Assessment of the Analgesic Effect of Meperidine in Patients Receiving Extracorporeal Shock Wave Lithotripsy

評估Meperidine對體外震波碎石病人的止痛效果

林志杰(Chih-Chieh Lin) ； 許衍申(Yen-Shen Hsu) ； 陳光國(Kuang-Kuo Chen) ； 林登龍(Alex T. L. Lin) ； 張延驊(Yen-Hwa Chang) ； 黃志賢(William J. Huang) ； 郭俊逸(Junne-Yih Kuo) ； 張心湜(Luke S. Chang)

《臺灣泌尿科醫學會雜誌》 15卷1期 (2004/03) Pp. 14-18

摘要

研究目的：此試驗主要目的在於比較，以每公斤1 mg meperidine和0.1 mg fentanyl靜脈注射，對接受體外震波碎石病人的止痛效果及其副作用。
材料與方法：自2001年3月到10月，共收集了240個病例，其中160個男性80個女性共分兩組，有125個人接受靜脈注射meperidine，而另外115個人接受靜脈注射fentanyl，然後分析visual analogue pain scale比較二者之止痛效果及其副作用。
結果：於meperidine group中，就止痛效果而言，於剛開始，十五分鐘及最後其visual pain analogue scale分別為1.2±1.0，1.1±0.6和1.4±0.8而於fentanyl group分別為1.3±0.9，1.1±0.8和1.1 ± 0.7，兩者於統計學上並無差異，另外在meperidine group中有8個人須再打25 mg meperidine來止痛，而於fentanyl group有10個人須再做其它的疼痛處理，於meperidine group中副作用（12%）來得比fentanyl group（22%）少，但統計學上並無意義。在所有副作用中暈眩（6.4%）是meperidine group最常見的，而嘔吐（12.8%）是fentanyl group最多的副作用。Meperidine group有2.4%，而fentanyl group有5.2%發生呼吸急迫，所有人於兩個小時內恢復進食。就同一個60公斤重的病人來說，使用meperidine僅花費3.6元，而fentanyl則需25.4元。
結論：儘管就治療的效果及副作用來說，兩種藥物是無統計上的差異，但就效價的觀點來看，靜脈注射meperidine可以完全取代fentanyl的麻醉效果。

關鍵字

體外震波碎石術

並列摘要

OBJECTIVE: Although lower energy sources are being used for extracorporeal shock wave lithotripter (ESWL) has becomes less energetic, pain control is still a critical issue. In this study, we attempted to compare the analgesic effect of an intravenous meperidine injection to that fentanyl in order to select a better analgesic for pain control during ESWL.
MATERIALS AND METHODS: From March to October 2001, 240 patients (160 males and 80 females) were enrolled in this study. There were 125 patients in the meperidine (Demerol) group (I) and another 115 patients in the fentanyl group (II). Pain during lithotripsy was assessed using a visual analogue scale (VAS). Side effects were also recorded.
RESULTS: Readings on the visual analogue pain scale checked at the beginning, at 15 minutes, and at the end of the procedure were 1.2±1.0, 1.1±0.6, and 1.4±0.8 in the meperidine group compared with 1.3±0.9, 1.1±0.8, and 1.1±0.7 in the fentanyl group. Differences between these 2 groups were not statistically significant. Furthermore, 8 patients required another 25 mg of meperidine for pain control in group I, while 10 in group II required further management. Patients in the meperidine group showed fewer side effects than those of the fentanyl group (12% vs. 22%), but the difference was not statistically significant. Among these side effects, dizziness (6.4%) was most common in the meperidine group and vomiting in the fentanyl group (12.8%). Respiratory distress was noted in 2.4% of patients in the meperidine group and 5.2% in the fentanyl group. All patients resumed oral intake 2 hours after the procedure. Meperidine costs only NT$3.6 for a 60-kg patient compared to NT$25.4 for fentanyl in the same patient.
CONCLUSIONS: Although no significantly difference in treatment efficacy was observed between these 2 groups, intravenous anesthesia with meperidine might replace intravenous fentanyl in consideration of its cost-effectiveness.

並列關鍵字

meperidine ； fentanyl ； extracorporeal shock wave lithotripsy