Epidural pethidine and bupivacaine in labour

A double-blind randomised study was performed to assess the value of the addition of pethidine 50 mg to the initial dose of bupivacaine given for epidural analgesia in labour. Forty-nine patients received either 1 ml of saline (n = 24), or 50 mg of pethidine (n = 25), added to 9 ml of 0.25% bupivacaine as an initial injection for intrapartum epidural analgesia. There was a significant increase in the mean duration of analgesia in the pethidine group. However, pethidine did not increase the speed of onset of analgesia, or improve the quality of analgesia.     

产程中应用杜冷丁对产程及新生儿的影响

目的　观察杜冷丁对产程及新生儿的影响。方法　将 16 0例初产妇随机分为观察组和对照组 ,各 80例 ,观察组在宫口开大 1.2cm时杜冷丁 10 0mg肌肉注射 ,对照组未用药。结果　第一产程用药组与对照组相比明显缩短 ,有显著差异 (P <0 .0 5 ) ,第二、三产程无差异 (P >0 .0 5 ) ,对新生儿影响、产后 2小时内出血量及新生儿体重两组无差异 (P >0 .0 5 )。结论　产程中应用杜冷丁可减轻产妇疼痛 ,缩短第一产程 ,不增加新生儿窒息 ,值得推广应用     

Comparison between pentazocine, pethidine and placebo in the treatment of post-anesthetic shivering

BACKGROUND: We have compared the effects of pethidine, pentazocine and placebo in the treatment of post-anesthetic shivering. METHODS: Forty-five patients who shivered after routine surgery were allocated randomly to receive normal saline (n=15), pentazocine 7.5 mg (n=15) or pethidine 17.5 mg (n=15). RESULTS: After 10 min, 13 patients had stopped shivering in the pethidine group, which was significantly more than the incidence in the two other groups (placebo=2; pentazocine=4) (P<0.01). Pentazocine was not significantly different from normal saline in affecting shivering. CONCLUSION: We conclude that pentazocine 7.5 mg was not effective in the treatment of post-anesthetic shivering.     

A comparison of a new analgesic,nefopam hydrochloride,with morphine sulphate,pentazocine and pethidine hydrochloride in post-operative pain

Summary

The analgesic potency of nefopam was compared to that of morphine, pentazocine and pethidine, double-blind in 200 patients with post-operative pain. Each drug was given as a single intramuscular injecton on the first post-operative day. Pain relief was measured both with a 0 to 3 graded pain scale and a 0 to 10 visual analogue scale and expressed as pain intensity, pain intensity difference and sum of pain intensity difference. The degree and time course of pain relief was similar for all four treatments with maximum analgesia 90 minutes after injection. Side-effects were reported by 58% of patients on nefopam compared to 68% on morphine, 82% on pentazocine and 74% on pethidine, the commonest side-effect being sleepiness. These results suggest that nefopam is a sufficiently potent analgesic agent to control post-operative pain, with a relatively low incidence of side-effects.     

Drugs for Treating Opioid-Induced Constipation: A Mixed Treatment Comparison Network Meta-analysis of Randomized Controlled Clinical Trials

Context

Opioid-induced constipation is a common problem associated with chronic use of opioid analgesics.

Non-neuraxial analgesia in labour

Pain in labour is often described as one of the most severe pains experienced. Neuraxial techniques provide the most effective form of labour analgesia. However, not all women wish to have this or indeed want complete pain relief in labour. There are also subgroups of women in whom neuraxial techniques are contraindicated or attempted placement is unsuccessful. Therefore delivery units must be able to offer a range of non-neuraxial analgesia options for labour.     

Effects of melatonin on pethidine-induced physical dependence and its antioxidative action

Objective To study the effects of melatonin on pethidine-induced physical dependence and its antioxidative action.Methods A trauma-pain model was established in Wistar rats by combining right limb amputation with 50 ℃ tail-flick test.The contents of MDA and the activity of the total superoxide dismutase(SOD)in the brain tissue of trauma-pain rats were detected by thiobarbituric acid method and the xanthine oxidase method.A physical dependence model in mice was reproduced by subcutaneous injection of pethidine and the withdrawal syndromes were induced by intraperitoneal injection of naloxone.Results The contents of MDA enhanced,but the activity of SOD decreased greatly in brain tissues postinjury in rats.Melatonin(30,60,120 mg·kg-1)i.p.reduced the contents of MDA and enhanced the activity of SOD dose-dependently.Melatonin alone showed no withdrawal syndrome when it was given until the dosage of 840 mg·kg-1.Moreover,Melatonin(5,15,20 mg·kg-1)obviously inhibited the withdrawal jumpings of mice in pethidine-treated groups dose-dependently(P<0.01),the jumping rates of mice were decreased 61.4%,72.8%,84.8%,respectively.Conclusions The present results indicated that melatonin has good antioxidative effects on the trauma rats.In addiction,melatonin might inhibit withdrawal syndromes in pethidine-dependent mice.     

