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The present work focuses on the development of a new electrochemical platform based on CoMn 2 O 4 -rGO/1-ethyl-3-methylimidazolium chloride modified carbon paste electrode (CoMn 2 O 4 -rGO/IL/CPE) for electrochemical determination of pethidine in the presence of biological species. For the first time, the electrooxidation mechanism of pethidine in presences of morphine and olanzapine is investigated by cyclic voltammetry (CV) and differential pulse voltammetry (DPV) technologies. The as-synthesized CoMn 2 O 4 -rGO nanocomposites are characterized by physicochemical measurements such as X-ray diffraction (XRD), energy dispersive X-ray spectroscopy (EDX), Field emission scanning electron microscopy (FE-SEM), and Fourier transform infrared (FT-IR). The obtained results illustrated synergistic interactions between rGO and CoMn 2 O 4 structures. Also, to investigate the electrode charge-transfer resistances, electrochemical features of the resulting nanocomposites are studied via electrochemical impedance spectroscopy (EIS) analysis. Based on the result, three segmented linear ranges are observed over the range 0.08–900 μM and detection limit of 0.024 μM. Over the 10.0–40.0 μM ranges of pethidine in phosphate buffer solution (PBS-pH 7.0), suitable diffusion coefficient of 5.67 × 10−7 cm2 s−1 is evaluated by chronoamperometry technique (CHA). Finally, the CoMn 2 O 4 -rGO/IL/CPE with high sensitivity, selectivity and repeatability is successfully used for determination of pethidine in real sample and drug formulation. [Display omitted] • CoMn 2 O 4 -rGO/IL nanocomposite is introduced as new electro-sensing catalyst. • A sensitive electrochemical sensor is used for analysis of pethidine. • Pethidine in presence of morphine and olanzapine are determined. [ABSTRACT FROM AUTHOR]

The present study was designed to evaluate the prescribing pattern of analgesics in post-operative patients in a surgical unit. Total number of 180 prescriptions containing analgesics was collected randomly. The only drug in the operation day that was used was pethidine (90.6%). Patients (9.4%) did not receive any analgesics in the operation day. Associated analgesics in the operation day were either tramadol (42.2 %) or ketorolac (54.4%). Only 3.3% did not receive any such drugs. In first post-operative day most of the patients received single drug tramadol (48.3%), ketorolac (38.9%) and pethidine (0.6%). In second, third, forth and fifth post-operative day most patients received tramadol (47.8%) (44.4%), (41.4%) and (33.2%) respectively. In sixth post-operative day most of the patients (81.1%) did not receive any analgesics. In this study tramadol was found to be widely used post-operative analgesics with minimal side effects and better adherence to this drug by the patient.

Objective Intramuscular (i.m.) pethidine is used worldwide for labour analgesia and i.m. diamorphine usage has increased in the UK in the last 15 years. This trial aims to ascertain the relative efficacy and adverse effects of diamorphine and pethidine for labour pain. Design Prospective, parallel-arm randomised controlled trial with blinding of participants, care-givers and outcome assessors. Setting Maternity units in two District General Hospitals in the UK. Population After written informed consent, 484 women were randomised and recruited (244 diamorphine, 240 pethidine). Inclusion criteria included women 16 years or older, established labour, singleton pregnancy, 37-42 weeks of gestation and weight 60-120 kg. Methods On request of i.m. analgesia, participants received either 150 mg pethidine or 7.5 mg diamorphine based on computer-generated block randomisation. Main outcome measures Maternal-reduction in pain intensity from baseline (10-cm visual analogue scale) at 60 minutes and over the 3-hour period after drug administration. Neonatal-requirement for resuscitation and Apgar score at 1 minute. Results Diamorphine provided modestly improved pain relief at 60 minutes, mean difference 1 cm (95% confidence interval [ CI] 0.5-1.5), and over the 3 hours, mean difference 0.7 cm (95% CI 0.3-1.1). However, average length of labour in women receiving diamorphine was 82 minutes longer (95% CI 39-124) and therefore they experienced more pain overall. There were no statistically significant differences in primary neonatal outcomes. Conclusions There is a modest difference between the analgesia provided by diamorphine or pethidine for labour analgesia but diamorphine is associated with significantly longer labours. [ABSTRACT FROM AUTHOR]

Reasons for performing study There are no peer reviewed, blinded controlled studies regarding the skeletal analgesic efficacy of intramuscularly administered meperidine in horses. Objectives Using an adjustable heart bar shoe model of equine foot pain, the objective of this study was to test the hypothesis that meperidine (pethidine) administered intramuscularly would prove more efficacious in alleviating lameness than a saline placebo. Study design Crossover pharmacodynamic experiment. Methods Eight healthy adult Thoroughbred horses randomly underwent weekly i.m. treatments 1 h after lameness induction: saline placebo (1 ml/45 kg bwt) or meperidine hydrochloride (1 mg/kg bwt i.m.). Heart rate ( HR) and lameness score ( LS) responses were assessed by a blinded observer every 20 min for 5 h after lameness induction and then hourly through 12 h after treatment. Jugular venous blood samples were obtained at -1, 0, 0:05, 1, 2, 4, 6, 8, 10 and 12 h and were subsequently analysed for drug concentrations (lower limit of detection, 1 ng/ml). Repeated measures ANOVA and post hoc Tukey's test were used to identify analgesic effects at a significance level of P<0.05. Results Mean (± s.e.) HR were lower in meperidine trials at 2.3, 3.3 and 3.7 h post administration (P<0.05). Mean LS were lower in meperidine trials at 2.0, 2.3 and 3.3 h post administration (P<0.05). Mean plasma (meperidine) peaked at 227 ± 52 ng/ml at 1 h post administration and decreased to 2.7 ± 0.3 ng/ml at 12 h post administration. In 3 of 8 subjects, plasma (meperidine) was below the lower limit of detection at 12 h after administration. Conclusions Intramuscular meperidine was more effective than the saline placebo but only for 2.0-3.7 h post administration compared with the 8-12 h durations of efficacy reported previously using this same model when horses were treated with nonsteroidal anti-inflammatory drugs ( NSAIDs). Meperidine may be a suitable non NSAID alternative analgesic for acute foot pain with efficacy lasting from 2-3 h after a single i.m. dose. [ABSTRACT FROM AUTHOR]

