Meperidine Group Research Articles

Comparing the Effect of Granisetron with Meperidine on Post-Shivering in Elective Cesarean Section under Spinal Anesthesia

Background: Post-operative shivering after spinal anesthesia is a common issue in women undergoing cesarean section, then its management is necessary to increase patients’ satisfaction. Therefore, the current study aimed to compare the prophylactic effect of Granisetron and meperidine on post-spinal shivering in elective cesarean section. Methods: In this double-blinded clinical trial study, 100 women under elective cesarean section using block randomization were divided into two groups. The spinal anesthesia was performed in all women with 10 mg hyperbaric bupivacaine 0.5 %. Then, after the birth of the baby, the patients received 0.04 mg/kg Granisetron or 0.4 mg/kg meperidine intravenously. Mean Arterial Pressure (MAP), Heart Rate (HR), and percentage of arterial blood oxygen saturation (SpO2) were measured before intervention and 60 minutes after surgery using a standard monitoring device. Shivering was evaluated 30 minutes after the surgery in the recovery room according to the clinical examinations. Results: The changes in hemodynamics parameters were similar between the two groups. There was a statistically significant difference in the rate of shivering between the two groups. The rate of shivering in the Granisetron group was higher than in the meperidine group. Thus, 13 patients (26%) and 5 patients (10%) had shivering in the Granisetron and meperidine groups, respectively (p=0.037). Conclusion: Granisetron was not more effective than meperidine as routine treatment in preventing shivering after spinal anesthesia in women under elective cesarean section.

The Role of Adrenaline, Noradrenaline, and Cortisol in the Pathogenesis of the Analgesic Potency, Duration, and Neurotoxic Effect of Meperidine.

Background and Objectives: The purpose of the study was to investigate the role of adrenaline (ADR), noradrenaline (NDR), and cortisol in the pathogenesis of the analgesic potency, duration, and epilepsy-like toxic effect of meperidine. Materials and Methods: The experimental animals were separated into 11 groups of six rats. In the meperidine (MPD) and metyrosine + meperidine (MMPD) groups, paw pain thresholds were measured before and after the treatment between the first and sixth hours (one hour apart). In addition, ADR and NDR analyses were performed before and after the treatment, between the first and fourth hours (one hour apart). For the epilepsy experiment, caffeine, caffeine + meperidine, and caffeine + meperidine + metyrapone groups were created, and the treatment was applied for 1 day or 7 days. Groups were created in which caffeine was used at both 150 mg/kg and 300 mg/kg. Epileptic seizures were observed in epilepsy groups, latent periods were determined, and serum cortisol levels were measured. Results: In the MPD group, pain thresholds increased only at the first and second hours compared to pre-treatment, while ADR increased at the third hour, leading to a decrease in pain thresholds. In the MMPD group, the increase in paw pain thresholds at 1 and 6 h was accompanied by a decrease in ADR and NDR. In the caffeine (150 mg/kg) + meperidine group, 1-day treatment did not cause epileptic seizures, while seizures were observed and cortisol levels increased in the group in which treatment continued for 7 days. When cortisol levels were compared between the group in which caffeine (300 mg/kg) + meperidine + metyrapone was used for 7 days and the animals receiving caffeine (300 mg/kg) + metyrapone for 7 days, it was found that cortisol levels decreased and the latent period decreased. Conclusions: The current study showed that if serum ADR and cortisol levels are kept at normal levels, a longer-lasting and stronger analgesic effect can be achieved with meperidine, and epileptic seizures can be prevented.

