute postoperative and labor pain in adults. Randomized controlled trials that compared the analgesic efficacy and side effect profile of meperidine versus another analgesic drug in adult patients were evaluated. A systemized search of randomized controlled trials studying meperidine for acute postoperative or labor pain in the adult patient population from PubMed, Medline, and EMBASE was performed. Included studies reported on different routes of meperidine administration including intramuscular, intravenous, and patient-controlled analgesia in various surgical procedures such as abdominal surgery, Cesarean section, gynecological surgery, orthopedic surgery, cardiothoracic surgery, as well as for labor analgesia. Meperidine's analgesic efficacy and safety profile were compared to other opioids (morphine, tramadol, fentanyl, buprenorphine, nalbuphine, and pentazocine), nonsteroidal anti-inflammatory drugs (ketorolac, diclofenac, and indomethacin), dipyrone, ketamine, and bupivacaine. A total of 62 randomized controlled trials published between 1972 and 2018 were reviewed. Meperidine had a similar or inferior analgesic efficacy compared to other analgesics for acute postoperative or labor pain. Meperidine was associated with more sedation and respiratory depression. The sample sizes of many clinical studies were small, and therefore probably insufficiently powered to detect differences in uncommon side effects, such as central nervous system toxicity. In addition, some of the included clinical studies were old. Considering the availability of other effective analgesics with potentially fewer side effects, the use of meperidine for acute postoperative or labor pain should not be recommended. Acute postoperative pain, adverse effects, labor analgesia, meperidine, pethidine.

Investigation of the effects of systemic meperidine administration on fascia healing in an experimental rat model.

Purpose:To evaluate the effects of meperidine on fascial healing.Methods:Seventy adult male Sprague-Dawley rats divided into 7 groups with 10 rats in each group. One of these groups was determined as the sham group, 3 of the remaining 6 groups as meperidine groups, and 3 as control groups. These were grouped as 1st, 2nd, and 6th weeks. In the anterior abdominal wall of the rat, the skin was detached and a wound model including the peritoneum was created with a median incision. Mice in the meperidine group were injected with meperidine intraperitoneally (IP) 3 × 20 mg/kg meperidine on postoperative days 0, 1 and 2, and 2 × 20 mg/kg meperidine on postoperative days 3, 4, 5, and 6 after surgical intervention. Similar to the control group, an equal volume of saline was administered, corresponding to the doses. After sacrifice, the midline fascia was used for facial tensile strength measurement, and the other for histopathological analysis.Results:When compared, the meperidine and control groups inflammatory cell density was higher in the 1st week (p < 0.05) in the meperidine group, fibroplasia density was found to be higher at the 2nd week in the meperidine group than the control group (p < 0.05) When the tensile strength in the meperidine and control groups were compared, there was no significant difference (p > 0.05) at each of the three weeks.Conclusion:The application of postoperative systemic meperidine affects positively wound healing in the inflammatory stage and fibroplasia without changing the resistance to traction.

Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT)

BackgroundHypothermia and shivering are common complications after spinal anaesthesia, especially after uroscopic procedures in which large amounts of cold intraluminal irrigation fluids are used. Magnesium sulfate and dexmedetomidine are the most effective adjuvants with the least side effects. The aim of this study was to compare the effects of intrathecal dexmedetomidine versus intrathecal magnesium sulfate on the prevention of post-spinal anaesthesia shivering.MethodsThis prospective randomized, double-blinded controlled study included 105 patients who were scheduled for uroscopic surgery at the Kasr El-Aini Hospital. The patients were randomly allocated into three groups. Group C (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 0.5 ml of normal saline, Group M (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 25 mg of magnesium sulfate in 0.5 ml saline, and Group D (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 5 μg of dexmedetomidine in 0.5 ml saline. The primary outcomes were the incidence and intensity of shivering. The secondary outcomes were the incidence of hypothermia, sedation, the use of meperidine to control shivering and complications.ResultsGroup C had significantly higher proportions of patients who developed shivering (21), developed grade IV shivering (20) and required meperidine (21) to treat shivering than group M (8,5,5) and group D (5,3,6), which were comparable to each other.The time between block administration and meperidine administration was similar among the three groups. Hypothermia did not occur in any of the patients.The three groups were comparable regarding the occurrence of nausea, vomiting, bradycardia and hypotension. All the patients in group C, 32 patients in group M and 33 patients in group D had a sedation score of 2. Three patients in group M and 2 patients in group D had a sedation score of 3.ConclusionsIntrathecal injections of both dexmedetomidine and magnesium sulfate were effective in reducing the incidence of post-spinal anaesthesia shivering. Therefore, we encourage the use of magnesium sulfate, as it is more physiologically available, more readily available in most operating theatres and much less expensive than dexmedetomidine.Trial registrationClinical trial registration ID: Pan African Clinical Trial Registry (PACTR) Trial Number PACTR201801003001727; January 2018, “retrospectively registered”.

