Anaesthesia and adverse effects after intrathecal pethidine hydrochloride for urological surgery

Grace, D.; Fee, J. P. H.

doi:10.1111/j.1365-2044.1995.tb05946.x

Cited by 17 publications

(18 citation statements)

References 16 publications

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“…About 45 years later, Mircea et al and then Cousins et al published reports of spinal and saddle anesthesia by using intrathecal meperidine (IM) as the sole agent [2]. Till to date, doses up to 100 mg have been reported for the same purpose.…”

Section: Intrathecal Meperidine and Shivering!mentioning

confidence: 95%

Intrathecal Meperidine and Shivering! Premium Non Nocere

Khan¹,

Zanjani²

2016

J Anesth Clin Res

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Shivering is one of the most discomforting side effects of hypothermia in patients emerging from anesthesia. Meperidine is currently widely used to treat shivering. However there are controversies about the intrathecal injection of this unique opiate in attenuating or else obtunding shivering.Keywords: Shivering; Meperidine; Hypothermia Intrathecal Meperidine and Shivering!Meperidine is currently widely used to treat shivering which is one of the most discomforting side effects of hypothermia in patients emerging from anesthesia. However there are controversies about the intrathecal injection of this unique opiate in attenuating or else obtunding shivering.The incidence of shivering has been reported to be 6%-66% after anesthesia and occurs in up to 50% of unwarmed cases following spinal anesthesia [1]. Losing heat in combination with inhibited hypothalamic thermoregulation reflexes by anesthetic drugs is responsible for a decline of core temperature during anesthesia. In fact, hypnotics and some other drugs reduce the thermoregulation threshold, while the patient is losing heat by various routes in the operating room. Thus, no thermoregulatory mechanism is elicited during the hypothermic condition under anesthesia. While recovering from anesthesia, the thermoregulation response returns to the preanesthetic state and compensatory reflexes such as shivering start. Apart from patient discomfort, shivering increases the metabolic rate by up to 600% and increases adverse cardiovascular events. Some pharmacologic and non-pharmacologic interventions have been introduced to prevent and treat shivering, but none are foolproof.The local anesthetic characteristic of meperidine was described by Eisleb and Schaumann for the first time in 1939. About 45 years later, Mircea et al. and then Cousins et al. published reports of spinal and saddle anesthesia by using intrathecal meperidine (IM) as the sole agent [2]. Till to date, doses up to 100 mg have been reported for the same purpose. Later, lower doses of IM in combination with local anesthetics had been tried to extend postoperative analgesia [3]. Increased intraoperative nausea and vomiting, respiratory depression, pruritus, and emesis are known and common side effects of IM.Meperidine is a potent and inexpensive antishivering drug presently available. Its efficacy to decrease the intensity and prevalence of postanesthesic shivering has been confirmed by many studies in doses ranging between 0.1-0.5 mg/kg of body weight. Of course, these good results should be considered with annoying side effects of the drug. A group of studies have only focused on the antishivering effect of IM and thus concluded that it could effectively controll shivering [4][5][6]. These studies have documented the antishivering effects of IM but have not dilated on the adverse effects of nausea and vomiting either because they were not their primary end points or else their sample size was too small to reveal these side effects. Others have mostly dwelt on the adverse effects of IM which had ...

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Section: Intrathecal Meperidine and Shivering!mentioning

confidence: 95%

Intrathecal Meperidine and Shivering! Premium Non Nocere

Khan¹,

Zanjani²

2016

J Anesth Clin Res

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“…The finding also correlates well with that of previous workers. 8 Patients who received pethidine spinal block were able to plantar-flex after 92.88±12.01 minutes whereas those in bupivacaine group recovered plantar-flexion after 193.85±39.56 minutes. Similarly, pethidine group also recovered proprioception of the big toe faster than those in the bupivacaine group.…”

Section: Discussionmentioning

confidence: 89%

“…This disparity is broadly in keeping with the findings of Grace and Fee who compared intrathecal pethidine with intrathecal bupivacaine and observed that while there was incomplete motor block in both groups, it was significantly greater with the pethidine group. 8 In their study of low dose pethidine for spinal anaesthesia, Patel et al, observed that though surgical anaesthesia was adequate, motor block was absent in 10% of subjects. 10 The mean time of return of pin prick sensation to S2 among respondents who received pethidine was also significantly shorter than for bupivacaine.…”

Section: Discussionmentioning

confidence: 99%

“…This finding is in keeping with that of other workers. [7][8][9] Reported side effects from subarachnoid pethidine have included nausea and vomiting, pruritus, urinary retention, respiratory depression, and hypotension. 13,18 Grace and Fee observed that only subjects in the pethidine group experienced pruritus.…”

