Anestesia espinal con meperidina en paciente con hipersensibilidad a anestésicos locales / Spinal cord anesthesia with meperidine in a patient with hypersensitivity to local anesthesia

Introducción: La meperidina (o petidina) es un opioide sintético que tiene propiedades anestésicas locales bien conocidas, y ha sido utilizada por vía intratecal en cirugía general, urológica y obstétrica de forma segura. Este puede ser usado en anestesia espinal en paciente con hipersensibilidad a los anestésicos locales. Objetivo: Describir el manejo anestésico en una paciente con hipersensibilidad a los anestésicos locales con uso de meperidina intratecal. Presentación del caso: Se presenta una paciente femenina de 54 años de edad con historia previa de hipersensibilidad a los anestésicos locales, programada para colporrafia anterior, a la cual se le realiza una técnica regional, administrando meperidina intratecal. Para la analgesia posoperatoria se suministró diclofenaco de sodio en dosis única de 75 mg, por vía IV previo a la incisión. Conclusiones: Con la técnica descrita se logra un bloqueo sensitivo y motor adecuado, estabilidad de los signos vitales intraoperatoria y recuperación óptima en el posoperatorio inmediato. Es una alternativa más en el manejo de los pacientes con hipersensibilidad a los anestésicos locales(AU)

Introduction: Meperidine (or pethidine) is a synthetic opioid with well-known local anesthetic properties. It has been safely used intrathecally in general, urological and obstetric surgery. This can be used in spinal anesthesia in patients with hypersensitivity to local anesthetics. Objective: To describe anesthetic management of a patient with hypersensitivity to local anesthetics with the use of intrathecal meperidine. Case presentation: The case is presented of a 54-year-old female patient with a previous history of hypersensitivity to local anesthetics, scheduled for anterior colporrhaphy, who is performed regional technique, administering intrathecal meperidine. For post-operative analgesia, diclofenac sodium was administered intravenously in a single dose of 75 mg before the incision. Conclusions: The described technique allowed to achieve adequate sensory and motor block, stability of intraoperative vital signs, and optimal recovery in the immediate postoperative period. It is another alternative in the management of patients with hypersensitivity to local anesthetics(AU)

Eficacia de ketamina y meperidina para prevención de temblores en pacientes sometidas a cesárea bajo anestesia regional / Efficacy of ketamine and meperidine for the prevention of shivering in patients undergoing cesarean section under regional anesthesia

INTRODUCCION: en el postoperatorio de anestesia obstétrica, los temblores representan el 54%. Por lo cual, se pretende evitarlo en la sala de recuperación, usando medicamentos que regulen los temblores como ketamina y meperidina. OBJETIVOS: determinar la eficacia de la ketamina y meperidina para prevención de temblores en pacientes sometidas a cesárea bajo anestesia regional. METODOS: se realizó un ensayo clínico, simple ciego, aleatorizado y controlado. En el Hospital Obrero N° 2, Ingresaron en el estudio 40 pacientes cumpliendo criterios de inclusión, 20 pacientes por grupo. Las dosis usadas en el grupo Ketamina de 0.25 mg/kg y grupo meperidina de 0.1 mg/Kg. Se usó la escala de Crossley para determinar temblores, medición de temperatura periférica y efectos secundarios maternos y fetales. Para análisis estadístico se usó Chi x2 de Pearson. RESULTADOS: la edad media del estudio es 29,77±3,35 años; Tiempo quirúrgico media de 50 ± 8,8 minutos;Temperatura en quirófano más frecuente se encontraba entre 22° a 23° C; La temperatura periférica se encontró entre 36.6°C a 37.5 °C; en el grupo de meperidina se presentó más nauseas. No existen efectos secundarios en neonatos. CONCLUSIONES: Los temblores redujeron en los pacientes que recibieron ketamina mientras que en los que recibieron meperidina presentaron más nauseas como efecto secundario.

