Recommended Dosage of Pethidine (Meperidine) for Pediatric Patients
The recommended dose of pethidine (meperidine) for pediatric patients is 1 mg/kg intravenously or intramuscularly for postoperative pain management. This dosing has been shown to provide effective analgesia in pediatric patients undergoing surgical procedures 1.
Dosing Guidelines
Route-specific dosing:
- Intravenous (IV): 1 mg/kg per dose
- Intramuscular (IM): 1 mg/kg per dose
- Maximum single dose: Should not exceed adult dosing (typically 100 mg)
- Frequency: Every 3-4 hours as needed for pain
Age-specific considerations:
- Neonates and infants under 6 months: Use with extreme caution due to immature hepatic metabolism; reduced dosing (0.5-0.7 mg/kg) may be necessary
- Children 6 months to 12 years: 1 mg/kg per dose
- Adolescents: 1 mg/kg per dose (not to exceed adult dosing)
Clinical Considerations
Efficacy and Monitoring
- Pethidine has been shown to provide better postoperative analgesia compared to tramadol in pediatric patients undergoing lower abdominal surgery 1
- Monitor for:
- Vital signs (heart rate, blood pressure, respiratory rate)
- Pain scores using age-appropriate scales
- Sedation level
- Respiratory depression (particularly in neonates and young infants)
Adverse Effects
- Respiratory depression (most serious concern)
- Sedation
- Nausea and vomiting
- Hypotension
- Constipation
- Urinary retention
Special Populations
Neonates
- Neonates are particularly sensitive to the respiratory depressant effects of pethidine 2
- If administered to mothers during labor, neonates may experience respiratory depression that can be reversed with naloxone 3
- Consider naloxone (0.01-0.02 mg/kg IV) as a reversal agent if respiratory depression occurs 2
Breastfeeding Considerations
- Pethidine and its metabolite norpethidine are excreted in breast milk, but studies suggest the amount transferred to the infant is below the safety threshold 4
- The combined relative infant dose via breast milk is below the 10% recommended safety level 4
Important Precautions
Respiratory monitoring: Close respiratory monitoring is essential, especially in younger children and those receiving multiple doses
Avoid in patients with:
- Head injury (can increase intracranial pressure)
- Severe asthma or respiratory conditions
- Hepatic or renal impairment (dose reduction required)
Drug interactions: Use with caution when combined with:
- Other CNS depressants
- MAO inhibitors (contraindicated within 14 days)
- Serotonergic medications (risk of serotonin syndrome)
Norpethidine accumulation: The metabolite norpethidine has a longer half-life than pethidine and can accumulate with repeated dosing, potentially causing CNS excitation and seizures
Alternative analgesics: Consider alternative analgesics for chronic pain management in children due to the risk of norpethidine accumulation with repeated dosing
Remember that individualized dosing based on the child's weight is essential for safe and effective pain management with pethidine, and close monitoring for adverse effects is required throughout treatment.