Comparison of Preemptive Post-Intubation 15 Mg/KgBW Paracetamol to 0.35 Mg/KgBW Meperidine in Incidence of Post-Anesthetic Shivering

Post anesthesia shivering (PAS) is a repetitive involuntary movement of one or more muscle groups as a result of a decrease in core body temperature. Pharmacological therapy in preventing PAS may include meperidine and paracetamol. This study compared the effectiveness of paracetamol to meperidine in reducing the incidence of post-anesthesia shivering. This study used an experimental randomized double-blind comparative analytic design on patients underwent exploratory laparotomy surgery under general anesthesia at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from September 2021 to August 2022. Patients with 50 ASA 1-2 physical status were included and divided into two groups. One group received 15 mg/kg group paracetamol and the other received 0.35 mg/kg meperidine. Data on tympanic membrane temperature and hemodynamics before and after induction and after extubating were collected. Furthermore, data on the results of the assessment of the incidence and grade of shivering in each treatment group were also collected. The results of this study showed that there was a decrease in the frequency of PAS in patients receiving intravenous 15 mg/kg paracetamol (p<0.05), as well as less side effects in the form of nausea and vomiting (p < 0.05). The incidence and degree of shivering after general anesthesia using intravenous 15 mg/kg paracetamol was lower compared to the use of 0.35 mg/kg meperidine. In the meperidine group, the decrease in body temperature was lower than in the paracetamol group, while the incidence of nausea and vomiting in the paracetamol group was lower than in the meperidine group. In conclusion, paracetamol reduces the incidence of post-anesthesia shivering better than meperidine.

Comparison of Analgesic Effects of Ketorolac Plus Apotel to Meperidine in Patients Undergoing Right Thoracotomy: A Double-Blind Randomized Clinical Trial.

Postoperative pain management using nonsteroidal anti-inflammatory drugs with no narcotic-attributed adverse effects, such as respiratory depression, nausea, and vomiting, is still the subject of extensive research. However, concerns about bleeding and nephrotoxicity have limited routine use. The present trial aimed to compare the effects of ketorolac/apotel and meperidine on postoperative pain relief in patients undergoing thoracotomy. This randomized controlled trial enrolled 122 patients who were candidates for right thoracotomy. The patients were randomly divided into two groups that received ketorolac (30 mg)/apotel (1 g) or meperidine (0.5 - 1 mg/kg) at the beginning of recovery, respectively. This study assessed the Numeric Rating Scale pain score immediately and 30 and 60 minutes after the surgery in the recovery room, blood pressure, oxygen saturation (SpO2), sweating, and pulse rate. The average pain score at recovery time was significantly lower in the ketorolac/apotel group (2.06 ± 1.40) than in the meperidine group (2.76 ± 1.61) (P = 0.011). In contrast to the ketorolac/apotel group, an increasing trend was observed in pain scores in the meperidine group throughout the time sequence (P < 0.05). However, a slight non-significant increase was also observed in the ketorolac/apotel group. No statistical differences were observed in blood pressure (P = 0.826), SpO2 (P = 0.826), and pulse rate (P = 0.811) between the two study groups. This study provides support that the combination of ketorolac/apotel offers a slightly superior analgesic effect for patients undergoing thoracotomy, compared to meperidine. Pain management is crucial during recovery, and the current study's findings suggest that administering ketorolac/apotel provides effective analgesia during recovery after thoracic surgery.

Comparative effect of intrathecal meperidine, tramadol, magnesium sulfate, and dexmedetomidine on preventing post-spinal anesthesia shivering and adverse events in hip fracture repair patients

Objective: To compare effect of intrathecal meperidine, tramadol, magnesium sulfate, and dexmedetomidine on the prevention of postspinal anesthesia shivering and adverse events in hip fracture repair patients. Methods: In a randomized, double-blind trial, 132 patients with American Society of Anesthesiology (ASA) I and II spinal anesthesia who needed hip fracture surgery were enrolled. Patients were stratified into 4 intervention groups based on a randomized block pattern: meperidine, tramadol, magnesium sulfate, and dexmedetomidine. Hemodynamic parameters including blood pressure, heart rate, and oxygen saturation, as well as the severity of shivering, core body temperature, Ramsay sedation score, adverse events, meperidine consumption were recorded and compared. Results: There was no statistically significant difference in the normal hemodynamic parameters, temperature, duration of surgery, meperidine consumption, and adverse events such as dizziness, hypotension, nausea, and bradycardia among groups (P&gt;0.05). Compared to other groups, severity of shivering was the lower in the dexmedetomidine group 6 and 8 h after surgery. The Ramsay sedation scores were higher in the dexmedetomidine and meperidine groups 4 h after surgery (P=0.020). Conclusion: Dexmedetomidine acts better than the other three adjuvants in reducing complications such as shivering. Overall, these four adjuvants are helpful to prevent postoperative shivering and could be put forward as promising local anesthetics in spinal anesthesia, based on anesthesiologists’ discretion and patients’ general conditions. Clinical registration: The study was approved by the Research and Ethics Committee at the Valiasr Hospital (Arak, Iran) with the clinical trial code of IRCT20141209020258N153.

