Pain Management
Susan Carmody, Sue Forster in Nursing Older People, 2017
Opioid analgesics are used for moderate-to-severe pain. Morphine can also be used for the relief of severe dyspnoea—for example, in cases of lung cancer and terminal chronic obstructive pulmonary disease (COPD). ‘Pethidine should therefore be avoided in older people. ’Active toxic metabolites can accumulate in older people with renal impairment—especially with pethidine. Pethidine should therefore be avoided in older people. Fentanyl, a synthetic opiate that possesses inactive metabolites, is the most suitable drug for older people, especially those with renal impairment. Opioids can produce cognitive and neuropsychiatric dysfunction. Older people should therefore be given lower initial doses of opioids, and the dose should then be gradually titrated to the optimum level. Constipation is a significant problem with opioids. This is exacerbated by infirmity, inadequate fluid intake, reduced physical activity, and other constipating drugs (for example, tricyclic antidepressants, major tranquillisers, and diuretics). High-fibre diets, adequate fluid intake, and faecal softeners are advised for older people.
More complex patients
Pamela E. Macintyre, Stephan A. Schug in Acute Pain Management, 2014
Most pure 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 best avoided in the treatment of pain. Using an opioid other than the one the patient is taking long term (opioid rotation—see below) may offer some advantage in some circumstances. Tramadol may also be of use, although its sole administration instead of any opioid is not recommended as it may not prevent opioid withdrawal.
Neonatal effects of drugs administered during pregnancy
Evelyne Jacqz-Aigrain, Imti Choonara in Paediatric Clinical Pharmacology, 2021
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].
Raised pethidine concentrations with acidosis in newborn babies
Published in Journal of Obstetrics and Gynaecology, 1984
S. W. D'souza, S. F. Freeborn, J. Cadman, B. Richards
Summary In 15 infants born to mothers who had received pethidine (100mg intramuscularly) during a normal labour, arterial and venous blood specimens were collected from the umbilical cord at birth for measurement of pH and pethidine concentrations. Blood pH was determined as a measure of hypoxia at birth. Raised pethidine concentrations were associated with lower pH values in umbilical arterial and venous blood. The baby's condition at birth, as assessed by a birth score based on colour, respiratory rate and heart rate (a modified Apgar score), and the time taken for the infants to breathe spontaneously were recorded but did not show any relationship to pethidine concentrations. More pethidine seems to accumulate in the hypoxic fetus but none of the infants in our study was significantly affected by the pethidine concentration at birth.
A double blind quantitative study of the effects of meptazinol and pethidine on the fetal heart rate in labour
Published in Journal of Obstetrics and Gynaecology, 1988
A. M. Wheble, G. S. Dawes, M. D. G. Gillmer, G. S. Sykes
Summary A double blind controlled trial was carried out to measure the effects of pethidine and meptazinol on the fetal heart rate in labour. Patients who selected epidural or inhalational analgesia were used as controls. The fetal heart rate was analysed numerically, using a microcomputer, for 45-60 min before and after drug administration to allow for fetal behavioural state changes. Controls showed no change in heart rate or its variation over two successive periods of observation. The mean numbers of accelerations (> 10 beats per min and 15 s duration) were reduced by 46 per cent (P < 0.001) with pethidine administration and by 33 per cent (p < 0.05) with meptazinol. The reduction in overall fetal heart rate variation with pethidine was only 20 per cent (P < 0.05); no change was demonstrated with meptazinol. The mean umbilical artery pH at delivery was 7.28 in the meptazinol babies, higher than the mean of 7.22 in the controls (P
New Online Tool for Exploring Global Opioid Consumption Data
Published in Journal of Pain & Palliative Care Pharmacotherapy, 2017
Each year for nearly two decades, the Pain & Policy Studies Group (PPSG) has received from the International Narcotics Control Board, the global monitoring body for the implementation of the United Nations international drug control conventions, consumption data for six principal opioids used to treat moderate and severe pain: fentanyl, hydromorphone, methadone, morphine, oxycodone, and pethidine. To provide these statistics to a wider audience, PPSG developed an extensive section of its Web site featuring these data in the form of global, regional, and individual country graphs. In recent years, PPSG developed and launched three new interactive Web features for exploring opioid consumption data and generating hypotheses about patterns of opioid consumption. In July 2016, PPSG announced the addition of a new tool on its Web site to explore opioid consumption data: custom consumption graphs for opioid medicines. This tool allows users to select, customize, and create charts of the opioid consumption data and download them for use in presentations or publications. PPSG encourages colleagues to use these tools to explore and study these data to inform their work to improve the accessibility and availability of these important medicines.
Related Knowledge Centers
- Antispasmodic
- Isonipecotic Acids
- Meperidine
- Inn
- Opioid
- Analgesic
- Intramuscular