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    Use of meperidine in patient-controlled analgesia and the development of a normeperidine toxic reaction

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    Authors
    Simopoulos, Thomas T.
    Smith, Howard S.
    Peeters-Asdourian, Christine
    Stevens, Donald S.
    UMass Chan Affiliations
    School of Medicine
    Department of Anesthesiology
    Document Type
    Journal Article
    Publication Date
    2002-01-31
    Keywords
    Adult
    *Analgesia, Patient-Controlled
    Analgesics, Opioid
    Case-Control Studies
    Central Nervous System Diseases
    Dose-Response Relationship, Drug
    Female
    Humans
    Male
    Meperidine
    Middle Aged
    Pain, Postoperative
    Retrospective Studies
    Time Factors
    Anesthesiology
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    Link to Full Text
    http://dx.doi.org/10.1001/archsurg.137.1.84
    Abstract
    HYPOTHESIS: Intravenous patient-controlled analgesia (IV PCA) meperidine hydrochloride can be used with a reasonable margin of safety. DESIGN: A retrospective review was performed of 355 medical records of patients receiving IV PCA meperidine treatment. Four groups of patients were defined, based on daily meperidine dose and the presence or absence of central nervous system excitation adverse effects. Use of more than 600 mg/d of meperidine hydrochloride was considered a high dose. SETTING: University tertiary care hospital. PARTICIPANTS: Postoperative patients from general, orthopedic, neurosurgical, gynecological, and urologic procedures receiving IV PCA. INTERVENTIONS: If patients were judged to have consumed significant amounts of meperidine, the analgesic regimen was modified to (1) discontinue meperidine therapy, (2) substitute hydromorphone hydrochloride, or (3) decrease the use of meperidine by adding oral methadone hydrochloride or transdermal fentanyl citrate to the regimen. MAIN OUTCOME MEASURES: Patients who received less than 10 mg/kg per day of IV PCA meperidine hydrochloride therapy were unlikely to experience central nervous system excitatory adverse effects and maintain adequate analgesia. RESULTS: The mean meperidine hydrochloride consumption for those patients classified as high dose, asymptomatic was 13.3 mg/kg per day (95% confidence interval, 12.1-14.4 mg/kg per day). This differed statistically significantly (P<.05) from the mean meperidine hydrochloride dose in patients classified as high dose, symptomatic, which was 16.9 mg/kg per day (95% confidence interval, 14.7-19.2 mg/kg per day). The duration of meperidine use did not differ among the 4 patient groups. The incidence of a central nervous system toxic reaction associated with IV PCA meperidine therapy was 2%. CONCLUSIONS: We recommend 10 mg/kg per day as a maximum safe meperidine hydrochloride dose by an IV PCA device for no longer than 3 days. Daily patient evaluation is mandatory. Care must also be taken when using this dose to ensure the absence of renal dysfunction or enhanced hepatic metabolism of meperidine.
    Source
    Arch Surg. 2002 Jan;137(1):84-8. doi:10.1001/archsurg.137.1.84.
    DOI
    10.1001/archsurg.137.1.84
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49227
    PubMed ID
    11772223
    Notes
    Thomas T. Simopoulos participated in this study as a medical student in the Senior Scholars research program at the University of Massachusetts Medical School.
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1001/archsurg.137.1.84
    Scopus Count
    Collections
    T.H. Chan School of Medicine Student Publications
    Senior Scholars Program

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