Comparing the Effect of Intrathecal Injection of Meperidine, Meperidine-Bupivacaine, and Bupivacaine Alone on Pain Severity and Hemodynamic Parameters after Elective Cesarean Section.

This study aimed to evaluate the effect of meperidine and bupivacaine on maternal hemodynamic changes prior to anesthesia and compare it with post-intervention. In this clinical trial, the rate of postoperative analgesia on 90 healthy women candidates for elective cesarean section with spinal anesthesia was evaluated by meperidine, bupivacaine, and a combination of these two drugs. The study was conducted on 90 patients, including 30 patients receiving injection of meperidine, 30 patients receiving injection of bupivacaine, and 30 patients receiving injection of meperidine plus bupivacaine. Nausea, vomiting, headache, itching, and shortness of breath were also recorded. The mean systolic and diastolic blood pressure as well as heart rate and mean arterial blood pressure in the meperidine group were significantly lower than those detected before the intervention (P < 0.05). The mean SpO2 index was significantly decreased in meperidine and meperidine+bupivacaine groups (P < 0.05). The prevalence of nausea, vomiting and itching was higher in meperidine group compared to those in the other two groups (P = 0.032). In sum, the prevalence of nausea, vomiting, and itching in the meperidine group was higher than those in the other two groups. Due to almost equal performance of meperidine and meperidine plus bupivacaine in analgesia, the stabilization of other hemodynamic indices in the meperidine plus bupivacaine group, and the decline in the prevalence of nausea, vomiting, and itching, this combination may have been a good alternative to meperidine.

Intravenous magnesium sulfate &lt;em&gt;versus&lt;/em&gt; intravenous meperidine to prevent shivering during spinal anesthesia

BACKGROUND Shivering is a frequent event during neuraxial anesthesia due to impaired central and peripheral thermoregulation control. Meperidine and MgSO4 are effective in lowering the shivering threshold. Hence, this study aimed to compare the efficacy of MgSO4 and meperidine to prevent shivering in patients undergoing spinal anesthesia.&#x0D; METHODS This was a double-blind randomized clinical trial of 100 patients divided into 2 groups. One group had MgSO4 30 mg/kg, and the other group had meperidine 0.5 mg/kg intravenously in 100 ml of 0.9% NaCl before undergoing spinal anesthesia. Participants were non-pregnant patients aged 18–65 years and had physical status I or II (based on the American Society of Anesthesiologist). Shivering was considered significant if it occurred in grade 3 or 4. Patient characteristics, shivering degree, tympanic membrane temperature, and side effects were recorded.&#x0D; RESULTS Shivering occurred 10% in the MgSO4 group and 19% in the meperidine group, with p = 0.23. Both groups had similar side effects of nausea, vomiting, and hypotension.&#x0D; CONCLUSIONS MgSO4 30 mg/kg was not superior to meperidine 0.5 mg/kg intravenously in preventing shivering in patients undergoing spinal anesthesia.

