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

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. 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. 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). 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.