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Abstract Background Intravenous lidocaine has shown promise as an effective analgesic in various clinical settings, but its utility for pain management in emergency departments, especially for bone fractures, remains relatively understudied. Objective This study compared intravenous lidocaine to pethidine for femoral bone fracture pain management. Methods This double-blind, randomized, controlled clinical trial was conducted in the emergency department of AJA University of Medical Sciences affiliated hospitals. Patients aged 18–70 years-old with femoral bone fracture and experiencing severe pain, defined as a numerical rating scale (NRS) of pain ≥ 7, were included in the study. One group received intravenous pethidine (25 mg), while the other group received intravenous lidocaine (3 mg/kg, not exceeding 200 mg), infused with 250 ml saline over 20 min. Pain levels were evaluated before treatment administration (0 min) and at 10, 20, 30, 40, 50, and 60 min after treatment administration using the NRS. Results Seventy-two patients were enrolled in the study. Demographic characteristics and pain scores were similar between the two groups. The mean pain scores upon arrival for the lidocaine and pethidine groups were 8.50 ± 1 and 8.0 ± 1, respectively; after one hour, they were 4.0 ± 1 and 4.0 ± 1, respectively. While there was a statistically significant reduction in pain in both groups after one hour, there were no clinically or statistically significant differences between the two groups (p = 0.262). Pethidine had a higher incidence of adverse events, though not statistically significant. Additionally, females required more rescue analgesics. Conclusion The administration of intravenous lidocaine is beneficial for managing pain in femoral bone fractures, suggesting that lidocaine could be a potent alternative to opioids. Trial Registration IRCT20231213060355N1 ( https://irct.behdasht.gov.ir/trial/74624 ) (30/12/2023).

Background: Intravenous lidocaine has shown promise as an effective analgesic in various clinical settings, but its utility for pain management in emergency departments, especially for bone fractures, remains relatively understudied. Objective: This study compared intravenous lidocaine to pethidine for femoral bone fracture pain management. Methods: This double-blind, randomized, controlled clinical trial was conducted in the emergency department of AJA University of Medical Sciences affiliated hospitals. Patients aged 18–70 years-old with femoral bone fracture and experiencing severe pain, defined as a numerical rating scale (NRS) of pain ≥ 7, were included in the study. One group received intravenous pethidine (25 mg), while the other group received intravenous lidocaine (3 mg/kg, not exceeding 200 mg), infused with 250 ml saline over 20 min. Pain levels were evaluated before treatment administration (0 min) and at 10, 20, 30, 40, 50, and 60 min after treatment administration using the NRS. Results: Seventy-two patients were enrolled in the study. Demographic characteristics and pain scores were similar between the two groups. The mean pain scores upon arrival for the lidocaine and pethidine groups were 8.50 ± 1 and 8.0 ± 1, respectively; after one hour, they were 4.0 ± 1 and 4.0 ± 1, respectively. While there was a statistically significant reduction in pain in both groups after one hour, there were no clinically or statistically significant differences between the two groups (p = 0.262). Pethidine had a higher incidence of adverse events, though not statistically significant. Additionally, females required more rescue analgesics. Conclusion: The administration of intravenous lidocaine is beneficial for managing pain in femoral bone fractures, suggesting that lidocaine could be a potent alternative to opioids. Trial Registration: IRCT20231213060355N1 (https://irct.behdasht.gov.ir/trial/74624) (30/12/2023). [ABSTRACT FROM AUTHOR]

Background: The use of regional anesthesia for lower limb orthopedic surgery is preferable to general anesthesia. In some studies comparing regional anesthesia and general anesthesia, the one-month mortality of patients undergoing regional surgery was significantly lower. Given the relative advantages observed about intrathecal injection of pethidine, including fewer side effects, and longer postoperative analgesia, in combination with effective sensory, motor, and sympathetic blocks, we sought to compare the influence of intrathecal injection of pethidine and bupivacaine on the hemodynamics of patients. Methods: In this double blind randomized parallel trial, patients undergoing surgery with femoral and hip fractures, were divided into two groups. In the first group bupivacaine and in the second group pethidine were used for spinal anesthesia. Hemodynamic changes were examined and recorded during surgery. The results were analyzed by SPSS18 software Results: 67 patients undergoing surgery with femoral and hip fractures, were divided into two groups of 30 and 37 individuals. The mean heart rate in patients with a high risk of surgery was higher in the group receiving pethidine compared to the group of bupivacaine, with a Cohen's effect size of 0.294. This effect size is evaluated as average, while the rate of mean arterial pressure with Cohen's effect size of 0.511 was evaluated as large. Conclusion: Pethidine can be a good alternative to bupivacaine, especially in patients at high risk of surgery, given its hemodynamic stability.

Abstract Background: Postoperative pain management has been found to reduce postoperative morbidity, length of hospital stays, and overall healthcare cost and increased patient satisfaction. There is currently no gold standard for pain management in the immediate postoperative period following cesarean section. The goal of this study was to assess the effectiveness of nefopam for postoperative pain management in cesarean section compared with pethidine. Materials and Methods: A total of 144 ASA II and III pregnant women scheduled for cesarean section under spinal anesthesia were recruited in the study. The two groups of patients were randomly assigned, receiving either nefopam-dexamethasone (group N) or pethidine-dexamethasone (group P). The measured outcomes were pain scores measured by the numeric rating scale (NRS), time to first analgesic request, side effects. Results: The demographic properties of the patients were comparable. No patients reported moderate or worse pain. Patients in group N reported lower NRS scores compared with group P. However, the differences were not statistically significant. Moreover, the time to first analgesic request was 315.18 ± 103.61 min in group N and 286.86 ± 101.79 min in group P (P = 0.100). No side effects were noted in this study. Conclusion: The combination of nefopam and dexamethasone is equipotent to the combination of pethidine and dexamethasone in pain control after cesarean section and can be proposed as an alternative to opioids postoperatively.

Introduction: Pain after surgery is an unpleasant experience that occurs following various stimuli and people react to it. This process causes physiological disorders in all systems of the body. Therefore, the aim of this study was to compare the effect of ketorolac and pethidine on analgesia after lower limb orthopedic surgery by spinal anesthesia. Methods: In this three-blind randomized clinical trial study, 59 patients with anesthesia class 1 and 2 underwent lower limb orthopedic surgery with spinal anesthesia. Patients were divided into 4 groups, pethidine, ketorolac, placebo and combination of ketorolac and pethidine. VAS scale was used to measure patients' pain. Data analysis was done using descriptive statistics (percentage, frequency, mean and standard deviation) and inferential statistical tests (chi-square, ANOVA, Kruskal-Wallis, Mann-Whitney) at a significance level of P<0.05. Results: Ketorolac, pethidine, placebo and ketorolac + pethidine groups were similar in terms of age, sex and anesthesia class. There was no statistically significant difference between ketorolac, pethidine, placebo and ketorolac + pethidine groups in terms of systolic and diastolic blood pressure and heart rate. Oxygen saturation percentage before and after spinal was significant 15 minutes after surgery (p <0.05). But at other times there was no significant difference (p> 0.05). There was a significant difference in terms of pain in recovery at 6 and 12 hours after surgery (p <0.05). But at other times, the difference was not significant. At 6 hours postoperatively, severe pain was observed in patients in the pethidine and placebo groups and in patients in the ketorolac + pethidine and ketorolac groups; However, at 12 hours postoperatively, severe pain was more common in patients in the pethidine group than in the other groups and was not present in patients in the ketorolac + pethidine group. Conclusion: The results of this study showed that ketorolac and the combination of ketorolac + pethidine reduce analgesia in patients undergoing orthopedic lower limb surgery. It is recommended that the combination of these two drugs be used in orthopedic surgery of the lower and even upper limbs. [ABSTRACT FROM AUTHOR]

