@article {Maurette290, author = {Pierre Maurette and Philippe Erny and G{\'e}rard Bonada and Veronique Djiane}, title = {A Comparison Between Lidocaine Alone and Lidocaine With Meperidine for Continuous Spinal Anesthesia}, volume = {18}, number = {5}, pages = {290--295}, year = {1993}, doi = {10.1136/rapm-00115550-199318050-00005}, publisher = {BMJ Specialist Journals}, abstract = {Background and Objectives. Experimental investigations have demonstrated a synergistic interaction between opioids and local anesthetics. This study aims to assess the effective benefit-risk ratio of continuous spinal anesthesia (CSA) induced with either 1.6\% lidocaine alone or in combination with 1\% meperidine.Methods. Thirty-four elderly patients (80.7 {\textpm} 7.3 years) operated on for fracture of the neck of the femur were randomly allocated to two groups. In the first group ( n = 15), CSA was induced with lidocaine 1.6\% plain, whereas in the second group ( n = 19) 1\% meperidine was added. Reinjections were performed in both groups using lidocaine 1.6\% alone.Results. In the lidocaine group, 43 {\textpm} 13 mg was used for induction whereas in the other group the addition of 18 {\textpm} 5 mg of meperidine significantly reduced the dose of lidocaine required to 28 {\textpm} 8 mg ( p \< 0.001). Delay between two reinjections was increased to 51 {\textpm} 7 minutes in the lidocaine plus meperidine group, compared to 35 {\textpm} 6 minutes in the lidocaine group ( p \< 0.001). Ephedrine was required for 9 out of the 19 patients in the lidocaine plus meperidine group, whereas it was required for only two patients in the other group ( p = 0.05). Mean plasma concentrations of meperidine 1 hour and 3 hours after induction was 45.5 {\textpm} 12 ng/ml and 59 {\textpm} 22 ng/ml, respectively, and drowsiness was observed in 95\% of the patients in the second group. Delay before requirement for pain medication was 2.2 {\textpm} 2 hours in the lidocaine group and 14.1 {\textpm} 8 hours in the lidocaine plus meperidine group ( p \< 0.001).Conclusions. The association of 1\% meperidine with 1.6\% lidocaine during the induction of CSA decreases the initial induction dose, prolongs analgesia, produces initial drowsiness, and provides long-lasting pain relief. However, such benefits are offset by some impairment of hemodynamic stability that is likely to make this combination of drugs unacceptable as an enhanced analgesic technique.}, issn = {0146-521X}, URL = {https://rapm.bmj.com/content/18/5/290}, eprint = {https://rapm.bmj.com/content/18/5/290.full.pdf}, journal = {Regional Anesthesia \& Pain Medicine} }