A comparison of epidural infusions of fentanyl or pethidine with bupivacaine in the management of postoperative pain

Cox, C. R.; Serpell, Michael; Bannister, J.; Coventry, D.M.; Williams, Denis

doi:10.1111/j.1365-2044.1996.tb07859.x

Cited by 7 publications

(3 citation statements)

References 21 publications

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“…Pethidine has also been given by continuous epidural infusion in combination with local anaesthetic. Pethidine 1.5 mg/ml plus bupivacaine 0.06% infused at rates up to 20 ml/h provided good analgesia after aortic surgery that was comparable to that achieved with fentanyl 4 µg/ml plus bupivacaine 0.06% 43 .…”

Section: Continuous Epidural Infusionmentioning

confidence: 78%

Epidural Pethidine: Pharmacology and Clinical Experience

Kee

1998

Anaesth Intensive Care

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Pethidine is an effective epidural opioid for the treatment of acute pain. Its use has been well described in Australian and New Zealand practice, particularly in the field of obstetric anaesthesia. Reported methods of delivery have included bolus injection, continuous infusion and patient-controlled epidural analgesia. Areas of application have included treatment of postoperative pain, labour pain and intraoperative pain. Because of its intermediate lipid solubility, pethidine may have advantages over many other epidural opioids. However, potential for accumulation of norpethidine limits its use to relatively short durations of treatment.

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Section: Continuous Epidural Infusionmentioning

confidence: 78%

Epidural Pethidine: Pharmacology and Clinical Experience

Kee

1998

Anaesth Intensive Care

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“…Previous studies [ 14 – 16 ] compared the analgesic efficacy of epidural meperdine and fentanyl with nearly similar finding to the present study, Paech, [ 14 ] compared the epidural meperdine or fentanyl during caesarean section and concluded that the quality of analgesia and duration of effective analgesia was good in both groups with minimum side effects. Cox et al, [ 15 ] compared epidural fentanyl and meperdine with bupivacaine in the management of postoperative pain after major abdominal surgery. Postoperative pain scores using a visual analogue scale were not significantly different between the two groups.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to our experience multiple clinical studies were performed evaluating the value of epidural meperdine and demonstrated comparable effects to this study; Baraka et al, [ 17 ] demonstrated that epidural meperidine was associated with stable hemodynamics, satisfactory analgesia and reduced the need for administration of rescue analgesics when administered epidurally for obstetric patients. Cardiac output and mean arterial pressure was increased after epidural injection of meperidine [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of fentanyl versus meperidine as supplements to epidural clonidine-bupivacaine in patients with lower limb orthopedic surgery under combined spinal epidural anesthesia

2015

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BackgroundThe analgesic and sedative effect of clonidine explain its common use as adjuvant in regional anesthesia, however the hemodynamic instability associated with its neuroaxial administration is the major drawback. Our study hypothesis is to compare the hemodynamic and analgesic effect of epidural fentanyl in comparison to meperidine when added to clonidine in patients undergoing lower limbs orthopedic surgery using combined spinal–epidural anesthesia.MethodsOne hundred thirty five ASA physical status I or II patients were recruited for lower limb orthopedic surgery. All received 2 mL intrathecal 0.5 % hyperbaric bupivacaine, 10 mL epidural 0.25 % plain bupivacaine, and 1 mL epidural clonidine 2 μg/kg (Clonidine group) and then either 1 ml fentanyl 25 μg (Fentanyl Group) or 1 ml meperidine 25 mg (Meperidine Group). The quality of surgical anesthesia, incidence of hypotension and bradycardia, intra-operative pain assessment, and onset of postoperative pain, sedation scores and side effects in the postoperative period were recorded.ResultsThe 1st analgesic requirement in the postoperative period was significantly prolonged in the meperidine group (p = 0.001). Significant decrease in the mean arterial blood pressure in fentanyl group was at 15, 30, 45, 60 and 90 min (p = 0.035, 0.019, 0.027, 0.032 and 0.039) respectively, significant decrease in meperdine group was at 15 and 30 min (p = 0.038 and 0.043), while in clonidine group a significant decrease was at 15, 30, 45, and 60 min (p = 0.025, 0.028, 0.036 and 0.042) respectively. Among group changes, the mean arterial blood pressure was significantly higher in meperdine group at 30, 45, 60 and 90 min (p = 0.007, 0.015, 0.029 and 0.033) respectively. A significant decrease in the heart rate in fentanyl group at 15, 30 and 45 min (p = 0.035, 0.018 and 0.029), in meperdine group a significant decrease in the heart rate was at 15 min (p = 0.038), while in clonidine group a significant decrease was at 15, and 30 min (p = 0.016 and 0.003) . Among group changes, the heart rate was significantly higher in meperdine group at 30, 45 and 60 min (p = 0.021, 0.017 and 0.011). VAS were significantly lower in meperdine group in comparison to fentanyl and clonidine groups at 2 h, 3 h and 4 h post-operative period (p = 0.024, 0.001 and 0.039).ConclusionThe combined administration of epidural clonidine and meperidine provided better intraoperative hemodynamics and prolonged postoperative analgesia than epidural clonidine fentanyl combination in patients undergoing lower limb orthopedic surgery.Trial registrationClinical Trail Registry (Clinicaltrail.gov) NCT02128451.

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