Background and purpose: A bone marrow examination is necessary to diagnose some hematologic diseases. In this study, we compared the effects of acetaminophen and promethazine versus intravenous injections of midazolam and pethidine on pain reduction after bone marrow sampling. Materials and methods: In this study, 88 patients were divided into two groups. The first received one gram of acetaminophen as an infusion and 25 milligrams of promethazine syrup 30 minutes before the procedure. The second group received intravenous injections of 25 milligrams of pethidine and 5 milligrams of midazolam five minutes before the procedure. In two groups, local anesthesia with lidocaine was given before the procedure. The pain and presence of anxiety in the patients were assessed using a 10-point Likert scale. Results: We analyzed the results of 88 patients. At 30 minutes after sampling, patients in the pethidine-midazolam group reported lower pain compared to those in the promethazine-acetaminophen group (1.18±0.90 vs. 1.77±0.99) (P=0.004). This difference was particularly notable among men (0.90±0.98 vs. 0.99±1.67) (P=0.001). Among men, those older than 30 years showed a reduction in pain (1.01±0.9 vs. 0.99±1.46) (P=0.049). No significant difference was observed between the two groups in terms of pain immediately after sampling. The administration of promethazine and acetaminophen showed a more positive future perspective in patients older than 46 years (P=0.033). Additionally, the average incidence of anxiety 30 minutes after the procedure was 27.3% in the pethidine-midazolam group and 22.7% in the promethazine-acetaminophen group. However, there was no significant difference in the level of anxiety between the two groups (P=0.806). Conclusion: Based on our data, the combination of promethazine and acetaminophen had similar analgesic effects to the combination of pethidine and midazolam immediately after sampling. As a result, according to the various side effects of pethidine and midazolam, especially in patients with respiratory diseases and outpatients, the combination of promethazine and acetaminophen can be used. (Clinical Trials Registry Number: IRCT20200427047215N2)

Background and Objectives: Long and ineffective labor causes hardships for mothers and doctors and increases the rate of cesarean sections and medical comorbidities. Several factors contribute to effective and less painful labor, including maternal age, parity, fetal characteristics, and the medications or procedures that obstetricians use for labor. We aimed to study the factors that affect labor duration and identify those that make labor more effective. Materials and Methods: This retrospective study included 141 patients who underwent normal vaginal deliveries at the Daegu Catholic University Medical Center between April 2013 and April 2022. Among the 141 patients, 44 received pethidine intravenously, 88 received oxytocin intravenously, and 64 received epidural anesthesia. The duration of the active phase and second stage of labor were recorded according to the findings of a manual examination of the cervix and continuous external electronic monitoring. We analyzed maternal and neonatal medical records and performed binomial logistic regression to identify the factors associated with a shorter active phase of labor. The clinical outcomes in mothers and neonates were also evaluated. Results: Among the various clinical factors, multiparity (odds ratio of parity 0.325) and the use of pethidine (odds ratio 2.906) were significantly associated with shortening the active phase of labor to less than 60 min. The use of epidural anesthesia or oxytocin was not significantly associated with reducing the active phase of labor. When patients were divided into two groups based on whether a pethidine injection had been used during labor, the duration of the active phase was shorter in the pethidine injection group than in the control group for both nulliparas and multiparas. No significant differences in the duration of the second stage of labor were observed between the pethidine injection and control groups. There were no significant differences in pregnancy outcomes, including the need for mechanical ventilation of neonates, Apgar scores, neonatal intensive care unit admissions, number of precipitous deliveries, maternal adverse side effects of drugs, or duration of maternal hospitalization between the two groups. Conclusions: Pethidine can be safely administered to women during labor to help reduce the duration of the active phase by promoting dilatation of the cervix and preventing complications that may result from prolonged labor. Pethidine may be helpful, especially for those who cannot receive epidural anesthesia or who cannot afford it. However, large-scale randomized controlled studies are required to evaluate the efficacy and safety of this drug during labor. Furthermore, it would be helpful if various studies were conducted depending on the timing of administration and indications for delivery. [ABSTRACT FROM AUTHOR]

Background and purpose: A bone marrow examination is necessary to diagnose some hematologic diseases. In this study, we compared the effects of acetaminophen and promethazine versus intravenous injections of midazolam and pethidine on pain reduction after bone marrow sampling. Materials and methods: In this study, 88 patients were divided into two groups. The first received one gram of acetaminophen as an infusion and 25 milligrams of promethazine syrup 30 minutes before the procedure. The second group received intravenous injections of 25 milligrams of pethidine and 5 milligrams of midazolam five minutes before the procedure. In two groups, local anesthesia with lidocaine was given before the procedure. The pain and presence of anxiety in the patients were assessed using a 10-point Likert scale. Results: We analyzed the results of 88 patients. At 30 minutes after sampling, patients in the pethidine-midazolam group reported lower pain compared to those in the promethazine-acetaminophen group (1.18±0.90 vs. 1.77±0.99) (P=0.004). This difference was particularly notable among men (0.90±0.98 vs. 0.99±1.67) (P=0.001). Among men, those older than 30 years showed a reduction in pain (1.01±0.9 vs. 0.99±1.46) (P=0.049). No significant difference was observed between the two groups in terms of pain immediately after sampling. The administration of promethazine and acetaminophen showed a more positive future perspective in patients older than 46 years (P=0.033). Additionally, the average incidence of anxiety 30 minutes after the procedure was 27.3% in the pethidine-midazolam group and 22.7% in the promethazine-acetaminophen group. However, there was no significant difference in the level of anxiety between the two groups (P=0.806). Conclusion: Based on our data, the combination of promethazine and acetaminophen had similar analgesic effects to the combination of pethidine and midazolam immediately after sampling. As a result, according to the various side effects of pethidine and midazolam, especially in patients with respiratory diseases and outpatients, the combination of promethazine and acetaminophen can be used. [ABSTRACT FROM AUTHOR]

The rats model has never thoroughly investigated the influence of tramadol on plasma pethidine concentration besides pethidine pharmacokinetics. Individually, analgesic ED50s for pethidine and tramadol are estimated as 3.55 and 24.21 mg/kg, i.p. Subsequently, their measures decreased to 1.65 and 11.27 mg/kg, i.p., when both were given in combination at 1:1 from ED50s. Tramadol and pethidine have a form of synergistic analgesic interaction, which is therefore classified as a pharmacodynamic interaction. Pethidine (7.1mg/kg, i.p.) reveals the plasma concentration of 369.00, 493.33, 373.33, 305.33, 306.33 and 247.67 µg/ml that was measured over distinctive times of 0.25,0.5,1,2,4, and 24 hours. At the same time, the concentration of plasma levels of tramadol and pethidine (48.42 and 7.1mg/kg, i.p., correspondingly) declined to 229.33, 268.33, 233.00, 198.33, 195.67 and 180.33 µg/ml by 38, 46, 38, 35, 36 and 27%, respectively. Tramadol affected the pethidine pharmacokinetics through an elevation in the area-under-curve (AUC0-∞) 49%, area-under-moment-curve (AUMC0-∞) 343%, mean-residence-time (MRT) 137%, half-life (t1/2β) 136%, and the distribution volume (Vss) 64%. Other estimated pharmacokinetic measures were reduced which included maximal concentration (Cmax) 47% and elimination rate constant (Kel) 60%. In general, the findings revealed a synergism as a mode of pharmacological interaction between pethidine and tramadol, in addition to a change in pethidine pharmacokinetics, which could improve pethidine effectiveness in the rat’s model.

