Comparative randomized controlled blind study of the anti-shivering effect of hydrocortisone, granisetron and meperidine in post-spinal anesthesia in patients undergoing cesarean section

Background: it was observed that a considerable proportion of patients undergoing surgery experience intraoperative and postoperative hypothermia and it was found that misregulation of body temperature due to anesthesia as well as the cold temperature of the operation room were the main cause

Purpose: to compare the anti-shivering effect of meperidine, hydrocortisone and granisetron after spinal anesthesia during elective cesarean section

Patients and Methods: this study presents a placebo-controlled prospective randomized blind study. Included patients were randomly [using computer generated randomization table] allocated into four equal groups each group consists of 28 patients

Results: in our study, age, sex, and ASA grade distribution of patients were nearly identical in the four groups. Furthermore, the duration of surgery and amount of irrigation fluid used in the four different groups were also similar. We did not observe a change in temperature gradient between the four groups. A study with a more prolonged duration of postoperative temperature monitoring is needed to note if core-periphery temperature changes occur with passage of time

Conclusion: the results indicate that IV granisetron 40 micro g/kg was effective as IV meperidine 0.4 mg/kg and both are slightly effective than IV hydrocortisone 2 mg/kg in reducing the incidence and intensity of shivering during spinal anesthesia compared to control group

[Comparing the efficacy of low dose ketamine versus pethidine in controlling shivering after tonsillectomy surgery]

Postoperative shivering is one of the most common problems after general and local anesthesia. We compared the efficacy of low dose ketamine versus pethidine in controlling shivering after surgery. In a double-blind randomized Clinical trial, 132 ASA I,II patients candidate for tonsillectomy were randomized to receive either pethidine and ketamine. At the time of arrival to the recovery and after 30 minutes, the occurrence of chills and possible complications were evaluated and compared between the two groups. Two patients in the ketamin group [3%] experienced shivering while none of the patients in the pethidine group reported shivering [p>0.05]. Other complications were more in the ketamin group [p<0.05]. Ketamin and pethidine are equally effective in controlling postoperative shivering, but regarding the lower incidence of other complications, pethidine is still the first choice of treatment

efficacy of a single dose of pethidine, fentanyl and morphine in treating postanesthesia shivering

Postanesthesia shivering is an undesirable event that may induce a variety of adverse consequences including patient discomfort, increased oxygen consumption and wound pain. Thus, its pharmacological treatment should be regarded. The purpose of this study was to compare the efficacy of morphine, fentanyl and pethidine for the treatment of postanesthesia shivering. Fifty patients who developed shivering were treated in a randomized double blinded manner with an intravenous bolus dose of 2 or 4 mg morphine, 25 or 50 mg pethidine, and 50 microg fentanyl. Then, they were monitored for 30 minutes and the shivering suppression grade, the time taken to stop shivering, the shivering cessation time, recurrence of shivering and opioid side effects were evaluated. Core body temperature was measured immediately before, and at 15 and 30 minute after administering the drug. The groups did not differ significantly regarding shivering suppression grade, shivering cessation time, and recurrence of shivering. There was a significant difference in the time taken to stop shivering between groups. Following injection of the drugs, the core temperatures increased in the five groups with statistical difference. All opioids were effective in treating postanesthesia shivering in a similar extent

Involvement of opioid, adenosine and 5-HT3 receptors in antinociceptive effects of an ayurvedic polyherbal formulation