曲马多、哌替啶与恩丹西酮预处理对全麻恢复期寒战的影响

目的探讨不同药物预处理对全麻恢复期寒战的预防效果。方法80例妇科腹腔镜病人随机分为曲马多2.0mg/kg(T)组、哌替啶1.0mg/kg(P)组、恩丹西酮0.08mg/kg(O)组和生理盐水10mL(C)组,每组20例。常规全麻诱导,气管内插管,插管后各组分别静脉注射试验药物,以丙泊酚5~6mg/kg·h、瑞芬太尼0.20~0.25μg/kg·min及维库溴铵维持麻醉。术中监测血压、心率、体温,术后5、30、60min分别对寒战、镇静、疼痛进行评估,并观察不良反应的发生情况。结果T组术中体温降低幅度明显小于其他各组;T组与P组术后寒战发生率明显小于O、C组,T、P组间无明显差别;T组术后VAS疼痛评分明显小于其他各组;镇静评分各组无明显差别。结论曲马多预处理可以明显减轻全麻术后寒战。     

Opiate-sensitivity: clinical characteristics and the role of skin prick testing

BACKGROUND: The value of skin prick testing in opiate-sensitive individuals is uncertain as opiates cause non-specific weals by direct degranulation of mast cells. OBJECTIVE: To define whether skin prick test (SPT) responses to opiates in opiate-sensitive individuals are different to those seen in the normal population and to describe the clinical characteristics of this group of subjects. METHODS: The SPT responses of eight opiate-sensitive subjects to morphine 10 mg/mL, pethidine (meperidine) 50 mg/mL and papaveretum 15.4 mg/mL at four different concentrations (undiluted, 1/10, 1/50 and 1/100) were compared with the responses of 100 (32 atopic) non-opiate-sensitive control subjects. Four of the opiate-sensitive subjects had a clinical history of asthma, rhinitis or urticaria on occupational exposure to morphine. One subject developed urticaria with codeine, one developed urticaria and asthma with morphine and diamorphine and two subjects reacted to intravenous papaveretum with anaphylaxis or urticaria. Five out of the eight cases had opiate sensitivity confirmed by single-blind placebo-controlled oral challenge. RESULTS: Skin prick tests to all three opiates were not significantly different when the eight opiate-sensitive subjects were compared with either the entire normal control group or the subgroup of 47 definite opiate-tolerant controls that had previously received opiates for clinical indications. Furthermore, there were no significant differences in size of opiate SPT responses between atopic and non-atopic control subjects. In the control subjects, there was a positive correlation in SPT weal size between the three opiates. CONCLUSION: Skin prick testing is not useful in the diagnosis of opiate sensitivity and placebo-controlled challenge should be considered.     

野木瓜用于术后镇痛的疗效

目的 :观察野木瓜用于术后镇痛疗效。方法 :将 5 8例腹部、下肢择期手术病人分为 2组 ,野木瓜组 30例用野木瓜 0 .16 6 g·kg- 1,哌替啶组 2 8例用哌替啶 0 .8mg·kg- 1,均在术后疼痛时肌内注射 ,共 2次。结果 :野木瓜组优良 2 4例 (80 % ) ,有效 5例 (16 % ) ,无效 1例 (4% ) ,总有效率 96 % ,哌替啶组优良 2 3例 (82 % ) ,有效 4例 (14% ) ,无效 1例(4% ) ,总有效率 96 %。 2组总有效率经 χ2 检验 ,差异无显著意义 (P >0 .0 5 )。野木瓜组镇痛时间6 .2h±s1.4h ,哌替啶组 3.5h± 1.2h ,经t检验差异有显著意义 (P <0 .0 5 )。结论 :野木瓜术后镇痛效果确定 ,镇痛维持时间长