Abstract
Purpose
To study the haemodynamic effects of intrathecal meperidine, administered either alone or mixed with bupivacaïne.
Methods
We studied 42 Chinese patients, aged 59–87 yr, scheduled for transurethral bladder or prostate surgery, randomized into three equals groups, that received either meperidine 0.8 mg · kg−1 meperidine 0.4 mg · kg−1 plus 1.5 ml of 0.5% heavy bupivacaïne or 3 ml of heavy bupivacaïne 0.5%. Non-invasive systolic (SAP) and mean (MAP) arterial pressures, central venous pressure and cardiac index, stroke index and heart rate (HR) measured by the BoMed NCCOM3-R7S bioimpedance device, were recorded over the first 25 min. Systemic vascular resistance index (SVRI) was derived. Onset of sensory and motor block was also measured. Decreases in MAP of 25% were treated with colloid and metaraminol. Results: The onset of block was slower in the meperidine group (P < 0.05). Decreases in SAP, MAP and SVRI (all; P < 0.001) occurred within five minutes in all three groups. The HR was increased in the bupivacaïne group (P = 0.03), but bradycardias treated with atropine occurred in six patients receiving meperidine and four patients receiving the mixture. Six patients receiving meperidine and two patients receiving the mixture required general anaesthesia for inadequate block. The incidence of nausea and vomiting was higher in the patients receiving meperidine (P < 0.05). No other complications were encountered.
Conclusions
Intrathecal meperidine used alone or mixed with bupivacaïne has no intra-operative advantage over heavy bupivacaïne 0.5%.
Résumé
Objectif
Etudier les effets de la mépéridine sous-arachnoïdienne administrée seule ou associée à la bupivacaïne.
Méthode
Etaient inclus dans l’étude 42 patients de race chinoise, âgés de 59–87 ans; programmés pour une chirurgie prostatique ou vésicule, répartis aléatoirement en trois groupes égaux: mépéridine 0,8 mg · kg−1, mépéridine 0,4 mg · kg−1 avec bupivacaïne hyperbare 0,5% 1,5 ml ou bupivacaïne hyperbare 3 ml. Les pressions artérielle systolique (PAS) et moyenne (PAM) non effractives, la pression veineuse centrale et l’index cardiaque, l’index systolique et la fréquence cardiaque (Fc) ont été mesurés à-l’aide de l’appareil à impédance BoMed NCCOM3- R7S et enregistrés pendant les 25 premières minutes. L’index de résistance vasculaire systémique (IRVS) a été déduit. Le début du bloc sensitif et moteur a aussi été mesuré. Les baisses de PAM de 25% ont été traitées avec un colloïde et du métaraminol.
Résultats
Le bloc a débuté plus lentement dans le groupe mépéridine (P < 0,05). Des baisses de PAS, PAM et de IRVS (P < 0,001 pour les trois) sont survenues en moins de cinq minutes dans les trois groupes. La Fc a augmenté dans le groupe bupivacaïne (P = 0,03), mais des bradycardies traitées avec de l’atropine sont survenues chez six patients qui recevaient de la mépéridine et quatre qui recevaient le mélange. Six patients recevant la mépéridine et deux patients le mélange ont eu besoin d’une anesthésie générale parce que le bloc était insuffisant. L’incidence des nausées et des vomissements a été plus élevée chez les patients qui recevaient de la mépéridine (P < 0,05). Il n’y a pas eu d’autres complications. Conclusion: La mépéridine sous-arachnoïdienne seule ou mélangée à la bupivacaïne n’offre pas d’avantages sur la bupivacaïne 0,5 hyperbare.
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References
Brownridge P. Epidural and intrathccal opiates for post-operative pain relief (Letter). Anaesthesia 1983; 38: 74–5.
Way EL. Studies on the local anesthetic potency of isonipecaine. Journal of the American Pharmaceutical Association 1946; 35: 44–57.
Beyazova M, Babacan A, Bilir E, Akcabay M, Kaya K, Baysal A. Perineural pethidine: effects of different doses on nerve conduction. Eur J Anaesthesiol 1993; 10: 353–6.
Lewis RP, Spiers SPW, McLaren IM, Hunt PCW, Smith HS. Pethidine as a spinal anaesthetic agent — a comparison with plain bupivacaine in patients undergoing transurethral resection of the prostate. Eur J Anaesthesiol 1992; 9: 105–9.
Sangarlangkarn S, Klaewtanong V, Jonglerttrakool P, Khankaew V. Meperidine as a spinal anesthetic agent: a comparison with lidocaine-glucose. Anesth Analg 1987; 66: 235–40.
Patel D, Janardhan Y, Merai B, Robalino J, Shevde K. Comparison of intrathecal meperidine and lidocaine in endoscopic urological procedures. Can J Anaesth 1990; 37: 567–70.