MMP-9 and MMP-2 regulation in patients undergoing non-oncological and non-vascular elective surgery independent of the use of propofol or sevoflurane.

There is debate regarding whether inhaled sevoflurane or intravenous propofol used during anesthesia achieves the best outcome. Propofol has been shown to affect expression of matrix metalloproteinases (MMPs). MMPs are enzymes that play a role in extracellular matrix remodeling, with activity balance disturbances during surgery. The goal of this study was to compare MMP-2/9 concentrations, activity, and tissue inhibitors of metalloproteinases (TIMPs) 1/2 concentrations in blood of who had undergone 2 types of anesthesia: based on volatile sevoflurane and intravenous propofol during non-oncological, non-vascular surgery. 39 patients were enrolled into analysis, 20 anesthetized with total intravenous anesthesia with propofol (P), 19 with volatile induction/maintenance of anesthesia with sevoflurane (S). Plasma samples collected before and 24 h after surgery were analyzed for MMP-2/9, and TIMP-1/2 concentrations using ELISAs. Additionally, MMP-2/9 activities were assessed by gelatin zymography. Study revealed increased MMP-9 concentration (ELISA) (P:p = 0.011; S:p = 0.001) and activity (zymography) (P:p = 0.004; S:p = 0.008) in both groups 24 h after surgery. We noticed decreased (both groups) MMP-2 concentration (P:p = 0.044; S:p = 0.027) with MMP-2 activity increase (P:p = 0.002; S:p = 0.006) 24 h after surgery. We observed decreased TIMP-1 plasma concentrations (P:p = 0.002; S:p = 0.000) 24 h after procedures, while TIMP-2 plasma levels remain unchanged (P:p = 0.097; S:p = 0.172). There were no differences between concentration and activity of MMPs and TIMPs in regard to anesthetic used. Meperidine administration correlated with lower MMP-9 activity (R=-0.430; p = 0.006). Concluding, neither sevoflurane nor propofol used as anesthetics modulate MMP-2 and MMP-9 concentrations and activities during non-oncological, non-vascular elective surgery. Meperidine seems to decrease MMP-9 activity.

Synthetic Phenylpiperidine Derivative Meperidine as a Trigger for Type I Negative Pressure Pulmonary Edema in General Anesthesia

We present a case of type I negative pressure pulmonary edema in a healthy 17-year-old boy who underwent an emergent appendectomy under general anesthesia. The particularity of our case revolves around the administration of meperidine for perioperative shivering, along with other anesthetic risk factors, which may have served as the trigger of type I negative pressure pulmonary edema.We present the pathophysiological mechanisms, the formulation of clinical and paraclinical diagnosis and the principles of intensive care therapy. This was the first such case experienced in our practice, with a remarkable learning opportunity.

Meperidine-induced QTc-interval prolongation: prevalence, risk factors, and correlation to plasma drug and metabolite concentrations .

To evaluate in the clinical setting the frequency and risk factors associated with the QT-interval prolongation induced by meperidine. We recruited patients requiring meperidine administration and recorded their medical history and comorbidities predisposing to QT-interval prolongation. Ionograms and electrocardiograms (ECGs) were performed at baseline and during treatment; QT was corrected using the Bazzet, Fridericia, Framinghan, and Hogdes formulas. We measured meperidine and normeperidine by gas chromatography. Values are expressed as mean ± SD (range). 58 patients were studied (43.1% males). All patients received meperidine at a dose of 304 ± 133 (120-480) mg/day. Meperidine and normeperidine concentrations were 369 ± 60 (265-519) and 49 ± 17 (15-78) ng/mL, respectively. Intratreatment control found QTcB 370 ± 30 (305-433), QTcFri 353 ± 35 (281-429), QTcFra 360 ± 30 (299-429), QTcH 359 ± 27 (304-427), ΔQTcB +9 ± 42 (-90 to +136), ΔQTcFri +4 ± 45 (-86 to +137), ΔQTcFra +5 ± 40 (-77 to +129), and ΔQTcH +7 ± 40 (-76 to +129) ms. Meperidine concentration correlated with QTc-interval (R>0.36) and ΔQTc (R>0.69) but the correlation was even better for normeperidine concentration, QTc (R>0.52) and ΔQTc (R>0.81). Depending on the QTc correction formula used, 13 - 15 patients (22.41-25.86%) presented ΔQTc values >30 ms, and 7 - 8 patients (12.07- 13.79%) showed ΔQTc values > 60 ms. Renal failure was associated with risk for ΔQTc >30ms of 3.74 (IC95% 1.73 - 8.10) and for ΔQTc > 60 ms of 4.27 (IC 95% 1.26 - 14.48). No patient developed arrhythmias during the study. Meperidine treatment causes ECG changes (QTc-interval prolongation) in high correlation with normeperidine plasma concentration. Renal failure increases the risk. .

