Comparison of intranasal versus intravenous pethidine for pain relief after cesarean section

Background:  Intranasal route administration of opioid drugs has been shown to be an alternative treatment method without major side effects. In this study we evaluated the intranasal (IN) versus intravenous (IV) pethidine for postoperative pain relief after cesarean section.

Materials and Method: In this clinical trial , 126 women undergoing elective cesarean section with general  anesthesia  using thiopental sodium 5 mg/kg, succynylcholine 1.5 mg /kg, then O2/N2O with 50/50 ratio, halothane 0.5 MAC, atracurium 0.2 mg /kg and fentanyl were entered into the study. Parturients were randomized in to two groups receiving IN pethidine (1mg/kg, n=63) or IV pethidine (1mg/kg, n=63) in recovery room. Pain intensity, incidence of nausea and vomiting and systolic blood pressure were recorded after pethidine administration and then every half an hour for 4 hours. Data analyzed with independent student t-test using SPSS software.

Results: The mean visual analogue scale score in IV group was less than IN group at first two hours after pethidine administration. No significant difference in the incidence of nausea and vomiting was found between two groups. There was a significant decrease in mean systolic blood pressure in IV group compared with IN group at all the times (P<0.05).

Conclusion: Although, IN pethidine  was  less effective on post cesarean pain  relief, it  seems  to be an  interesting  alternative  route  for  those  who  had  no  intravenous access, or  had  an  allergy  to  morphine   and   unabale  oral  intake