Background: Post-operative pain is one of the problems, wherein lack of control on it has many side-effects such as tachycardia, hypertension, myocardial ischemia, decreased alveolar ventilation, and poor wound healing. Aims: In this study, we evaluated the pre-operative administration of pregabalin sufficiency and security in relieving post-operative pain after lower limb orthopedic surgery and reducing the need for opioids and their possible side-effects. Materials and Methods: This study is a randomized, double-blind clinical trial. It was performed on 60 patients under lower limb surgery by spinal anesthesia. Patients were randomly allocated to two groups, one group has received a 150 mg pregabalin capsule 2 h before surgery and the other group has received placebo as a control. In both groups at 2, 6, 12, and 24 h after surgery, the patients were evaluated and the pain score, the score of sedation, incidence of nausea and vomiting was recorded in the checklists. Then, the data were analyzed by SPSS v16. Results: Visual analog pain scores at all hours in pregabalin group significantly reduced compared to the placebo group (P < 0.0001). Also, in the pregabalin group nausea and vomiting scores at all hours, sedation levels at 2 h and 6 h post-operatively, and pethidine consumption in all hours have significantly been reduced. Conclusion: A single pre-operative oral dose of pregabalin 150 mg is an effective method for reducing post-operative pain and pethidine consumption in patients undergoing orthopedic surgery. [ABSTRACT FROM AUTHOR]

Background: Postoperative shivering is very common and followed by many problems such as increasing oxygen consumption, blood pressure, intracranial and intraocular pressure, and postoperative pain. Therefore, prevention of shivering is important, especially in elderly and ischemic heart disease patients. The goal of this study was to compare the effect of pethidine (meperidine), dexamethasone, and placebo on prevention of shivering. Methods: This double blind clinical trial study was carried out on 120 patients who were candidates for surgery under general anesthesia. The patients were randomly divided into three groups. Induction and maintenance of anesthesia for all patients were similar. Temperature of patients was measured every 5 min interval. After induction, saline 0.9%, dexamethasone and pethidine were injected to groups a, b, and c, respectively. In recovery, patients were controlled for visible shivering. All data were statistically analyzed by analysis of variance (ANOVA) and Chi square tests. Results: There were no significant differences among three mentioned groups regarding gender, age, duration of surgery and anesthesia, extubation time, duration of recovery, and basic clinical characteristics. Nineteen cases (47.5%) of placebo group had postoperative shivering, whereas in dexamethasone group only four cases (10%) had shivering and the difference between the two groups was significant. Also in pethidine group, 15 cases (37.5%) had shivering and the difference with placebo group was significant (P value = 0.001). Conclusion: The present study showed that pethidine and dexamethasone are effective drugs for prevention of postoperative shivering in elective surgery and the effect of dexamethasone in preventing the postoperative shivering is better than pethidine. [ABSTRACT FROM AUTHOR]

Abstract: Pain in labour is often described as one of the most severe pains known. Neuraxial techniques provide the most effective form of labour analgesia. However, not all women wish to have a neuraxial technique or indeed want complete pain relief for labour. There are also subgroups of women in whom neuraxial techniques are contraindicated or attempted placement is unsuccessful. Therefore delivery units must be able to offer a range of non-neuraxial analgesia options for labour. [Copyright &y& Elsevier]

A new approach for lowering the detection limit of a pethidine ion-selective electrode is presented. A coated graphite (CGE) and carbon paste (CPE) electrodes for pethidine ions based on pethidine-phosphotungstate (PD-PT) as ion-pair complex are described. The sensors exhibit a Nernstian slope of 58.1 and 54.2 mVdecade−1 for pethidine ion over a wide concentration range from 2.6 × 10−7 to 1.0 × 10−2 M and 2.1 × 10−6 to 1.0 × 10−2 M with a detection limit of 1.8 × 10−7 M and 7.3 × 10−7 M for pethidine coated graphite (PD-CGE) and pethidine carbon paste electrode (PD-CPE), respectively. These sensors exhibited a fast response time (about 5-8 s) and good stability. The standard electrode potentials, Eo, were determined at different temperatures and used to calculate the isothermal temperature coefficient (dEo/dT) of the PD-CGE and PD-CPE, which was 0.0062 and 0.0071 V/ °C, respectively. Selectivity coefficients, determined by matched potential method (MPM) and separate solution method (SSM), showed high selectivity for pethidine hydrochloride (PDCl) over a large number of inorganic cations, organic cations, sugars, urine components, and some common drug excipients. The sensors were applied for determination of PDCl in ampoule and in spiked urine samples using potentiometric determination, standard addition and the calibration curve methods. The results obtained were satisfactory with excellent percentage recovery comparable and sometimes better than those obtained by other routine methods for the assay. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: Newborn hearing screening may fail due to some perinatal and neonatal factors. False positivity of newborn hearing screening increases costs, familial concerns and anxiety. The objective of this study was to determine the effects of pethidine administered in the mother for labor analgesia on the false positivity rates of the newborn hearing screening test., Methods: This study was designed as a retrospective and cross-sectional study. A total of 75 pregnant women scheduled for vaginal delivery who received 50 mg intramuscular pethidine at the beginning of the active phase of the labor were included as the patient group and 68 pregnant women who did not receive pethidine as the control group. A total of 143 infants born with vaginal delivery were evaluated with otoacoustic emission (OAE) test before discharge. Perinatal and neonatal variables and test outcomes were recorded, and the correlation between false positivity rate and pethidine usage was evaluated., Results: Initially, system records of 148 healthy term newborns were screened. Four patients who failed in both OAE tests and were referred to the Automated Auditory Brainstem Response (AABR) test and one patient who failed in all tests (first OAE, control OAE and AABR) and was referred to an upper center for further investigations and treatment were excluded from the study. No statistically significant difference was found between the groups in terms of birth features. First stage OAE test was reported as 'passed' in 8 (10.7%) and 58 (85.3%) newborns in the study and control groups, respectively; while OAE was reported as 'referred' and 'passed' in the second test in 67 (89.3%) and 10 (14.7%) newborns in the study and control groups, respectively. There was a statistically significant difference between both groups in terms of false positivity ratio ( p  < 0.5)., Conclusion: Pethidine significantly decreases the duration of the active phase, providing a good analgesic effect for pain management during labor. Therefore, it seems that pethidine can be used as an acceptable agent during labor. However, it may have neonatal effects after the delivery, causing false positivity in newborn hearing screening tests. The results of this study support the opinion that the OAE test should be performed in postpartum later dates in order to increase OAE passing rates and minimize costs and parents' concerns.