The present study was undertaken to evaluate the antinociceptive effects of an ayurvedic polyherbal formulation in rats and mice employing the tail immersion test and acetic acid-induced writhing test, respectively. With the tail immersion method, rats received two different doses [270 and 405 mg/kg BW, p.o.] of a formulation, pethidine [5.4 mg/kg BW, p.o.] as a reference standard and the combination of the higher dose of the formulation with naloxone [2 mg/kg, i.p.], an opioid receptor antagonist, and caffeine [16 mg/kg, i.p.], used as an adenosine receptor antagonist. In the acetic acid-induced writhing test, mice received two different doses [390 and 585 mg/kg, BW, p.o.] of formulation, diclofenac sodium [15 mg/kg, BW, p.o.] as a reference standard and the combination of the higher dose of the polyherbal formulation with ondansetron [0.5 mg/kg, i.p.], a serotonin receptor antagonist. The polyherbal formulation [405 mg/kg] exhibited a significant [p < 0.01] antinociceptive effect using the tail immersion method. In the acetic acid-induced writhing test, the formulation showed significant [p < 0.01] dose-dependent activity. The antinociceptive effect of the polyherbal formulation apparently involved an opiate-like mechanism, since its antinociceptive action was attenuated by naloxone pretreatment. In addition, antinociceptive activity was attenuated by caffeine and reversed by ondansetron pretreatment. Our data suggest that the polyherbal formulation possessed centrally and peripherally mediated antinociceptive properties. The activity could be mediated through opioid, adenosine, and serotonin receptors and via inhibition of cyclo-oxygenase- and/or lipoxygenase-dependent pathways

[Comparison effect of different doses of Ketamine with Pethedine in reducing postoperative shivering after cesarean section]

Postoperative shivering is a common problem with multiple complications. This study was compared effect of low doses of Ketamine with Pethidine for controlling postoperative shivering. This clinical trial was done on 189 elective cesarean section with ASA class I or II who had postoperative shivering. Patients with grade 2 or higher were divided in three groups and were injected 0.3mg/kg Ketamine and 0.5mg/kg Pethidine intravenously. In 5[th] and 10[th] minutes after injection, they were investigated for shivering intensity. After 5 minute of injection drugs rate and intensity of shivering in Pethedine group was less than Ketamine group. Ketamine with 0.5 mg/kg was more effective than 0.3mg/kg dose of it and Ketamine[p=0.041]. In group with 0.5mg/kg dose of Ketamine, rate and intensity of postoperative shivering was more reduce than group with 0.3mg/kg of it in recovery [p=0/007]. In Pethedine group rate and intensity of shivering was more reduce then 0.5mg/kg dose of Ketamine[p<0/001]. This demonstrated that Pethedine is more effective than Ketamine. Although 0.5mg/kg dose of Ketamine has considerable effect on control of shivering but Pethedine is still a better choice for this side effect

Attenuation of cardiovascular responses to laryngoscopy and tracheal intubation - intravenous sufentanil vs pethidine

The study was undertaken to compare the eftects of small doses of sufentanil or pethidine on cardiovascular responses induced by tracheal intubation. Sixty ASA physical status I-II patients, scheduled for elective abdominal surgery under general anesthesia, were randomly allocated in a double blind fashion to receive an intravenous bolus of either sufantanil 0.1 micro g/kg [Group S, n = 30] or pethidine 1.5 mg/kg [Group P, n = 30] for induction of anesthesia. The heart rate [HR], systolic arterial pressure [SAP], diastolic arterial pressure [DAP], and mean arterial pressure [MAP] were measured before induction of anesthesia [baseline], at 1 -min intervals for 3 min after the induction of anesthesia, and at 1, 3, 5, and 7 mm after start of laryngoscopy. No significant differences in SAP. DAP. and MAP were observed between the two groups. Heart rate was significantly increased 2 and 3 minutes alter induction of anesthesia and 1 minute after intubation in group P as compared to group S [P < 0.01]. However, the numbers of patients who developed a heart rate increase more than 20% of basal value were not different between two groups. At the end of the study period, systolic, diastolic, and mean arterial pressure slightly decreased from preinduction values was transient and did not require treatment. If adequate timing in opioid administration is warranted according to the time to peak effect of each opioid drug, small doses of sufentanil or pethidine could provide effective control of the inotropic response induced by laryngoseopy and tracheal intubation

Antinociceptive activity of Vitex-negundo Linn leaf extract.