Famewo CE, Naguib M. Spinal anaesthesia with meperidine as the sole agent. Can Anaesth Soc J 1985; 32: 533–7.
Cozian A, Pinaud M, Lepage JY, Lhoste F, Souron R. Effects of meperidine spinal anesthesia on hemodynamics, plasma catecholamines, angiotensin I, aldersterone, and histamine concentrations in elderly men. Anesthesiology 1986: 64: 815–9.
Tauzin-Fin P, Maurette P, Vincon G, Hecquet D, Houdek M-C, Bonnet F. Clinical and pharmacokinetic aspects of the combination of meperidine and prilocaine for spinal anaesthesia. Can J Anaesth 1992; 39: 655–60.
Naguib M, Famewo CE, Absood A. Pharmacokinetics of meperidine in spinal anaesthesia. Can Anaesth Soc J 1986; 33: 162–6.
Maurette P, Tauzin-Fin P, Vinçon G, Brachet-Lierman A. Arterial and ventricular CSF pharmacokinetics after intrathecal meperidine in humans. Anesthesiology 1989; 70: 961–6.
Acalovschi I, Ene V, Lörinczi E, Nicolaus F. Saddle block with pethidine for perineal operations. Br J Anaesth 1986; 58: 1012–6.
Kafle SK. Intrathecal meperidine for elective Cacsarean section: a comparison with lidocaine. Can J Anaesth 1993; 40: 718–21.
Nguyen Thi TV, Orliaguet G, Liu N, Delaunay L, Bonnet F. A dose-range study of intrathecal meperidine combined with bupivacaïne. Acta Anaesthesiol Scand 1992; 36: 516–8.
Bo Med Ltd. Prepare the patient.In: BoMed Ltd. NCCOM3-R7S Cardiodynamic Monitor Operator’s Manual. Irvine, CA: BoMed Ltd, 1991: 15–7.
Bernstein DP. A new stroke volume equation for thoracic electrical bioimpedancc: Theory and rationale. Crit Care Med 1986; 14: 904–9.
Kubicek WG, Kottke FJ, Ramos MU, et al. The Minnesota impedance cardiograph-theory and applications. Biomedical Engineering 1974; 9: 410–6.
Bromage PR. A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand 1965; 16: 55–69.
Ramsay MAE, Savege TM, Simpson BRJ, Goodwin R. Controlled sedation with alphaxalone-alphadolone. BMJ 1974; 2: 656–9.
Altman DG. How large a sample?In: Statistics In Practice. London: British Medical Association, 1993: 6–8.
Hutton P, Dye J, Prys-Roberts C. An assessment of the Dinamap 845. Anaesthesia 1984; 39: 261–7.
Jewkes C, Sear JW, Verhoeff F, Sanders DJ, Foëx P. Non-invasive measurement of cardiac output by thoracic electrical bioimpedancc: a study of reproducibility and comparison with thermodilution. Br J Anaeslh 1991; 67: 788–94.
Castor G, Molter G, Helms J, Niedermark I, Altmayer P. Determination of cardiac output during positive end-expiratory pressure-noninvasive electrical bioimpedance compared with standard thermodilution. Crit Care Med 1990; 18: 544–6.
Thomas SHL. Impedance cardiography using the Sramek-Bernstein method: accuracy and variability at rest and during exercise. Br J Clin Pharmacol 1992; 34: 467–76.
Wong DH, Tremper KK, Stemmer EA, et al. Noninvasive cardiac output: simultaneous comparison of two different methods with thermodilution. Anesthesiology 1990; 72: 784–92.
Gotshall RW, Wood VC, Miles DS. Comparison of two impedance cardiographic techniques for measuring cardiac output in critically ill patients. Crit Care Med 1989; 17: 806–11.
Critchley LAH, Short TG, Gin T. Hypotension during sub-arachnoid anaesthesia: haemodynamic analysis of three treatments. Br J Anaesth 1994; 72: 151–5.
Critchley LAH, Stuart JC, Short TG, Gin T. Haemodynamic effects of subarachnoid block in elderly patients. Br J Anaesth 1994; 73: 464–70.
Critchley LAH, Stuart JC, Conway F, Short TG. Hypotension during subarachnoid anaesthesia: haemodynamic effects of ephedrine. Br J Anaesth 1995; 74: 373–8.
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Conway, F., Critchley, L.A.H., Stuart, J.C. et al. A comparison of the haemodynamic effects of intrathecal meperidine, meperidine-bupivacaine mixture and hyperbaric bupivacaïne. Can J Anaesth 43, 23–29 (1996). https://doi.org/10.1007/BF03015953
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DOI: https://doi.org/10.1007/BF03015953