Comparison of Meperidine and Meperidine with Ketamine for Postoperative Analgesia after Total Abdominal Hysterectomy / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare meperidine and meperidine with ketamine for postoperative analgesia after total abdominal hysterectomy (TAH) and to establish a correlation between three types of pain: pain at rest, pain with movement and pain with coughing (maximal pain). METHODS: This present study compared the quality of pain during pain management in 65 patients undergoing TAH. Patients received i.v. meperidine as the loading dose in the recovery room and PCA with meperidine 600 mg, droperidol 5 mg, normal saline 35 ml for three days (Group 1, n = 36), or with meperidine 600 mg, ketamine 200 mg, droperidol 5 mg, normal saline 16 ml for three days (Group 2, n = 29). Patients were then interviewed on postoperative day 1, 2 and 3 (POD1, 2 and 3) to assess their pain on a visual analogue scale (VAS) of 0 (none) to 10 (worst imaginable) and to compare meperidine and meperidine with ketamine for postoperative analgesia. RESULTS: The mean VAS of pain at rest was 4.5 on POD and decreased to 1.8 on POD 3 for patients receiving meperidine with ketamine was lower than the VAS scores of patients receiving meperidine 5.4 to 2.5. Patients receiving meperidine with ketamine also had less difficulty with side effects, less headache, nausea and vomiting. CONCLUSIONS: IVPCA ketamine in combination with meperidine provides superior postsurgical pain relief, especially at rest and with movement and has fewer side effects than meperidine alone.

Effects of Postoperative Patient-Controlled Ketorolac Analgesia on Recovery of Gastro-intestinal Motility after Gynecologic Surgery / 대한마취과학회지

BACKGROUND: Postoperative ileus remains a common condition that prolongs hospitalization and increases the cost of surgical therapy. Ketorolac, a potent nonsteriodal antiinflammatory drug, has been known to prevent small bowel ileus in a rodent model. Therefore, we compared the effect of intravenous patient-controlled analgesia (iv PCA) with or without ketorolac. METHODS: Fifty-four patients undergoing gynecologic surgery were assigned in a double-blind manner into one of three groups (n = 18). Pain control was achieved using meperidine 600 mg only (group M), meperidine 300 mg-ketorolac 150 mg (group MK) or butorphanol 10 mg-ketorolac 150 mg (group BK) during the 48 hours following surgery. It was designed as loading (30 mg), continuous infusion (9.6 mg/hr), PCA dose (9.6 mg) and lockout interval (15 min) for group M and as loading (30 mg of ketorolac), continuous infusion (2 ml/hr), PCA dose (2 ml), and lockout interval (15 min) for groups MK and BK. We measured the interval to the first flatus during the 72 hours following surgery and recorded the numerical rating score (NRS) of pain with side effects at 1, 6, 12, 24 and 48 hrs postoperatively. RESULTS: Ketorolac expedited the return of bowel function significantly (P < 0.05). Analgesic efficacy and side effect were not significantly different in all three groups. CONCLUSIONS: IV PCA with meperidine-ketorolac and butorphanol-ketorolac afforded equal analgesia compared to the meperidine only. It also allowed earlier recovery of bowel function in patients undergoing gynecologic surgery.

A Comparison of Thoracic Versus Lumbar Epidural Meperidine for Analgesia after Thoracotomy / 대한마취과학회지

BACKGROUND: Meperidine, having intermediate lipid solubility, permits postthoracotomy analgesia. The aim of this study is to compare the analgesic efficacy, side effects, and patient satisfactions of istered thoracic versus lumbar epidural route anesthesia during the first 48 hours postthoracotomy. METHODS: A prospective randomized study was conducted for 48 hours after thoracotomy with ridine administered 50 mg as a bolus and continuously at 0.21 mg/kg/hr via either a thoracic (group T), or a lumbar (group L) epidural catheter at the end of the operation. Postoperative pain was assessed 2, 8, 24, 48 hours after the operation on a visual analog scale (VAS). Side effects and levels of patient ction of the epidural analgesia were assessed. RESULTS: There were no significant intergroup differences in heart rate, blood pressure, pain score, side effects and levels of patient satisfaction with analgesia. CONCLUSIONS: We conclude that there is no difference between thoracic and lumbar epidural eridine analgesia for postthoracotomy pain relief.

