A comparison of meperidine and lidocaine for spinal anesthesia for postpartum tubal ligation.

BACKGROUND AND OBJECTIVES: This study compares the anesthetic potency, duration, and side effects of subarachnoid meperidine and lidocaine for postpartum tubal ligation. METHOD: Twenty healthy, unpremedicated postpartum women gave written informed consent to participate in this randomized double-blind study. After intravenous infusion of 200 mL physiologic salt solution, patients received subarachnoid injections from either lidocaine 70 mg in 7.5% glucose or meperidine 60 mg in saline while lying in the right lateral position. Heart rate, blood pressure, sensory and motor block, pain, nausea, and pruritus were recorded at intervals for up to 12 hours after injection. The time to first postoperative analgesic was also recorded. RESULTS: There were no differences between the groups in demographics, heart rate, or blood pressure at any time. Sensory or motor block developed slightly faster in the lidocaine group. One patient in each group required general anesthesia owing to inadequate sensory block. Beginning at 60 minutes, meperidine patients experienced more pruritus (P < .05). Lidocaine patients had more postoperative pain (P < .01) and required supplemental analgesia 83.3 +/- 32.7 minutes after induction versus 447.6 +/- 184.0 minutes in the meperidine group. No patient's oxygen saturation fell below 95%. Patients expressed equal satisfaction with both agents. CONCLUSION: Subarachnoid meperidine and lidocaine both provide adequate anesthesia for postpartum tubal ligation. Meperidine provided longer postoperative analgesia.

Subarachnoid labor analgesia. Fentanyl and morphine versus sufentanil and morphine.

BACKGROUND AND OBJECTIVES: To compare the duration of pain relief and incidence of side effects using two subarachnoid administered drug combinations for labor analgesia: fentanyl 25 micrograms with morphine 0.25 mg or sufentanil 10 micrograms with morphine 0.25 mg. METHODS: Thirty healthy term primagravid patients with cervical dilation < or = 5 cm consented to participate in this prospective, randomized, double-blind study. Patients received the assigned drug combination subarachnoid with simultaneous epidural catheter placement using a double needle technique. The authors recorded blood pressure and patient's rated pain, nausea, and pruritus using 10-cm visual analog scales at 0, 5, 10, 15, 20, 25, 30, and every 30 minutes until the patient requested additional analgesia. RESULTS: The onset of analgesia was rapid in both groups. The mean duration of analgesia was similar; 114 +/- 55 minutes in the fentanyl and morphine group and 134 +/- 79 minutes in the sufentanil and morphine group. The sufentanil and morphine group experienced more severe pruritus (P = .015). CONCLUSIONS: Both fentanyl and morphine and sufentanil and morphine provide adequate labor analgesia for about 2 hours. Patients who receive sufentanil experience more severe pruritus.

Intrathecal sufentanil labor analgesia: the effects of adding morphine or epinephrine.

Intrathecal opioids can provide labor analgesia. We attempted to prolong the duration of intrathecal sufentanil analgesia by adding epinephrine or morphine. Forty-one healthy, term nulliparae with cervical dilation < 5 cm participated in this double-blind, randomized protocol. Using a combined spinal and epidural technique, we gave intrathecal injections of either sufentanil 10 micrograms, sufentanil 10 micrograms plus epinephrine 200 micrograms, or sufentanil 10 micrograms plus morphine 250 micrograms. At baseline and every 5 min for 30 min thereafter, we recorded arterial blood pressure and asked the patients to rate their pain, nausea, and pruritus on visual analog scales. The women continued to rate these variables every 30 min until they requested additional analgesia. They then received 10 mL of 0.25% bupivacaine via the epidural catheter, and rated the above variables every 30 min until they requested additional epidural drug injection. Both morphine and epinephrine prolonged the duration of sufentanil analgesia. Only morphine prolonged analgesia after the first dose of epidural bupivacaine. However, because women in the morphine group experienced significantly more side effects throughout the study period, we do not recommend intrathecal morphine for labor analgesia.

Comparison among intrathecal fentanyl, meperidine, and sufentanil for labor analgesia.

This study compared the analgesic efficacy of intermittent injections of intrathecal fentanyl (10 micrograms), meperidine (10 mg), or sufentanil (5 micrograms) administered to 65 parturients during the first stage of labor. The groups did not differ in onset or duration of effective analgesia. The meperidine group, however, had significantly lower pain scores once cervical dilation progressed beyond 6 cm. Side effects included mild pruritus and nausea. After intrathecal drug injection, variable decelerations of the fetal heart rate increased in the fentanyl and meperidine groups. All neonates had a 5-min Apgar score of 7 or more. We conclude that intermittent intrathecal injections of fentanyl, meperidine, or sufentanil can provide adequate first-stage labor analgesia. Meperidine appears to provide more reliable analgesia as the first stage of labor progresses.

Histamine release following intrathecal administration of morphine for cesarean section.

We present a case of unusually profound, prolonged hypotension after induction of spinal anesthesia for cesarean section. The patient, a healthy parturient at 26 weeks gestation, received 0.75% bupivacaine, 15 mg and morphine, 0.15 mg by subarachnoid injection. Systolic blood pressure rapidly fell to below 80 mmHg despite left uterine displacement, 10 l of balanced saline solution, ephedrine 210 mg and phenylephrine 1000 microg. At the end of the operation we noted a pruritic, erythematous, circumscribed, raised rash, consistent with urticaria, over the patient's trunk, legs, arms and face. This rash persisted for 2 days. We postulate that the excessive hypotension following spinal anesthesia in this parturient was the result of intrathecal morphine induced histamine release.

Pneumothorax after electromyographic electrode insertion in the paracervical muscles: case report and radiographic analysis.

A patient developed pneumothorax after needle electrode examination of the paracervical muscles. Because such a complication appeared unlikely and had not been reported previously, we studied cadavers and examined cervical spine radiographs to assess the vulnerability of lung tissue to paracervical muscle needle insertion. Radiographs of the cervical spine were used to determine the depth and location of lung tissue. In five of 23 patient radiographs studied, lung tissue extended above the clavicle with a distance from skin surface to lung tissue of approximately 3.3 cm. The electromyographer examining the paracervical musculature should be aware that needle electrode penetration of lung tissue is possible. Examination must be conducted with care, especially in thin patients with long necks. Needle insertion close to the midline is the safest technique.