Background and Aim: Treatment of acute postoperative pain is one of the most important measures to improve recovery. Different methods of local and regional anesthesia, and also numerous intravenous drugs have been used. In this study, the analgesic effect ketorolac, paracetamol and pethidine in the postoperative pain control of outpatient transurethral lithotripsy was evaluated. Materials and Methods: This clinical trial was performed on 96 patients who were candidates for outpatient transurethral lithotripsy in Mashhad Imam Reza Hospital. In randomized double blinded study, at the end of the operation, 30 mg of intravenous ketorolac to the first group, 1 gram paracetamol in half an hour to the second group and 50 mg of pethidine to the third group were injected. Pain was assessed every 10 minutes to half an hour and then, every half an hour to 4 hours by numerical rating scale (NRS). Finally, the data were analyzed by SPSS v16 software. The relationship between quantitative variables was analyzed by analysis of variance and the qualitative variables was assessed by Chi-square test and P

The article presents a case of a patient treated with pethidine for several years due to stump pain. Due to numerous somatic (symptoms associated with concomitant cancer), mental (depressive and anxiety disorders), and social (disability) burdens, insufficient support from the environment, and improperly conducted pain therapy, the patient independently sought ways to cope with a difficult situation, which led to pethidine addiction. The use of the drug brought the patient temporary relief in the physical dimension. However, it led to the consolidation of incorrect behaviour and deterioration of quality of life. The paper presents the rotation of opioids used in the discussed case, which resulted in satisfactory analgesia. The description of the case was supplemented with a psychologist's comment. [ABSTRACT FROM AUTHOR]

Background: Currently, there is a lack of an established standard or protocol for the management of post-spinal anesthesia shivering (PSAS). We compared the efficacy of intravenous use of three drugs, e.g., acetaminophen, dexamethasone, and pethidine in prevention of PSAS. Methodology: We included 108 patients who were randomly assigned to three equal groups of 36 patients each. Group A patients received pethidine infusion at 0.5 mg/kg; Group B patients were infused with acetaminophen 15 mg/kg and Group C was given dexamethasone infusion at 0.1 mg/kg. The degree of shivering at its onset was determined using the Bedside Shivering Assessment Scale (BSAS). Data was analyzed using Statistical Package for Social Science (SPSS) version 22. Results: PSAS was observed in 10 (27.7 %) patients in Group A vs. 14 (38.8 %) patients in Group B (P = 0.32), and 21 (58.3 %) patients of Group C (P = 0.01). The P-value between B vs C was 0.10, and between all the groups was 0.03. The BSAS score was 26 in Group A (75% patients out of 36 did not develop shivering), 22 in Group B, and 15 in Group C. The P-value between A vs. B was 0.01, A vs. C = 0.01, B vs. C = 0.12, and between all groups was 0.02. Conclusion: Aacetaminophen was more effective than dexamethasone, while pethidine was more effective than both, acetaminophen as well as dexamethasone, in decreasing the incidence of post-spinal anesthesia shivering. [ABSTRACT FROM AUTHOR]

Background Patients undergoing abdominal surgeries may benefit from an ultrasound-guided quadratus lumborum block (QLB) as one of the postoperative pain management techniques. Objective This study compares the effects of bilateral ultrasound guided Transversus abdominis plane (TAP) block versus bilateral ultrasound guided QLB on postoperative analgesia in patients having laparoscopic sleeve gastrectomy (LSG) under general anaesthesia (GA). Patients and methods 45 patients who were scheduled for elective LSG participated in a randomized controlled trial. All patients were given 1--2 μg/kg of intravenous fentanyl as intraoperative narcotic during GA. QLB Group (15 patients): received ultrasoundguided QLB using 0.2 mL/kg of 0.25%bupivacaine per side after induction of general anaesthesia.TAPGroup (15patients): received ultrasound-guidedTAPblock using 0.2 mL/kg of 0.25% bupivacaine per side after induction of general anaesthesia. Control Group (15 patients): received general anaesthesia and then 1 gm IV paracetamol and 30mg IV ketorolac within first hour and 8 h postoperative. Results QLB group used pethidine as rescue analgesia mush less than other groups with highly statistically significant difference (P value<0.001). Also, there was statistically significant difference between groups innumber of patients needed rescue analgesia (60% of QLB group, 86.7% of TAP group and 100% of control group). Also, the QLB group had superior clinical pain scores than the other groups with a statistically significant difference at PACU arrival, 30 min, 2 h, and 4 h postoperative. The TAP group had a lower VAS score than the control group, with a statistically significant difference at PACU arrival and 4 h postoperative. In comparison to the TAP group, the VAS score was lower in the QLB group, with a statistically significant difference at 30 min postoperatively. MAP was significantly lower in the QLB group than in the control group at PACU entry, 30 min, and 6 h postoperatively. However, MAP was lower in the QLB group than in the TAP group, with a statistically significant difference only at the 12- and 24-hour post-operative time points. HR was less significantly in QLB group than control group at 30, 2, 12, 24 h postoperatively, when comparing the HR between the QLB and TAP groups, the difference became statistically significant only at the 12-hour post-operative time. Conclusion In compared to TAP block and IV analgesics, QLB was the most efficient method for delivering analgesia following LSG. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative shivering is a common complication in pregnant women undergoing cesarean section with spinal anesthesia, and since no ideal method has been proposed to prevent this complication, the present study was performed aimed to compare the effect of intravenous injection of pethidine and dexmedetomidine in prevention of shivering after cesarean section under spinal anesthesia. Methods: This double-blind randomized clinical trial study was performed in 2019-2020 on 90 women candidates for cesarean section with spinal anesthesia in Alzahra and Shahid Beheshti hospitals of Isfahan. The subjects were randomly assigned to three groups (n=30 in each group). The first group received 0.25 mg pethidine, the second group 0.1 μg/kg dexmedetomidine and the third group received the same volume of normal saline. The drugs were injected intravenously immediately after fetal removal and umbilical cord clamp, and the incidence and severity of shivering in recovery were evaluated. Data were analyzed by SPSS statistical software (version 25) and One-way analysis of variance, analysis of variance with repeated observations, Chi-square and Wilcoxon tests. P< 0.05 was considered statistically significant. Results: There was a significant difference between the three groups in the incidence of shivering (P

Background and Objectives: Long and ineffective labor causes hardships for mothers and doctors and increases the rate of cesarean sections and medical comorbidities. Several factors contribute to effective and less painful labor, including maternal age, parity, fetal characteristics, and the medications or procedures that obstetricians use for labor. We aimed to study the factors that affect labor duration and identify those that make labor more effective. Materials and Methods: This retrospective study included 141 patients who underwent normal vaginal deliveries at the Daegu Catholic University Medical Center between April 2013 and April 2022. Among the 141 patients, 44 received pethidine intravenously, 88 received oxytocin intravenously, and 64 received epidural anesthesia. The duration of the active phase and second stage of labor were recorded according to the findings of a manual examination of the cervix and continuous external electronic monitoring. We analyzed maternal and neonatal medical records and performed binomial logistic regression to identify the factors associated with a shorter active phase of labor. The clinical outcomes in mothers and neonates were also evaluated. Results: Among the various clinical factors, multiparity (odds ratio of parity 0.325) and the use of pethidine (odds ratio 2.906) were significantly associated with shortening the active phase of labor to less than 60 min. The use of epidural anesthesia or oxytocin was not significantly associated with reducing the active phase of labor. When patients were divided into two groups based on whether a pethidine injection had been used during labor, the duration of the active phase was shorter in the pethidine injection group than in the control group for both nulliparas and multiparas. No significant differences in the duration of the second stage of labor were observed between the pethidine injection and control groups. There were no significant differences in pregnancy outcomes, including the need for mechanical ventilation of neonates, Apgar scores, neonatal intensive care unit admissions, number of precipitous deliveries, maternal adverse side effects of drugs, or duration of maternal hospitalization between the two groups. Conclusions: Pethidine can be safely administered to women during labor to help reduce the duration of the active phase by promoting dilatation of the cervix and preventing complications that may result from prolonged labor. Pethidine may be helpful, especially for those who cannot receive epidural anesthesia or who cannot afford it. However, large-scale randomized controlled studies are required to evaluate the efficacy and safety of this drug during labor. Furthermore, it would be helpful if various studies were conducted depending on the timing of administration and indications for delivery.

