A Comparative Effect of Meperidine between Intravenous and Epidural Patient-Controlled Analgesia for the Postoperative Pain Relief after Cesarean Section

Lee, Byung Ho; Chea, Jun Seuk; Chung, Mee Young; Byun, Hyung Jin

Abstract

Patient-Controlled Analgesia (PCA) has been widely used for postoperative pain relief. Meperidine is useful for PCA and has efficient analgesia, rapid onset, and low incidence of adverse effect. To compare the analgesic effect, total dose and hourly dose, side effect and neonatal status of breast feeding with meperidine via intravenous or epidural PCA for 48hours after Cesarean Section, 40 parturient women undergoing elective Cesarean Section were randomly divided into two groups. Each respective group of 20 parturient women received meperidine via one of the intravenous PCA after general anesthesia with enflurane (IVPCA group) and the epidural PCA after epidural block with 2% lidocaine 20ml combined with general anesthesia with only N2O and O2 (EpiPCA group) when they first complained of pain in recovery room. Following the administration of analgesic initial dose, parturient women of lVPCA group were allowed intravenous meperidine l0mg every 8minutes when they felt pain. The EpiPCA group received additional bolus dose of meperidine 2mg and bupivacaine 0.7mg were administered every 8minutes as requested the patients with hourly continuous infusion of meperidine 4mg and bupivacaine 1.4mg. Data was collected during the 48 hours observation period including visual analog scale (VAS) pain scores, total meperidine dose, hourly dose during 48 hours and each time interval, incidence of adverse effect, satisfaction, and neonatal status with breast feeding. VAS pain scores of analgesic effect in EpiPCA group was significantly lower than in IVPCA group at 2hours after the initial pain after Cesarean Section. Total dose and hourly dose of meperidine significantly reduced in EpiPCA group. Hourly dose of meperidine at each time interval significantly reduced during first 6 hours and from 12hours to 24hours in EpiPCA group. The side effects in IVPCA group were mainly sedation, nausea, and local irritation of skin. And EpiPCA group experienced numbness and itching. The degree of satisfaction of parturient women was 88.2 in IVPCA group and 85.7% in EpiPCA group. We did not observe any sedation, abnormal behavior, or seizure like activity in any neonates of breast feeding. From the above results we conclude that epidural PCA was more efficiently analgesic, less sedative, and consumptional, and safer for neonate than intravenous PCA, and could be an alternative method to intravenous PCA.