Objective: To assess the use of single dose of paracetamol intravenously in management of labour pains., Background: Pain during labour is a complex, subjective and multi-faceted physiological phenomenon that varies in intensity among women and is subjected to many social and cultural modifiers., Subjects and Methods: This randomized clinical study was conducted in Obstetrics and gynecology department from March 2019 to March 2020 including 96 primiparous women randomized into paracetamol group ( n  = 48) received 1000 mg of paracetamol IV infusion and pethidine group ( n  = 48) received 50 mg of pethidine given slowly IV. Primary outcome is the change of the intensity of perceived labor pain. Pain score was followed and recorded by visual analogue scale (VAS). Our study protocol was registered at ClinicalTrials.gov; NCT04744727., Results: VAS score was highly significant improved gradually after 30 min, 1, 2 and 3 h of paracetamol and pethidine taken compared at start study, but participants in paracetamol group had lower pain after 2 and 3 h (3.92 ± 1.42 and 5.69 ± 1.07) than those of the pethidine groups (4.42 ± 1.87 and 5.38 ± 1.34). Also, 2.1% of paracetamol group developed dizziness and 4.2% developed nausea and vomiting, while there was 29.2% of pethidine group developed dizziness and 37.5% developed nausea and vomiting., Conclusions: Intravenous paracetamol as labour analgesia is effective, safe, inexpensive, available and with no maternal or fetal side effects as compared to Pethidine. Paracetamol needs to have more chance in comparison to other forms as a labour pain analgesia, especially in our communities.

Abstract: Context: Morphine consumption is an important indicator of a country''s progress in cancer pain relief. However, opioid prescription data are lacking for Taiwan. Objectives: To investigate opioid consumption patterns in Taiwan, compare the results with those from selected countries, identify differences between patients with and without cancer, and determine the associated expenditure. Methods: Data on prescriptions for three so-called strong opioids (fentanyl, morphine, and pethidine [meperidine]) and one so-called weak opioid (codeine) were obtained from the Taiwan National Health Insurance Research Database for 2002–2007. The data were converted into a defined daily dose for statistical purposes per million inhabitants per day. Associated payments and diagnoses also were obtained from the database. Results: From 2002 to 2007, opioid consumption in Taiwan increased by 55% from 362 to 560 defined daily dose for statistical purposes per million inhabitants per day. This ranks Taiwan as 56th among 181 countries and areas according to the statistical data for 2005–2007 from the International Narcotics Control Board. Among the investigated opioids, prescriptions for transdermal fentanyl and oral morphine increased markedly from 2002 to 2007. Pethidine (meperidine) was predominantly prescribed to patients without cancer diagnoses (around 80%). The total expenditure on opioid prescriptions was US$10.2 million in 2007 for a population of 23 million. Conclusion: Opioid prescriptions and expenditure increased steadily from 2002 to 2007 in Taiwan, as in nearby Asian countries, but remained much lower than in developed countries. Pethidine (meperidine) was predominantly prescribed to noncancer patients, whereas morphine and fentanyl were mainly prescribed for cancer patients. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the efficacy and adverse effects of an intravenous infusion of 1000mg of paracetamol as compared with an intravenous injection of 50mg of pethidine hydrochloride for intrapartum analgesia. Methods: In a randomized prospective study at Ain Shams University, Cairo, Egypt, between April and August 2010, 102 low-risk primiparous women in active labor were allocated to received either paracetamol (n=52) or pethidine hydrochloride (n=50). The primary outcome was the efficacy of the drug to supply adequate analgesia as measured by a change in the visual analog scale (VAS) pain intensity score at various times after drug administration. The secondary outcomes included the need for additional rescue analgesia and the presence of adverse maternal or fetal events. Results: As recorded by the VAS score, there was significant pain reduction at 15minutes, and at 1 and 2hours in both groups (P <0.001). The reduction in pain was significantly greater in the pethidine group only at 15minutes (P =0.004). None of the women in the paracetamol group had adverse effects, as compared with 64% of the women receiving pethidine. Conclusion: The effectiveness of intravenous paracetamol was comparable to that of intravenous pethidine, but paracetamol had fewer maternal adverse effects. [Copyright &y& Elsevier]

