• The Korean Journal of Pain
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• v.9 no.1
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• pp.172-177
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• 1996

We performed a study of epidural patient controlled analgesia of meperidine with or without 0.08% bupivacaine for 48 hours after Cesarean section. 51 parturients were randomly assigned to one of two treatment groups : 1) epidural 0.2% meperidine group(n:24) and 2) epidural combined group with 0.2% meperidine and 0.08% bupivacaine(n:27). All parturients used patient controlled analgesia with loading dose, 2 ml/hour continuous infusion, 1 ml bolus infusion and lockout time, 8 minutes. visual analog scales after loading doses were not significantly different in either groups. The total quantity of meperidine consumption and hourly consumption were significantly lower in the combined group than meperidine group(P<0.05). The cumulative amount of meperidine consumption were also significantly lower in the combined group than meperidine group at 6, 12, 24 and 48 hours. In combined group the hourly consumption of meperidien from 3 hours to 12 hours after loading dose was significantly lower than those of meperidine group. Above 90% of parturients were satisfied in both groups. Side effects were: numbness (2), thigh weakness (1), nausea (1), headache (1) and back pain (2) in epidural meperidine group. There were no case needed specific treatment in both groups. We conclude that analgesic effects were similar in both groups, however the amount of meperidine consumption was less for meperiding group than combined group.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.166-171
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• 1996

The purpose of this study is to compare the postoperative analgesic effect of morphine and meperidine, employing intravenous patient controlled analgesia after cesarean section. Among fifty nine parturients undergoing cesarean section with general anesthesia, 32 were administered morphine designated as 'morphine group', and 27 parturient administered meperidine as 'meperidine' group, during 48 hours after commencement of PCA. Doses administered, based on potency for this setting, were equivalent to 1 mg morphine or 10 mg meperidine. Loading dose was administered when parturient first complained of pain after cesarean section. This was followed with bolus dose, 1 mg for morphine group and 10 mg for meperidine group, with a lockout interval of 8 minutes between doses wherever parturient requested additional analgesia. Visual analog scale(VAS) pain scores during rest were significantly lower at only 1 and 2 hour for the meperidine group, than morphine group. Loading dose and cumulative dose at 1, 2 and 3 hours were significantly lower for meperidine group than the morphine group. There were no significant difference in total dose and hourly dose for 48 hours and cumulative dose at 6, 12, 24, and 48 hours between both groups. More than 90% of the parturients from both groups were satisfied with the analgesic effects of pain relief. Morphine group experienced side effects such as: pruritus, sedation and dizziness. Meperidine group had sedation, dizziness, nausea and local irritation. Neither group required any specific treatment for any of the above side effects. We conclude that meperidine had greater analgesic effect at early stage of post-operative period.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.192-196
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• 2006

Background: Epidural opioids are commonly used for postoperative analgesia. However, the side effects of epidural opioids include respiratory depression, sedation, pruritus, nausea, vomiting and urinary retention. Meperidine, due to its intermediate lipid solubility and local anesthetic properties, permits postoperative analgesia. The aim of this study was to compare meperidine alone to meperidine coupled with bupivacaine, and to determine the effects of epidural meperidine without bupivacaine, when used for epidural analgesia following hepatectomy abdominal surgery. Methods: Patients received thoracic epidural analgesia with meperidine alone (3.5 mg/ml in saline) or with additional bupivacaine (0.15%) for 2 days after surgery. Postoperative pain was assessed using a visual analog scale (VAS) pain score 2 days after the operation, with the incidence and dose supplementation also evaluated. Postoperative side effects were assessed using a 3 grade system. Results: No significant difference was found between the two groups in terms of age and weight, or in the pain scores, side effects, incidence and dose supplementation. Conclusions: 3.5 mg/ml epidural meperidine at a dose of 2 ml/hr provides effective postoperative analgesia.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.257-265
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• 1995