Famotidine-induced reversal of meperidine-related serotonin syndrome: a case report.

Serotonin syndrome is an unexpected fatal adverse event related to serotonergic medication. This case report is the first report describing the possible treatment effect of famotidine on serotonin syndrome. Furthermore, this is the first case report of serotonin syndrome induced by meperidine alone in a patient with no previous history suggesting a susceptibility to serotonin syndrome. A 70-year-old male with no recent history of serotonergic drug use presented with severe serotonin syndrome following ureteroscopy, possibly due to postoperative meperidine administration. The patient's symptoms included hypertension, tachycardia, tachypnea, hyperthermia, myoclonus, diaphoresis, retching, nausea, agitation, and semicoma mentality with no pupillary light reflex. Symptoms began to subside immediately after the administration of intravenous famotidine for prevention of aspiration pneumonia, with mental and neurological symptoms showing improvement initially, followed by autonomic symptoms. This case report suggests that the histamine type 2 receptor antagonist famotidine may be an effective emergency treatment for serotonin syndrome.

Determination of antepartum and intrapartum risk factors associated with neonatal intensive care unit admission.

To determine antepartum and intrapartum factors that are associated with admission to neonatal intensive care unit (NICU) among infants delivered between 36.0 and 42.0 weeks at our institution. The retrospective cohort study included 73 consecutive NICU admissions and 375 consecutive non-NICU admissions. Data on demographic, antepartum, intrapartum and neonatal factors were collected. The primary endpoint defined was admission to NICU. Univariate analyses using the Student's t-test, Mann-Whitney U-test, χ2 Fisher's exact test was performed along with multivariate analysis of significant non-redundant variables. Those with a significantly higher risk of NICU admission underwent induction of labor with prostaglandin analogs (12.5% vs. 24.7%, P=0.007). Length of first stage ≥720 min (33.5% vs. 51.9%, P=0.011), length of second stage of labor ≥240 min (10.6% vs. 31.6%, P<0.001) and prolonged rupture of membranes ≥120 min (54.0% vs. 80.0%, P=0.001) were all associated with an increased chance of NICU admission. Intrapartum factors predictive of NICU admission included administration of meperidine (11.7% vs. 27.4%, P<0.001), presence of preeclampsia (5.5% vs. 0.8%, P=0.015), use of intrapartum IV antihypertensives (1.1% vs. 13.7%, P<0.001), maternal fever (5.3% vs. 31.5%, P<0.001), fetal tachycardia (1.9% vs. 12.3%, P<0.001), and presence of meconium (30% vs. 8%, P<0.001). Identification of modifiable risk factors may reduce neonatal morbidity and mortality. Results from this study can be used to develop and validate a risk model based on combined antepartum and intrapartum risk factors.

A case of postoperative serotonin syndrome following the administration of fentanyl, palonosetron, and meperidine -A case report-

A case of postoperative serotonin syndrome following the administration of fentanyl, palonosetron, and meperidine -A case report-

Analgesic effect of gabapentin on post-operative pain after arthroscopic anterior cruciate ligament reconstruction.