Background: Pethidine, an opioid analgesic is used for pain management. Clomipramine a tricyclic antidepressant primarily used for mood management is also used to treat pain. The objective of this study was to investigate the potentiation of the analgesic effects of sub-threshold dose of pethidine by a tricyclic antidepressant, clomipramine. Methods: The antinociceptive activities of clomipramine and pethidine alone and in combination were investigated in Swiss albino mice using the formalin test. Normal saline was employed as the control. Ten animals were used in each experiment. Results: Pethidine 5mg / kg failed to cause any significant effect while the 6.25, 7.5, 8.75 and 10.0mg /kg showed highly significant antinociceptive effect (p< 0.01) compared to the controls in the late phase of formalin test. Clomipramine 0.5 mg / kg did not show any significant effect while 0.75 mg / kg caused a significant effect (p< 0.05) while 1.00 and 1.25mg /kg caused a very highly significant antinociceptive effect (p< 0.001) in the late phase of formalin test compared to the vehicle treated animals. The combination of pethidine 5mg / kg and clomipramine 0.75mg / kg caused a highly significant antinociceptive effect (P<0.01) in the late phase of formalin test. Conclusion: This study demonstrates a marked reduction in the time spent in pain behaviour produced by the combination of low dose pethidine and clomipramine in the late phase of formalin test. The findings demonstrate the potentiation of a narcotic analgesic by a tricyclic antidepressant. [ABSTRACT FROM AUTHOR]

The article offers information on a double blind clinical study conducted to compare the efficacy of intramuscular (IM) pethidine and oral methadone in relieving post operative pain after cesarean section. Topics discussed includes complications due to pain such as delayed discharge from hospital and improper neonatal care, role of opioids in dealing with postoperative analgesia, similar pain relief in both cases but enhanced patient satisfaction in patient group which used oral methadone.

Objective: To compare trends in opioid consumption in Israel and St. Petersburg/Russia (morphine, oxycodone, pethidine, fentanyl, methadone, buprenorphine, trimeperidine, and papaveretum) over the period 2000-2008, and to describe the regulatory barriers to their accessibility as an exploratory variable for between-country differences. Methods: Data were drawn from the databases maintained by the Israel Ministry of Health's Pharmaceutical Administration and the St. Petersburg Central Pharmaceutical Reserve. The data were converted into a defined daily dose (DDD)/1,000 inhabitants/day. Regulation was evaluated according to the WHO guidelines for the assessment of national opioid regulation. Results: The opioid consumption rates in Israel were substantially higher than those in St. Petersburg. The excess in DDD/1,000 inhabitants/day was for fentanyl +0.287 in 2000 and +1.206 in 2008, for morphine +0.245 in 2000 and +0.122 in 2008, and for pethidine/trimeperidine +0.035 in 2000 and +0.007 in 2008. Oxycodone consumption increased in Israel from 0.31 DDD/1,000 inhabitants/day in 2000 to 0.46 DDD/1,000 inhabitants/day in 2008, whereas this analgesic is not available in St. Petersburg. Methadone and buprenorphine consumption rose in Israel, whereas these drugs are not available in Russia. Conversely, omnopon consumption decreased in St. Petersburg from 0.0206 DDD/1,000 inhabitants/day in 2000 to 0.00304 DDD/1,000 inhabitants/day in 2008, whereas the compound is not available in Israel. St. Petersburg differs from Israel with less opioid formulary availability and greater regulatory restrictions. Conclusion: The results suggest that strong opioid analgesics consumption rates in St. Petersburg yield those in Israel, and that the between-countries differences in opioid formularies availability and legal and regulatory barriers to opioids accessibility are responsible for the consumption discrepancies. [ABSTRACT FROM AUTHOR]

Introduction: Review of opioid prescriptions in a hospital provides valuable information to health care professionals which may contribute to proper pain management; opioid utilization studies may help uncover factors that can be improved for better prescribing. To evaluate the use of opioid analgesics in a university hospital, a review of opioids prescribed in hospitalized patients was developed. Methods: Information was obtained from the pharmacy database and medical records. The study period was 1 month. Results: Medical records of 1156 patients admitted in July 2009 were analyzed. The most widely prescribed opioid was tramadol; the preferred administration route was intravenous; the main indication was severe pain; and major prescribers were from surgical departments. Discussion: Underutilization of potent opioids for acute and chronic pain seems to occur. Conclusion: Most prescribers prefer weak opioids, given intravenously to treat acute and chronic pain, while some patients may benefit from the prescription of more potent opioids. [ABSTRACT FROM AUTHOR]

Abstract: Paraoxonase-1 enzyme (PON1) is important in metabolism as an organophosphate (OP) hydrolyser, hydrolyses aromatic carboxyl esters, such as phenyl acetate, and is involved in drug and xenobiotic metabolism. Moreover, it hydrolyses various lactones, including naturally occurring lactone metabolites. PON1 also acts as an antioxidant bio-scavenger and protects low-density lipoproteins (LDL) from oxidative modifications. As PON1 levels are influenced by many environmental factors and this might be dangerous, interactions between these factors and HDL-associated enzyme PON1 should be well characterized. The objective of this study was to evaluate the in vitro and in vivo effects of the intravenous anesthetics, midazolam, diazepam, tramadol, pethidine and lidocaine, on the activity of human and rabbit serum paraoxonase-1. PON1 was purified from human serum with a final specific activity of 5685.7Umg−1 and a purity of 37.74% using simple chromatographic methods. The five anesthetics dose-dependently decreased in vitro hPON1 activity, with IC 50 values for midazolam, diazepam, tramadol, pethidine and lidocaine of 0.085, 0.104, 0.282, 0.463 and 1.678mM, respectively. Ki constants were 0.057, 0.181, 0.317, 0.632 and 1.174mM, respectively. Anesthetics showed two different inhibition mechanisms: midazolam, diazepam and tramadol was noncompetitive, others were competitive. In vivo studies were performed on five male New Zealand White rabbits for each drug. Rabbit serum PON1 activity was significantly inhibited by 0.2mg/kg midazolam, 2mg/kg diazepam, 2mg/kg lidocaine, 5mg/kg tramadol and 5mg/kg pethidin for up to 30min following intravenous administration. Our results showed that anesthetics significantly inhibit hPON1 activity, both in vitro and in vivo, with rank order midazolam>diazepam>tramadol>pethidine>lidocaine in vitro; and lidocaine>pethidin>tramadol>midazolam>diazepam in vivo. [Copyright &y& Elsevier]

