EFFECTS OF MEPERIDINE ON THE PANCREATIC AND BILIARY SPHINCTER

Background: Opioids are traditionally avoided during sphincter of Oddi manometry because of indirect evidence suggesting that these agents c ause sphincter of Oddi spasm. This study was undertaken to determine t he direct effects of meperidine on the biliary and pancreatic sphincte r. Methods: Forty-seven patients were prospectively evaluated by sphin cter of Oddi manometry in the conventional retrograde fashion. Manomet ry was initially performed with intravenous diazepam sedation alone. T he manometry was repeated 3 to 5 minutes after meperidine was administ ered. Results: The basal sphincter pressure of the biliary sphincter, pancreatic sphincter, and the combined sphincter group were not signif icantly altered by meperidine. Concordance (normal versus abnormal) be tween the basal sphincter pressure before and after meperidine was see n in 44 of 47 patients (94%). Meperidine produced a significant increa se in the pancreatic, biliary, and combined sphincter phasic frequency and a significant decrease in the phasic duration. The pancreatic and combined sphincter phasic pressures were significantly reduced follow ing meperidine administration. Seventeen manometry tracings (36%) were believed to be qualitatively better after meperidine,while only four (8.5%; p<.001) were qualitatively better with diazepam alone. Conclusi on: Meperidine can be used for additional analgesia during sphincter o f Oddi manometry if the basal sphincter pressure is the parameter used to determine therapy.