Patient-controlled Analgetics Therapy with Epidural Pethidine for Postoperative Pain Relief

A Preliminary Report
  • B. Zarén
  • P. Hartvig
  • A. Tamsen
Part of the Anaesthesiologie und Intensivmedizin Anaesthesiology and Intensive Care Medicine book series (A+I, volume 158)


For some 4 years, we have used patient-controlled analgesics therapy (PACAT) for clinical and pharmacologic studies on narcotic analgesics. The philosophy behind this is that only the suffering patient knows how severe the pain is and when the pain relief is effective. From this point of view, it seemed logical to entrust the patient in pain with the means of relieving it. Basically, PACAT implies the use of a drug-dispensing system which can administer a preset dose of analgesic when the patient requires pain relief by activating a press-button switch. This method has been used for intravenous administration in postoperative patients and has been shown to be useful for studies of individual analgesic requirements, analgesic plasma concentration, and equianalgesic dosage ratios of narcotic analgesics [1, 2]. In this investigation, this method was used for epidural administration of pethidine in order to study: (a) the analgesic dose requirements among patients and to establish an equianalgesic dose of intravenous pethidine; (b) the plasma concentration of analgesics after this route of administration; and (c) the distribution of pethidine in relation to cerebrospinal fluid (CSF) in subjective optimal pain relief.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Tamsen A, Hartvig P, Fagerlund C, Dahlstrom B (1982) Patient-controlled analgesic therapy, Part I: pharmacokinetics of pethidine in the preoperative and postoperative periods. Clin Pharmacokinet 7: 149PubMedCrossRefGoogle Scholar
  2. 2.
    Tamsen A, Hartvig P, Fagerlund C, Dahlström B (1982) Patient-controlled analgesic therapy, Part II: individual analgesic demand and analgesic plasma concentrations of pethidine in postoperative pain. Clinical Pharmacokinet 7: 164CrossRefGoogle Scholar
  3. 3.
    Hartvig P, Karlsson K-E, Lindberg C, Johansson L (1976) Determination of pethidine in plasma by electron capture gas chromatography after reaction with trichloroethylchloroformate. J Chromatogr 121: 235PubMedCrossRefGoogle Scholar
  4. 4.
    Hartvig P, Karlsson K-E, Lindberg C, Boreus LO (1977) Simultaneous determination of therapeutic plasma concentrations of pethidine and nor-pethidine in man by electron capture gas chromatography. Eur J Clin Pharmacol 11: 65PubMedCrossRefGoogle Scholar
  5. 5.
    Tamsen A, Sakurada T, Wahlström A, Terenius L, Hartvig P (1982) Postoperative demand for analgesics in relation to individual levels of endorphins and substance P in cerebrospinal fluid. Pain 13: 171PubMedCrossRefGoogle Scholar
  6. 6.
    Bapat AR, Kshirsagar NA, Bapat RD (1980) Extradural pethidine. Br J Anaesth 52: 637PubMedCrossRefGoogle Scholar
  7. 7.
    Cousins MJ, Mather LE, Glynn CJ, Wilson PR, Graham JR (1979) Selective spinal analgesia. Lancet 1: 1141PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1984

Authors and Affiliations

  • B. Zarén
  • P. Hartvig
  • A. Tamsen

There are no affiliations available

Personalised recommendations