Postanesthesia shivering is an undesirable event that may induce a variety of adverse consequences including patient discomfort, increased oxygen consumption and wound pain. Thus, its pharmacological treatment should be regarded. The purpose of this study was to compare the efficacy of morphine, fentanyl and pethidine for the treatment of postanesthesia shivering. Fifty patients who developed shivering were treated in a randomized double blinded manner with an intravenous bolus dose of 2 or 4 mg morphine, 25 or 50 mg pethidine, and 50 µg fentanyl. Then, they were monitored for 30 minutes and the shivering suppression grade, the time taken to stop shivering, the shivering cessation time, recurrence of shivering and opioid side effects were evaluated. Core body temperature was measured immediately before, and at 15 and 30 minute after administering the drug. The groups did not differ significantly regarding shivering suppression grade, shivering cessation time, and recurrence of shivering. There was a significant difference in the time taken to stop shivering between groups. Following injection of the drugs, the core temperatures increased in the five groups with statistical difference. All opioids were effective in treating postanesthesia shivering in a similar extent. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pain after knee surgery, if not relieved, it would lead to a more severe and prolonged pain that can delay the patients recovery and rehabilitation. The effect of pain relief by some drugs after intra-articular injection has been shown. This study compared the effect of intra-articular injection of opioids (morphine, pethidine, methadone, and tramadol) on postoperative relieving pain after arthroscopic anterior cruciate ligament (ACL) reconstruction. METHODS: 150 candidate patients for knee arthroscopic ACL reconstruction were randomly enrolled into five groups. At the end of the procedure, all patients in each group received a joint injection solution including 9.5 millimeters bupivacaine with 1:200,000 epinephrine. The remaining 0.5 milliliters of syringe capacity was filled with one of the five solutions listed below: methadone group I: 5 mg methadone, morphine group II: 5 mg morphine, pethidine group III: 37.5 mg pethidine, tramadol group IV: 100 mg Tramadol, and control group V: 0.5 ml normal saline. Afterwards, any drug further administered to the patients based on need was recorded, and the morphine equivalent for all drugs was calculated. Patients need to narcotic drugs during the first twelve hours of hospitalization and pain scores were recorded. After data gathering, they were analyzed by SPSS 16 software with chi-Square, Kruskal-Wallis and ANOVA statistical tests. RESULTS: The highest and the lowest significant pain intensity were seen in placebo and morphine groups, respectively, in the first, second and third 4 hours after surgery. There were significant differences among the groups for need to analgesics. In other words, placebo group needed the highest dosage of analgesics and morphine and methadone groups needed the lowest dosage of analgesics. Morphine and methadone groups had maximum and minimum response to pain, respectively, in the first, second and third 4 hours after surgery. CONCLUSIONS: Administering 5 mg intra-articular morphine after arthroscopic ACL reconstruction is a valuable choice and is recommended to be added to other local anesthetics administrated drugs after this procedure. [ABSTRACT FROM AUTHOR]

Objectives: The incidence of shivering in patients undergoing a laparoscopic procedure is stated to be about 40%. A majority of laparoscopic gynecological procedures are taken up on an outpatient basis. Postoperative shivering may delay hospital discharge and is a common cause of discomfort in patients recovering from anesthesia. Aims: To determine the effect of pre-induction, low-dose pethidine on postoperative shivering in patients undergoing laparoscopic gynecological surgeries. Setting and Design: Sixty females between 25 and 35 years of age, of American Society of Anesthesiologists (ASA) class 1 and 2, were randomly divided into three groups of 20 patients each. Group I and II patients received i.v. pethidine 0.3 mg/kg and 0.5 mg/kg, respectively , while Group III received i.v. 0.9% normal saline just before induction of general anesthesia. Temperature of the Operating Room and the Post Anesthesia Care Unit was standardized and all fluids given during the study period were warmed to 37°C. Materials and Methods: Temperature, measured with a tympanic membrane probe, was recorded preoperatively , after induction of anesthesia, on arrival at the Post Anesthesia Care Unit, and postoperatively at 15 minutes and 30 minutes. Shivering was graded (0 -- 4 scale) at arrival of the patients to the PACU and every five minutes thereafter , up to 30 minutes. Statistical Analysis: ANOVA, Chi-square test, Kruskal-Wallis ANOVA and Mann-Whitney U tests were used. A P-value of less than 0.05 was considered significant. Results: Core body temperatures were statistically insignificant between groups at pre-induction, post-induction, and in the PACU (P > 0.05). At the end of surgery , shivering was present in 18 patients (30%). In groups I, II, and III, six (30%), three (15%), and nine (45%) patients shivered, respectively . The differences in incidence and grading of shivering among groups was found to be statistically insignificant (P > 0.05). The core body temperature of shiverers and non-shiverers were compared. In the PACU at 0, 15, and 30 minutes, the temperature among shiverers was significantly lower than that in the non-shiverers. Rescue drug i.v. pethidine 20 mg was given to patients with shivering grade =2. None of the patients had shivering after 10 minutes. Conclusions: Prophylactic pre-induction, low-dose pethidine does not have major role in preventing postoperative shivering. [ABSTRACT FROM AUTHOR]