INTRODUCTION: The presence of shiviring in obstetric anesthesia in the postoperative period is up to 54%. Therefore, it is intended to avoid in the recovery room, using medications that regulate shiviring such as ketamine and meperidine. OBJECTIVES: to determine the efficacy of ketamine and meperidine for the prevention of shivering in patients undergoing cesarean section under regional anesthesia. METHODS: a single-blind, randomized, controlled clinical trial was conducted. In Hospital Obrero N ° 2, 40 patients enrolled in the study meeting inclusion criteria, 20 patients per group.The doses used in the Ketamine group of 0.25 mg / kg and meperidine group of 0.1 mg / Kg. The Crossley scale was used to determine shivering, peripheral temperature measurement and maternal and fetal side effects. For statistical analysis, Chi x2 from Pearson was used. RESULTS: the average age of the study is 29.77 ± 3.35 years; Average surgical time of 50 ± 8.8 minutes;Temperature in the most frequent operating room was between 22 ° to 23 ° C;The peripheral temperature was between 36.6 ºC to 37.5 ºC; in the meperidine group there was more nausea; No neonatal side effects. CONCLUSIONS: patients who received ketamine is better at preventing tremors while patients who received meperidine had more nausea as a side effect.

Investigation of the effects of systemic meperidine administration on fascia healing in an experimental rat model

Abstract Purpose: To evaluate the effects of meperidine on fascial healing. Methods: Seventy adult male Sprague-Dawley rats divided into 7 groups with 10 rats in each group. One of these groups was determined as the sham group, 3 of the remaining 6 groups as meperidine groups, and 3 as control groups. These were grouped as 1st, 2nd, and 6th weeks. In the anterior abdominal wall of the rat, the skin was detached and a wound model including the peritoneum was created with a median incision. Mice in the meperidine group were injected with meperidine intraperitoneally (IP) 3 × 20 mg/kg meperidine on postoperative days 0, 1 and 2, and 2 × 20 mg/kg meperidine on postoperative days 3, 4, 5, and 6 after surgical intervention. Similar to the control group, an equal volume of saline was administered, corresponding to the doses. After sacrifice, the midline fascia was used for facial tensile strength measurement, and the other for histopathological analysis. Results: When compared, the meperidine and control groups inflammatory cell density was higher in the 1st week (p < 0.05) in the meperidine group, fibroplasia density was found to be higher at the 2nd week in the meperidine group than the control group (p < 0.05) When the tensile strength in the meperidine and control groups were compared, there was no significant difference (p > 0.05) at each of the three weeks. Conclusion: The application of postoperative systemic meperidine affects positively wound healing in the inflammatory stage and fibroplasia without changing the resistance to traction.

Investigation of the effects of systemic meperidine administration on fascia healing in an experimental rat model

Purpose: To evaluate the effects of meperidine on fascial healing. Methods: Seventy adult male Sprague-Dawley rats divided into 7 groups with 10 rats in each group. One of these groups was determined as the sham group, 3 of the remaining 6 groups as meperidine groups, and 3 as control groups. These were grouped as 1st, 2nd, and 6th weeks. In the anterior abdominal wall of the rat, the skin was detached and a wound model including the peritoneum was created with a median incision. Mice in the meperidine group were injected with meperidine intraperitoneally (IP) 3 × 20 mg/kg meperidine on postoperative days 0, 1 and 2, and 2 × 20 mg/kg meperidine on postoperative days 3, 4, 5, and 6 after surgical intervention. Similar to the control group, an equal volume of saline was administered, corresponding to the doses. After sacrifice, the midline fascia was used for facial tensile strength measurement, and the other for histopathological analysis. Results: When compared, the meperidine and control groups inflammatory cell density was higher in the 1st week (p < 0.05) in the meperidine group, fibroplasia density was found to be higher at the 2nd week in the meperidine group than the control group (p < 0.05) When the tensile strength in the meperidine and control groups were compared, there was no significant difference (p > 0.05) at each of the three weeks. Conclusion: The application of postoperative systemic meperidine affects positively wound healing in the inflammatory stage and fibroplasia without changing the resistance to traction.(AU)

Analgesia subaracnoidea en el trabajo de parto: bupivacaína/fentanilo vs. petidina / Subarachnoid analgesia in labor: bupivacaine/fentanyl vs pethidine