To the Editor Mardani-Kivi et al presented results about a triple blinded randomized controlled trial with gabapentin in patients that underwent anterior cruciate ligament (ACL) reconstruction (1). In their manuscript, the introduction section is very illustrative about the subject. With respect to methodology, it is well known that the physical diagnosis of ACL injury is particularly difficult in several patients, and partial ACL tears are also difficult to diagnose on physical examination. In this particular case, how did the authors obtain the diagnosis of ACL in the patients? Likewise, ACL reconstruction can be delayed several weeks or months until the swelling has decreased and there is an appropriate range of motion. For this reason, I want to ask: was the cause of the ACL injury homogeneous in all patients?; was the time delay of the surgery the same for everyone; and was the type of damage the same for all participants? Meperidine is an opioid with analgesic effects. The American Pain Society and the Institute for Safe Medication Practice (ISMP) do not recommend meperidine use as pain relieving medication or they recommend it only in very special cases and with many precautions during its administration (2, 3). What was the rationale of the authors choosing meperidine as analgesic drug? In this same sense, authors did not indicate in their manuscript whether meperidine was administered by oral, intramuscular or intravenous pathways or patient-controlled analgesia. The time schedule of meperidine administration was not indicate in the manuscript; was meperidine administered q4h or q6h? How many doses were received by patients? I think it was a mistake to publish the demographic data of all patients (n=114). You had to eliminate the patients deleted in the presentation of the demographic characteristics of the patients (n=108), that is more correct. Table 2 and 3 were poorly prepared. Table 2 has missing data about the results at 24 hours in the placebo group. Table 3 does not specify the meaning of the values (milligrams or administration times or what the units were?)(Table 1, 2). Finally, pre-emptive analgesia is defined as the treatment that is initiated before and is operational during the surgical procedure in order to reduce the physiological consequences of nociceptive transmission provoked by the procedure (4). Do authors have any idea or hypothesis about the possible mechanism of gabapentin to produce pre-emptive analgesia in your patients? Are the injury and the surgical technique employed in your study candidate to pre-emptive analgesia? Was the meperidine utilization in your study the better option to get pre-emptive analgesia?

Clearance of Meperidine and Its Metabolite Normeperidine in Hemodialysis Patients With Chronic Noncancer Pain

ContextNormeperidine accumulates in patients with impaired renal function and may cause central neurotoxicity. However, some uremic patients still undergo meperidine treatment for chronic pain. ObjectivesTo prevent normeperidine side effects and complications, we investigated the clearance rate and extraction ratio of meperidine and normeperidine in hemodialysis patients with chronic pain. MethodsThree hemodialysis patients, with diagnoses of chronic pancreatitis, chronic back pain, and intractable intra-abdominal pain, received long-term (more than six months) administration of meperidine for chronic noncancer pain. During regular hemodialysis, 72 blood samples in total were collected from the afferent port, efferent port, and ultradiafiltrate port at eight time points. The plasma concentrations of meperidine and normeperidine were determined by high-performance liquid chromatography. ResultsThe prehemodialysis plasma concentrations of meperidine and normeperidine were 2963 ± 315 and 2369 ± 1974 ng/mL, which declined to 591 ± 109 and 853 ± 765 ng/mL, with 80% and 65% reduction, respectively. The plasma clearance and extraction ratios of meperidine were 22.7 ± 9.8 mL/minute and 10.1 ± 5.6% and for normeperidine 26.0 ± 11.4 mL/minute and 10.8 ± 2.5%, respectively. ConclusionHemodialysis can efficiently remove meperidine and its active metabolite, normeperidine, in uremic patients receiving long-term meperidine therapy for chronic noncancer pain.

Comparison of propofol-based sedation regimens administered during colonoscopy.

The ideal sedative agent for endoscopic procedures should allow a rapid modification of the sedation level and should not have any adverse effects. To evaluate and compare the efficacy, safety, cost and patient satisfaction of some propofol-based sedation regimens administered during colonoscopy. One hundred twenty one patients scheduled for elective outpatient colonoscopy with conscious sedation were randomized to four groups to evaluate the administration of dexmedetomidine, sufentanil, meperidine and midazolam in combination with propofol to maintain sedation during the procedure. Evaluated outcomes were efficacy, safety, cost and patient satisfaction of sedation procedures. Patients receiving dexmedetomidine achieved a higher degree of sedation when compared with the other groups (p < 0.05). The lapse to recover protective reflexes and motor function, was significantly shorter in groups receiving dexmedetomidine or sufentanil than in groups receiving meperidine or midazolam (p < 0.05). There were no differences between groups in pre-sedation and post-sedation neurophysiologic performance, measured by the Trail Making A and B tests. Sedation for endoscopy can be safely and effectively accomplished with low doses of propofol combined with dexmedetomidine, intranasal sufentanil, IV meperidine and IV meperidine with midazolam.