Background: Non-steroidal anti-inflammatory drugs (NSADs) and opioids are frequently administered to relieve postoperative pain. Uncontrolled postoperative pain may produce a range of detrimental acute and chronic health consequences and increase mortality and morbidity. Practically, the analgesic efficacy of opioids is typically limited by the development of tolerance to them or by opioid-related sideeffects such as nausea, vomiting, sedation or respiratory depression. This study aims to assess the effects of suppository diclofenac on post-herniorrhaphy pain management. Methods: In this prospective double-blind clinical trial, 60 patients who were candidate for the surgical repair of inguinal hernia were divided into two groups. Patients in group A received 100 mg of suppository diclofenac and patients in group B 50 mg of pethidine after the induction of anesthesia and before surgical incision. Postoperative pain assessment was done by an unbiased observer on the arrival of patients in the recovery room, using a 10-cm visual analogue scale (VAS) at 2-hour intervals for 6 hours. Results: Pain relief was similar in the two groups (P=0.3). Patients in group B required more analgesia two hours post-operatively (P=0.03), while patients in group A had more favorable results regarding pain control (P<0.05). Statistically, there was no difference between the two groups at other intervals. The occurrence of nausea and vomiting was similar in both groups. No respiratory depression was observed in the patients. Conclusion: Preventive analgesia with 100 mg of suppository diclofenac after anesthesia induction for herniorrhaphy produced effective postoperative analgesia with minimum side-effects. [ABSTRACT FROM AUTHOR]

sensitive and selective liquid chromatography-tandem mass spectrometry method for the determination of pethidine and atropine in rabbit plasma was developed and validated. The analytes and internal standard (IS) are extracted from plasma by liquid-liquid extraction using ethyl acetate, and separated on a Zorbax SB-Aq column (2.1 × 150 mm, 3.5 μm) using acetonitrile-0.1% formic acid as mobile phase with gradient elution. Electrospray ionization source was applied and operated in positive ion mode, and multiple reaction monitoring mode was used for quantification using target fragment ions m/ z 247.8 → 219.7 for pethidine, m/ z 289.9 → 123.8 for atropine and m/ z 295.0 → 266.8 for IS, respectively. The assay is linear over the range of 5-1,000 ng mL for pethidine and atropine, with a lower limit of quantification of 3 ng mL for pethidine and 5 ng mL for atropine. Intra-day and inter-day precision are less than 11% and the accuracy are in the range of 90.4-106.3%. Furthermore, the newly developed method is successfully used for the determination of pethidine and atropine in rabbit plasma for pharmacokinetic study. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is no information about the distribution of pethidine into breast milk and/or exposure of the breastfed infant during pethidine patient-controlled epidural analgesia after caesarean delivery. Methods: We conducted an observational study among 20 women. The mean (95% confidence interval) pethidine dose administered was 670 (346–818) mg over 41 (35–46) h. Maternal plasma and milk and neonatal plasma were collected near the time of pethidine cessation and 6h later. Absolute and relative infant doses via milk and infant exposure were calculated. Infant behaviour was assessed using the Neurologic and Adaptive Capacity Score. Results: At first and second sampling times, mean absolute infant doses for pethidine were 20 (14–27) μg/kg/day and 10 (7–13) μg/kg/day, while mean relative infant doses were 0.7 (0.1–1.4)% and 0.3 (0.1–0.5)% respectively. Similar values for norpethidine (expressed as pethidine equivalents) were 21 (16–26) μg/kg/day and 22 (12–32) μg/kg/day; and 0.7 (0.3–1)% and 0.6 (0.2–1)% respectively. Mean pethidine and norpethidine concentrations in neonatal plasma were 3 (0–6.1) μg/L and 0.6 (0.2–1) μg/L. Compared with a time-matched maternal sample, the infant’s exposure was 1.4 (0.2–2.8)% for pethidine and 0.4 (0.2–0.6)% for norpethidine. The mean (95% confidence interval) neurologic and adaptive capacity score was 33.6 (32.2–34.9). Conclusion: The combined absolute infant dose of pethidine and norpethidine received via milk was 1.8% of the neonatal therapeutic dose and the combined relative infant dose was below the 10% recommended safety level. Breastfed infants are at low risk of drug exposure when mothers self-administer epidural pethidine after caesarean delivery. [Copyright &y& Elsevier]

Objective: To describe trends in opioid consumption in Israel (morphine, methadone, oxycodone, pethidine, fentanyl, buprenorphine, codeine, and dextropropoxyphene) over the 9 years, 2000-2008, and to explore explanations for changes in consumption, in amounts and the pattern. Methods: Data for the 2000-2008 period (all treatment settings, private and public) were drawn from the database maintained by the Israel Ministry of Health's Pharmaceutical Administration. The data were converted into a defined daily dose (DDD)/1,000 inhabitants/day. Results: Consumption of the five strong opioids (requiring a special prescription form) increased by 47%, from 2.46 DDD/1,000 inhabitants per day in 2000 to 3.61 DDD/1,000 inhabitants per day in 2008. This rise was mainly the result of a 4-fold increase in fentanyl consumption from 0.32 DDD/1,000 inhabitants per day in 2000 to 1.28 DDD/1,000 inhabitants per day in 2008. Oxycodone and methadone consumption levels increased moderately, and buprenorphine and dextropropoxyphene consumption rose drastically, whereas morphine, pethidine, and codeine use significantly fell. Conclusion: There has been a modest increase in opioid consumption in the years 2000-2008. This has been associated with substantial changes in the pattern of differential opioid prescribing characterized by increased prescription of oxycodone, fentanyl, buprenorphine, and dextropropoxyphene, and decreases in morphine, pethidine, and codeine. [ABSTRACT FROM AUTHOR]