Tail flick test in rats and acetic acid induced writhing in mice were employed to study the antinociceptive activity of ethanolic leaf extract of Vitex-negundo (VN) (100, 250 and 500 mg/kg, p.o). The effect was compared with meperidine (40 mg/kg, sc) in tail flick method and aspirin (50 mg/kg, p.o) in writhing test as a standard control respectively. An interaction with naloxone hydrochloride was also studied in tail flick method for its mechanism of central analgesic action. The test drug showed significant analgesic activity in dose dependant manner in both the experimental models. In comparison to standard drug (meperidine), more than ten times dose of VN extract was required to produce comparable significant antinociceptive activity. The sub-effective dose (5 mg/kg, po) of VN potentiated the analgesic activity of meperidine (4 mg/kg, sc) and aspirin (25 mg/kg, po). Naloxone (1 mg/kg, sc) did not reverse the analgesic effect of VN extract. Our observations suggest that VN possesses both central and peripheral analgesic activity. The central analgesic action does not seem to be mediated through opioid receptors. It, may prove to be a useful adjuvant therapy along with standard analgesic drug.

Conscious sedation for pediatric cardiac catheterization

Diagnostic procedures make up a major portion of the practice of pediatric cardiology. Patient cooperation, often for extended periods, is of utmost importance for successful complication of many pediatric cardiac diagnostic procedures particularly those involving infants and preschool-age children. This requires the use of sedation. Invasive procedures such as cardiac catheterization and transesophageal echocardiography may cause significant discomfort, necessitating the use of additional analgesic and amnesic agents. Multiple drugs or repeated dose may be required during lengthy procedures. Ensuring patient safety by appropriate cardiorespiratory monitoring is mandatory. This review focuses on the pharmacologic agents used in pediatric cardiac catheterization. The pharmacology, indications for usage, and the risks and benefits of commonly used agents are addressed

Saddle block; with pethidine and cinchocaine

Twenty five patients each undergoing perineal operations were given saddle block intradural with Pethidine Hydrochloride 0.5 mg/kg and Cinchocaine 0.5%. The site of injection was given between L3/L4 and L4/L5. The motor blockade caused by Pethidine was adequate and post operative analgesia was much longer than that of Cinchocaine

Nasal ketamine versus nasal midazolam for pediatric premedication

Ninety patients A.S.A.I and 11 their age ranging from one to six years were undergoing general and urological surgeries. The patients were divided randomly into three groups, each of thirty patients. Group A, Group B and Group C. Group A received nasal ketamine in a dose of 5 mg/kg, Group B received nasal midazolam in a dose of 0.15 mg/kg [Control group] received IM midazolam in a dose of 0.1 mg/kg and Mepridine 1 mg/kg IM. Sedation was started as excellent in 19 children and as adequate in 6 children in the ketamine group [Group A] compared with 16 and 7 children in midazolam [Group B]. In Group C [control group], sedation was started as excellent in 9 children and adequate in 7 children

Infusión epidural continua con una mezcla de bupivacaina 0.1 y meperidina para analgesia post-operatoria / Epidural infusion of a mixture of bupivaine and mepridine for postoperative analgesia

