Texas State Journal of Medicine, Volume 51, Number 7, July 1955 Page: 464
70, [54] p. : ill. ; 27 cm.View a full description of this periodical.
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464
N I S E N T I L-Ashmore and Moon-continued
not significantly delayed. In 311 cases, a special at-
tempt was made to determine the effect of Nisentil
upon fetal respiration, with measurements of the
time between delivery and (a) the first respiration
and (b) the first lusty cry. There was no significant
depressant effect from Nisentil if given at least two
hours prior to delivery and little depressant effect
generally, except in a subgroup of 30 patients who
received disproportionately large amounts, that is, five
consecutive 40 mg. doses at regular two hour inter-
vals.
A total of 1,000 obstetric patients comprised the
case material for the study by LaForge.8 The routine
use of 40 mg. of Nisentil subcutaneously gave good
analgesic effects in 50 per cent of the mothers. Sub-
sequent experience showed much better results, that
is, "marked to full analgesia" from 87 per cent of
the doses, when a base-line dose of 60 mg. was
adopted with variations from 40 mg. to 80 mg., de-
pending upon the weight of the patient. Averagely,
five minutes was required for the onset of analgesic
action; the mean duration was one and a half to two
hours. The identical number of cases was reported
on by Kane.7 One a similar regimen of treatment-
that is, 40 or 60 mg. of Nisentil subcutaneously re-
peated when necessary at two to eight hour intervals
-satisfactory analgesia was obtained in 98.1 per cent
of cases. Analgesia classified as "full or marked"
occurred in 80 per cent with repeated doses. Con-
current medication with scopolamine appeared to
prolong the duration of the maximal effect for about
one hour.
USE IN UROLOGY
The rapid onset and relatively brief duration of
effect from Nisentil, as set down in these obstetric
reports, suggested to McCrea and Post10 the possible
utilization of this comparatively new analgesia in
urologic procedures. After preliminary trial estab-
lishing 30 mg. as the optimal intravenous dose, the
authors employed Nisentil in 100 patients requiring
cystoscopic examination. In 5 of these, the procedure
had to be postponed because of side effects. Of the
balance of 95, the analgesia was "marked" in 40,
"moderate" in 34, "little" in 11, and "none" in 10.
The duration of analgesia averaged 16 minutes, with
a range of from 2 to 60 minutes. Except for a con-
vulsive seizure in 1 patient, the side effects as seen in
the other 4 were not serious, consisting chiefly of diz-
ziness (4 patients) and vomiting (1 patient). It was
considered an advantage that no sedative effect oc-
curred in 48 per cent of the patients; when this did
appear, it persisted generally for not more than 30
minutes.
We, likewise, were attracted by the prospect ofachieving more satisfactory analgesia for urologic
procedures. This was especially true with respect to
cystoscopy, which has continued to be associated with
fear and apprehension despite the trial and abandon-
ment over the years of a succession of agents. Fur-
thermore, we sought rather specifically for a method
suitable for office procedure rather than for the hos-
pital where, of course, Pentothal Sodium, nerve block,
and the anesthetic gases are available. Defined more
precisely, we looked for an agent we could give the
patient upon arrival at the office which would allay
his apprehension, lower his pain threshold, last not
longer than two hours, and yet permit his complete
cooperation. Morphine, obviously, did not fulfill
these criteria.
Accordingly, in November, 1952, we began using
Nisentil (1,3-dimethyl -4-phenyl-4-propionoxypiperi-
dine) intravenously. A dose of 30 mg. almost always
produced immediate euphoria, which often caused
the patient to say that he was "getting drunk." Of
the initial 25 cases, 7 complained of nausea, lasting
about five minutes. Once this feeling had passed off,
the patients were generally relaxed, calm, and co-
operative. They also were able in most instances to
get off the table and leave the office at the conclu-
sion of the procedure, although a period of at least
30 minutes in the supine position is recommended
to obviate the recurrence of nausea and to prevent
dizziness; transfer of the patient to a cot or couch
for the "rest" period is probably the most practical
expedient. We also found nausea and vomiting to
be minimized by the administration, intramuscularly,
of 50 mg. of Dramamine 20 to 30 minutes before
the Nisentil. Since we have begun this, we have had
only about 1 per cent of the patients complain of
nausea, and none has vomited. Residual discomfort,
that is, after the analgesic action of Nisentil had
worn off, in our experience was controlled in most
instances by I2 grain of codeine.
To date, Nisentil has been used, in doses of 30 mg.
intravenously, in more than 600 office procedures.
In this series of 600 there was only 1 reaction. This
response, urticarial in nature, was relieved by an in-
travenous injection of 2 cc. of Benadryl. The pa-
tients ranged in age from 16 to 101, with an average
of 38 years. Table 1 shows the procedures used, with
the number of patients for each.
TABLE 1.-Urologic Procedures in Which Nisentil Hydrochloride
Was Used in 624 Patients.
Procedure No. Patients
(:rtoscopy-dilatation of ureteral stricture. .. 252
Diagnostic ureteropyelograms ........................130
Ureteral manipulations (stones and the like) ......... 35
Bladder biopsies ..... .................. . . ... 24
* Prostatic biopsies (needle) ..... 9
Cystourethroscopic examination ..... ....... 73
* Ligations of vas deferens ......................... .. 79
*circum cisions ................................. .. . 22
T o tal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2 4
*In conjunction with procaine infiltration.TEXAS State Journal of Medicine
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Texas Medical Association. Texas State Journal of Medicine, Volume 51, Number 7, July 1955, periodical, July 1955; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth599868/m1/66/: accessed July 10, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting Texas Medical Association.