title: Use of meperidine in patient-controlled analgesia and the development of a normeperidine toxic reaction.
abstract: OBJECTIVE
  Intravenous patient-controlled analgesia (IV PCA) meperidine hydrochloride can be used with a reasonable margin of safety.
  
  
  METHODS
  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.
  
  
  METHODS
  University tertiary care hospital.
  
  
  METHODS
  Postoperative patients from general, orthopedic, neurosurgical, gynecological, and urologic procedures receiving IV PCA.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Anesthesiology and Critical Care, Postoperative Pain Services, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA. tsimopou@caregroup.harvard.edu
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Simopoulos
authors.forename: Howard S
authors.initials: HS
authors.lastname: Smith
authors.forename: Christine
authors.initials: C
authors.lastname: Peeters-Asdourian
authors.forename: Donald S
authors.initials: DS
authors.lastname: Stevens
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D002493:Central Nervous System Diseases / Q000139:chemically induced*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008614:Meperidine / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000097:blood; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D008614:Meperidine; C002752:normeperidine