Epidural Pethidine: Pharmacology and Clinical Experience

Abstract

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.

Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery

“…1 Its moderate lipophilicity makes it attractive for epidural administration, after which it provides rapid onset of analgesia and a very low risk of respiratory depression. In adults, pethidine has a short elimination half-life (mean 3.2 h).…”

A Comparison of Patient Controlled Epidural Pethidine versus Single dose Epidural Morphine for Analgesia after Caesarean Section

“…Epidural pethidine has intermediate lipophilicity and crosses the dura in five to eight minutes, reaching a peak CSF concentration in 15 to 30 minutes. The onset and duration of analgesia are dose dependent: 25 mg appears to be the optimal bolus dose, providing analgesia within 12 minutes, with a duration ranging from 40 minutes to 4 hours 7,8 . These properties make epidural pethidine a good candidate for PCEA 7,10,16 .…”

“…The onset and duration of analgesia are dose dependent: 25 mg appears to be the optimal bolus dose, providing analgesia within 12 minutes, with a duration ranging from 40 minutes to 4 hours 7,8 . These properties make epidural pethidine a good candidate for PCEA 7,10,16 . A potentially serious side-effect of epidural opioids is delayed respiratory depression.…”

Post caesarean delivery pain management: do not dismiss pethidine

“…Severe epistaxis leading to maternal and fetal compromise is rare; a literature search revealed only three published reports of life-threatening epistaxis in the past forty years. [2][3][4] The extent of our patient's blood loss was difficult to quantify due to effective cardiovascular compensation of pregnancy.…”

“…3 Epidural pethidine was reviewed by Ngan Kee in 1998 and its use in obstetric anaesthesia was highlighted. 4 It has been used extensively in Australasia for some time by bolus, infusion and PCEA for postoperative analgesia following caesarean section. It compares favourably to epidural and spinal morphine in providing good quality analgesia but with fewer side effects such as respiratory depression, pruritus and nausea and vomiting.…”