INTRANASAL MEPERIDINE TITRATION FOR POSTOPERATIVE PAIN RELIEF

A prospective, randomized, double-blind study investigating the effica cy of intranasal meperidine as compared with intravenous (IV) administ ration for postoperative pain relief is described. The study was limit ed to the initial titration of pain relief during a 2-h period immedia tely after surgery. Sixty women having undergone a hysterectomy were s tudied. Initially and when complaining of a pain intensity greater-tha n-or-equal-to 40 on the 101-point numerical rating scale (NRS), 30 pat ients received 6 s prays (27 mg) meperidine intranasally and simultane ously 6 mL NaCl 0.9% IV (nasal group); another 30 patients received 6 sprays of NaCl 0.9% intranasally and 6 mL of a diluted meperidine solu tion (27 mg) IV (intravenous group). Patients already having a pain re duction < 40 on the 101-point NRS, received half of the above dose. Me peridine was repeated every 5 min until the patients were pain free or refused further analgesic. Before the onset of meperidine titration a nd at 5- to 10-min intervals for 2 h thereafter, pain was evaluated wi th a 101-point NRS and a verbal rating scale. Within 20 and 35 min the pain scores evaluated by the NRS and verbal rating scale decreased in the intravenous and nasal group to a median of zero. The total dose o f meperidine was 76.5 mg (range, 40.5-135.0) in the intravenous group and 104.4 mg (range, 27-135.0) in the nasal group (P < 0.05). One pati ent in each group showed a brief decrease in arterial hemoglobin oxyge n saturation to <90%. No patient complained of pain or burning in the nose. Intranasal meperidine titration is suitable for demand-adjusted titration, and provides a fast-acting and efficacious analgesia.