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.
Division of Women's Anesthesia, the Departments of Anesthesiology and Biostatistics, Duke University Medical Center, Durham, NC 27710, USA. booth006@mc.duke.edu
J V
JV
Booth
D R
DR
Lindsay
A J
AJ
Olufolabi
H E
HE
El-Moalem
D H
DH
Penning
J D
JD
Reynolds
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