Comparison of Meptazinol and Pethidine Given I.V. On Demand in the Management of Postoperative Pain

Slattery, Peter; Harmer, M.; Rosen, Michael J.; Vickers, M. D.

doi:10.1093/bja/53.9.927

Cited by 29 publications

(5 citation statements)

References 14 publications

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“…The tramadol/pethidine potency ratio, although obtained on relatively few patients, can be accepted with reasonable confidence. The mean 24 h consumption of pethidine at 606 mg closely matches our previous findings for the mean consumption of pethidine after cholecystectomy of 595 mg [2], 570 mg [3] and 614 mg [4] in three double-blind trials. It also accords with a 1 : l ratio found in another similar trial by Lehmann et al [17].…”

Section: Discussionsupporting

confidence: 88%

Tramadol: pain relief by an opioid without depression of respiration

et al. 1992

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SummaryTwo independent clinical trials were conducted simultaneously. In one, tramadol and pethidine were compared in 30 patients by patient-controlled analgesia during the first 24 h following abdominal surgery. The mean 24 h consumption of tramadol and pethidine was 642 mg and 606 mg respectively, giving a potency estimate of tramadol relative to pethidine of 0.94 (95% confidence interval0.72-1.17). In the second trial, the effect on respiration of three doses of tramadol(0.5, 1.0, and 2.0 mg.kg-') was compared with that of morphine sulphate (0.143 mg.kg-') by intravenous injection during stable halothane anaesthesia. A t approximately 1.5 times the equipotent dose, as estimated from the first trial, tramadol transiently depressed the rate of respiration but had no effect on end-tidal carbon dioxide tension. Morphine caused apnoea or considerable depression of ventilation. The results suggest that mechanisms other than opioid receptor activity play a significant role in the analgesia produced by tramadol. Key wordsAnalgesia; postoperative, patient-controlled. Analgesics; morphine, pethidine, tramadol. Measurement techniques; spirometry, gas analysis, visual analogue scores.When a pharmaceutical company approaches an experienced research worker with the story that they have an analgesic drug, with activity at p-opioid receptors but which does not depress respiration, the response is likely to be the scientific equivalent of 'pull the other one'. It is a claim which has often been made but never really substantiated.The work described in this paper was part of a 'crash' programme of studies undertaken in response to such a claim for tramadol, a drug available in Germany since 1977 and marketed in many other countries throughout the world since then, for which a British partner company wished to obtain a Product Licence in the United Kingdom. The ensuing research programme, born initially of some scepticism, attempted to compare this drug in four different but relevant ways with existing standard drugs. These were, (i) a relative potency estimate against pethidine by patient controlled analgesia (PCA), a method of which we had considerable experience [I] and against a drug for which we had previous data [24], (ii) a comparison with morphine (and saline) on the effect of three different doses on respiratory parameters when given intravenously during halothane anaesthesia (again a method with which we had previous experience) [5], (iii) a comparison with codeine as a cough suppressant against ammonia inhalation and (iv) a comparison with morphine (and placebo) on gut motility after minor gynaecological surgery. For various reasons, neither of the two latter trials produced statistically significant results. However, the first two bear most on the point at issue, namely the respiratory depressing potential of tramadol versus other similar analgesics at equipotent doses. Even though, unfortunately, for what seemed good reasons at the time, these two studies were carried out using different comparators, it seems logic...

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Section: Discussionsupporting

confidence: 88%

Tramadol: pain relief by an opioid without depression of respiration

et al. 1992

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“…The role of these other mechanisms, which are thought to be mediated through cholinergic systems, is not clear in man. It has been shown to be effective in postoperative pain [38] by parenteral administration and has a potency approximately similar to that of pethidine. It is well absorbed rectally, but it has been shown that a dose of 150 mg by this route is not adequate for treatment of pain on the first day following hysterectomy [23].…”

Section: Opioid Agonist/antagonistsmentioning

confidence: 99%

The Control of Acute Postoperative Pain

Mitchell¹,

Smith²

1989

British Journal of Anaesthesia

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“…6 However, it has dropped below this level within one minute of the administration of the suxamethonium. This may offer an explanation for the reduction of muscle fasciculations but not for any therapeutic effect of magnesium on pain.…”

Section: Discussionmentioning

confidence: 96%

Meptazinol as an analgesic adjunct to total intravenous anaesthesia in cystoscopy patients

Hargreaves¹,

Healy²

1985

Anaesthesia

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SummarySixty-four unpremedicated patients undergoing cystoscopy received either intravenous meptazinol2 mglkg or saline in equivalent volume in a randomised, double-blind manner immediately before induction of anaesthesia with Althesin. Inclusion of meptazinol reduced the total dose of anaesthetic required, allowed a more rapid recovery und wus associated with less movement in response to surgery. The patients in the control group tended to hyperventilate, and had lower end-tidal CO, tension @ < 0.001), and also higher pulse rates during surgery @ < 0.01) than the meptazinol group. However, the patients who received meptazinol had a more frequent incidence of complications during induction and recovery @ < 0.05).

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Comparison of Meptazinol and Pethidine Given I.V. On Demand in the Management of Postoperative Pain

Cited by 29 publications

References 14 publications

Tramadol: pain relief by an opioid without depression of respiration

Tramadol: pain relief by an opioid without depression of respiration

The Control of Acute Postoperative Pain

Meptazinol as an analgesic adjunct to total intravenous anaesthesia in cystoscopy patients

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