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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.

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)

The aim of this work was finding new flurescent dyes as sensitizers for chemiluminescence (CL) determination some of narcotics. In this way 6 different dyes incloding rhodamine 6G, brilliant blue, orange G, chromatrope, eosin‌‌Y and [Ru(phen)3]2+ and 14 drugs incloding pethidine hydrochloride, thebaine, dextromethorphan, acetaminophen, codeine, oxymorphone, oxycodone, morphine, pholcodine, naltrexone, buprenorphine, methadone, tramadol, diphenoxylate were investigated. In the preliminary experiments, we found that pethidine hydrochloride in CL system of [Ru(phen)3]2+- Ce(IV) and thebaine in CL system of rhodamine 6G- Ce(IV) could be determined. After optimizing the important variables, linear dynamic range for pethidine hydrochloride and thebaine were 5.6×10-7 to 1.4×10-3 mol L-1 and 1.0×10-5 to 4.0×10-4 mol L-1 and limit of detection were 7.1×10-8 mol L-1 and 4.3×10-6 mol L-1, respectively. The percent of relative standard deviation for pethidine hydrochloride and thebaine were 5.7 and 4.0%, respectively.

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

Background: Spinal anesthesia remains the preferred technique for lower abdominal and orthopedic procedures. Objectives: This study compares the effects of an intrathecal injection of pethidine combined with dexamethasone versus intrathecal bupivacaine alone in patients undergoing lower extremity orthopedic surgeries. Methods: In this prospective, randomized, controlled, double-blinded study, 46 participants scheduled for elective lower extremity orthopedic surgeries were randomly allocated into two groups. Group PD (n = 23) received an intrathecal injection of 1 mg/kg preservative-free pethidine combined with 4 mg dexamethasone, diluted with 0.9% sodium chloride saline to a total volume of 3 mL. Group B (n = 23) received an intrathecal injection of 3 mL (15 mg) of 0.5% hyperbaric bupivacaine alone. The primary outcome measured was the time to the first need for rescue analgesia. Secondary outcomes included spinal anesthesia characteristics, intraoperative hemodynamic stability, and incidence of perioperative adverse events. Results: The time to first need for rescue analgesia was significantly longer in Group PD (7.76 ± 0.79 hours) compared to Group B (4.48 ± 0.63 hours). Differences in the onset of sensory and motor blocks between Group PD (6.39 ± 1.12 and 10.09 ± 2.23 minutes, respectively) and Group B (6.43 ± 1.99 and 9.96 ± 2.33 minutes, respectively) were statistically non-significant. However, the regression time for sensory and motor blocks was significantly shorter in Group PD compared to Group B (146.74 ± 15.35 and 119.56 ± 14.13 minutes vs. 188.44 ± 6.84 and 168.04 ± 5.25 minutes, respectively). Incidence of hypotension and shivering was also less frequent in Group PD than in Group B. Conclusions: Intrathecal administration of 1 mg/kg pethidine plus 4 mg dexamethasone provided improved spinal anesthesia, with extended postoperative analgesia, minimal intraoperative hemodynamic disturbances, and reduced incidence of shivering compared to bupivacaine alone in patients undergoing lower extremity orthopedic surgeries. This approach may be particularly beneficial for patients with hypersensitivity to ester or amide local anesthetics, offering a cost-effective alternative to standard local anesthetics. [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.

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.

Objectives: Endoscopic ultrasonography (EUS) plays an important role in the diagnosis of pancreatobiliary diseases. However, an appropriate sedation method for EUS has not been established. Therefore, this study aimed to examine the safety and complications of sedation with pentazocine or pethidine hydrochloride for outpatient diagnostic EUS., Methods: We retrospectively reviewed 1302 consecutive cases in our department that underwent outpatient diagnostic EUS between April 2019 and September 2021. Until June 2020, EUS was performed under sedation with midazolam and pentazocine (pentazocine group) in principle; after June 2020, sedation with midazolam and pethidine hydrochloride (pethidine hydrochloride group) was used. A cohort of patients with comparable backgrounds was identified using propensity score matching., Results: A total of 486 cases were included in this study. Sedation-related adverse events during the endoscopic procedures were not significantly different between the groups. The median time spent in the recovery room after EUS was significantly shorter in the pethidine hydrochloride group than in the pentazocine group (69 versus vs. 77 min; p  < 0.001). The frequency of nausea or vomiting after EUS was significantly lower in the pethidine hydrochloride group than in the pentazocine group (0% [0/486] vs. 6.2% [29/486]; p  < 0.001). The frequency of readmission to the recovery room after discharge was significantly lower in the pethidine group than in the pentazocine group (0 [0%] vs. 18 [3.7%], respectively; p  < 0.001)., Conclusions: The combination of midazolam and pethidine hydrochloride is a more favorable anesthetic than the combination of midazolam and pentazocine for diagnostic EUS in outpatients., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)

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.

