Demerol, YUCK!

  1. What is the love affair that PMD's and even some general surgeons have with demerol . On our ortho floor is we are not even giving our doctors the option to use it in the new pain management protocol. It doesn't work, gives elderly people narcotic induced psychosis with very little amounts and ust isn't a justifable medication unless the patien is allergic to dilaudid or ms04. Is this just and issue in our area or is this nation/world wide?
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  2. 25 Comments

  3. by   sharann
    Our hospital pharmacist won't even stock our unit w/meperidine without calling us and the doc's if they get an order. The docs are strongly discouraged from even prescribing it d/t the very reasons you cited as well as the fact that it can build up and cause seizures.Demerol is used for some procedures such as Conscious Sedation etc, but generally not. Our new protocol(pain is the 5th vital you know....thanks JHACO) is very against demerol. Try to get your pain management team or experts (you have at least one) to make a form or do a physiscian inservice or something about it. Good subject.
    Bye!
  4. by   TracyRN
    Glad to hear that there are others out there who don't like Demerol. My hospital practically bathes in it. On the same hand, though, I really think MSO4 doesn't do much good, either, on ortho. Makes people "dingy," for want of a better word, and constipated. I'm the queen of warm prune juice down here.

    When I work ortho, I go thru the a.m. of 1st day post op, take down the PCAs and start the Percocet. The patients have less nausea, constipation, light-headedness and disorientation. Of course, it does require nursing to be on the spot with PO meds but folks are happier with the PO.

    Apparently my pain mgmt team is in the dark ages because they thought they were making great strides ahead by going to a continuous PCA with bolus. I'm so ashamed...
  5. by   Doey
    Kewlnurse, thank-you thank-you thank-you! This has been a pet peeve for me for some time now. I don't know what it is with surgeons and demerol. Do they think it's some kind of miracle drug? There is certaintly a vast array of pharmacologic and non-pharmacologic methods of pain control, all of which are superior to demerol. I absolutely hate using it. No sooner than it's given and the 80yo fresh hip or belly is climbing oob and hallucinating and still not getting adequate pain control. Then the med is d/c'd and of course nothing else is ordered because "we have to let it get out of their system". Other meds are ordered to cover the behavior, ativan or haldol, but again inadequate pain control. When an alternative to demerol is suggested, like morphine etc. the answer seems to always be that the doc doesn't want to decrease their respirations. Nurses are continually being updated on issues re: pain control, proper medicating for ETOH withdrawal etc, but who updates the docs? We have mandatory inservices on these issues and others but it seems like no one tells the docs. To be fair some do take suggestions when they are offered and I guess after 20 nurses throughout the hospital are giving the same spiel they take the hint. But how many patients have to suffer needlessly in the mean time. So this is not just issue in your area. I think it's probably widespread.
  6. by   mustangsheba
    It is incredible how pain management differs from hospital to hospital and among geographical areas. Docs get very little education in school about pain. We nurses get far more instruction and, of course, we have to deal with it from hour to hour. How many docs have actually prescribed a pain medication and then evaluated it's effectiveness on at least an hourly basis? Nurses deal directly with pain issues. Doctors write orders and base their decisions on what they learned in medical school and what the pharmaceutical companies tell them. We need to be more assertive in presenting our observations to the docs and provide meticulous narrative documentation regarding what works and what doesn't work. I don't think we can overstate the importance of this issue.
  7. by   Zee_RN
    I hate demerol too. We use it ALL the time for post-op pain. And if we do get the occasional MSO4 order, it is 2 mg! Yeesh. Personally, I'm listing Demerol as an ALLERGY and telling everyone my reaction is PROJECTILE VOMITING. Figure no one will want to give it to me 'cause no one will want to clean it up! I think the drug is practically useless.
  8. by   JillR
    Zee!!!! I love the projectile vomiting thing, I can not stop laughing. I think I will be using that in the future.

    Jill
  9. by   swmn
    Excellent, a worthy subject for a change.
    Before I get started, I have never personally taken Demerol or Fentanyl (or even percocet really), but I have sedated a lot of patients for endoscopic procedures.

    I despise Demerol. I hear repeatedly from folks that have had it that they still "feel" pain, they are just powerless to do anything about the pain they are experiencing. The only thing I know of Demerol has going for it is that it is relatively cheap.

    In combination with Versed, concious sedation is relatively easy, but lets see, the patient is still feeling pain and can't do anything about it, but because of the Versed they can not remember later they were in pain. To me that sounds like "pain control" maybe, but definitely not "controlled pain."

    I do like sedating with IV Fentanyl just fine. It seems to me it is a lot smoother induction (takes a little longer than Demerol), and a smoother recovery too. Intra-procedure, once I got a good handle on dosing and onset timing, my patients seem, to me, to be more relaxed during their procedures. The folowing is anecdotal, but I think I see fewer EKG changes too.