Introducción: La analgesia subaracnoidea es una alternativa para el trabajo de parto por su seguridad y adecuada relación riesgo/beneficio. Objetivo: Evaluar la efectividad de la analgesia durante el trabajo de parto con la comparación de dos métodos analgésicos. Método: Se realizó un estudio cuasiexperimental, longitudinal y prospectivo en 92 gestantes que se atendieron en el Hospital General Docente Abel Santamaría Cuadrado durante el período entre enero de 2014 y enero de 2017. Las pacientes se dividieron en dos grupos de 46 cada uno, al azar, por orden de llegada a la unidad quirúrgica. El grupo A, bupivacaína al 0,5 por ciento, en dosis de 2 mg y fentanilo en dosis de 25 mcg; y grupo B en el que se utilizó petidina en dosis de 25 mg, en todos los casos por vía intratecal. Las variables analizadas fueron: tensión arterial media, frecuencia cardíaca media, saturación parcial de oxígeno, tiempo de inicio de la analgesia, calidad analgésica, efectos adversos y nivel de satisfacción de las pacientes. Se empleó el análisis descriptivo y la diferencia de proporciones. Resultados: El grupo A mantuvo una TAM entre 84 y 88 mmHg, (Z= 6,0 significativa); FC media entre 80 y 88 lat/min, (Z= 1,94 no significativa); SpO2 con una media de 99,2 por ciento. En 46,74 por ciento (43 casos) el tiempo de inicio de la analgesia fue corto (Z= 8,47), siendo Buena en 100 por ciento de los casos (Z= 6,89 significativa), con recién nacido vigoroso en 100 por ciento (Z= 10,25 significativa). La evolución fue satisfactoria en 48,19 por ciento de las pacientes. Presentaron prurito 8,69 por ciento. En el grupo B hubo hipertensión arterial en 2,17 por ciento de los casos, con menos estabilidad de la FC, tiempos mayores de inicio de trabajo de parto en 12,96 por ciento y fue Buena en 40,22 por ciento. Estas pacientes mostraron menos satisfacción (41,30 por ciento). Conclusiones: La administración subaracnoidea de fentanilo/bupivacaína fue más efectiva que la petidina para la analgesia durante el trabajo de parto(AU)

Introduction: Subarachnoid analgesia is an alternative for labor due to its safety and suitable risk-benefit relationship. Objective: To evaluate the effectiveness of analgesia during labor with the comparison of two analgesic methods. Method: A quasiexperimental, longitudinal and prospective study was carried out in 92 pregnant women who attended Abel Santamaría Cuadrado General Teaching Hospital during the period between January 2014 and January 2017. The patients were divided into two groups of 46 each, randomly assigned, in order of arrival to the surgical unit. Group A was treated with intrathecal administration of bupivacaine 0.5 percent, in a dose of 2 mg, and fentanyl in a dose of 25 mcg; and group B was treated with intrathecal administration of pethidine, in a dose of 25 mg. The variables analyzed were mean arterial blood pressure, mean heart rate, partial oxygen saturation, time of onset of analgesia, analgesic quality, adverse effects and level of patient satisfaction. The descriptive analysis and the difference in proportions were used. Results: Group A maintained a mean arterial blood pressure between 84 and 88 mmHg, (Z=6.0 significant); heart rate averages between 80 and 88 beats per minute, (Z=1.94 not significant); partial oxygen saturation with an average of 99.2 percent. In 46.74 percent (43 cases) the time of onset of analgesia was short (Z=8.47), being good in 100 percent of the cases (Z=6.89 significant), with vigorous newborn in 100 percent (Z=10.25 significant). The evolution was satisfactory in 48.19 percent of the patients. They presented pruritus 8.69 percent. In group B, there was arterial hypertension in 2.17 percent of the cases, with less stability of the heart rate, greater times of labor beginning in 12.96 percent and it was good in 40.22 percent. These patients showed less satisfaction (41.30 percent). Conclusions: Subarachnoid administration of fentanyl/bupivacaine was more effective than pethidine for analgesia during labor(AU)

Meperidine: opioid not indicated for analgesia / Meperidina: opioide não indicado para analgesia

BACKGROUND AND OBJECTIVES: Pain evaluation and the choice of the analgesic best providing its control are extremely important for patients’ quality of life. This study aimed at describing the characteristics which make meperidine unfeasible for pain management, at calling the attention to the incidence of its prescriptions and to the need of a multidisciplinary educative action aiming at decreasing its use, in addition to presenting two opioids as options for analgesia. CONTENTS: National or international scientific and governmental publications between the years 1997 and 2013 used in this study report that meperidine is not indicated for pain management, primarily due to its short action time, presence of neurotoxic metabolite (normeperidine) and possibility of rapidly developing tolerance. CONCLUSION: According to analyzed data, meperidine was the most widely used opioid for analgesic or was among the most prescribed analgesics. This fact shows the real need for an educative multidisciplinary action to promote awareness of meperidine risks and to decrease its prescription. According to searched literature, morphine and methadone have longer action time and higher analgesic potency, with metabolites which are less toxic and noxious for patients as compared to meperidine. .