Introduction: The pain relief effect of Paracetamol, as a safe analgesic drug in labor, compared to Pethidine, as a well-known analgesic drug, need to be more evaluated. Objective: This study aims to compare the effects of Paracetamol and Pethidine on the first-stage labor pain relief and neonatal and maternal complications. Materials and Methods: This single-blind, parallel group, randomized clinical trial conducted on 100 nulliparous pregnant women referred to a maternity hospital in Rafsanjan Iran in 2018 who were selected using a convenience sampling method and by assigned into two groups Paracetamol (n=49, receiving 100 mg intravenous Paracetamol) and Pethidine (n= 51, receiving 50 mg intravenous Pethidine) using the minimization method. The drugs were administered when there was at least a 4-cm cervical dilation. Maternal complications and infant’s 1 and 5-min the Apgar scores and ability to breastfeed were evaluated. Pain intensity measured by the Visual Analogue Scale (VAS) and compared using two-way repeated measures ANOVA before and 30 minutes, 1, 2, 3 and 4 hours after drug administration. Results: There were no significant differences between the two groups in term of age, body mass index, and gestational age, and no significant difference in pain intensity in any groups among the time points. Maternal complications were significantly lower in the Paracetamol group than in the Pethidine group; however, the difference was statistically significant only in terms of nausea (P=0.04). Infants’ breastfeeding ability was significantly better in Paracetamol group than in the Pethidine group (P=0.04). The results of two-way ANOVA showed that the mean VAS score was not significantly different between the two groups. Conclusion: Paracetamol can alleviate the first-stage labor pain similar to Pethidine, but with fewer maternal and neonatal complications.

Abstract Background Bronchoscopy can be a distress for the patient. There have been few studies on the combination of sedatives and opioids. The aim of this study was to demonstrate the usefulness and safety of administration of the combination of midazolam and pethidine during bronchoscopy. Methods In this prospective randomized single (patient)-blind study, we randomly assigned 100 patients who were scheduled to undergo bronchoscopy biopsy to receive treatment with either the midazolam/pethidine combination (combination group) or midazolam alone (midazolam group) during examinations. After the end of bronchoscopy, patients completed a questionnaire and the visual analogue scale was measured. The primary outcome was the patients’ acceptance of re-examination assessed by visual analogue scale. We also assessed pain levels, vital signs, midazolam use, xylocaine use, and adverse events. Univariate analyses were performed using Fisher’s exact test for categorical data, and the t-test or Mann-Whitney test was carried out for analysis of numeric data. All P-values were two-sided, and values

Abstract Background Massage during labour is one form of intrapartum non-pharmacological pain relief but it is not known whether the frequency of practicing these massage techniques among couples during the antenatal period could enhance the effectiveness of intrapartum massage. This study was to evaluate the association between compliance of antenatal massage practice with intrapartum application and their impact on the use of analgesics during labour. Methods This was a sub-analysis of a childbirth massage programme which was carried out in two public hospitals with total births of around 8000 per year. Data from women who were randomized to the massage group were further analysed. After attending the pre-birth training class on massage at 36 weeks gestation, couples would be encouraged to practice at home. Their compliance with massage at home was classified as good if they had practiced for at least 15 minutes for three or more days in a week, or as poor if the three-day threshold had not been reached. Application of intrapartum massage was quantified by the duration of practice divided by the total duration of the first stage of labour. Women’s application of intrapartum massage were then divided into above and below median levels according to percentage of practice. Logistic regression was used to assess the use of epidural analgesia or pethidine, adjusted for duration of labour and gestational age when attending the massage class. Results Among the 212 women included, 103 women (48.6%) achieved good home massage compliance. No significant difference in the maternal characteristics or birth outcomes was observed between the good and poor compliance groups. The intrapartum massage application (median 21.1%) was inversely associated with duration of first stage of labour and positively associated with better home massage practice compliance (p = 0.04). Lower use of pethidine or epidural analgesia (OR 0.33 95% CI 0.12, 0.90) was associated with above median intrapartum massage application but not antenatal massage compliance, adjusted for duration of first stage of labour. Conclusions More frequent practice of massage techniques among couples during antenatal period could enhance the intrapartum massage application, which may reduce the use of pethidine and epidural analgesia. Trial registration (CCRBCTR) Unique Trial Number CUHK_ CCRB00525 .

Introduction: Proper management of labor and proper anesthesia is very important in order to create pain relief and maintain the health of mother and fetus during cesarean section. Therefore, this study was performed aimed to compare the effect of adding pethidine to 0.5% bupivacaine and 0.5% bupivacaine on pain intensity in women undergoing elective cesarean section with spinal anesthesia referred to Motahhari Hospital. Methods: This double-blind randomized clinical trial study was performed in 2021 on 60 patients undergoing elective cesarean section referred to Motahhari Hospital in Jahrom. Using the random number table, the patients were randomly divided into two groups: bupivacaine-pethidine and ropivacaine-pethidine. Patients' pain was assessed during entry into recovery, exit from recovery, 2, 6, 12 and 24 hours after the surgery. Data were analyzed using SPSS software (version 21) and T-test, Mann-Whitney and Chi-square test. P 0.05), pain intensity after cesarean section during recovery and postoperative periods (P >0.05), and opiate use in 12 hours after the surgery (P >0.05). Conclusion: There was no significant difference between the groups of pethidine + ropivacaine and pethidine + bupivacaine in terms of pain intensity. The anesthesiologist can use either ropivacaine or bupivacaine in spinal anesthesia, depending on the patient's condition.

Objective: To assess the efficacy of Pethidine versus Tramadol in controlling shivering after spinal anaesthesia in patients selected for lower limb surgery. Study Design: Quasi-experimental study Place and Duration of the Study: Department of Anaesthesiology, Combined Military Hospital, Multan Pakistan, from Jun 2019 to Dec 2020. Methodology: Seventy-four individuals (aged: 18 to 65 years) selected through non-probability consecutive sampling for elective lower limb orthopaedic procedures under spinal anaesthesia were included in the study. The patients were distributed among two groups through computer-generated random numbers to receive Tramadol at a dose of 0.5 mg/kg (Group-T) or Pethidine at 0.5 mg/kg (Group-P). The frequency of post-anaesthetic shivering was recorded in all patients. Results: The average age of patients in Groups T and P were 30.2 ± 9 years and 34.5 ± 10 years, respectively. Fifty (67.6%) patients were males, while 24(32.4%) were females. Post-anaesthetic shivering was reported in 37(78.7%) patients in the Tramadol- Group compared to 26(96.3 percent) patients in the Pethidine- Group (p = 0.041). Conclusion: Tramadol caused less post-anaesthetic shivering than Pethidine after spinal anaesthesia in our sample of patients undergoing lower limb surgery.