Section: Discussionmentioning

confidence: 99%

“…2 Subarachnoid pethidine has been used successfully for procedures of the inguinal area, lower limb and perineum. [7][8][9][10] The analgesic effect of intrathecal opioids of which pethidine is one, is derived from binding of the agent to opioid receptors in the substantia gelatinosa of the spinal cord.…”

Section: Background and Concepts: Spinal Anesthesiamentioning

confidence: 99%

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Pethidine and bupivacaine spinal anaesthesia: a comparative evaluation of postoperative complications and recovery profile

2017

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Background: Bupivacaine is commonly used as a sole agent for spinal anaesthesia unlike Pethidine. This study compares the immediate postoperative complications and recovery profile following spinal anaesthesia with pethidine and bupivacaine.Methods: Fifty-two patients who required short duration surgical procedures below the umbilicus were randomized to receive spinal anaesthesia with pethidine 1mg/Kg and 2.5 mL 0.5% bupivacaine. Time to recovery of pin prick sensation at S2, plantar flexion, proprioception of the big toe, and full motor recovery were compared for the two agents. Complications of pain, sedation, nausea and vomiting, pruritus and urinary retention in the immediate postoperative period were also compared.Results: Comparing Pethidine and Bupivacaine, time to return of pinprick sensation at S2 was 94.62±20.25 and 205.96±31.05 minutes respectively; return of plantar flexion was 92.88±12.01 and 193.85±39.56 minutes respectively; recovery of proprioception of the big toe was 31.15±9.41 and 172.50±42.70 minutes respectively; complete motor recovery was 47.89±14.08 and 221.73±44.72 minutes respectively. All the differences in recovery times were statistically significant (p<0.0001). There was no statistically significant difference in the incidence of pain and sedation. Only 4 (15.38%) patients in the Bupivacaine group experienced mild pain. There was no incident of nausea and vomiting. However, pethidine group experienced pruritus (19.22%) and bupivacaine group none. Bupivacaine group also had urinary retention (11.54%), while pethidine group had none. These differences were statistically significant (p=0.01).Conclusions: Pethidine exhibited a shorter recovery profile than Bupivacaine and also caused no significant complication in the immediate postoperative period.

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A comparison of 50, 100 and 200 mg of intra-articular pethidine during knee joint surgery, a controlled study with evidence for local demethylation to norpethidine

Söderlund

Boréus

Westman

et al. 1999

Pain

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Pethidine (meperidine) is a compound with both local anaesthetic and opioid agonist properties. We have in a recent study demonstrated that pethidine could be an interesting alternative to prilocaine in arthroscopy with local anaesthetic technique. Therefore, we investigated, in a controlled randomized double-blind study, the effect of three doses of pethidine compared with a standard local anaesthetic, in patients subjected to arthroscopic knee joint surgery. Ten patients in each group received 50 mg (P50), 100 mg (P100), 200 mg (P200) of pethidine or prilocaine (5 mg/ml) + adrenaline (4 mg/ml) (PC), injected intra-articularly (i.a.) before surgery. We measured pain intensity and discomfort during arthroscopy and pain intensity at rest and at movement, nausea and tiredness for 3 days post-operatively at regular intervals using the VAS-technique. We also measured the concentration of pethidine and its demethylated metabolite, norpethidine, in plasma by collecting blood samples at 20, 40, 60, 80, 140 and 200 min following injection, and in synovial fluid which was collected through the arthroscope at the start and the end of the surgery. It was found that significantly more patients in the P50 group (n = 6) needed general anaesthesia due to intense pain than those in the P100 group (n = 1), P200 group (n = 0) or the PC group (n = 1). The PC group required significantly more analgesics and had a significantly higher calculated total sum of pain scores at movement post-operatively, than the other three groups. The P200 group more often reported tiredness post-operatively than the other three groups. We conclude that 100 or 200 mg pethidine i.a. produces satisfactory anaesthesia for surgery. There was a rapid transfer of pethidine from synovial fluid to plasma, resulting in plasma levels earlier reported to produce centrally mediated effects, such as analgesia and tiredness. We found much higher concentrations of norpethidine in the synovial fluid than in plasma, suggesting a local demethylation in the knee joint tissues. This site of drug oxidation has not earlier been demonstrated neither in vitro nor in vivo. The results suggest that pethidine given i.a. in the dose range of 50 to 200 mg results in analgesia due to both peripheral and central mechanisms. The significant systemic uptake of pethidine can cause unwanted side-effects.

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Anaesthesia and adverse effects after intrathecal pethidine hydrochloride for urological surgery

Cited by 17 publications

References 16 publications

Intrathecal Meperidine and Shivering! Premium Non Nocere

Intrathecal Meperidine and Shivering! Premium Non Nocere

Pethidine and bupivacaine spinal anaesthesia: a comparative evaluation of postoperative complications and recovery profile

A comparison of 50, 100 and 200 mg of intra-articular pethidine during knee joint surgery, a controlled study with evidence for local demethylation to norpethidine

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