JUSTIFICATIVA E OBJETIVOS: A avaliação da dor e a escolha do analgésico que mais bem provenha o seu controle são de extrema importância para a qualidade de vida do paciente. O objetivo deste estudo foi elucidar as características que inviabilizam a administração da meperidina para o tratamento da dor, atentar para a incidência de sua prescrição e a necessidade de uma ação educativa multidisciplinar visando à redução do seu uso e apresentar dois opioides como opções de escolha para a analgesia. CONTEÚDO: As publicações científicas e governamentais de âmbito nacional ou internacional entre os anos de 1997 e 2013 utilizadas neste artigo relatam que a meperidina não é indicada para o tratamento da dor devido, principalmente, ao seu curto tempo de ação, presença de metabólito neurotóxico (normeperidina), e a possibilidade de desenvolver tolerância rapidamente. CONCLUSÃO: Segundo os dados das pesquisas analisadas, a meperidina foi o opioide mais utilizado para analgesia ou estava entre os analgésicos mais prescritos. Esse fato relata a real necessidade de uma ação multidisciplinar educativa em prol da conscientização sobre os riscos presentes no tratamento com a meperidina e da diminuição da sua prescrição. De acordo com a literatura consultada, a morfina e a metadona apresentam maior tempo de ação e potência analgésica com metabólitos menos tóxicos e prejudiciais ao paciente que a meperidina. .

Eficacia de la asociación dipirona-meperidina en disminuir la necesidad de opioide en dolor agudo posterior a cirugía abdominal / Efficacy of the association of dipyrone and meperidine in decreasing the need of opioid in acute postoperative pain after abdominal surgery

Introducción. La principal preocupación de los pacientes que van a ser intervenidos es el dolor agudo postoperatorio, en cuyo manejo los opioides son los fármacos más recomendados, aunque sus efectos secundarios han limitado su uso. En nuestro medio, su manejo lo realizan los médicos generales o los cirujanos, con uso prevalente de la dipirona y resultados subóptimos. Una alternativa segura sería la adición a la dipirona de meperidina, obteniéndose así una adecuada alternativa para su manejo por parte de médicos no especialistas, sin los efectos adversos. Objetivo. Determinar si la adición de dipirona a la meperidina disminuye en 50 % las necesidades del opioide en el manejo eficaz del dolor agudo postoperatorio. Métodos. Se llevó a cabo un ensayo clínico controlado con 107 pacientes distribuidos en dos grupos. Se usaron dosis de 0,5 mg/kg de meperidina más 2,5 g de dipirona (n = 57), comparadas con la dosis usual de meperidina de 1 mg/kg (n = 50). El dolor agudo postoperatorio se evaluó según escala visual análoga. Resultados. La incidencia del dolor agudo postoperatorio fue de 28 % en el grupo intervenido y de 26,32 % en el control. El riesgo relativo (RR) fue mayor en el grupo intervenido (RR = 1,06; IC95 % 0,57-1,98), sin diferencias entre ellos. La incidencia de efectos secundarios presentó mayores riesgos absolutos en el grupo control, con una diferencia significativa (p = 0,0055). Conclusiones. La mezcla de dipirona más meperidina nos permite disminuir en 50 % la necesidad de opioide, con menos efectos adversos, sin que el control del dolor agudo postoperatorio sea eficaz.

Introduction. The main concern of patients who undergo surgery is postoperative pain, for which opioids are the most common medication used even though their side effects limit their use. In Colombia, pain is managed by general practitioners or surgeons who mainly use dipyrone with suboptimal results. A safe alternative with minimal side effects could be the addition of meperidine to dipyrone which could be used by non specialists. Objective. To determine if the addition of meperidine to dipyrone decreases in 50 % the opioid requirements to achieve an effective postoperative pain management. Methods. A controlled clinical trial with 107 patients distributed in two groups was performed. The study group received 0.5 mg per kilogram of meperidine plus 2.5 g of dipyrone (n = 57), and the control group received the usual dose of 1 mg per kilogram of meperidine (n = 50). Postoperative pain was assessed with the visual analog scale (VAS).Results. The incidence of acute postoperative pain was 28 % in the study group and 26.3 % in the control group. The relative risk (RR) was higher in the study group (RR = 1.06; confidence interval 95 % 0.57-1.98), without difference between them. The incidence of side effects had a higher RR in the control group with a significant difference (p = 0.0055). Conclusions. The combination of dipyrone and meperidine allows a 50 % reduction in the need of opioid with lesser side effects. However, postoperative pain was not effectively controlled.