Aim and Objective: To compare the analgesic effectiveness of the patient-controlled inhaled nitrous oxide (Entonox®) with intravenous opioids (pethidine/midazolam) in reducing pain during minor gynecological operative procedures, including manual vacuum aspiration (MVA), fractional curettage and dilatation and curettage. Materials and Methods: Patients undergoing minor gynecological procedures from August 2021 to December 2022 were randomized to receive nitrous oxide or intravenous pethidine (50–75 micrograms) plus midazolam (2 mg). Pain scores during and post-procedure, satisfaction level, and side effects were assessed and compared. Results: A total of 106 patients met the inclusion criteria, including 53 in the pethidine/midazolam group and 53 in the nitrous oxide group. Baseline characteristics were comparable (p-value > 0.05). Pain scores during, immediately and 30 min after procedures were not significantly different in two groups (4.94 ± 3.15, 2.74 ± 2.57, 1.58 ± 2.13 vs. 5.47 ± 2.80, 2.98 ± 2.70, 1.64 ± 2.70; p-value: 0.174, 0.634, 0.889, for pethidine/midazolam vs. nitrous oxide group, respectively. Satisfaction scores were comparable in both groups (p-value > 0.05). However, the rate of side effects was significantly lower in the nitrous oxide group (3.8% vs. 28.3%; p-value 0.001). Additionally, the discharge scores showed a significantly faster recovery time in the nitrous oxide group at 60 and 90 min after the procedure; median (IQR): 10 (9–10) vs. 9 (8–10) and 10 (10–10) vs. 10 (8.5–10); p-value 0.002 and 0.029, respectively). Conclusions: Nitrous oxide is as effective as pethidine/midazolam for pain relief in minor gynecological operative procedures but associated with significantly lower side effects and significantly faster recovery time. [ABSTRACT FROM AUTHOR]

Background and Aim: Treatment of acute postoperative pain is one of the most important measures to improve recovery. Different methods of local and regional anesthesia, and also numerous intravenous drugs have been used. In this study, the analgesic effect ketorolac, paracetamol and pethidine in the postoperative pain control of outpatient transurethral lithotripsy was evaluated. Materials and Methods: This clinical trial was performed on 96 patients who were candidates for outpatient transurethral lithotripsy in Mashhad Imam Reza Hospital. In randomized double blinded study, at the end of the operation, 30 mg of intravenous ketorolac to the first group, 1 gram paracetamol in half an hour to the second group and 50 mg of pethidine to the third group were injected. Pain was assessed every 10 minutes to half an hour and then, every half an hour to 4 hours by numerical rating scale )NRS(. Finally, the data were analyzed by SPSS v16 software. The relationship between quantitative variables was analyzed by analysis of variance and the qualitative variables was assessed by Chi-square test and P<0.05 was considered significant. Results: There was no significant difference between three groups in demographic information. The pain intensity in the first 10 minutes after surgery was the same between the groups (P=0.372), but the pain intensity at 20, 30 and 60 minutes after surgery was significantly different in the three groups )P.values 0.005, 0.006, and 0.001 respectively(, and was lower in the pethidine group. In other hours after surgery, no significant difference in pain control was observed between the three groups. The need for additional analgesia was higher in the paracetamol group than in the other two groups (P=0.025) in the first hour. Hemodynamic changes and surgical complications such as nausea and vomiting were the same in both groups. Conclusion: The present study showed that pethidine causes better pain relief than ketorolac and paracetamol in the first hour after surgery, but after 60 minutes there is no significant difference between these three groups. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the effectiveness of caudal block (CB) using dexmedetomidine and pethidine instead of local anesthesia (LA) for prostate needle biopsy and the effect of CB on urinary retention. Material and Methods A transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) was performed on 68 patients with a mean age of 65 ± 2.18 years. CB with a combination of dexmedetomidine and pethidine without LA was administered to the patients. The pain levels of the patients were determined using numeric rating scale (NRS) scores to evaluate the effectiveness of CB. Preoperative and postoperative postvoid residual urine volumes (PRUV) were also calculated. Results The CB success rate was 93.15%. The NRS scores were 0.79 ± 0.19 and 0.89 ± 0.22 during probe entry and manipulation and biopsy, respectively, without any significant differences between them (p = 0.382). The mean PRUVs before and after biopsy did not differ significantly (41 ± 15.6 vs. 71.93 ± 22.3, p = 0.379). The degree of sedation, as assessed using the Ramsay scale, was 2 or 3 in all patients. Conclusion The combination of dexmedetomidine and pethidine for CB in TRUS-Bx provided quality analgesia for the patient and prevented the development of postoperative urinary retention.

Background: The search for the ideal analgesia following caesarean section remains elusive but opioids provide good postoperative analgesia. Intramuscular opioid induces pain at the site of injection and its repeated administration proved to be more demanding for caregivers. Oral opioids especially morphine have become increasingly accessible in our environment and may be more effective than the conventional parenteral opioids for postcaesarean analgesia. Aim: To compare the efficacy of multiple doses of 10 mg oral morphine with that of 50 mg intramuscular pethidine in treatment of postcaesarean pain among parturients in Abeokuta, Nigeria. Patients, Materials and Methods: The study was a randomised controlled trial among parturients who had elective caesarean section in Abeokuta between November 2019 and August 2020. A total of 136 consenting and eligible pregnant women were randomised into two groups. Group A received multiple doses of 10 mg oral morphine while Group B had multiple doses of 50 mg intramuscular pethidine. The summed pain intensity difference (SPID) of the two groups was calculated and compared using the Chi-square and P < 0.05 was statistically significant. Results: The mean ± standard deviation (SD) of SPID at rest for morphine group and pethidine group was 6.00 ± 76.25 and 8.51 ± 77.60, respectively (t = −0.439 P = 0.662); the mean ± SD of SPID on movement for morphine and pethidine group was 29.13 ± 75.25 and 25.52 ± 28.47 (t = 0.139, P = 0.890). The median maternal satisfaction reported was similar in both groups (χ2 = 2.773, P = 0.4963) and somnolence was experienced in 3.1% of parturients in morphine group. Conclusion: The efficacy and maternal satisfaction of oral morphine in the control of postcaesarean section pain was similar to that of intramuscular pethidine. Hence, oral morphine is an acceptable alternative to intramuscular pethidine in management of pain following Caesarean section.

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 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. [ABSTRACT FROM AUTHOR]

Pethidine is a short and fast-acting synthetic opioid that has a high potential for abuse and addiction compared to other opioids. It is popularly used in the management of pain such as pancreatitis, and cholecystitis peri- and post-operations. Among patients, addiction to pethidine is usually induced unintentionally by a health worker in the course of treating the patient’s pain. Addiction to pethidine is a common but silent problem for healthcare workers such as doctors, nurses, and midwives, and it is often underreported. Childhood adversity and co-dependency roles by family members have been linked to the development and maintenance of addiction to psychoactive substances including pethidine. This case study on a midwife with pethidine addiction in Uganda is a call to draw attention to childhood adversity and co-dependency roles in pethidine addiction.

Background: ultrasound-guided quadratus Lumborum block (QLB) performed as one of the postoperative pain management procedures for patients undergoing abdominal surgeries. Objective: The aim of this study is to compare the effect of ultrasound guided bilateral QLB versus bilateral ultrasound guided Transversus abdominis plane (TAP) block on postoperative analgesia in patients undergoing laparoscopic sleeve gastrectomy (LSG) under general anesthesia. Patients and Methods: Setting and design: pilot exploratory study conducted on 45 patients scheduled for elective LSG. All patients received general anesthesia using IV fentanyl (1-2 Mg/kg). QLB Group (15 patients): received ultrasound-guided QLB after induction of general anesthesia using 0.2 mL/kg of 0.25% bupivacaine per side. TAP Group (15 patients): received ultrasound-guided TAP block after induction of general anesthesia using 0.2 mL/kg of 0.25% bupivacaine per side. Control Group (15 patients): received general anesthesia and then 1gm IV paracetamol and 30mg IV ketorolac 1 hour and 8 hour postoperative. Results: there was statistically significant difference between the three groups as regards the VAS score, total dose of pethidine used postoperatively, number of patients needed rescue analgesia and postoperative hemodynamics; indicating that TAP block was more effective than intravenous drug analgesia, while QLB was more effective than TAP block. Conclusion: QLB was the most effective technique in providing analgesia after LSG in comparison to TAP block and intravenous analgesic drugs. [ABSTRACT FROM AUTHOR]

