Bupivacaine with meperidine versus bupivacaine with fentanyl for continuous epidural labor analgesia
Department of General Surgery, Anesthesia and Intensive Care, University of Jordan, Jordan University Hospital, PO Box 13046, Amman, Jordan. Saudi medical journal
(Impact Factor: 0.59).
To compare the efficacy of bupivacaine-meperidine and bupivacaine-fentanyl mixtures when continuously infused epidurally to relief the labor pain.
We performed this prospective double-blinded study at Jordan University Hospital, Amman, Jordan between October 2005 and April 2006. Sixty-seven American Society of Anesthesia physical status I parturients were randomly divided into 2 groups, Group M (n=34) received a continuous infusion of 1 mg/ml of bupivacaine mixed with 1 mg/ml meperidine, and Group F (n=33) received a continuous infusion of 1 mg/ml bupivacaine mixed with 2 micrometer/ml fentanyl. Efficacy of analgesia, degree of motor block, hemodynamic variability, incidence of nausea and vomiting, pruritus, sedation, and the neonatal outcome were all compared between the 2 groups. A p value <0.05 was considered to be significant.
Highly effective analgesia was achieved in both groups with a similar incidence of motor block, sedation, pruritus, and neonatal outcome. The only significant difference was in the incidence of nausea and vomiting. Group M had 8 parturients with nausea, compared with only 2 parturients in Group F (p=0.003).
Bupivacaine-meperidine in a continuous epidural infusion is as efficient as bupivacaine-fentanyl for pain relief during labor, but associated with a higher incidence of nausea and vomiting.
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ABSTRACT: Meperidine (Demerol®) is a mu- and kappa-opiate receptor agonist used for moderate to severe pain. Overdose can result in respiratory depression,
hypotension and coma, while accumulation of its toxic metabolite, normeperidine, can cause delirium and seizures. Little data
exist examining the inter- and intrasubject variability of the normeperidine-to-meperidine metabolic ratio (MR) in urine.
This retrospective data analysis examined meperidine and normeperidine urine concentrations collected from chronic pain patients.
In 98 subjects with multiple visits, the geometric mean urinary MR = 6.1 (coefficient of variation, %CV = 68%). From single
specimens obtained from 799 subjects, the geometric mean urinary MR = 6.2 (%CV = 212%). The urinary MR increased in young
subjects compared with elderly (P = 0.004) and middle-aged subjects (P = 0.01). A 27% difference was found between the male and female urinary MR (male geometric mean MR = 5.1, female geometric
mean MR = 7.0, P = 0.02). Intersubject variability in meperidine metabolism was 3-fold greater than intrasubject variability. A significant
difference in the urinary MR was found between males and females. The substantial variability in meperidine metabolism and
the serious side effects of its metabolite normeperidine require greater vigilance in patient medication monitoring.
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