Analgesia-Induced Respiratory Depression: Comparison of Meptazinol and Morphine in the Postoperative Period

Abstract

Forty-nine patients undergoing elective total hip replacement received either morphine or meptazinol for postoperative analgesia from a patient-controlled analgesia apparatus. Ventilatory rate and volume and arterial oxyhaemoglobin saturation were recorded continuously for the first 24 h following surgery. Episodic hypoxaemia was seen in both groups, associated with disturbances in ventilatory pattern. There was no significant difference in the incidence or severity of observed hypoxia between the groups, or with respect to the class of ventilatory disturbance. Mean linear analogue scores for pain and nausea were significantly (P less than 0.05) greater in the meptazinol group than in the morphine group 8 h after operation, but did not differ significantly at any other time. The mean number of demands for analgesic drugs was similar in the two groups. The meptazinol group had a greater requirement for anti-emetic drugs than the morphine group (P less than 0.05). It was concluded that meptazinol and morphine in equianalgesic doses had similar effects on ventilation in the postoperative period.

Pain Control and Functional Milestones in Total Knee Arthroplasty: Liposomal Bupivacaine versus Femoral Nerve Block

“…During the inpatient stay, pain scores during 8-hour intervals, narcotic use, and physical therapy milestones were compared. Results With the numbers available, we detected no clinically important difference in pain scores throughout the hospital stay; however, patients treated with liposomal bupivacaine consumed very slightly less narcotics overall (96 ± 62 versus 84 ± 73 eq mg of morphine; [95% confidence interval, [11][12][13] Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. One of the authors (RI) received a grant and personal fees from Pacira Pharmaceuticals (Parsippany, NJ, USA).…”

“…The traditional approaches, pairing opioid patient-controlled analgesia with oral narcotics and the use of peripheral nerve blocks, have been shown to be effective in controlling pain [19]. Despite the effectiveness of narcotics, these agents are associated with side effects such as respiratory depression, hypotension, urinary retention, and postoperative ileus [11,25]. Additionally, peripheral motor nerve blocks are associated with specific complications, including increased fall risk as a result of quadriceps weakness, potential injury to the nerve itself as well as increased resource utilization and total costs of care [10].…”

A comparison of the effects of zolpidem and placebo on respiration and oxygen saturation during sleep in the healthy elderly.

“…A fuller description of the technique of analysis can be found in a previous paper (Frater et al, 1989 Table 1 also shows the duration of sleep on each recording night for the two groups. There was no significant difference in the mean duration of sleep between the two groups on any night.…”

Obstructive Sleep Apnoea

“…It has been demonstrated that the incidence of arrhythmias is as great in the postoperative period as during the operation [31]. Arrhythmias commonly accompany OSA which has been shown to occur in the postoperative period even in apparently asymptomatic subjects [24].…”