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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study compared the analgesic efficacy of intermittent injections of intrathecal fentanyl (10 micrograms), meperidine (10 mg), or sufentanil (5 micrograms) administered to 65 parturients during the first stage of labor. The groups did not differ in onset or duration of effective analgesia. The meperidine group, however, had significantly lower pain scores once cervical dilation progressed beyond 6 cm. Side effects included mild pruritus and nausea. After intrathecal drug injection, variable decelerations of the fetal heart rate increased in the fentanyl and meperidine groups. All neonates had a 5-min Apgar score of 7 or more. We conclude that intermittent intrathecal injections of fentanyl, meperidine, or sufentanil can provide adequate first-stage labor analgesia. Meperidine appears to provide more reliable analgesia as the first stage of labor progresses.
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PMID:Comparison among intrathecal fentanyl, meperidine, and sufentanil for labor analgesia. 141 27

Nursing management of second trimester abortion by PGE2 suppository after cervical dilatation with laminaria or Lamicel focuses on monitoring and treating side effects, managing pain, and supporting the patient emotionally. Mean abortion time by this method is 15-17 hours, within 24 hours in 80% of women. The side effects expected from PGs are nausea, vomiting, abdominal cramps, and diarrhea. Premedication with transdermal scopolamine, and ancillary methods such as giving ice chips, airing the room, keeping the patient clean are helpful. Acetaminophen is given orally or rectally for fever, headache, or chills. A beta-adrenergic tocolytic drug such as ritodrine HC1 is given if uterine contractions become tetanic, contractions 2-3 per minute or lasting longer than 6-90 seconds, detected by palpation. This drug must be used with caution in patients with asthma. Pain management in midtrimester abortion depends solely on the woman's comfort. Meperidine, morphine, epidural anesthesia with bupivacaine, lidocaine or morphine SO4, or patient-controlled anesthesia may be used. The nurse should monitor side effects such as hypotension, allergic responses, arrhythmias, and inability to void. Midtrimester abortion is often a stress-filled experience, since women may be ambivalent upon learning of fetal abnormalities. The women should be monitored after delivery to ensure that her uterus remains contracted, and assisted if surgical removal of retained products is necessary. Patients teaching for discharge, including medication to prevent lactation, is described. A care plan is suggested for assisting the family with bereavement, based on that used in case of stillbirth or neonatal deaths.
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PMID:Second-trimester termination of pregnancy: nursing care. 156 89

Meperidine 1 mg kg-1 and pentazocine 0.3 mg kg-1 were administered epidurally to investigate their effect on vesical function in twenty American Society of Anesthesiologists Classification I (ASA-1) adult males. Cystometry was performed before and 45 minutes following epidural administration of meperidine and pentazocine. There was no significant change in maximum cystometric capacity, detrusor pressure at which detrusor reflex occurred and in vesical compliance following epidural administration of meperidine in ten patients and also in ten patients who received epidural pentazocine. The mean onset of analgesia after epidural administration of meperidine was 8 minutes which lasted for more than 360 minutes whereas mean onset of analgesia after epidural administration of pentazocine was 4 minutes which lasted for more than 360 minutes. There was no significant change in heart rate, blood pressure and respiratory rate after epidural administration of either meperidine or pentazocine. None of the subjects in either of the groups experienced any difficulty in passing urine, frequency or urgency of micturition. Side-effects like nausea, vomiting, pruritus and respiratory depression were not observed. It is concluded that epidural administration of meperidine 1 mg kg-1 or pentazocine 0.3 mg kg-1 produces significant analgesia of faster onset without altering vesical function as documented, both subjectively by voiding symptoms and objectively by cystometry.
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PMID:Analgesic and urodynamic effects of epidural meperidine and pentazocine--a comparative study. 771 90

We compared analgesia and sedation provided by one of four different opioids in combination with midazolam during gastrointestinal endoscopy. Patients were given 1-3 mg midazolam and meperidine 50-100 mg, fentanyl 50-100 micrograms, sufentanil 5-10 micrograms, or alfentanil 150-300 micrograms, plus additional opioid and/or midazolam if needed. No untoward effects (i.e., O2 saturation < 85%, nausea, vomiting, severe bradycardia) occurred. Sedation and analgesia were comparable in the upper gastrointestinal groups. The number of patients with amnesia for the examination was highest in the meperidine group. Recovery time generally was shorter with alfentanil and sufentanil. Recovery time of the lower gastrointestinal patients was significantly longer in the meperidine group than in the other groups; analgesia scores for sufentanil were significantly lower than for meperidine. Sedation scores for these patients were highest in the meperidine group. The number of patients given meperidine who were amnesic was significantly greater than for the other opioids. Meperidine was better than the other opioids with regard to patient comfort and amnesia during colonoscopy.
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PMID:Sedation and analgesia for gastrointestinal endoscopy. 809 40