Comparison of Effect of Meperidine Versus Fentanyl as an Adjuvant to Epidural Bupivacaine on Duration of Labor: A Randomized Controlled Study

Epidural analgesia (EA) is one of the best pain relief for many pregnant women in labor. This study was conducted to evaluate the effect of epidural analgesia provided by a combination of bupivacaine plus meperidine or fentanyl on the mother, fetus, and labor process in term nulliparous women. A total of 558 nulliparous women were randomized into two groups of 279 subjects. The BF (Bupivacaine-Fentanyl) group received 16 ml bupivacaine 0.125% plus 50 mg fentanyl as a loading dose; then, an intermittent bolus of the same solution was administered once the patient requested analgesia. The BM (Bupivacaine-Meperidine) group received a loading dose of 16 ml bupivacaine 0.125% plus 20 mg meperidine followed by an intermittent bolus of the same solution if the patient requested analgesia. The time of labor phases 1 and 2 and the incidence of side effects were recorded. After the intervention, the pain score was significantly lower in the meperidine group compared to the fentanyl group during labor (P=0.006). The duration of the active phase of labor (P=0.04) and the rate of cesarean section (P=0.01) were significantly higher in the fentanyl group compared to the meperidine group. The duration of the second stage of labor was not significantly different between the two groups (P=0.24). Apgar score was significantly higher in the meperidine group. This study found that epidural meperidine could be a suitable alternative to fentanyl for improving pain relief and shortening the active phase of delivery without increasing the risk of the neonatal low Apgar score.

Comparison of clinical effects of meperidine and sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean delivery: a randomized controlled trial.

The objective of this study was to compare the effect of adding meperidine or sufentanil to hyperbaric bupivacaine in patients undergoing elective cesarean delivery (CD) under spinal anesthesia. The primary outcome was the first analgesic request time, and secondary outcomes included an analgesic requirement in the first 24h and intraoperative and postoperative side effects. This was a randomized, double-blind clinical trial in which patients were allocated into two groups. One group received preservative-free meperidine 12.5mg (1mL) in addition to 0.5% 10mg (2mL) of hyperbaric bupivacaine for spinal anesthesia. The other group received sufentanil 5μg (1mL) added to 0.5% 10mg (2mL) of hyperbaric bupivacaine. A total of 60 parturients were included in the study, 30 patients in each group. Time to first analgesic request was significantly longer in the meperidine group (400.0 ± 142.1min) compared to (274.0 ± 104.1min) in the sufentanil group (P < 0.0001). Around 73% of the parturients in the sufentanil group required analgesics at 4h compared to 13% in the meperidine group (P < 0.0001). There were no significant differences in postoperative pruritus, nausea and vomiting, in addition to shivering. As for surgeon satisfaction, 56.7% reported excellent abdominal muscle relaxation during the surgery in the meperidine group compared to 10% in the sufentanil group (P < 0.0001). Meperidine was superior to sufentanil in terms of improved analgesia, intraoperative postoperative pruritus, and shivering, as well as increased surgeon satisfaction in women undergoing spinal anesthesia for elective cesarean delivery. ClinicalTrials.gov (NCT04446715).

Effectiveness of meperidine versus tramadol on post spinal anesthesia shivering in elective cesarean section: A prospective observational cohort study

BackgroundPost Spinal Anesthesia Shivering (PSAS) is common side effect during spinal anesthesia. Shivering could be treated with tramadol or meperidine. However, comparative effectiveness of the two drugs has not been assessed in our institution. Study objectiveTo evaluate effectiveness of meperidine versus tramadol on post spinal anesthesia shivering in mothers under go cesarean section. MethodsThis prospective observational cohort study was conducted on74 ASA II and III obstetric mothers from December 20-March 20, 2017/18. Patients with PSAS received IV tramadol (0.5 mg/kg) or meperidine 0.5 mg/kg as independent decision of responsible anesthetist. Then they were followed for time of cessation of shivering, reoccurrence of shivering, hemodynamic changes, and occurrence of side effects such as sedation, nausea and vomiting. The collected data were entered Epi Info version 7.0 and exported to SPSS version 22. The mean difference of categorical data was analyzed with the Chi-Square test. Independent samples t-test or Mann-Whitney U test was used to evaluate numerical data -value less than 0.05 were considered statistical significance. ResultsThe mean time to ceased shivering was 4.45 ± 3.18 min and 3.08 ± 1.30 min in meperidine and tramadol groups, respectively (p = 0.021). The hemodynamic changes like mean arterial pressure (MAP), heart rate (HR), arterial saturation (SpO2) and body temperature changes were all comparable between the two groups. Recurrence of shivering after treatment was less in tramadol group 6 (16.2%) than meperidine group 9 (24.3%). Sedation, nausea and vomiting were reported as a side effect in both groups with no statistical significant (p > 0.05). Sedation was higher in Meperidine group 9 (24.3%) than tramadol group 3 (8.1%). Nausea and vomiting were found to be higher in tramadol group 9 (24.3%) than meperidine group 3 (8.1%). ConclusionsBoth tramadol and meperidine effectively controlled shivering in clients during cesarean section under spinal anesthesia. Tramadol offered rapid onset, less recurrence and less sedation as a side effect when compared to meperidine.