Background: The use of transcutaneous electrical nerve stimulation (TENS) to relieve labor pain remains controversial and existing evidence is neither strong nor consistent. This research was designed to compare TENS' effect with the injection of pethidine and promethazine in labor pain reduction. Methods: In this trial, for 45 pregnant women in the active phase of labor, TENS electrodes were placed (two on both arms, and two over the participants’ low back) continuously for 120 minutes; and for another group 45 pregnant women, 100 milligrams of pethidine and 250 micrograms of promethazine were injected intramuscularly which could be repeated once at least one hour later. Labor pain and duration, need for labor induction/augmentation/other pain control methods/ instrumental delivery, delivery type, and maternal and newborn complications were measured in both groups. Results: The baseline mean visual analog scale (VAS) score, in the TENS group was 8.51±0.62 and in the pethidine and promethazine groups was 8.37±0.61 (P=0.31). While in a 120min post-intervention, it was 6.29±1.50 and 5.73±1.46 in the TENS group and the pethidine and promethazine group, respectively with no statistically significant difference (P=0.07). The labor duration in the TENS group was 6.61±1.71 hours and in the pethidine and promethazine group was 6.17±2.07 hours, with no statistically significant difference (P=0.33). In addition, no complication was recorded neither in the mothers nor newborns. Conclusion: This study showed that applying TENS in the active labor phase can reduce at least two scores in patient labor pain with no significant complications.

The aim of this study was to compare three different anesthetic protocols administered intramuscularly (IM) in cats undergoing elective ovariectomy, while evaluating the quality of sedation, antinociceptive, isoflurane-sparing effect, and analgesia in the intra-operative and post-operative phases. A total of 71 female cats were sedated IM with alfaxalone (3 mg/kg) combined with either butorphanol (0.3 mg/kg), methadone (0.3 mg/kg), or pethidine (5 mg/kg). During surgery, vital parameters were constantly monitored; at the end of the procedure, the quality of recovery was assessed through a specific form and each cat was scored for perceived pain using the UNESP-Botucatu scale for 5 days, and rescue analgesia was provided with buprenorphine IM when indicated. Moreover, differences between two different post-operative resting regimens (hospital kennels vs. home) were also assessed. A significant difference emerged for the amount of IM dexmedetomidine required to achieve an adequate level of sedation for intravenous catheterization, highlighting a greater need in the pethidine group (p = 0.021). There was no significant difference between opioid groups for the requirement of intra-operative rescue analgesia, and the clinical parameters were kept within physiological ranges regardless of the opioid used in premedication. Lastly, differences between the UNESP-Botucatu scores were detected from day 3 to day 5 post-operatively, with lower scores in cats with home resting regimens compared to the hospitalized animals, likely due to the presence of an unfamiliar condition and the absence of a cat-friendly environment.

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: 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.Clinical Trial Registration: Chictr.org.cn. ChiCTR1900025971

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: Spinal anesthesia is the most preferred method for cesarean section (C-section). This meta-analysis was performed to determine the effect of low and high intrathecal doses of pethidine on the maternal outcomes after C-section., Methods: A systematic search of PubMed, Scopus, Cochrane Library, and Google Scholar was performed. Random-effects meta-analysis was performed to derive odds ratios (ORs) from dichotomous data., Results: Seventeen randomized controlled trials with 1304 C-section patients were included. Patients who had received intrathecal pethidine experienced decreased shivering and intensity of shivering (OR 0.13; P <0.001) and (OR 0.21; P <0.001), respectively. Moreover, vomiting (OR 2.47; P =0.002) and pruritus (OR 5.92; P <0.001) were significantly higher in the pethidine group. There was no statistically significant difference in the incidence of nausea (OR 2.55; P =0.06) and hypotension (OR 0.91; P =0.67)., Conclusions: Intrathecal pethidine can effectively decrease shivering, although it increases the risk of vomiting and pruritus. No significant difference was found both in the maternal hypotension and nausea., Competing Interests: Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

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.