Meperidine is a synthetic opioid analgesic frequently prescribed in the emergency department. Meperidine is most often administered intramuscularly or intravenously, due to its poor oral bioavailability, and is metabolized extensively by the liver. Analgesic effects usually last 3-4 hours with parenteral administration, and some adverse effects such as nausea may be reduced when meperidine is combined with antiemetic or antihistaminic medications. Although meperidine is often a preferred analgesic by both patients and physicians in the treatment of disorders such as migraine headaches, its analgesic efficacy has rarely proven superior to alternative parenteral pain medications in controlled trials. In addition, meperidine can precipitate monoamine oxidase inhibitor reactions, and during metabolism it is demethylated to normeperidine, a compound with significant central nervous system (CNS) toxicity. Meperidine should be considered a second line agent in the treatment of pain when opioid analgesics are required.
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PMID:Meperidine: therapeutic use and toxicity. 874 29

The choice between morphine and meperidine for postoperative pain is usually based on the preference of the prescriber, as few objective comparative data are available. This blind, randomized study compared the efficacy and side effects of morphine and meperidine administered by patient-controlled analgesia (PCA) for postoperative pain. One hundred two consenting patients scheduled for major abdominal surgery were randomly assigned to receive PCA with morphine (0.75, 1.0, or 1.5 mg bolus dose size) or meperidine (9, 12, or 18 mg) for pain control. Postoperative assessments included pain at rest and on sitting, nausea, unusual dreams, the Multiple Affect Adjective Check List (a measure of mood), and the trailmaking tests A and B (measures of ability to concentrate). Pain on sitting (P = 0.037) but not pain at rest (P = 0.8) was significantly less in patients receiving morphine. Meperidine use was associated with poorer performance in the trailmaking tests and a greater incidence of dryness of the mouth. Severity of nausea, mood, and incidence of unusual dreams did not differ significantly between drugs. We conclude that meperidine should be reserved for those patients in whom morphine is judged inappropriate.
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PMID:Morphine patient-controlled analgesia is superior to meperidine patient-controlled analgesia for postoperative pain. 908 60

Pethidine (meperidine) is a compound with both local anaesthetic and opioid agonist properties. We have in a recent study demonstrated that pethidine could be an interesting alternative to prilocaine in arthroscopy with local anaesthetic technique. Therefore, we investigated, in a controlled randomized double-blind study, the effect of three doses of pethidine compared with a standard local anaesthetic, in patients subjected to arthroscopic knee joint surgery. Ten patients in each group received 50 mg (P50), 100 mg (P100), 200 mg (P200) of pethidine or prilocaine (5 mg/ml) + adrenaline (4 mg/ml) (PC), injected intra-articularly (i.a.) before surgery. We measured pain intensity and discomfort during arthroscopy and pain intensity at rest and at movement, nausea and tiredness for 3 days post-operatively at regular intervals using the VAS-technique. We also measured the concentration of pethidine and its demethylated metabolite, norpethidine, in plasma by collecting blood samples at 20, 40, 60, 80, 140 and 200 min following injection, and in synovial fluid which was collected through the arthroscope at the start and the end of the surgery. It was found that significantly more patients in the P50 group (n = 6) needed general anaesthesia due to intense pain than those in the P100 group (n = 1), P200 group (n = 0) or the PC group (n = 1). The PC group required significantly more analgesics and had a significantly higher calculated total sum of pain scores at movement post-operatively, than the other three groups. The P200 group more often reported tiredness post-operatively than the other three groups. We conclude that 100 or 200 mg pethidine i.a. produces satisfactory anaesthesia for surgery. There was a rapid transfer of pethidine from synovial fluid to plasma, resulting in plasma levels earlier reported to produce centrally mediated effects, such as analgesia and tiredness. We found much higher concentrations of norpethidine in the synovial fluid than in plasma, suggesting a local demethylation in the knee joint tissues. This site of drug oxidation has not earlier been demonstrated neither in vitro nor in vivo. The results suggest that pethidine given i.a. in the dose range of 50 to 200 mg results in analgesia due to both peripheral and central mechanisms. The significant systemic uptake of pethidine can cause unwanted side-effects.
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PMID:A comparison of 50, 100 and 200 mg of intra-articular pethidine during knee joint surgery, a controlled study with evidence for local demethylation to norpethidine. 1020 35

