Subarachnoid meperidine (Pethidine) causes significant nausea and vomiting during labor. The Duke Women's Anesthesia Research Group.
BACKGROUND
The combined spinal-epidural (CSE) technique using bupivicaine-fentanyl has become an established method of pain control during parturition. One limitation is the relatively short duration of effective analgesia produced by bupivicaine-fentanyl. In contrast, subarachnoid meperidine has been shown to provide a long duration of anesthesia in nonobstetric patients. Therefore, the authors tested the hypothesis that subarachnoid meperidine produces a significant increase in the duration of analgesia compared with bupivicaine-fentanyl.


METHODS
Based on a power analysis of preliminary data, the authors intended to recruit 90 patients for the study, randomized to three groups: 2.5 mg bupivicaine-25 microg fentanyl, 15 mg meperidine, or 25 mg meperidine. However, after enrolling 34 patients, the study was discontinued because of a significant increase in nausea or vomiting in the study patients.


RESULTS
Nausea or vomiting was substantially increased in both meperidine groups compared with the bupivicaine-fentanyl group: 16 with nausea or vomiting in the meperidine groups (n = 21), compared with 1 in the bupivicaine-fentanyl group (n = 11), P = 0.0011. The mean duration of analgesia provided by 25 mg meperidine was 126 +/- 51 min, compared with 98 +/- 29 min for bupivicaine-fentanyl and 90 +/- 67 min for 15 mg meperidine. These data were not significant (P = 0.27).


CONCLUSIONS
Although intrathecal meperidine could potentially prolong subarachnoid analgesia during labor, its use was associated with a significant incidence of nausea or vomiting. These data do not support the use of subarachnoid meperidine in doses of 15 or 25 mg for labor analgesia.
Booth
J V
JV
Division of Women's Anesthesia, the Departments of Anesthesiology and Biostatistics, Duke University Medical Center, Durham, NC 27710, USA. booth006@mc.duke.edu
Lindsay
D R
DR
Olufolabi
A J
AJ
El-Moalem
H E
HE
Penning
D H
DH
Reynolds
J D
JD
D000328:Adult; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D000775:Anesthesia, Spinal; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D001034:Apgar Score; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine; D004305:Dose-Response Relationship, Drug; D005260:Female; D005283:Fentanyl; D006801:Humans; D008614:Meperidine / Q000008:administration & dosage / Q000009:adverse effects*; D010147:Pain Measurement; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced*; D011247:Pregnancy; D013346:Subarachnoid Space
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008614:Meperidine; D005283:Fentanyl; D002045:Bupivacaine