The Efficacy of Meperidine for Pain Management in Orthopedic, Dental, and General Surgery in Children: A Review Study

Background: The present study aimed to assess the efficacy of Meperidine for pain relief in children after orthopedic, abdominal surgery, and laceration repair. Materials and Methods: A systematic serch was performed using the following online databases: Medline, Cochrane, Web of Science, Scopus, and Embase to 2 June 2020, with keywords: (Meperidine OR Pethidine) AND (Pain) AND (Child OR Children) with no language restriction. Results: The Acetaminophen had slightly higher pain scores compared to Meperidine after dental restoration among children. There was better sedation along with more rapid onset and recovery in the combined regimens of Atropine/Midazolam/Ketamine compared to Meperidine/Midazolam. Two studies reported the superiority of Morphine over Meperidine for pain management. A study found a significant increase in the mean pediatric pain scores in the Tramadol group compared to the Meperidine group after 24 hours. There was no difference in the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) between MPC (Meperidine/Promethazine/Chlorpromazine), and OTFC (Oral Transmucosal Fentanyl Citrate) groups during the laceration repair. In the study on the incidence of sleep on the way home or shortly after arriving at home, there were differences in chloral hydrate, Meperidine, and Hydroxyzine regimen compared to Midazolam alone among children being sedated during endodontic procedures. Conclusion: Meperidine was effective for controlling pain in orthopedic, abdominal surgery, laceration repair, and dental restoration. However, it was only superior to the Tramadol group. Regarding dental surgery, a combination regimen were more effective compared to single Midazolam. The pain intensity during early recovery was slightly lower in Meperidine group. The regimen had better sedation with more rapid onset and recovery compared to Meperidine/Midazolam.

Effect of intrathecal lipophilic opioids on the incidence of shivering in women undergoing cesarean delivery after spinal anesthesia: a systematic review and bayesian network meta- analysis of randomized controlled trials