Pharmacological Prevention of Post-Anesthetic Shivering: Clonidine Vs Meperidine: A Meta-Analysis of Randomized-Controlled Trials / 대한마취과학회지

BACKGROUND: Post-operative shivering is one of the potential complications for any surgical patient. Its incidence varies from 5% to 65%, and many preventive and treatment modalities have been reported. For the effective prevention of post-anesthetic shivering by using intravenous clonidine or meperidine, randomized controlled studies were reviewed. The overall incidence of shivering after clonidine or meperidine administration, and the anti-shivering effect of clonidine and meperidine were evaluated. METHODS: DATA SOURCES: Medline search from 1978 to March 1998. DATA SELECTION: We selected studies that had investigated the preventive anti-shivering effect of intravenous clonidine or meperidine by randomized controlled trials. Ten clinical trials were evaluated. RESULTS: The pooled odd ratio of the patients who received clonidine was 0.32 (95% confidence interval, 0.22~0.47) and it seemed to be effective. But these studies showed little evidence of significant homogeneity (P=0.01). In the subgroup analysis, the pooled odd ratio of group A (early administration or intra-operative infusion group) was 0.47 (95% CI 0.31~0.72) evidenced effectiveness but failed to prove homogeneity (P=0.047). But group B (the late intra-operative administration group) had a pooled odd ratio of 0.10 (95% CI 0.05~0.22) and showed homogeneity (P=0.98). In meperidine trials, the pooled odd ratio was 0.20 (95% CI 0.07~0.55). CONCLUSION: We present quantitative evidence based on a meta-analysis of pooled effect size from randomized trials that clonidine is more beneficial for the prevention of post-anesthetic shivering and more effective than meperidine when it is administrated during later period of surgery.

Effects of Epidural Analgesia with Morphine and Bupivacaine on Bowel Motility after Gastrectomy / 대한마취과학회지

BACKGROUND: Postoperative ileus is a universal complication after major intraabdominal surgery. Choice of postoperative analgesia may affect the rate of functional recovery of bowel. Epidural analgesia with morphine and bupivacaine is a popular method for pain relief. However little is known about the effects of this regimen on bowel motility. METHODS: Forty patients undergoing partial or total gastrectomy were randomized into two groups. All groups received a standardized general inhalation anesthesia with enflurane. Control group received traditional intramuscular(IM) administration of meperidine for the postoperative analgesia. Experimental group received a bolus of epidural 0.5% bupivacaine 10 ml followed by continuous epidural infusion of 0.21% bupivacaine with 0.01% morphine, started at the end of operation with the basal infusion rate of 1 ml/hours, bolus 1 ml, and ldegrees Ckout interval 30 min during 48 hr. We compared the analgesic effect, side effects and restoration of bowel function(first passage of flatus and feces)between two groups. Postoperative pain was assessed using the 10 cm visual analog pain scale (0=no pain, 10=worst imaginable pain) at rest. Scores were taken at 1, 6 hours after operation and 7 AM, 6 PM of the 1st postoperative day and 7 AM of the 2nd postoperative day. RESULTS: Experimental group revealed superior analgesia(p<0.005) but had a greater incidence of nausea, pruritus and urinary retention. No significant difference was found in restoration of bowel function between two groups. CONCLUSION: There was no superior effect of epidural analgesia with morphine and bupivacaine on bowel motility after gastrectomy than the effect of traditional IM meperidine administration.