Estudiamos la seguridad y la eficacia de la analgesia epidural por infusión continua con una mezcla de meperidina-bupivacaína. Métodos: los catéteres epidurales se colocaron desde el preoperatorio y fueron utilizados para anestesia (epidural o epidural más general ligera). La infusión epidural se preparó con sol. salina 250 ml, meperidina 200 mg y bupivacaína 0.1 por ciento y se inició al llegar el paciente a la sala de recuperación a una velocidad de 10 ml/hora. Los pacientes fueron evaluados a intervalos de 4 - 6 horas y se valoraron dolor en reposo y con la inspiración (EVA 0 - 10), sedación (0 - 3) y aparición de efectos indeseables y complicaciones. Resultados: el estudio incluyó a 110 pacientes sometidos a cirugía abdominal mayor (47), ortopédica (21), urológica (17), ginecológica (17) y vascular (8). Los catéteres epidurales fueron usados por 1 (16 por ciento), 2 (32 por ciento) ó 3 (52 por ciento) días. Un 26 por ciento de los casos necesitaron algún AINE durante el primer día. La calidad de la analgesia fue muy buena en todos los casos con una EVA promedio menor a 3 desde las 6 horas del postoperatorio. La incidencia de efectos indeseable fue baja y no hubo ningún caso de depresión respiratoria. Conclusión: la infusión epidural continua de una mezcla de meperidina-bupivacaína 0.1 por ciento es segura y eficaz, pudiendo emplearse en salas generales de hospitalización

Analgesia postoperatoria por administracion de meperidina por via subdural vs. peridural / Postoperative analgesia by meperidina via subdural vs peridural

Se estudiaron 90 pacientes programados para cirugia que requerian anestesia conductiva en el H.O. y H.S.G. de la ciudad de La Paz. Los objetivos del estudio fueron, determinar la analgesia postanestesica administrando meperidina por via peridural y subdural, evaluar su duracion ademas de los efectos indeseables y su tratamiento. El estudio fue prospectivo longitudinal comparativo, dividido en tres grupos; al grupo A se administro lidocaina al 5 por ciento via subdural; al grupo B lidocaina al 5 por ciento mas meperidina tambien subdural y al grupo C Bupivacaina al 0.5 por ciento mas meperidina por via peridural. Como conclusiones se observo que la meperidina prolonga el efecto analgesico del anestesico de base, aparentemente la via subdural es la que prolonga un mayor tiempo esta analgesia, pero no en la totalidad de pacientes. La meperidina por via conductiva ocasiona en la mayoria de los pacientes efectos secundarios como nauseas, vomitos, sedacion, somnolencia, los dos ultimos pueden ser efectos deseables y los dos primeros son suceptibles de ser tratados efectivamente

Uso de opioides en la analgesia epidural postoperatoria / Opioids use in epidural postoperative analgesia

En este estudio se hizo una revisión bibliográfica (1980 a 1994), en la cual se revisaron distintos opioides, los cuales son usados por vía epidural para el control del dolor en el periodo postoperatorio y con los cuales contamos en nuestro medio hospitalario. Se analizaron uno por uno de estos pioides, con el fin de corroborar que la vía epidural es una buena y segura opción para el control del dolor postoperatorio, y que todos los opioides en mayor o menor grado presentan efectos indeseables como son: náusea, vómito, prurito, sedación, llegada alguna de ellos a provocar depresión respiratoria con intervalos de apnea hasta de 30 segundos. La duración analgésica fue de 130 minutos hasta 20 horas dependiendo del tipo de opiáceo que se haya administrado. Debiéndose de seleccionar el pioide dependiendo del tipo de paciente, sitio de la cirugía, tipo de la cirugía y tiempo de estancia hospitalaria

Buprenorfina sublingual versus meperidina intramuscular en el manejo del dolor postoperatorio en pacientes sometidas a cirugía ginecológica / Sublingual buprenorphine versus intramuscular meperidine in the post-operative pain management in patients submitted to ginecological surgery