BackgroundShivering is a common side effect in women having cesarean delivery (CD) under spinal anesthesia, which can be bothersome to the patient, and it can also interfere with perioperative monitoring. In several studies, the intrathecal (IT) addition of a lipophilic opioid to local anesthetics has been shown to decrease the incidence of shivering.ObjectiveWe performed this network meta-analysis to evaluate the effects of intrathecal lipophilic opioids in preventing the incidence of shivering in patients undergoing CD.MethodsThis review was planned according to the PRISMA for Network Meta-Analysis (PRISMA-NMA) guidelines. An English literature search of multiple electronic databases was conducted. We included randomized controlled trials (RCTs) that reported on the incidence of shivering, with study groups receiving either IT fentanyl, sufentanil, or meperidine in women undergoing CD under spinal anesthesia. Quality of the studies was assessed using the modified Oxford scoring system. Using random-effects modeling, dichotomous data were extracted and summarized using odds ratio (OR) with a 95% credible interval (CrI). Statistical analysis was conducted using R studio version 1.0.153 - Inc.ResultsTwenty-one studies consisting of 1433 patients (Control group: 590 patients in twenty-one studies; Fentanyl group:199 patients in seven studies; Sufentanil group: 156 patients in five studies; Meperidine group: 488 patients in ten studies) met the inclusion criteria for this systematic review investigating the effect of intrathecal lipophilic opioids in preventing the incidence of shivering in women undergoing cesarean delivery under spinal anesthesia. Methodological validity scores ranged from 3 to 7. The Bayesian mixed network estimate showed the incidence of shivering was significantly lower with IT fentanyl (pooled odds ratio (OR): 0.13; 95% credible interval (CrI): 0.04 to 0.35; P = 0.0004) and IT meperidine (OR: 0.12; 95% CrI: 0.05 to 0.29; P < 0.00001), but not with IT sufentanil (OR: 0.37; 95% CrI: 0.11 to 1.22; P = 0.23). The IT fentanyl group had a significantly lower incidence of intraoperative discomfort [Risk Ratio (RR): 0.19; 95% CI: 0.10–0.35; P < 0.00001], the IT sufentanil group had a significantly higher incidence of pruritus (RR: 6.18; 95% CI: 1.18–32.46; P = 0.03) The IT meperidine group had a significantly lower incidence of intraoperative discomfort (2.7% vs. 13.6%; RR: 0.22; 95% CI: 0.09–0.55; P = 0.001), but there was a significant increase in nausea and vomiting (IT meperidine group vs. Control group: 42.7% vs. 19.4%; RR: 2.56; 95% CI: 1.14–5.75; P = 0.02). Meta-regression analysis based on the opioid dose and quality of the study did not impact the final inference of our result.ConclusionIT fentanyl significantly decreased the incidence of shivering in women undergoing CD under spinal anesthesia without increasing maternal adverse events, confirming that routine use in this patient population is a good choice. IT sufentanil did not decrease the incidence of shivering. IT meperidine decreased the incidence and severity of shivering, but its use was also associated with significant nausea and vomiting.

Eficacia de ketamina y meperidina para prevención de temblores en pacientes sometidas a cesárea bajo anestesia regional

Introducción: En el postoperatorio de anestesia obstétrica, los temblores representan el 54%. Por lo cual, se pretende evitarlo en la sala de recuperación, usando medicamentos que regulen los temblores como ketamina y meperidina.&#x0D; Objetivos: Determinar la eficacia de la ketamina y meperidina para prevención de temblores en pacientes sometidas a cesárea bajo anestesia regional.&#x0D; Métodos: Se realizó un ensayo clínico, simple ciego, aleatorizado y controlado. En el Hospital Obrero N° 2, Ingresaron en el estudio 40 pacientes cumpliendo criterios de inclusión, 20 pacientes por grupo. Las dosis usadas en el grupo Ketamina de 0.25 mg/kg y grupo meperidina de 0.1 mg/Kg. Se usó la escala de Crossley para determinar temblores, medición de temperatura periférica y efectos secundarios maternos y fetales. Para análisis estadístico se usó Chi x2 de Pearson.&#x0D; Resultados: La edad media del estudio es 29,77±3,35 años; Tiempo quirúrgico media de 50 ± 8,8 minutos;Temperatura en quirófano más frecuente se encontraba entre 22° a 23° C; La temperatura periférica se encontró entre 36.6°C a 37.5 °C; en el grupo de meperidina se presentó más nauseas. No existen efectos secundarios en neonatos.&#x0D; Conclusiones: Los temblores redujeron en los pacientes que recibieron ketamina mientras que en los que recibieron meperidina presentaron más nauseas como efecto secundario.

Comparison between Tramadol and Meperidine for Treating Shivering in Patients undergoing Surgery under Spinal Anaesthesia

Shivering during regional anesthesia is a common problem and is distressing for patients with variety of complications. Therefore this study was conducted to compare the efficacy, potency, hemodynamic effects and side effects of tramadol with that of meperidine for the control of shivering during Spinal Anaesthesia. Sixty patients of ASA physical status I or II, aged 18 to 65 years, undergoing routine surgery under spinal anaesthesia and developed shivering intraoperatively were randomly allocated to receive 0.5 mg/kg meperidine intravenously (Group A, n=30) or 0.5 mg/kg tramadol intravenously (Group B, n=30). Treatment that stopped shivering was considered to have been successful. The response rate was 100 % in both the groups. The time that elapsed from treatment to the time shivering ceased was 5.37±2.20 minutes for meperidine group and 5.87±2.92 minutes for tramadol group (p&gt;0.05). The number of patients who assessed treatment efficacy as no, partial or marked improvement was 0, 2 and 28 for meperidine group and 0, 3 and 27 for tramadol group (p&gt;0.05). Only two patients receiving meperidine developed pruritis and both the grops were similar in terms of Haemodynamic response. The result of this study concluded that tramadol (0.5 mg/kg) is as effective as meperidine (0.5 mg/kg) for treating post anaesthetic shivering with high safety profile.