Dose efetiva de sedação em ecocardiograma transesofágico: relação com idade, área de superfície e função do ventrículo esquerdo / Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function / Dosis efectiva de sedación en ecografía transesofágica: relación con edad, área de superficie y función del VI

Fundamento: A sedação com midazolam e meperidina é amplamente utilizada em ecocardiografia transesofágica, entretanto, não existe dose média estabelecida para cada caso. Objetivo: Correlacionar as doses médias de midazolam e meperidina para sedação adequada em ecocardiografia transesofágica com faixa etária, área de superfície corpórea e fração de ejeção do ventrículo esquerdo. Métodos: Estudo retrospectivo envolvendo 1.841 pacientes submetidos à sedação baseada na escala de Ramsay, com solução contendo midazolam 1,5 mg (1,5 ml), meperidina 1 mg (1 ml) e água destilada (7,5 ml). Analisamos quatro grupos etários: G1: < 24 anos; G2: 25 a 44 anos; G3: 45 a 64 anos; e G4: > 65 anos. Obtivemos a área de superfície corpórea pela fórmula: {[(altura x 100)0,725] x (peso0,425) x 0,0071}. Com relação à fração de ejeção do ventrículo esquerdo, estudamos dois grupos: GA: < 55 por cento; e GB: > 55 por cento. Na análise estatística utilizamos o teste de Kruskal-Wallis para correlação com idade e fração de ejeção do ventrículo esquerdo, e correlação linear simples para área de superfície corpórea. Resultados: No estudo da idade, as doses médias de sedação necessárias foram significativamente menores no G3 e G4 (p < 0,01). Na análise da fração de ejeção do ventrículo esquerdo, esta foi significativamente menor no GA (p < 0,01). O coeficiente de correlação linear entre dose de sedação e área de superfície corpórea foi 0,09 (nulo). Conclusão: Houve menor dose média necessária de sedativos nos indivíduos com maior idade e em portadores de disfunção sistólica do ventrículo esquerdo, e não houve correlação com área de superfície corpórea.

Background: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case. Objective: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction. METHODS: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml), meperidine 1 mg (1 ml) and distilled water (7.5 ml). Four age groups were analyzed: G1: < 24 years; G2: 25 to 44 years; G3: 45 to 64 years; and G4: > 65 years. Body surface area was calculated using the formula {[(height x 100)0.725] x (weight0.425) x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: < 55 percent; and GB: > 55 percent. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area. Results: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01). The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01). The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null). Conclusion: The mean dose of sedatives required was lower in older individuals and in those with left ventricular systolic dysfunction. No correlation with body surface area was found.

Fundamento: La sedación con midazolam y meperidina es ampliamente utilizada en ecografía transesofágica, no obstante, no existe dosis media establecida para cada caso. Objetivo: Correlacionar la dosis media de midazolam y meperidina para sedación adecuada en ecografía transesofágica con intervalo de edades, área de superficie corporal y fracción de eyección del ventrículo izquierdo. Métodos: Estudio retrospectivo involucrando 1.841 pacientes sometidos a sedación basada en la escala de Ramsay, con solución conteniendo midazolam 1,5 mg (1,5 ml), meperidina 1 mg (1 ml) y agua destilada (7,5 ml). Analizamos cuatro grupos etarios: G1: < 24 años; G2: 25 a 44 años; G3: 45 a 64 años; y G4: > 65 años. Obtuvimos el área de superficie corporal mediante la fórmula: {[(altura x 100)0,725] x (peso0,425) x 0,0071}. Con relación a la fracción de eyección del ventrículo izquierdo, estudiamos dos grupos: GA: < 55 por ciento; y GB: > 55 por ciento. En el análisis estadístico utilizamos el test de Kruskal-Wallis para correlación con edad y fracción de eyección del ventrículo izquierdo, y correlación lineal simple para área de superficie corporal. Resultados: En el estudio de la edad, las dosis medias de sedación necesarias fueron significativamente menores en el G3 y G4 (p < 0,01). En el análisis de la fracción de eyección del ventrículo izquierdo, ésta fue significativamente menor en el GA (p < 0,01). El coeficiente de correlación lineal entre dosis de sedación y área de superficie corporal fue 0,09 (nulo). Conclusión: Hubo menor dosis media necesaria de sedantes en los individuos con mayor edad y en portadores de disfunción sistólica del ventrículo izquierdo, y no hubo correlación con el área de superficie corporal.