Patient-Controlled Analgesia (PCA) has been widely used for postoperative pain relief. Meperidine is useful for PCA and has efficient analgesia, rapid onset, and low incidence of adverse effect. To compare the analgesic effect, total dose and hourly dose, side effect and neonatal status of breast feeding with meperidine via intravenous or epidural PCA for 48 hours after Cesarean Section, 40 parturient women undergoing elective Cesarean Section were randomly divided into two groups. Each respective group of 20 parturient women received meperidine via one of the intravenous PCA after general anesthesia with enflurane (IVPCA group) and the epidural PCA after general anesthesia with enflurane (IVPCA group) and the epidural PCA after epidural block with 2% lidocaine 20ml combined with general anesthesia with only $N_2O$ and $O_2$ (EpiPCA group) when they first complained of pain in recovery room. Following the administration of analgesic initial dose, parturient women of IVPCA group were allowed intravenous meperidine 10 mg every 8 minutes when they felt pain. The EpiPCA group received additional bolus dose of meperidine 2 mg and bupivacaine 0.7 mg were administered every 8 minutes as requested the patients with hourly continuous infusion of meperidine 4 mg and bupivacaine 1.4 mg. Data was collected during the 48 hours observation period including visual analog scale (VAS) pain scores, total meperidine dose, hourly dose during 48 hours and each time interval, incidence of adverse effect, satisfaction, and neonatal status with breast feeding. VAS pain scores of analgesic effect in EpiPCA group was significantly lower than in IVPCA group at 2 hours after the initial pain after Cesarean Section. Total dose and hourly dose of meperidine significantly reduced in EpiPCA group. Hourly dose of meperidine at each time interval significantly reduced during first 6 hours and from 12 hours to 24 hours in EpiPCA group. The side effects in IVPCA group were mainly sedation, nausea, and local irritation of skin. And EpiPCA group experienced numbness and itching. The degree of satisfaction of parturient women was 88.2 % in IVPCA group and 85.7 % in EpiPCA group. We did not observe any sedation, abnormal behavior, or seizure like activity in any neonates of breast feeding. From the above results we conclude that epidural PCA was more efficiently analgesic, less sedative, and consumptional, and safer for neonate than intravenous PCA, and could be an alternative method to intravenous PCA.

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.2
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• pp.262-269
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• 2005

The purpose of this study was to compare the efficacy and complications of two oral sedative regimens, chloral hydrate (60mg/kg)/hydroxyzine(25mg) versus midazolam(1mg/kg)/meperidine(1mg/kg) for the sedation of pediatric dental patients. Fifteen patients(mean age 36.2months, range 24-47months), ASA Class I or II, who needed at least two restorative dental procedures were selected in this double-blind, randomized study. All subjects were randomly assigned to receive either chloral hydrate/hydroxyzine or midazolam/meperidine and 50% $N_2O/O_2$ was administered at each appointment. Behavior assessment(sleep, movement, crying, overall behavior) was made using Houpt Sedation Rating Scale and physiologic parameters(pulse rate, oxygen saturation) were monitored using pulse oximeter. The incidence of hypoxia($SpO_2$ 90% or less, at least 10s duration) and vomiting was recorded. Patients sedated with chloral hydrate/hydroxyzine showed significantly better overall behavior score than patients sedated with midazolam/meperidine. There was no clinically significant difference in the incidence of hypoxia and vomiting. It was concluded that oral administration of chloral hydrate/hydroxyzine is more effective than midazolam/meperidine for the sedation of pediatric dental patients.

• The Korean Journal of Pain
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• v.26 no.4
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• pp.379-386
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• 2013

Background: Shivering related to spinal anesthesia may interfere with monitoring and is uncomfortable. The aim of the present study was to investigate low-dose intrathecal meperidine for the prevention of shivering after induction of spinal anesthesia in parturients with cesarean section. Methods: This was a prospective randomized, double-blind, placebo-controlled trial including 100 parturients, of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for elective cesarean section under spinal anesthesia who were randomly assigned to a meperidine (0.2 mg/kg) plus hyperbaric lidocaine (5%, 75 mg, n = 50; group M) group or a placebo plus hyperbaric lidocaine (5%, 75 mg, n = 50; group L) group. Demographic and surgical data, adverse events, and the mean intensity for each parturient were assessed during the entire study period by a blinded observer. Results: There were no significant differences between the two study groups regarding the demographic and surgical data (P > 0.05). The incidence of shivering during the entire study period significantly decreased in the group of parturients who received intrathecal meperidine (P = 0.04). There were no significant differences in nausea and vomiting between the two groups. Conclusions: Low-dose intrathecal meperidine (10 mg) is safe and effective in reducing the incidence and severity of shivering associated with spinal anesthesia in parturients with cesarean section.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.374-379
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• 1996

Background: Recently, improvements in drug administration technology have intensified interest in the treatment of postoperative pain. this has resulted in increased use of continuous intravenous infusion of opioid and epidural opioid as alternative to traditional intramuscular administration of opioid. The goal of this study, therefore, was to document the effects of pain control and side effects following continuous intravenous infusion of morphine or meperidine and intramuscular meperidine following cesarean section. Methods: The vital signs, pain score, oxygen saturation and side effects were compared in 150 patients receiving continuous intravenous infusion of morphine, 30 ${\mu}g/kg/hr$ (n=50, group 1); continuous intravenous infusion of meperidine, 150 ${\mu}g/kg/hr$ (n=50, group 2); or intramuscular meperidine, 50mg/every 6hrs (n=50, group 3). Results: VAS (Visual Analogue Scale) was significantly decreased after 30 minutes of administration in all three groups and was significantly lower at 1 hour, but higher at 6 hours in group 3 than two other groups. Severe desaturation episode, defined as $SpO_2$<90%, occurred in the group 3(0.2%). Moderate desaturation episodes, defined as $SpO_2$ 91~95%, occurred more in group 3 than in group 1 and 2 (17.4% vs. 10.4%, 8.2%). The incidence of side effects were similar among three groups. Conclusion: The continuous infusion of opioid was more effective and safe method of postoperative pain control than traditional intramuscular injection.

