Background and Objectives. We report the first controlled analysis of the use of patient-controlled epidural meperidine. This randomized, prospective study compares the efficacy and safety of patient-controlled epidural meperidine to conventional intramuscular meperidine for the management of postoperative pain after elective cesarean delivery.
Methods. After delivery, 60 patients were randomly assigned to receive either conventional intramuscular meperidine therapy or epidural meperidine by a patient-controlled analgesia pump, which was programmed to deliver bolus doses in addition to a continuous background infusion.
Results. Patients in the patient-controlled epidural analgesia group used significantly less meperidine in the first 24 hours after surgery ( p < 0.05) and had significantly lower visual analog pain scores ( p < 0.05) from three hours postoperatively until study completion at 24 hours. Patients in the patient-controlled epidural analgesia group ambulated sooner (19 ± 7.8 versus 29.2 ± 2.2 hours, p < 0.005) and cared for their infants earlier (4.6 ± 0.9 versus 8.1 ± 6.8 hours, p < 0.05) than patients receiving intramuscular meperidine. One patient developed a respiratory rate of four breaths per minute, 25 minutes after receiving 75 mg epidural meperidine in the operating room. This was treated with intravenous naloxone. No other serious side effects occurred in either group. Both groups were similar with regard to minor intraoperative and postoperative side effects.
Conclusions. Patient-controlled epidural meperidine after cesarean delivery more effectively manages postoperative pain than conventional intramuscular use. The technique is preferred by both patients and nursing staff and can be used in the ward setting with appropriate organization and education. Respiratory depression, if it occurs, should present early after epidural bolus administration.
- obstetric anesthesia
- anesthetic techniques
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Supported in part by Abbott Laboratories, Montreal, Canada.
The authors are indebted to the nurses of the postpartum wards at the Ottawa Civic Hospital for their efforts and cooperation, which made this study possible. Gratitude is expressed to the Department of Anesthesia— Main Division which provided the support of a research assistant and non-clinical time. Partial funding for this project was provided by Abbott Laboratories, Montreal, Canada.