Comparison of Fentanyl versus Meperidine in Combination with Midazolam for Sedative Colonoscopy in Korea.

Background/AimsCombination of midazolam and opioids is used widely for endoscopic sedation. Compared with meperidine, fentanyl is reportedly associated with rapid recovery, turnover rate of endoscopy room, and quality of endoscopy. We compared fentanyl with meperidine when combined with midazolam for sedative colonoscopy. MethodsA retrospective, cross-sectional, 1:2 matching study was conducted. Induction and recovery time were compared as the primary outcomes. Moreover, cecal intubation time, withdrawal time, total procedure time of colonoscopy, paradoxical reaction, adenoma detection rate, and adverse effect of midazolam or opioids were assessed as the secondary outcomes. ResultsA total of 129 subjects (43 fentanyl vs. 86 meperidine) were included in the analysis. The fentanyl group showed significantly more rapid induction time (4.5±2.7 min vs. 7.5±4.7 min, p<0.001), but longer recovery time (59.5±25.6 min vs. 50.3±10.9 min, p=0.030) than the meperidine group. In multivariate analysis, the induction time of the fentanyl group was 3.40 min faster (p<0.001), but the recovery time was 6.38 min longer (p=0.046) than that of the meperidine group. There was no difference in withdrawal time and adenoma detection rate between the two groups. ConclusionsThe fentanyl group had more rapid sedation induction time but longer recovery time than the meperidine group.

Effects of different analgesic methods used for vaginal delivery on mothers and fetuses

Background/aimKnowledge regarding pain relief during labor remains insufficient. We aimed to determine and compare the effectiveness and safety of epidural analgesia, combined spinal–epidural analgesia, and parenteral meperidine on both mothers and fetuses.Materials and methods This study was designed as an observational case-control study. We collected prospective data from patients whose labor pain management was conducted with meperidine in addition to retrospective cohort data of neuraxial methods; 138 patients were enrolled. Epidural analgesia group consisted of 68 patients, whereas combined spinal-epidural (CSE) analgesia group and meperidine group consisted of 50 and 20 patients, respectively. We compared the delivery patterns, labor durations, pain levels, side effects, maternal satisfaction levels, and neonatal outcomes of the various pain management methods. Results Patient demographics, duration of first, second, and third labor stages, and instrumental delivery rates were comparable among groups (P > 0.05). Cesarean section tended to be less frequent in the CSE group. In the meperidine group, visual analog scale (VAS) values and sedation were significantly higher (P < 0.001) and maternal satisfaction lower (P < 0.001). Hypotension tended to be more frequent in the meperidine group. APGAR scores at the 1st and 5th min were similar among the groups and between meperidine subgroups defined by three different administration times (<1 h, 1‒4 h, ≥4 h; P > 0.05).Conclusion Neuraxial methods had no effect on instrumental delivery rates. CSE represented a near significant risk reduction in cesarean section. Our results demonstrated that regional analgesia methods were reasonably safe for both mother and fetus, and regional analgesia methods resulted in greater maternal satisfaction and pain control compared to meperidine.

