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Comparative efficacy of chlorpromazine and meperidine with dimenhydrinate in migraine headache
Abstracts
Wisconsin Hospital with frostbite injury during the winter of 1985 were examined using triple phase bone scanning. The scanning involved blood flow scans, blood pool images, and delayed images in order to determine if there was a correlation with ultimate tissue viability. Results of the scans were not used to influence treatment. All the scans fell into one of three distinct categories: hyperemic blood flow with normal early blood pool and normal delayed bone images; absent blood flow and early blood pooling, but later depiction of bone; and absent perfusion, pooling, and delayed bone depiction. It was found that patients falling into either of the first two categories could be treated conservatively or with minimal surgical debridement only. The three patients in the last category, however, required amputation of the affected limb with the clinical line of demarcation that ultimately developed corresponding exactly to the delayed scan finding. Thus, triple phase bone scanning can be a useful adjunct in defining the extent of [David Rosenberg, MD] frostbite injury. Editor’s Note: The number of patients studied here is too small to allow much precision in assessing the accuracy of this technique; however, it does appear to be a promising method providing very early prognostic information to clinicians and patients.
Cl THE EFFECT OF NOREPINEPHRINE VERSUS EPINEPHRINE ON MYOCARDIAL HEMODYNAMICS DURING CPR. Robison LA, Brown CG, Jenkins J, et al. Ann Emerg Med. 1989;18:336-340. Successful cardiac resuscitation depends significantly on cornonary perfusion pressure. Alpha adrenergic agonists may improve coronary perfusion compared to beta-2 agonists by increasing vasoconstriction and thus aortic diastolic pressure (a major determinant of coronary perfusion pressure). This experimental animal study measured hemodynamic variables in 20 swine before and during induced cardiac arrest. The animals were then resuscitated in four groups, receiving either epinephrine 0.20 mg/kg or norepinephrine at 0.08, 0.12, or 0.16 mglkg. Hemodynamic variables improved in all groups after receiving adrenergic agonists; the greatest improvement was seen in
681
the higher dosages. A trend toward improved myocardial blood flow was seen in the highest dose norepinephrine group compared to the epinephrine group, although this was not statistically significant. The authors conclude that in pigs, norepinephrine, because of its lack of beta-2 effects, may be more beneficial during CPR than epinephrine. [Randy Sato]
Cl COMPARATIVE EFFICACY OF CHLORPROMAZINE AND MEPERIDINE WITH DIMENHYDRINATE IN MIGRAINE HEADACHE. Lane PL, McFellan BA, Baggoley CJ. Ann Emerg Med. 1989;18:4:360-5. Migraine headache is commonly encountered in the emergency department. Management frequently requires parenteral narcotics, which have the disadvantages of tolerance, abuse, and addiction. This randomized, double-blind controlled trial compared the effectiveness of intravenous chlorpromazine and intravenous meperidine (plus dimenhydrinate) in migraine headaches. One group (22 patients) received dymenhydrinate 25 mg followed by meperidine 0.4 mglkg intravenously, while the other (24 patients) received saline followed by chlorpromazine 0.1 mg/kg. Doses were repeated every 15 minutes as needed up to a maximum of three doses. Pain was assessed by visual and verbal analog scales every 15 minutes. No significant dystonic or hypotensive reactions were encountered in the chlorpromazine group. Two patients (8%) in the chlorpromazine group experienced inadequate relief and required other medication compared with 11 (50%) in the meperidine group (PC 0.01). The visual and verbal pain analog scales showed significantly greater improvement in the severity of pain in the chlorpromazine group (P < 0.001). Intravenous chlorpromazine appears to offer effective relief for ED patients with acute migraine headaches while avoiding the potential for narcotic abuse and addiction. [Douglas A. Schneider, MD] Editor’s Note: It can be remarkable how good relief can be achieved with chlorpromazine. It also is a good antiemetic. Even if the patient requires subsequent opiate, it provides as excellent alternative of care and helps remove the often inappropriate designation of drug-seeking behavior.