Background: Hydromorphone patient-controlled analgesia (PCA) provides satisfactory postoperative pain therapy, but its effect has not been assessed in acute pancreatitis (AP). Aim: To assess the safety and efficacy of intravenous hydromorphone PCA for pain relief in AP. Methods: This open-label trial included AP patients admitted within 72 h of symptom onset, aged 18-70 years old, and with Visual Analog Scale (VAS) for pain intensity =5. They were randomized to receive intravenous hydromorphone PCA (0.05 mg/h with 0.2 mg on-demand) or intramuscular pethidine (50 mg as required) for three consecutive days. Intramuscular dezocine (5 mg on demand) was the rescue analgesia. The primary outcome was the change of VAS score recorded every 4 h for 3 days. Interim analysis was conducted by an Independent Data and Safety Monitoring Committee (IDSMC). Results: From 26 July 2019 to 15 January 2020, 77 patients were eligible for the intention-to-treat analysis in the interim analysis (39 in the hydromorphone group and 38 in the pethidine group). Baseline parameters were comparable between groups. No difference in VAS between the two groups was found. Hydromorphone PCA was associated with higher moderately severe to severe cases (82.1% vs. 55.3%, p = 0.011), acute peripancreatic fluid collections (53.9% vs. 28.9%, p = 0.027), more cumulative opioid consumption (median 46.7 vs. 5 mg, p < 0.001), higher analgesia costs (median 85.5 vs. 0.5 $, p < 0.001) and hospitalization costs (median 3,778 vs. 2,273 $, p = 0.007), and more adverse events (20.5% vs. 2.6%, p = 0.087). The per-protocol analysis did not change the results. Although a sample size of 122 patients was planned, the IDSMC halted further recruitment as disease worsening or worse clinical outcomes between the groups in the interim analysis. Conclusion: Hydromorphone PCA was not superior to pethidine in relieving pain in AP patients and might have worse clinical outcomes. Therefore, its use is not recommended. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare the quality of sedation with three different anaesthetic protocols (alfaxalone combined with butorphanol, methadone or pethidine) administered intramuscularly in cats, and to evaluate the influence of the injection site (between supraspinatus and quadriceps muscles) on the onset and quality of sedation. Methods: A total of 151 cats were selected for this study. Cats were sedated with alfaxalone (3 mg/kg) combined with either butorphanol (0.3 mg/kg; n = 50), methadone (0.3 mg/kg; n = 53) or pethidine (5 mg/kg; n = 48). The combination was injected intramuscularly into the supraspinatus (n = 79) or quadriceps muscle (n = 72). The data included a scoring system for the quality of sedation and physiological parameters, such as heart rate (HR), respiratory rate, body temperature and occurrence of mydriasis, monitored during the first 30 mins of anaesthesia. Results: The opioid associated with alfaxalone influenced the overall sedation score, the degree of myorelaxation, the occurrence of mydriasis and HR. The overall sedation score was poorer with butorphanol than with methadone (P = 0.008), and butorphanol induced a lower degree of myorelaxation than methadone (P = 0.013). The injection into the supraspinatus showed better qualitative results for sedation and a faster onset time (in about 3 mins) than that into the quadriceps (P <0.001). HR decreased from baseline (P <0.001) and over time (P <0.001), mainly in cats of the butorphanol–supraspinatus and pethidine–quadriceps groups (P = 0.004). The occurrence of mydriasis was lower after butorphanol than after methadone and pethidine (P = 0.025), while the incidence of side effects did not differ among groups. Conclusions and relevance: All three protocols provided a good quality of sedation and allowed performing the scheduled procedure. Moreover, the injection into the supraspinatus muscle showed superior results in all the qualitative scores of sedation and quicker onset time than that into the quadriceps muscle. [ABSTRACT FROM AUTHOR]

BackgroundShivering is the most common and unpleasant complication of anesthesia with an incidence of 70.7% in cesarean section done under spinal anesthesia which is associated with cardiovascular and respiratory complications. Even though it causes such devastating complications; the prevention of shivering is not well investigated. This study aimed to assess the effect of intrathecal pethidine on the incidence and severity of shivering in patients undergoing cesarean section under Spinal anesthesia.Materials and MethodsAfter obtaining ethical clearance double-blinded single centered a randomized controlled trial was conducted in a total of 86 pregnant mothers who were randomly allocated into two groups by computer-generated random number. Approximately 1 ml of 10 mg preservative-free pethidine was added to 12.5 mg of 0.5% bupivacaine for spinal anesthesia in the treatment group and 12.5 mg of 0.5% bupivacaine alone was given in the control group. Incidence and severity of shivering, as well as adverse effect was recorded intraoperatively, in post-anesthesia care unit (PACU) and ward. Independent sample t-test, Mann–Whitney U test and chi-square were used for analysis. A p-value less than 0.05 was considered statistically significant.ResultsShivering was observed in 53.5 and 20.9% in the control and treatment groups, respectively, which was statistically significant with p = 0.002. The risk of developing shivering was reduced by 61% in the treatment group with (RR = 0.39 and CI of 0.205–0.745); the intensity of shivering was also higher in the control group than in the treatment group with p = 0.004. Considering an adverse effect, the incidence of PONV was not significantly different between with p > 0.05 while the incidence of pruritus was higher in the treatment group than the control group with p = 0.003.ConclusionAdding 10 mg of preservative free pethidine intrathecally during spinal anesthesia is effective in reducing incidence and severity of shivering, without causing significant adverse effects on mother.

Background: A standard obstetric analgesic should have a good analgesic effect without reducing the intensity of uterine contraction. The present study aimed to evaluate and compare the efficacy of intramuscular tramadol and pethidine on labor pain and duration. Material and Methods: A total of 170 multigravida women in active labor were randomly assigned to two identical groups, so that 85 pregnant women received pethidine (50mg/2ml) and 85 pregnant women received tramadol (100mg/2ml) intramuscularly. Results: The labor duration in the tramadol group was shorter than in the pethidine group. In 1st stage of labor, 64.7% of the participants in the tramadol group received the drug for 120±30 minutes, while 67.1% in the pethidine group received the drug for 180±30 minutes. In the 2nd stage, 44.7% of the participants in the tramadol group received the drug for 15±5 minutes, while 51.8% in the pethidine group received the drug for 25±5 minutes. The Visual Analog Scale (VAS) was used before, and 1 and 3 hours after drug administration. The pethidine group obtained a lower VAS mean score compared to those in the tramadol group at 1 hour after drug administration (4 vs 6; P≤.001). Moreover, there was a significant higher level of vomiting and dizziness among women in the pethidine group (29.4% vs 1.2%; P≤.001). Conclusion: Tramadol appears to lead to a shorter labor duration and cause lower maternal side-effects, although its analgesic efficacy was not as much as pethidine.

Objective: To compare the effectiveness of Ketamine vs Pethidine for treating postoperative shivering in patients undergoing surgery under general anaesthesia. Study Design: Quasi-experimental study. Place and Duration of Study: Operation Theatre, Combined Military Hospital Sialkot Pakistan, from Jan to Apr 2020. Methodology: Following strict inclusion and exclusion criteria, patients who experienced postoperative shivering in the postanesthesia care unit (recovery) were enrolled through consecutive sampling and randomized into group-A or group B using the lottery method. Group-A received Pethidine 0.5 mg/kg and Group-B received Ketamine 0.2 mg/kg. The shivering grade was evaluated at 0 minutes and 5 minutes after administration of drugs by using a validated four-point scale. Results: Mean age of the patients was 34.12 ± 9.88 years and 34.83 ± 9.77 years in group-A and group B, respectively. At 5 min, the recovery rate of shivering was significantly higher in the Pethidine group than in the Ketamine group. In group-A, effecttiveness (grade 0) was noticed in 124 patients (86.2%) and in group-B effectiveness (grade-0) was seen in 74 patients (51.4%). A statistically significant difference (p<0.01) was found between the two groups. Conclusion: Pethidine 0.5 mg/kg is a more effective drug for treating postoperative shivering. [ABSTRACT FROM AUTHOR]