Meperidine was the first synthetic opioid agent. It acts mainly as an antagonist of mu (#m) receptors and has an analgesic potency ten times greater than that of morphine. Like other opioid drugs, meperidine causes nausea, vomiting, urinary retention and respiratory depression; a point of difference, however, is that it acts on nerve fibers and has properties similar to those of local anesthetics. It has therefore been used as an alternative to other opioids for anesthetic blockade. We review the indications and contraindications of meperidine administered by different routes. For pain, epidural administration has proven to be a good alternative to intravenous administration and epidural meperidine has been combined with local anesthetics using lower doses of both drugs and producing fewer side effects. Intradural meperidine has been used as the sole anesthetic agent in various types of surgery, its principal advantage being that it provides long-lasting postoperative analgesia. Spinal meperidine has the advantage over morphine of a lower incidence of respiratory depression, particularly late-occurring depression. An intravenous route has been used for treating moderate to severe pain, for regional anesthesia, for premedication and for analgesia during anesthesia. Meperidine's action on kappa receptors has meant that it is considered the most effective drug for treating postanesthetic trembling. Although meperidine has been used effectively to treat non-surgical pain, mainly from colic, this review focuses on its usefulness in the perioperative period.
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PMID:[Usefulness of meperidine in anesthesiology]. 1084 14

Many systemic techniques, so-called "alternatives" to labor epidural analgesia, have been described: they are all poorly effective and some are associated with significant maternal and neonatal side effects. Nonetheless, these techniques can provide good maternal satisfaction. Accordingly, they are indicated when epidural analgesia is contraindicated or unavailable. Administration of systemic opioids mandates maternal respiratory supervision, oxygen supplementation and/or pulse oxymetry. Systemic opioids may also decrease fetal heart rate variability and produce neonatal respiratory depression; naloxone administration to the neonate is therefore widely indicated. Pethidine should be abandoned because it can produce prolonged neonatal respiratory depression. Nalbuphine produces less nausea/vomiting and less long lasting neonatal respiratory depression. Intravenous PCA fentanyl or sufentanil is presently the method of choice during early labor. Alfentanil seems less effective and may produce more neonatal side effects. Intravenous PCA remifentanil is the most effective technique, but safe administration may be problematic during intermittent supervision usually implemented in labour ward. Nitrous oxide 50% provides little pain relief. Nonetheless, it is associated with few side effects, quite good maternal satisfaction and can be quickly implemented during advanced painful labor. It is not recommended to add it to systemic opioid (except under continuous supervision by the anaesthetic team), because of an increased incidence of maternal desaturation. The use of a subanaesthetic concentration of sevoflurane has been described recently; it is more effective than nitrous oxide. However, guidelines for safe implementation in labor ward remain to be determined.
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PMID:[Alternative techniques to labour epidural analgesia]. 1611 46

A 54-year old man with a family history of hyperlipidemia was admitted with a 12 h history of severe generalized abdominal pain associated with nausea, vomiting and abdominal distension. Examination of the abdomen revealed tenderness in the periumblical area with shifting dullness. Serum pancreatic amylase was 29 IU/L and lipase 44 IU/L, triglyceride 36.28 mmol/L. Ultrasound showed ascites. CT of the abdomen with contrast showed inflammatory changes surrounding the pancreas consistent with acute pancreatitis. Ultrasound (US) guided abdomen paracentesis yielded a milky fluid with high triglyceride content consistent with chylous ascites. The patient was kept fasting and intravenous fluid hydration was provided. Meperidine was administered for pain relief. On the following days the patient's condition improved and he was gradually restarted on a low-fat diet, and fat lowering agent (gemfibrozil) was begun, 600 mg twice a day. On d 14, abdomen US was repeated and showed fluid free peritoneal cavity. The patient was discharged after 18 d of hospitalization with 600 mg gemfibrozil twice a day. At the time of discharge, the fasting triglyceride was 4.2 mmol/L. After four weeks the patient was seen in the clinic, he was well.
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PMID:Chylous ascites secondary to hyperlipidemic pancreatitis with normal serum amylase and lipase. 1723 Jun 25


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