La buprenorfina, de reciente introducción en nuestro medio, es un agonista parcial de los receptores opioides del subtipo µ con gran biodisponibilidad al ser administrada por vía sublingual (s.1) y larga duración de acción. El propósito del trabajo fue evaluar la calidad de la analgesia producida por la buprenorfina s.1 en el postoperatorio de pacientes sometidas a cirugía ginecológica, comparándola con un esquema de meperidina intramuscular (i.m.). Estudiamos en forma prospectiva, randomizada y doble ciego 27 pacientes (42 ñ 9 años), ASA i-II, sometidas a cirugía ginecológica electiva bajo anestesia general. Luego de la inducción anestésica, las pacientes fueron randomizadas en: grupo 1 (n= 12) que recibió meperidina 100 mg i.m. (intraoperatorio) y luego 50 mg i.m. c/6 horas por 48 horas; y, el grupo 2 (n= 15) que reciió buprenorfina 0,3 mg i.m. (intraoperatorio) y luego 0,2 mg s.1 c/6 horas por 48 horas en el posoperatorio. En caso de dolor se administró clonixino 100 mg i.v. a solicitud de la paciente. La evaluación posoperatoria duró 72 horas. Los pacientes que recibieron buprenorfina, tuvieron menos dolor durante todo el período en estudio que las pacientes del grupo meperidina, siendo esta diferencia significativa sólo a las 6 horas (p= 0,024). No hubo diferencias significativas en los requerimientos d clonixino, así como en el nivel de sedación, náuseas y vómitos, parámetros hemodinámicos y frecuencia respiratoria entre ambos grupos. Dos pacientes, una de cada grupo, presentaron depresión ventilaroria clínica (frecuencia respiratoria < 10 por minuto) sin problemas posteriores. Si bien beprenorfina s.1 como meperidina i.m. ofrecen un alivio adecuado del dolor después de cirugía ginecológica, la anagesia producida por la buprenorfina es superior con una incidencia similar de efectos adversos. La buprenorfina, por su facilidad de administración, se presenta como una buena alternativa para el manejo del dolor posoperatorio en cirugía de abdomen bajo

Piroxicam or pethidine for analgesia after elective laparoscopic surgery

Laparoscopic surgery is commonly performed as a day case surgery procedure despite difficulties in providing adequate postoperative analgesia for all patients were examined. The analgesic utility of intramuscular piroxicam have been studied in this setting by comparing it with intramuscular pethidine, both given after induction of anesthesia in a randomized double blind study in 60 patients. Although, the analgesic effect of 2 drugs were comparable in the immediate postoperative period, piroxicam provided significantly better analgesia four hours after surgery. The recovery time taken to awake, to ambulate and for discharge were all significantly shorter after piroxicam and the unplanned admission rate also significantly less after piroxicam. Piroxicam appeared to be useful supplement for analgesia after laparoscopic surgery, providing improved analgesia as well as decreased recovery time and fewer unplanned admissions

Estudio comparativo de nalbufina contra meperidina durante el trabajo de parto / A comparative study of nalbufine vs meperidine during labor

A fin de valorar la eficacia y seguridad de dosis analgésicas de nalbufina en comparación con mepreidina, así como cotejar los efectos que uno y otro fármaco ejercen sobre el recién nacido, fueron seleccionados 51 embarazadas a término. Se formaron dos grupos: el primero con 26 pacientes, siendo nueve primíparas y 17 multíparas; el segundo con 25, ocho primíparas y 17 multíparas. Los resultados mostraron que la administración de clorhidrato de nalbufina en analgesia obstétrica, a dosis de 10 mg por vía endovenosa, seguidos de 10 mg por vía intramuscular, proporciona una buena analgesia, comparable a la que producen 25 mg de meperidina por vía endovenosa seguidos de otros 25 mg por vía intramuscular. En ambos grupos la dilatación cervical fue de un mínimo de res centímetros. Sin embargo, el índice de Apgar tuvo modificaciones importantes al nacimiento y a los cinco minutos

Study of awareness during noninhalational anaesthesia.

Forty-five adult patients underwent a noninhalational anaesthetic method for investigation of awareness during surgery and recall of events associated with surgery in postoperative period. All the patients were divided into two groups. The first group of patients were male and had upper abdominal operations. The second group were female and had lower abdominal operations. No significant difference was found between these two groups either in requirements of depth of anaesthesia or in the evidence of per-operative awakefulness. Eighty percent patients of both the groups showed various signs of peroperative awakefulness but did not recall any events associated with surgery in the postoperative period. There was no report of dream either.