The Influence of Varying Dose and Lockout Interval on Patient-controlled Analgesia Using Meperidine / 대한마취과학회지

BACKGROUND: The lockout interval is a safe guard to prevent patients from taking additional dose before the full effect of the preceding dose. Therefore, it should correlate with the time-to-peak effect of the opioid selected. The time-to-peak effect of meperidine is known to be different from that of morphine and fentanyl. But there have been few reports about the influence of varying lockout interval on IV-PCA using meperidine. So we studied the influence of varying lockout interval with constant hourly maximum dose on IV-PCA using meperidine. METHODS: This study included sixty patients undergoing low abdominal surgery under general anesthesia. After administration of initial dose of meperidine (0.5 mg/kg) they were randomly assigned to three groups according to the lockout interval; Group 1 (6-min lockout interval, 0.2 mg/kg bolus dose), Group 2 (9-min lockout interval, 0.3 mg/kg bolus dose), Group 3 (12-min lockout interval, 0.4 mg/kg bolus dose). We examined NRS pain score, sedation score, satisfaction score, PCA measurements and the incidence of side effects during 24 hours. RESULTS: There were no significant differences in NRS pain score, sedation score, satisfaction score, the amount of meperidine consumed, injections/attempts ratio and the incidence of side effects among three groups. The numbers of injections and attempts were significantly higher in Group 1 than in Group 2 and Group 3 (P<0.05). CONCLUSIONS: The lockout intervals chosen for this study (6-min, 9-min, 12-min) do not influence pain, side effects, satisfaction and meperidine consumption in IV-PCA using meperidine when hourly maximum dose is constantly 2 mg/kg.

Comparison Morphine with Meperidine in PCA Intravenously for Post-operative Pain Control after Cesarean Section / 대한마취과학회지

BACKGROUND: Previous studies have shown that morphine in intravenous PCA provides effective pain control in the postoperative patient, but many patients received morphine have complained side effects. Many studies have suggested that meperidine is less common than morphine in side effects, especially nausea and vomiting. We studied morphine and meperidine in intravenous PCA to compare analgesic effects and side effects in both drugs. METHODS: 100 ASA class I patients undergoing cesarean section were chosen and randomly divided into two groups. Group I (n=50) received morphine (initial 0.1 mg/kg, maintenance 12.5~62 microgram/kg/hr) and group II (n=50) received meperidine (initial 1 mg/kg, maintenance 0.15~0.75 mg/kg/hr). We compared the analgesia and side effects of group I to those of group II for 2 days. We used Basal-Bolus Infusor R (15 minutes lock-out interval, 0.5 ml/hr, 0.5 ml/one push module, Baxter Healthcare Corporation, USA)) for intravenous PCA. RESULTS: There were no significant differences in effects of analgesia between both groups. Nausea was more in group I. There were no significant differences in patient's comfort between both groups. CONCLUSIONS: We concluded that meperidine is more useful than morphine in PCA intravenously for post-operative analgesia after cesarean section because there were no significant differences in analgesic effects between both groups but nausea was less in group received meperidine.

Electron Microscopic Examination of Neurohistological Changes Following Narcotics Injection on Peripheral Nerve of Rats / 대한마취과학회지

We have already reported good effect of meperidin and pentazocin as the sole agent for spinal anesthesia. The present study was undertaken to examine toxic effects of pentazocin and meperidine on peripheral nerve tissue. 11 rats were divided into three groups i.e. pentazocine, meperidine and control group. The sciatic nerves of adult rats were exposed and injected with pentazocin 0.5ml(15mg) or meperidine 0.5ml (25mg). Two specimens of normal nerve and another two specimens injected with normal saline 0.5 ml were used as the controIs. The nerve was examined under electron microcopy at 24 hours, 48 hours, 1 week and 4 weeks after the injection of each of the drugs. A total of twenty injections were carried out in 11 rats. The results were as follows: The pentazocien group revealed hydropic changes in the mitochondria and ER of axon and Schwann cell but the degree of injury was not significant and was reversible. The meperidine group showed hydropic changes that were not significant but the specimen taken at one week revealed severe axonal and myeline changes, admixed with fat globules and Schwann cell with severe fatty changes in the cytoplasm. Although most of the above mentioned changes may reverse, it is not certain yet that pentazocin and meperidine are free of toxicity on nerve cells until further study is done to find the causes of the severe histolgical changes which were shown in the one week specimen with demerol.