Background & objective: Perioperative shivering after spinal anesthesia for cesarean section is a common and unpleasant complication. Currently pethidine is being used but the search continues to look for other agents with faster action and with fewer side effects. Tramadol is a potential anti-shivering drug with modulation of central thermoregulation. We compared the efficacy of tramadol versus pethidine in the treatment of perioperative shivering of patients undergoing cesarean section under spinal anesthesia. Methodology: After institutional ethical review committee approval, 42 patients undergoing cesarean section under spinal anesthesia, who experienced shivering, were randomized into two groups, Group T (n = 21) received 1 mg/kg tramadol and Group P (n = 21) received 0.5 mg/kg pethidine. The outcome measures included the time taken to cessation of shivering after the medication, recurrence of shivering and the incidence of side effects. Results: The parturients with mean age 30.2 ± 5.2 y and body mass index (BMI) 29.9 ± 4.9 kg/m2 were recruited with comparable data between the two groups. Median time taken from drug administration until cessation of shivering of the tramadol group was faster than the pethidine group (7 min vs 13 min, P = 0.049). However, there was no significant difference in terms of the number of recurrences of shivering (P = 0.606) and incidence of nausea (P = 0.19) between the two groups. Conclusion: Intravenous tramadol has faster alleviation of perioperative shivering than intravenous pethidine in the treatment of perioperative shivering. [ABSTRACT FROM AUTHOR]

Pain in labour is often described as one of the most severe pains experienced. Neuraxial techniques provide the most effective form of labour analgesia. However, not all women wish to have this or indeed want complete pain relief in 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. [ABSTRACT FROM AUTHOR]

Background: Massage during labour is one form of intrapartum non-pharmacological pain relief but it is not known whether the frequency of practicing these massage techniques among couples during the antenatal period could enhance the effectiveness of intrapartum massage. This study was to evaluate the association between compliance of antenatal massage practice with intrapartum application and their impact on the use of analgesics during labour.Methods: This was a sub-analysis of a childbirth massage programme which was carried out in two public hospitals with total births of around 8000 per year. Data from women who were randomized to the massage group were further analysed. After attending the pre-birth training class on massage at 36 weeks gestation, couples would be encouraged to practice at home. Their compliance with massage at home was classified as good if they had practiced for at least 15 minutes for three or more days in a week, or as poor if the three-day threshold had not been reached. Application of intrapartum massage was quantified by the duration of practice divided by the total duration of the first stage of labour. Women's application of intrapartum massage were then divided into above and below median levels according to percentage of practice. Logistic regression was used to assess the use of epidural analgesia or pethidine, adjusted for duration of labour and gestational age when attending the massage class.Results: Among the 212 women included, 103 women (48.6%) achieved good home massage compliance. No significant difference in the maternal characteristics or birth outcomes was observed between the good and poor compliance groups. The intrapartum massage application (median 21.1%) was inversely associated with duration of first stage of labour and positively associated with better home massage practice compliance (p = 0.04). Lower use of pethidine or epidural analgesia (OR 0.33 95% CI 0.12, 0.90) was associated with above median intrapartum massage application but not antenatal massage compliance, adjusted for duration of first stage of labour.Conclusions: More frequent practice of massage techniques among couples during antenatal period could enhance the intrapartum massage application, which may reduce the use of pethidine and epidural analgesia.Trial Registration: (CCRBCTR) Unique Trial Number CUHK_ CCRB00525 . [ABSTRACT FROM AUTHOR]

Background: Bronchoscopy can be a distress for the patient. There have been few studies on the combination of sedatives and opioids. The aim of this study was to demonstrate the usefulness and safety of administration of the combination of midazolam and pethidine during bronchoscopy.Methods: In this prospective randomized single (patient)-blind study, we randomly assigned 100 patients who were scheduled to undergo bronchoscopy biopsy to receive treatment with either the midazolam/pethidine combination (combination group) or midazolam alone (midazolam group) during examinations. After the end of bronchoscopy, patients completed a questionnaire and the visual analogue scale was measured. The primary outcome was the patients' acceptance of re-examination assessed by visual analogue scale. We also assessed pain levels, vital signs, midazolam use, xylocaine use, and adverse events. Univariate analyses were performed using Fisher's exact test for categorical data, and the t-test or Mann-Whitney test was carried out for analysis of numeric data. All P-values were two-sided, and values < 0.05 were considered statistically significant.Results: We analyzed 47 patients in the combination group and 49 patients in the midazolam group. The primary outcome was a good trend in the combination group, but not significantly different (3.82 ± 2.3 in combination group versus 4.17 ± 2.75 in midazolam alone, P = 0.400). In the combination group, the visual analog scale score for pain during bronchoscopy was significantly lower (1.10 ± 1.88 versus 2.13 ± 2.42, P = 0.022), and the sedation level score per the modified observer's assessment of alertness/sedation scale was significantly deeper (3.49 ± 0.98 versus 3.94 ± 1.03, P = 0.031). Maximal systolic blood pressure during testing was significantly lower (162.39 ± 23.45 mmHg versus 178.24 ± 30.24 mmHg, P = 0.005), and the number of additional administrations of midazolam was significantly lower (2.06 ± 1.45 versus 2.63 ± 1.35, P = 0.049). There were also significantly fewer adverse events (30 versus 41, P = 0.036).Conclusions: The combination uses of midazolam and pethidine for sedation resulted in significant improvements in the pain, blood pressure, additional use of midazolam, and safety during bronchoscopy among patients.Trial Registration: This study was registered in the University Medical Hospital Information Network in Japan (UMINCTR Registration number: UMIN000032230 , Registered: 13/April/2018). [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of caudal block (CB) using dexmedetomidine and pethidine instead of local anesthesia (LA) for prostate needle biopsy and the effect of CB on urinary retention. A transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) was performed on 68 patients with a mean age of 65 ± 2.18 years. CB with a combination of dexmedetomidine and pethidine without LA was administered to the patients. The pain levels of the patients were determined using numeric rating scale (NRS) scores to evaluate the effectiveness of CB. Preoperative and postoperative postvoid residual urine volumes (PRUV) were also calculated. The CB success rate was 93.15%. The NRS scores were 0.79 ± 0.19 and 0.89 ± 0.22 during probe entry and manipulation and biopsy, respectively, without any significant differences between them (p = 0.382). The mean PRUVs before and after biopsy did not differ significantly (41 ± 15.6 vs. 71.93 ± 22.3, p = 0.379). The degree of sedation, as assessed using the Ramsay scale, was 2 or 3 in all patients. The combination of dexmedetomidine and pethidine for CB in TRUS-Bx provided quality analgesia for the patient and prevented the development of postoperative urinary retention. [ABSTRACT FROM AUTHOR]

Aim and Objective: To compare the analgesic effectiveness of the patient-controlled inhaled nitrous oxide (Entonox®) with intravenous opioids (pethidine/midazolam) in reducing pain during minor gynecological operative procedures, including manual vacuum aspiration (MVA), fractional curettage and dilatation and curettage. Materials and Methods: Patients undergoing minor gynecological procedures from August 2021 to December 2022 were randomized to receive nitrous oxide or intravenous pethidine (50–75 micrograms) plus midazolam (2 mg). Pain scores during and post-procedure, satisfaction level, and side effects were assessed and compared. Results: A total of 106 patients met the inclusion criteria, including 53 in the pethidine/midazolam group and 53 in the nitrous oxide group. Baseline characteristics were comparable (p-value > 0.05). Pain scores during, immediately and 30 min after procedures were not significantly different in two groups (4.94 ± 3.15, 2.74 ± 2.57, 1.58 ± 2.13 vs. 5.47 ± 2.80, 2.98 ± 2.70, 1.64 ± 2.70; p-value: 0.174, 0.634, 0.889, for pethidine/midazolam vs. nitrous oxide group, respectively. Satisfaction scores were comparable in both groups (p-value > 0.05). However, the rate of side effects was significantly lower in the nitrous oxide group (3.8% vs. 28.3%; p-value 0.001). Additionally, the discharge scores showed a significantly faster recovery time in the nitrous oxide group at 60 and 90 min after the procedure; median (IQR): 10 (9–10) vs. 9 (8–10) and 10 (10–10) vs. 10 (8.5–10); p-value 0.002 and 0.029, respectively). Conclusions: Nitrous oxide is as effective as pethidine/midazolam for pain relief in minor gynecological operative procedures but associated with significantly lower side effects and significantly faster recovery time.