Objective: The present study was undertaken to evaluate the antinociceptive effects of an ayurvedic polyherbal formulation in rats and mice employing the tail immersion test and acetic acid-induced writhing test, respectively. Materials and Methods: With the tail immersion method, rats received two different doses (270 and 405 mg/kg BW, p.o.) of a formulation, pethidine (5.4 mg/kg BW, p.o.) as a reference standard and the combination of the higher dose of the formulation with naloxone (2 mg/kg, i.p.), an opioid receptor antagonist, and caffeine (16 mg/kg, i.p.), used as an adenosine receptor antagonist. In the acetic acid-induced writhing test, mice received two different doses (390 and 585 mg/kg, BW, p.o.) of formulation, diclofenac sodium (15 mg/kg, BW, p.o.) as a reference standard and the combination of the higher dose of the polyherbal formulation with ondansetron (0.5 mg/kg, i.p.), a serotonin receptor antagonist. Results: The polyherbal formulation (405 mg/kg) exhibited a significant (p < 0.01) antinociceptive effect using the tail immersion method. In the acetic acid-induced writhing test, the formulation showed significant (p < 0.01) dose-dependent activity. The antinociceptive effect of the polyherbal formulation apparently involved an opiate-like mechanism, since its antinociceptive action was attenuated by naloxone pretreatment. In addition, antinociceptive activity was attenuated by caffeine and reversed by ondansetron pretreatment. Conclusion: Our data suggest that the polyherbal formulation possessed centrally and peripherally mediated antinociceptive properties. The activity could be mediated through opioid, adenosine, and serotonin receptors and via inhibition of cyclo-oxygenase- and/or lipoxygenase-dependent pathways. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: We conducted this study to evaluate the knowledge and attitudes of interns regarding cancer pain and its management. Materials and methods: This study included 116 interns recently graduated from the Faculty of Medicine, Prince of Songkla University. They provided their demographic characteristics and completed a questionnaire in regards to their knowledge and attitudes about cancer pain and its management. Results: Data were obtained from 116 interns. The majority of interns did not hesitate to provide maximal doses of analgesics for patients in severe pain when the prognosis was poor. A significant number favored to prescribe pethidine more than morphine and thought that pethidine caused less harmful effects in long-term use. Most respondents agreed or strongly agreed that they would prescribe opioids carefully to avoid tolerance and addiction. They considered that barriers to effective pain management were inadequate knowledge, inadequate pain assessment and lack of time to attend patients' requirements. Conclusion: The interns demonstrated positive attitudes toward cancer pain and its management, principally on opioid usage. However, a significant number of them had misconceptions in terms of knowledge for prescribing opioids. To provide better cancer pain management, attention must be given to improving the curriculum and integrating it into clinical practice. [ABSTRACT FROM AUTHOR]

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Background: The ideal obstetric analgesia should provide analgesic efficacy without attenuation of uterine contractions. Aims: To compare the outcome of intramuscular administration of pethidine and tramadol in labour analgesia. Methods: One hundred and sixty full-term parturients were randomly assigned to two equal groups in active labour. Group P received 50 mg pethidine; and group T, 100 mg tramadol intramuscularly. Primary outcome measure was the duration of the labour. The analgesic efficacy, maternal side-effects, mode of delivery, maternal satisfaction and Apgar score as the secondary outcome were assessed. Results: The duration of labour was shorter in group T, for first stage (190 vs 140 min; P < 0.0001) and for second stage (33 vs 25 min; P = 0.001). There were no differences in Groups P and T with respect to median (7 vs 8) and maximum (7.5 vs 8) visual analog scores (VAS) for pain at 10 min and one hour after drug administration. Women in group P had lower VAS pain scores than those in group T in the second stage of labour (8 vs 9; P = 0/009). There was a significantly higher incidence of nausea and vomiting (35% vs 15%; P = 0.003) and drowsiness (80% vs 29%; P < 0.0001) in group P. Conclusion: Both 100 mg tramadol and 50 mg pethidine provide moderate analgesia in first stage of labour. Tramadol seems to cause a shorter duration of labour and lower incidence of maternal side-effects. However, its analgesic efficacy was not found to be as effective as pethidine, especially in the second stage of labour. [ABSTRACT FROM AUTHOR]

In recent years the use of mild therapeutic hypothermia as a means of neuroprotection has become an important concept for treatment after cerebral ischemic hypoxic injury. Mild therapeutic hypothermia has been shown to improve outcome after out-of-hospital cardiac arrest, and many studies suggest a beneficial effect of mild therapeutic hypothermia on patient outcome after traumatic brain injury, cerebrovascular damage and neonatal asphyxia. This review article explores the numerous possibilities and methods for the induction of mild therapeutic hypothermia, reviews thermoregulatory management during maintenance and discusses associated risks and complications. [Copyright &y& Elsevier]

Abstract: In this paper, we described a simple and rapid method, capillary electrophoresis with electrochemiluminescence (CE–ECL) detection using tris(2,2′-bipyridyl)ruthenium(II) (Ru(bpy)3 2+), to simultaneously detect pethidine and methadone. Analytes were injected to separation capillary of 67.5 cm length (25 μm i.d., 360 μm o.d.) by electrokinetic injection for 10 s at 10 kV. Under the optimized conditions: ECL detection at 1.20 V, 30 mM sodium phosphate (pH 6.0) as running buffer, separation voltage at 14.0 kV, 5 mM Ru(bpy)3 2+ with 50 mM sodium phosphate (pH 6.5) in the detection cell, the linear range from 2.0×10−6 to 2.0×10−5 M for pethidine and 5.0×10−6 to 2.0×10−4 M for methadone and detection limits of 0.5 μM for both of them were achieved (S/N=3). Relative standard derivations of the ECL intensity were 2.09% and 6.59% for pethidine and methadone, respectively. [Copyright &y& Elsevier]

