Peridural meperidine in humans: analgesic response, pharmacokinetics, and transmission into CSF

Effective analgesia resulted from the injection of peridural meperidine in two groups of cancer patients, eight with postoperative pain and eight with intractable pain. Peridural meperidine HCl, 100 mg (n = 8), in 10 ml saline administered to patients following surgery was followed by a median duration of analgesia of 6 hours (range 4-20 hours) over periods ranging from 1-4 days. Peridural meperidine HCl, 30-100 mg (n = 8), in 10 ml saline administered to patients with intractable pain gave a median duration of analgesia of 8 hours (range 4-20 hours) over periods ranging from 1-9 days. There was no obvious tendency towards tolerance. In all patients, the onset of analgesia was within 5 min and was complete within 30 min. This analgesia paralleled the rise in CSF meperidine concentrations following peridural administration. Systemic absorption of peridurally administered meperidine occurred with a half-life of 15-30 min and produced blood concentrations high enough to contribute to analgesia after approximately 20 min in the majority of patients. There was no objective evidence in any neurological change nor sympathetic blockade after peridural meperidine. From this evidence the dorsal horn of the spinal cord may be the major site of action as distinct from the axonal blockade produced by local anesthetics, indicating 'selective' spinal analgesia.