• The Korean Journal of Pain
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• v.6 no.1
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• pp.49-54
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• 1993

The use of intravenous patient-controlled analgesia is an effective and increasingly used means of providing postoperative pain relief. Recently a non-electric, disposable and portable infusor, the Baxter $Infusor^{(R)}$, has developed. This delivers not only a continuous drug infusion but can also deliver extradoses of medication on demand. The present study examined the benefits of two kinds of analgesics for pain management in 28 patients undergoing gynecological surgery. One group, 14 patients, received i.v. meperidine 0.5 mg/kg as loading dose in the recovery room and PCA with meperidine 3 mg/kg/day for 3 days only(M group). In the other group, 14 patients, also received i.v. meperidine 0.5 mg/kg as loading dose in the recovery room and PCA meperidine 3 mg/kg/day for 3 days and droperidol 5 mg(MD group). The PCA device used was the Baxter $Infusor^{(R)}$. This unit was fitted with patient control module which had a flow rate 0.5 ml/hr and the lockout time was 15 min. Resulting from the study, the MD patients in the first and second days post-operatively, reported less pain compared with the M group. VAPS(Visual Analogue Pain Scales) values were $3.52{\pm}l.61$ vs. $2.22{\pm}0.69$, $2.38{\pm}1.12$ vs. $1.45{\pm}0.48$ and $1.93{\pm}1.65$ vs. $0.98{\pm}0.36$, respectively pertaining to M and MD groups. In conclusion, the MD group with meperidine and droperidol(mixed regimen) provided more effective postoperative analgesia than M group(meperidine only).

• The Korean Journal of Pain
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• v.5 no.2
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• pp.213-220
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• 1992

The sciatic nerves of anesthetized rabbits were exposed and stimulated by a nerve stimulator in order to observe the myoneural response. These rabbits were divided into three groups and respectively injected with morphine (Group 1), meperidine(Group 2) and pentazocine (Group 3). The sciatic nerves were stimulated periodically and gait changes were observed to see the myoneural activity after the injections. When the distal part of the sciatic nerves were stimulated by the nerve stimulator after the respective drug injections, the normal muscle twitch responses were observed in all the progressional stages of Group 1. However, in Group 2 and 3, the muscle twitch responses decreased gradually, finally disappearing after approximately 10 minutes in these two groups. Complete motor paralysis continued for about 60 minutes. The muscle reactions returned to normal approximately 90 minutes after injection. Specimens drug-injected tissues were severed 4 hours, 24 hours and 1 week after injection respectively. These tissue were investigated under light as well as electron microscopy. The tissue revealed rare to moderate vacuolizations scattered in the axons of the myelinated and unmyelinated nerves of some of the specimens; however, there were no significant pathologic lesions. These results provide evidence that neurophysiologically, meperidine and pentazocine have a local anesthetic-like effect such as motor paralysis, but morphine does not. In addition, the results indicated that neurohistologically, the three narcotics have no significant toxic effects on the nerve tissue.

• The Korean Journal of Pharmacology
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• v.25 no.1
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• pp.23-30
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• 1989

Buprenorphine, one of the mixed agonist-antagonist opioid drugs was used to inverstigate the opioid receptor on frog sciatic nerve A fibers. Action potentials were recorded for 4 hrs by a sucrose gap apparatus which were separated by four rubber membranes. To examine the one of the mechanism of action of buprenorphine, meperidine or naloxone was added after or before the treatment of buprenorphine. The results of this experiment were as follows: 1. Buprenorphine suppressed significantly the compound action potentials of frog sciatic nerve, and the maximal effects were shown both at $10^{-4}\;M$ and at $10^{-8}\;M$. 2. The dose-response relationship of buprenorphine on the depressant effect in frog sciatic nerve was biphasic and inverted U-shaped. 3. Buprenorphine blocked the effect of Meperidine $(10^{-3}\;M)$ on this preparation. 4. The depressant effcct of Buprenorphine on frog sciatic nerve was blocked by $10^{-8}\;M$ naloxone. From the above results, buprenorphine acts as one of agoinist-antagonistic effect on frog sciatic nerve, and the opioid receptor on this preparation is located on or near the intracellular opening of the sodium channels, which are sensitive to naloxone.