Pethidine is a synthetic opioid that is widely used in cats. However, the sedative, cardiorespiratory, and histaminic effects following administration of pethidine with midazolam in cats remain unclear. The objectives of this study were to evaluate and compare changes before and after intravenous (IV) and intramuscular (IM) administration of pethidine with midazolam in healthy cats. In this prospective randomized blind study, 12 cats were assigned equally to either the IV or IM treatment group. The IV group received pethidine 3 mg/kg and midazolam 0.1 mg/kg. The IM group received pethidine 6 mg/kg and midazolam 0.2 mg/kg. The sedative effects, heart rate, respiratory rate, non-invasive arterial blood pressures, and behavioral signs were recorded before and at 2, 5, 15, 30, 45, and 60 min after the injection. Blood samples were taken for an ELISA histamine assay at baseline and at 5 and 15 min after treatment. Cats that received IV treatment were rapidly induced a moderate degree of sedation but those received IM treatment were only mildly sedated. There was no significant difference in the cardiorespiratory values within and between the treatments over time. Plasma histamine concentrations increased by 3 and 5 times at 5 and 15 min after IV treatment, respectively, compared to baseline values. IM injections induced minimal changes in the plasma histamine concentration. In summary, intravenous pethidine with midazolam induced potentially superior sedative effects without serious side effects in clinically healthy cats. However, further studies with larger sample sizes are required to validate this finding.

To compare the efficacy of tramadol with pethidine on the treatment of post spinal anaesthesia shivering. Electronic databases including PubMed, Google Scholar, Embase and Cochrane were searched to find the randomized controlled trials (RCTs) comparing the efficacy of tramadol with pethidine on the treatment of post spinal anaesthesia shivering. Review Manager 5.3 was used. The meta-analysis was conducted with fixed-effect model or random-effect model according to the heterogeneity. Seven randomized controlled trials involving 463 patients were included. Compared with pethidine, tramadol had a significantly higher incidence of effective rate of shivering treatment (OR: 3.02, 95% CI 1.25 to 7.28, P = 0.01; I2 = 0%), shorter time to cease shivering (mean difference − 1.72, 95% CI − 2.59 to − 0.84, P = 0.0001; I2 = 89%) and lower recurrent rate of shivering (OR 0.18, 95% CI 0.05 to 0.57, P = 0.004; I2 = 0%), with a lower incidence of nausea and vomiting (OR 0.20, 95% CI 0.09 to 0.41, P < 0.0001; I2 = 23%). There was no significant difference in the incidence of pruritus between tramadol and pethidine. Tramadol is superior to pethidine when used for shivering treatment after spinal anaesthesia. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Shivering is a common side effect of central neuraxial anaesthesia. Intravenous pethidine is commonly used in reducing shivering but has been associated with significant opioid side effects. Dexamethasone as a powerful anti-inflammatory and analgesia agent is postulated to inhibit inflammatory mediators' release thus inhibiting central thermoregulatory centre, potentially attenuating post spinal shivering. This double -blind randomised controlled study was to determine the ability of intravenous dexamethasone in decreasing the incidence, severity and the need for treatment for post spinal shivering. MATERIALS AND METHODS: We recruited a total of 72 patients who required spinal anaesthesia and randomised them to either dexamethasone 0.1 mg/kg (maximum of 8 mg) or normal saline (placebo). The subjects' tympanic membrane temperatures (TMT), mean arterial pressures (MAP) and shivering scores were observed at regular intervals up to 2-hours post-spinal or till end of surgery (minimum 30 minutes post spinal). An intravenous pethidine 25 mg were given as rescue therapy for Grade 3 and 4 shivering. RESULTS: There were consistent and comparable drop in TMT and MAP after spinal anaesthesia in both groups, except at 15 minutes whereby dexamethasone group demonstrated significantly higher temperatures than saline group (p=0.04). There was significantly less incidence of visible muscular shivering (Grade 2 to Grade 4) in the dexamethasone group as compared to placebo group (p=0.003). The highest grade of shivering observed for dexamethasone and saline group was 2 and 3 respectively. A total of 2 subjects from saline group required rescue therapy. CONCLUSION: Dexamethasone can potentially mitigate the reduction in core body temperature, especially at 15-minutes post spinal with significantly less visible muscular shivering. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to investigate the analgesic effect of 3 different regimens of combination analgesics administered to patients undergoing thyroidectomy. Material and methods: A total of 152 patients undergoing total or subtotal thyroidectomy were enrolled. Patients allocated to group A received a combination of intravenous (IV) paracetamol and intramuscular (IM) pethidine, patients in group B received a combination of IV paracetamol and IV parecoxib, while patients in group C received IV paracetamol monotherapy. Results: The analgesic regimens of groups A and B were found to be of equivalent efficacy (p-value = 1.000). In contrast, patients in group C (paracetamol monotherapy) had higher numerical rating scale scores, compared to both patients in groups A (p-value < 0.001) and B (p-value < 0.001). Conclusions: The combinations of IV paracetamol with either IM pethidine or IV parecoxib are superior to IV paracetamol monotherapy in achieving pain control in patients undergoing thyroid surgery. [ABSTRACT FROM AUTHOR]

Background: Peri-operative shivering a challenging discomfort faced in anesthesiologists’ daily practice. Many drugs were used as a prophylaxis, but there was no consensus on ideal or standard drug yet. Aim of the work: To compare the effectiveness and safety of pethidine, granisetron and tramadol in prophylaxis against perioperative shivering after spinal anesthesia. Patients and methods: Sixty adult patients, who underwent spinal anesthesia, were included. They were randomly assigned to granisetron, pethidine or tramadol (20 in each group), and submitted to standard intraoperative monitoring and follow up for postoperative 4 hours. Monitoring included electrocardiography, oxygen saturation, respiratory rate, temperature, non-invasive blood level, conscious level and sedation score. Side effects were documented. Results: Intra- and post-operatively, there was significant reduction of heart rate in granisetron and tramadol groups. Mean arterial pressure significantly decreased in granisetron group at the time from 30 minutes to the end of surgery and during the first two postoperative hours. Respiratory rate significantly decreased in pethidine group during the complete intra- and post-operative period. Granisetron had no sedative effect at all, but sedation was significantly increased among pethidine group. Finally, perioperative shivering was reported in 25%, 15% and 15% of pethidine, granisetron and tramadol groups respectively. Nausea/vomiting was reported in 20%, 10.0%, and 0% of pethidine, tramadol and granisetron groups respectively. Pruritus was confined to 30% pethidine group with significant difference. Conclusion: Granisetron, tramadol and pethidine, all are effective as a prophylaxis against perioperative shivering after spinal anesthesia. However, granisetron seems to be the most suitable drug.

Objective: The aim of the present study was to evaluate the effects of ondansetron for prevention of postoperative shivering. Patients and Methods: The study was carried out on 40 patient ASA I or II scheduled for lower abdominal surgery. They were categorized into two equal groups Group I (Group P): Patients were receiving intravenous pethidine in a dose of 0.5 mg/kg. Group II (Group O): Patients were received intravenous ondansetron in a dose of 4 mg. just before induction of spinal block. Results: The studied groups showed no significant difference regarding demographic data, or postoperative shivering. However, postoperative nausea, vomiting and sedation were significantly increased in pethidine when compared to ondansetron group. Conclusion: Ondansetron is effective as Pethidine for prevention of postoperative shivering. However, side effects postoperative nausea & vomiting were significantly higher in pethidine group. Thus, ondansetron could be used as a safe and effective alternative for pethidine for postoperative shivering.