Abstract
The aim of this study was to determine whether the addition of a small dose of prilocaine could augment the spinal block induced by meperidine and affect intrathecal meperidine pharmacokinetic behaviour. Spinal anaesthesia was performed in 60 men scheduled for endoscopic resection of a prostatic adenoma or bladder tumour under spinal anaesthesia. They were allocated randomly to receive either 1 mg ·kg−1 meperidine (Group l, n = 30), or 1 mg· kg−1 meperidine plus 0.5 mg· kg−1 prilocaine (Group 2, n = 30). Blood samples were collected prior to and for 24 hr after spinal injection in 24 patients (12 in each group). Plasma meperidine levels were assayed by gas chromatography. Complete motor block was achieved in all Group 2 patients, but was incomplete in seven of Group 1 (P < 0.05). The onset of both motor and sensory blocks was shorter (P <0.01) in Group 2 and the duration was longer (P < 0.05). Coadministration of prilocaine modifies meperidine pharmacokinetic behaviour. The area under curve was 48% greater (P < 0.01) and Cmax was higher in Group 2 than in Group 1,145.8 ±42.2 vs 107 ±20.5 ng·ml−1 (P <0.001). No evidence of respiratory depression was noted in any of the patients. Despite the increase in plasma meperidine concentrations, no side effects were observed. The plasma concentrations remained at one third to one sixth the levels reported to induce a respiratory depression. It is concluded that the addition of prilocaine to meperidine improves motor and sensory block during surgery and alters meperidine kinetics without producing major side effects.
Résumé
Le but de ce travail et d’étudier si l’adjonction d’une faible dose de prilocaine améliore le bloc moteur de la péthidine et modifie sa pharmacocinétique. Soixante patients prévus pour chirurgie endoscopique sous rachianesthésie sont inclus dans l’etude. Ils sont répartis par randomisation en deux groupes: le groupe 1 (n = 30) reçoit 1 mgm · kg−1 de pethidine en intrathécal, le groupe 2 (n = 30) 1 mgm · kg−1 de péthidine associé à 0.5 mgm · kg−1 de prilocaine. Des prélèvements sanguins sont faits après l’injection intrathécale et pendant les 24 h suivantes chez 24 patients (12 dans chaque groupe). Le dosage de la péthidine est réalisé par chromatographie en phase gazeuse. Le bloc moteur grade 3 est présent chez tous les patients du groupe 2 mais incomplet dans sept cas du groupe 1 (P < 0.05). L’installation du bloc moteur et du bloc sensitif est plus rapide dans le groupe 2 et ils durent plus longtemps (P < 0.05). L’adjonction de prilocaine modifie la pharmacocinétique de la péthidine. La surface sous la courbe est de 48% plus grande dans le groupe 2 (P < 0,01). Cmax est plus élevée dans ce groupe 2:145,88 ±42.2 ng· ml−1 que dans le groupe 1:107 ±20.5 ng · ml−1 (P < 0,001). Il n’y a pas de dépression respiratoire, les concentrations sanguines étant de trois à six fois inférieures à celles requises pour entraîner cette complication. En conclusion l’adjonction de prilocaine à la péthidine en rachi anesthésie améliore la qualité des blocs moteur et sensitif, mais modifie la pharmacocinétique sans effet secondaire.
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Tauzin-Fin, P., Maurette, P., Vincon, G. et al. Clinical and pharmacokinetic aspects of the combination of meperidine and prilocaine for spinal anaesthesia. Can J Anaesth 39, 655–660 (1992). https://doi.org/10.1007/BF03008225
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DOI: https://doi.org/10.1007/BF03008225