Propofol compared with bolus and titrated midazolam for sedation in outpatient colonoscopy: a prospective randomized double-blind study

The safest and most efficient method of sedation for outpatient colonoscopy remains unclear. This study aimed to compare the efficiency and safety of bolus administration of midazolam compared with titrated administration and propofol administration for patients undergoing outpatient colonoscopy. We randomly divided patients undergoing colonoscopy into the propofol group, bolus midazolam group, and titrated midazolam group. We compared total procedure time, induction time, recovery time, and discharge time among the 3 groups. We also compared patient satisfaction and the incidence of adverse events. In total, 267 patients (89 in each study group) were enrolled during the study period. Patients in the propofol group had a shorter total procedure time (39.5 vs 59.4 vs 58.1 minutes; P< .001), induction time (4.6 vs 6.3 vs 7.6 minutes; P< .001), recovery time (11.5 vs 29.5 vs 29.2 minutes; P< .001), and discharge time (20.6 vs 34.9 vs 34.7 minutes; P< .001) than patients in the bolus midazolam group and titrated midazolam group. Patients in the propofol group reported higher degrees of satisfaction than patients in the bolus or titrated midazolam plus meperidine groups (9.9 vs 9.6 vs 9.6 [P= .007] and 4.9 vs 4.7 vs 4.8 [P= .008], respectively). Adverse events were not significantly different between groups. In this randomized trial, propofol was superior to bolus or titrated midazolam in terms of endoscopy unit efficiency and patient satisfaction during outpatient colonoscopy. (Clinical trial registration number: KCT0002805.).

Efficacy of Sedation by Midazolam in Association With Meperidine or Fentanyl and Role of Patient Distress During Elective Colonoscopy.

Meperidine and fentanyl are opioids currently used in addition to midazolam for sedation and analgesia during colonoscopy in Italy. The aim of the study was to assess the impact of patients' psychological state before elective colonoscopy on the efficacy of the sedation regimens. Eighty outpatients who underwent an elective colonoscopy were included in our study. The Hospital Anxiety and Depression Scale questionnaire was self-administered to evaluate basal anxiety and depression state. The rate of baseline discomfort was evaluated by a standard 100-mm visual analog scale. Sedation was obtained alternatively with a midazolam-meperidine or midazolam-fentanyl combination. There were no statistically significant differences between the fentanyl and meperidine groups on body mass index, age, and gender composition. Patients in the meperidine group reported less pain during colonoscopy than patients in the fentanyl group. There were statistically significant positive correlations in the meperidine group with the distress, anxiety, and depression. Our study has pointed out greater effectiveness of the midazolam plus meperidine regimen, equal recovery times, and no significant differences in the duration of the endoscopic examinations. The evaluation of patients' psychological status seems to predict the efficacy of sedation when the nociceptive component of pain is well controlled.

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.

Meperidine for patients expected to have poor tolerance to esophagogastroduodenoscopy: A double‐blind, randomized, controlled study

Anxious patients and those with poor tolerance to previous esophagogastroduodenoscopy (EGD) usually have poor tolerance for EGD. To investigate the effect of meperidine on these patients during EGD. A total of 110 patients undergoing diagnostic EGD were randomized to receive either meperidine (n = 55) or placebo (n = 55) before EGD. The primary outcome was patient discomfort scores during esophageal intubation. Patients in the meperidine group reported less discomfort during esophageal intubation (median score of 5.0 and interquartile range (IQR) 1.5-7.0) compared with the control (median score of 6.0, IQR 5.0-8.5, P = .003). Patients in the meperidine group had better tolerance during the procedure (median score of 2 (IQR 1.0-3.0) versus 3 (IQR 1.0-4.0), P = .048), and the endoscopists reported higher overall satisfaction scores (median score of 9 (IQR 7.0-9.0) versus 8 (IQR 7.0-9.0), P = .043). There was significantly less increase in heart rate and blood pressure during the procedure in the meperidine group than in the placebo group (23 bpm (IQR 9-32) versus 30 bpm (IQR 18-52); P = .006); (7 mmHg (IQR 1-14) versus 18 mmHg (IQR 2-30); P = .008). Connect-the-numbers test showed comparable results before and after EGD between the two groups. For patients expected to have poor tolerance during EGD, meperidine reduced discomfort, decreased cardiovascular distress, and improved endoscopist satisfaction, without adverse effects on their psychomotor function after the procedure.