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More Complex Patients
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Most conventional opioid agonists are suitable for use in these patients. The exception is pethidine (meperidine), where doses would have to be limited because of potential problems with norpethidine (normeperidine) toxicity (see Chapter 4). Pethidine is generally best avoided for the treatment of pain in any patient. Using an opioid other than the one the patient is taking long term (opioid rotation—see later) may offer some advantage in some circumstances.
Drugs in pregnancy and lactation
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Pethidine is widely used during pregnancy, and it is metabolised to norpethi-dine. The half-lives of pethidine and norpethidine in neonates are extremely prolonged (20 and 60 hours, respectively). The parent drug and its metabolite cause low Apgar scores, prolonged time to sustained respiration, and respiratory acidosis. It is therefore prudent to expect neonatal respiratory depression if the pregnant woman has received any pethidine within a few hours before delivery [8].
Disorders of the nervous system
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
The midwife should encourage the woman to take her usual AEDs at her regular time and, if not tolerated orally, a suitable alternative given by IV or rectal route. One-to-one midwifery care is essential, and the woman should not be left alone, and precautions taken, such as not locking toilet doors. Most forms of pain relief are acceptable (TENS, Entonox), and an epidural may be particularly helpful in minimising triggers to seizures such as fatigue, pain and hyperventilation. Pethidine should be avoided as it can trigger seizures.
MATERNAL SATISFACTION TOWARDS SPINAL ANAESTHESIA FOR CAESAREAN SECTION
Published in Egyptian Journal of Anaesthesia, 2022
M Babajide Adegboye, I Kayode Kolawole, K. Adewale Adegboye, C Iyabo Oyewopo, O Oyewole Oladosu
There was a high level of maternal satisfaction with intraoperative pain control in this study 87.6%. Most intraoperative pain is usually a discomfort felt during the uterus exteriorization and peritoneal retraction[27]. Once the baby is delivered patients that complained of pain was given intravenous pethidine and diclofenac sodium according to their body weight. A similar study by Siddiqi and Jafi [23] reported a maternal satisfaction score of 74.09% to intraoperative pain control. The higher satisfaction in our study may be because our data collection was done in the recovery room (immediate postoperative period) compared to the study by Siddiqi and Jafi [23] in which there was no limit on the time of data collection after the caesarean delivery. When the analgesic effect of spinal anaesthesia wears off, the patient starts having post-operative pain and if the pain is not managed properly it may be difficult for some parturients to differentiate between intraoperative and post-operative pain, therefore, resulting in a lower anaesthesia satisfaction score. The high score of maternal satisfaction to pain control in this study shows that spinal anaesthesia is effective in controlling pain during the surgery and in the immediate post-operative period after the caesarean delivery.
Qualitative exploration of the experiences of men who use drugs of obtaining psychoactive medicinal products in Jordan
Published in Journal of Ethnicity in Substance Abuse, 2022
Mayyada Wazaify, Nour Alhusein, Jenny Scott
Some participants reported getting their abused drug from hospitals. In one situation, the participant was a healthcare professional who became addicted to pethidine. He (participant 14) describes that he used to collect the dose by taking some from each ampoule he was instructed to administer to patients: ‘There would be a patient, we’d sometimes prescribe him 100 [mg], I’d give him 75 and hide 25, yeah…a prescription and another prescription, until I take the full dose’. Although the regulations in Jordan indicate that two members of hospital staff should witness the administration of drugs scheduled like pethidine, ‘softening’ of this regulation, by staff themselves, was noted by this participant as enabling him to divert the pethidine ‘This never used to happen [witnessed administration]… It was an issue of trust”.
Comparative evaluation of intraperitoneal bupivacaine and bupivacaine ketamine combined with lung recruitment for reducing postoperative shoulder pain in laparoscopic cholecystectomy
Published in Egyptian Journal of Anaesthesia, 2018
Raham Hasan Mostafa, Yehia Mamdouh Hassan Mekki
The following measures were assessed and recorded once reaching the recovery room, and at 1, 2, 6, 12, and 24 h postoperatively: Postoperative hemodynamics (heart rate, mean blood pressure, oxygen saturation), postoperative shoulder pain which was evaluated by visual analogue scale (VAS) score of 0 to 10 (0 = no pain, 10 = unendurable pain). In case of a pain score >4, a 25 mg pethidine was given intravenously. Also we assessed severity of postoperative abdominal pain which if was >4, a 25 mg pethidine was given intravenously, sedation using a four-point scale (0 = alert, 1 = quietly awake, 2 = asleep but easily aroused, and 3 = deep sleep) and finally postoperative nausea and vomiting (PONV) was rated on a 4-point scale (0 = no PONV, 1 = Mild nausea, 2 = Severe nausea, 3 = Vomiting). If PONV scale was 2 or more, ondansetron 4 mg was given intravenously (with a maximum total dose of 16 mg / day).