    When it is my turn for a colonoscopy, I am going some place that uses Fentanyl.
  10. by   nursejanedough
    I just have to unload again. This is about pain control. I am still haunted by a situation when I worked adult psych. There was a geriatric psych unit next door to us that was overflowing. We accepted this elderly lady (Alzheimer's). She would cry and grab me and beg for pain relief. I called MD in middle of night one time (Oops!) Most of the nurses felt she was drug seeking (we were all used to drug seekers on our unit). I really felt she was in pain. She was 83 years old and I worked the night shift and she would cry and beg for something for pain. We had only been giving her Tylenol and I had told charge nurse to talk to MD "in daytime hours" - that I really felt patient was in real pain. After about a week of moaning and groaning, she had tests done and had bone cancer and transferred to another unit. All I know is this, if I ever reach age 83 y/o I want a doctor who will give me whatever I need for pain. Are we really worried about addiction at age 83?
  11. by   OC_An Khe
    Much prefer to use Fentanyl. Demerol can be nasty at times, but does have some limited uses. Only problem is the Fentanyl is becoming scarce. Seems one major (?the only) manufacturer is no longer going to produce Fentanyl as they can't make enough money on it.
  12. by   fergus51
    nurse jane, that is TERRIBLE! That poor woman shouldn't have had to suffer like that and I agree with you that we shouldn't worry about addiction in an 83 year old or in any age for that matter. Study after study has shown the adiction rates for people getting narcotics for pain relief in a medical settin is less than 1%. But we continually force people to stay in pain because we don't want them to turn into addicts.

    We use meperedine ALL the time, I think because it's cheaper than ms04. I don't think we give our patients proper pain relief anyways seeing as they're all a bunch of "drug seekers" (I mean, they must be lying, why would you feel pain after having your abdomen cut open, or your hip replaced?).
  13. by   karenccma
    Originally posted by nursejanedough:
    I just have to unload again. This is about pain control. I am still haunted by a situation when I worked adult psych. There was a geriatric psych unit next door to us that was overflowing. We accepted this elderly lady (Alzheimer's). She would cry and grab me and beg for pain relief. I called MD in middle of night one time (Oops!) Most of the nurses felt she was drug seeking (we were all used to drug seekers on our unit). I really felt she was in pain. She was 83 years old and I worked the night shift and she would cry and beg for something for pain. We had only been giving her Tylenol and I had told charge nurse to talk to MD "in daytime hours" - that I really felt patient was in real pain. After about a week of moaning and groaning, she had tests done and had bone cancer and transferred to another unit. All I know is this, if I ever reach age 83 y/o I want a doctor who will give me whatever I need for pain. Are we really worried about addiction at age 83?
    THANK YOU! YES I BELIEVE THAT DEMEROL IS MISUSED AND ABUSED. I WORK IN A URGENT CARE AND I SEE THE ABUSE WHEN THESE PT.COME IN WITH SO CALLED "MIGRAINES" AND WHAT DOES THE DR.TELL US TO GIVE 100 ML DEMEROL AND WHAT IS SO FUNNY THESE PT. ARE HAPPY AS CLAMS WALKING OUT OF THE PLACE. WE HAVE COUGHT 1 LADY AFTER TELLING US THAT THEY HAVE A RIDE HOME GET INTO THEIR CAR AND DRIVE OFF, WE CALLED THE POLICE AND SHE WAS ARRESTED YEH!!!SHE EVEN HAD HER 3 YEAR OLD DAUGHTER IN THE CAR WITH HER AT THE TIME. SHE GOT THE GIRL TAKEN AWAY WE FOUND OUT THANK GOD BUT SHE GOT HER BACK AFTER GOING INTO REHAB.NOW THAT IS THE BAD THING ABOUT DEMEROL. I JUST WISH THAT MY FATHERS DR. WOULD HAVE GIVEN HIM DEMEROL WHEN HE WAS DYING OF LUNG CANCER ALL THEY GAVE HIM WAS TYLENOL #3. WHAT A JOKE THEY SAID THEY DIDN'T WANT HIM ADDICTED HE WAS DYING THE TYLENOL 3 JUST GOT HIM SO CONSTIPATED THAT HE WOULD CALL ME UP CRYING. WHO CARES ABOUT ADDICTION WHEN YOU ARE DYING. SO I THINK THERE IS A PLACE FOR THAT MED. BUT I ALSO THINK THERE IS ALOT OF ABUSE WITH IT TOO.
    THANKS KARENCCMA

  14. by   JillR
    I have two things to say here.

    First I had an endoscopy doen recently and they gave me Demeral and Versed for the conscious sedation. Was it effective? I have no idea, I remember nothing of the procedure. If a patient feels pain, but cannot remember it, is it considered adequate pain control? That is a good question.

    Second, I take offense at generalizing about the fact that all migraine sufferers are drug seeking. I suffer terrible debilitating migraines at times, and although I seem to have them under fairly good control at this time, there have been times that I have had to seek opiate relief for these migraines. I have news for you,imitrex does not work for everyone, it does not touch my migraines.

    Yes demerol can be abused, and so can all of the other opiates. There will always be drug seekers. I guess there have been times that I have been one of those drug seekers, I had been seeking a drug that would give me relief from my pain.

    Anyone who thinks that a migraine is just a bad headache, has never had one and needs to get some eduction about this problem.

    Is demerol an effective pain medication? Well, I can tell you from personal experience that it does not really make the pain get better, it just makes me not care that I have pain and it oly last for about 2 hours and then I really have pain again. Percocet works much better in my opinion, but when you can not keep any oral medication down, you will take what you can get.


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