Abstract
Purpose
Patient-controlled epidural analgesia (PCEA) with meperidine provides effective analgesia following thoracotomy. Accumulation of normeperidine, a meperidine metabolite with neuroexcitatory effects, has led to recommendations to limit the use of meperidine postoperatively. The purpose of this study was to determine if the addition of adrenaline to PCEA meperidine decreased meperidine consumption, reduced serum normeperidine levels, and improved analgesia following thoracotomy.
Methods
Following Research Ethics approval consenting patients were randomly assigned to PCEA with either meperidine (2 mg·mL-1) + adrenaline (2 μg·mL-1) or meperidine alone (2 mg·mL-1). All patients received a standardized anesthetic and similar perioperative care. Visual analogue pain scores (at rest and with activity), quality of recovery (QoR) scores, and side effects were documented six, 24, and 48 hr postoperatively. Serum levels of meperidine and normeperidine were measured at the same time points.
Results
Forty-six patients completed the study protocol. Meperidine consumption (mean ± SD) was similar in the meperidine + adrenaline and the meperidine groups (601 ± 211 mg vs 580 ±211 mg over 48 hr, respectively; P = 0.744). Serum meperidine levels were similar at all study time points. Serum normeperidine was not detected in any sample. Pain scores, QoR scores, and adverse events were comparable in both study groups.
Conclusion
The addition of adrenaline did not influence PCEA meperidine consumption, analgesia outcomes, or QoR. Normeperidine did not accumulate in patients of either study group during the 48-hr study period. Meperidine for patient-controlled epidural analgesia, with or without adrenaline, provides effective post-thoracotomy analgesia in selected patients.
Résumé
Objectif
L’analgésie péridurale contrôlée par le patient (APCP) avec de la mépéridine offre une analgésie efficace après une thoracotomie. L’accumulation de normépéridine, un métabolite de la mépéridine aux effets neuroexcitateurs, a engendré des recommandations dans le but de limiter l’utilisation de mépéridine dans le contexte postopératoire. L’objectifde cette étude était de déterminer si l’adjonction d’adrénaline à la mépéridine APCP réduit la consommation de mépéridine, abaisse les niveaux sériques de normépéridine, et améliore l’analgésie après une thoracotomie.
Méthode
Avec l’assentiment du comité d’éthique de la recherche, les patients consentants ont été randomisés à une APCP avec soit de la mépéridine (2 mg·mL-1) + adrénaline (2 μg·mL-1), soit de la mépéridine seule (2 mg·mL-1). Tous les patients ont reçu un anesthésique standardisé et des soins périopératoires similaires. Les scores de douleur visuels analogues (au repos et à l’effort), les scores de la qualité de la récupération (QoR), et les effets secondaires ont été enregistrés à six, 24 et 48 h postopératoires. Les niveaux sériques de mépéridine et de normépéridine ont été mesurés aux mêmes temps.
Résultats
Quarante-six patients ont terminé le protocole d’étude. La consommation de mépéridine (moyenne ± déviation standard (SD)) était similaire dans les groupes mépéridine + adrénaline et mépéridine seule (601 ± 211 mgvs 580 ±211 mg sur 48 h, respectivement; P = 0,744). Les niveaux sériques de mépéridine étaient similaires à tous les points temporels de l’étude. Aucune normépéridine sérique n’a été détectée dans les échantillons. Les scores de douleur, les scores QoR et les événements indésirables étaient comparables dans les deux groupes à l’étude.
Conclusion
L’ajout d’adrénaline n’a pas influencé la consommation de mépéridine APCP, l’analgésie, ou la QoR. La normépéridine ne s’est accumulée chez les patients déaucun des deux groupes durant la période d’étude de 48 h. La mépéridine pour l’analgésie péridurale contrôlée par le patient, avec ou sans adrénaline, offre une analgésie efficace après une thoracotomie chez certains patients.
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Funding: This research was supported by the 2004 Baxter Corporation Canadian Research Award in Anesthesia, the Ontario Thoracic Society, and the Department of Anesthesiology at the University of Ottawa. Investigators were supported by the Ottawa Hospital Department of Anesthesiology.
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Bryson, G.L., Thompson, C., Gagne, S. et al. The addition of adrenaline to thoracic epidural meperidine does not improve analgesia following thoracotomy. Can J Anesth 54, 882–890 (2007). https://doi.org/10.1007/BF03026791
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DOI: https://doi.org/10.1007/BF03026791