Wisconsin Hospital with frostbite injury during the winter of 1985 were examined using triple phase bone scanning. The scanning involved blood flow scans, blood pool images, and delayed images in order to determine if there was a correlation with ultimate tissue viability. Results of the scans were not used to influence treatment. All the scans fell into one of three distinct categories: hyperemic blood flow with normal early blood pool and normal delayed bone images; absent blood flow and early blood pooling, but later depiction of bone; and absent perfusion, pooling, and delayed bone depiction. It was found that patients falling into either of the first two categories could be treated conservatively or with minimal surgical debridement only. The three patients in the last category, however, required amputation of the affected limb with the clinical line of demarcation that ultimately developed corresponding exactly to the delayed scan finding. Thus, triple phase bone scanning can be a useful adjunct in defining the extent of [David Rosenberg, MD] frostbite injury. Editor’s Note: The number of patients studied here is too small to allow much precision in assessing the accuracy of this technique; however, it does appear to be a promising method providing very early prognostic information to clinicians and patients.
Cl THE EFFECT OF NOREPINEPHRINE VERSUS EPINEPHRINE ON MYOCARDIAL HEMODYNAMICS DURING CPR. Robison LA, Brown CG, Jenkins J, et al. Ann Emerg Med. 1989;18:336-340. Successful cardiac resuscitation depends significantly on cornonary perfusion pressure. Alpha adrenergic agonists may improve coronary perfusion compared to beta-2 agonists by increasing vasoconstriction and thus aortic diastolic pressure (a major determinant of coronary perfusion pressure). This experimental animal study measured hemodynamic variables in 20 swine before and during induced cardiac arrest. The animals were then resuscitated in four groups, receiving either epinephrine 0.20 mg/kg or norepinephrine at 0.08, 0.12, or 0.16 mglkg. Hemodynamic variables improved in all groups after receiving adrenergic agonists; the greatest improvement was seen in
681
the higher dosages. A trend toward improved myocardial blood flow was seen in the highest dose norepinephrine group compared to the epinephrine group, although this was not statistically significant. The authors conclude that in pigs, norepinephrine, because of its lack of beta-2 effects, may be more beneficial during CPR than epinephrine. [Randy Sato]
Cl COMPARATIVE EFFICACY OF CHLORPROMAZINE AND MEPERIDINE WITH DIMENHYDRINATE IN MIGRAINE HEADACHE. Lane PL, McFellan BA, Baggoley CJ. Ann Emerg Med. 1989;18:4:360-5. Migraine headache is commonly encountered in the emergency department. Management frequently requires parenteral narcotics, which have the disadvantages of tolerance, abuse, and addiction. This randomized, double-blind controlled trial compared the effectiveness of intravenous chlorpromazine and intravenous meperidine (plus dimenhydrinate) in migraine headaches. One group (22 patients) received dymenhydrinate 25 mg followed by meperidine 0.4 mglkg intravenously, while the other (24 patients) received saline followed by chlorpromazine 0.1 mg/kg. Doses were repeated every 15 minutes as needed up to a maximum of three doses. Pain was assessed by visual and verbal analog scales every 15 minutes. No significant dystonic or hypotensive reactions were encountered in the chlorpromazine group. Two patients (8%) in the chlorpromazine group experienced inadequate relief and required other medication compared with 11 (50%) in the meperidine group (PC 0.01). The visual and verbal pain analog scales showed significantly greater improvement in the severity of pain in the chlorpromazine group (P < 0.001). Intravenous chlorpromazine appears to offer effective relief for ED patients with acute migraine headaches while avoiding the potential for narcotic abuse and addiction. [Douglas A. Schneider, MD] Editor’s Note: It can be remarkable how good relief can be achieved with chlorpromazine. It also is a good antiemetic. Even if the patient requires subsequent opiate, it provides as excellent alternative of care and helps remove the often inappropriate designation of drug-seeking behavior.