Abstract: A new method was developed for the analysis of illicit drugs in human urine by coupling carrier-mediated liquid phase microextraction (LPME) to high performance liquid chromatography (HPLC). By adding an appropriate carrier in organic phase, simultaneous extraction and enrichment of hydrophilic (morphine and ephedrine) and hydrophobic (pethidine) drugs were achieved. Effects of the types of organic solvents and carriers, the carrier concentration in the organic phase, the HCl concentration in the acceptor solution, the stirring rate, and the extraction time on the enrichment factor of analytes were investigated. Under the optimal experimental conditions, high enrichment factors (202–515) were obtained. The linear detection ranges were 0.1–10mgL−1 for the studied drugs. The limits of detection (LOD) at signal-to-noise ratio of 3 were 0.05mgL−1 for both morphine and ephedrine, and 0.02mgL−1 for pethidine. This method was successfully applied to analysis of ephedrine in real urine specimens, revealing that the determination of illicit drugs in urine was feasible. [Copyright &y& Elsevier]

Prevention of postoperative pain in children is one of the most important objectives of the anesthesiologist. Opioids have been used as an analgesic for postoperative pain in children for many years. Tramadol has both opioid and monoaminergic agonist actions. The aim of the study was to determine if the analgesic potency and occurrence of adverse effects of tramadol differ from pethidine when administered to children. A total of 110 healthy children, aged 2-12 years, scheduled for elective lower abdominal surgery were randomized to receive either pethidine 1 mg/kg (Group I, n = 60) or tramadol 2 mg/kg (Group II, n = 50) for postoperative pain after anesthesia induction. Pain intensity, adverse effects, heart rate, and systolic and diastolic blood pressure were recorded at regular intervals. The mean pain scores on postoperative 24 h were significantly greater with tramadol than with pethidine. Sedation scores, heart rate and systolic and diastolic blood pressure showed no significant differences between the groups. We conclude that pethidine and tramadol are effective in providing analgesia in pediatric patients, but pethidine provided better postoperative analgesia than tramadol. Changes in blood pressure, heart rate and arterial oxygen saturation were minimal and were similar in both drugs. [ABSTRACT FROM AUTHOR]

Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive procedure that allows urinary stones to be fragmented using acoustic shock waves. The impact of the shock waves causes transient stinging pain at the entry site as well as deep visceral discomfort, requiring analgesia during the procedure. The objective of this study was to compare the clinical efficacy of Entonox and pethidine for pain relief during outpatient ESWL. We randomized 150 outpatients undergoing elective ESWL into three groups of 50 patients, each group receiving inhalational Entonox, intravenous pethidine, or inhalational compressed air during ESWL. Quantitative evaluation of pain was performed according to a visual analogue scale (VAS), before and after the intervention. Analysis of variance (ANOVA) and paired t tests were used to compare VAS scores in the three groups, before and after the intervention. Entonox and pethidine decreased the pain score significantly, while compressed air did not. There was no significant difference between pain relief by Entonox and pethidine. This study demonstrates for the first time that inhalational Entonox is an effective analgesic regimen for ESWL. Entonox can be regarded as an appropriate alternative to analgesics like opioids in relieving pain during ESWL. [ABSTRACT FROM AUTHOR]

Abstract: We have recently reported that rat/mouse hemokinin-1 (r/m HK-1), a mammalian tachykinin, produced dose- and time-related antinociceptive effects at the supraspinal level via activating NK1 receptors. Moreover, r/m HK-1 remarkably enhanced both the antinociceptive extent and duration of morphine administered at the peripheral and supraspinal level through a convergence of pharmacological effects of opioid-responsive neurons. Pethidine hydrochloride is an important narcotic analgesic, which acts as an opiate agonist and has pharmacological effects similar to morphine. To improve our knowledge of the pharmacology of pethidine, the aim of the present study was to investigate the relationship between the nociception of r/m HK and pethidine by comparing it with that of r/m HK-1 and morphine. Our data showed that r/m HK-1 remarkably enhanced the antinociceptive extent of pethidine administered at the peripheral level, but not at the supraspinal level. These antinociceptive effects were blocked by prior treatment with the classical opioid receptor antagonist naloxone, indicating that the potentiated analgesic effect is mediated by opioid-responsive neurons. Differences in the antinociceptive activity of pethidine and morphine in combination with r/m HK-1, arise because there are differences in the physicochemical and pharmacokinetic properties of pethidine and morphine, particularly their lipophilicity. Our results may pave the way for a new strategy for the control of pain and may provide a clinical strategy to enable selection of either opioid as a priority. [Copyright &y& Elsevier]

Abstract: Background and objectives: The aim of this prospective, randomized study was to compare the standard regimen of midazolam and pethidine administered by the gastroenterologist versus patient controlled sedation with a propofol–fentanyl mixture during upper gastrointestinal tract endoscopic ultrasonography. Our primary end-points were patient satisfaction and patient cooperation assessed by endoscopist. Methods: Fifty-four consecutive patients, undergoing endoscopic ultrasonography, received sedation with midazolam and pethidine (Group M: n =27) or propofol and fentanyl (Group P: n =27). Group M: pethidine 0.7mg/kg midazolam 0.04mg/kg before examination; boluses of same drugs if the sedation was insufficient plus a sham patient controlled sedation analgesia; Group P: propofol 17mg plus fentanyl 15μg before examination and a patient controlled sedation analgesia pump containing 170mg propofol plus 150μg fentanyl injecting 0.5ml every time the patient pressed the button (no “lock out”). Boluses of 1ml of the same mixture if the sedation was insufficient. Results: Group M: mean dosage of pethidine and midazolam 88.6 and 5mg, respectively. Group P: mean dosage of propofol and fentanyl 119.7mg and 106μg, respectively. Both groups were similar for duration and difficulty of the procedure, the grade of sedation (Observer''s Assessment of Alertness/Sedation Score) and judgement by endoscopist and patient about cooperation and satisfaction. The only difference between groups was about the extra boluses administered during the procedure. Conclusion: This study demonstrated that a patient controlled sedation analgesia with propofol and fentanyl is an effective and safe technique for upper gastrointestinal tract endoscopic ultrasonography procedures and results in a high level of satisfaction both for patients and operator. [Copyright &y& Elsevier]