pancreatitis and demerol

[ORNurseAngie]

Had a young patient the other day with pancreatitis, pretty much from drinking so much. Patient was receiving Dilaudid 2 mg Q 4 hours prn pain. Was getting it every four hours pretty much but would freak out everytime I was ten minutes late or so. (God forbid I have six other patients that need me) Called the house officer to see patient about pain meds, the doc came up and started saying something about Demerol being the drug of choice for pancreatitis because of dilaudid and morphine and the spinchter of oddi. I started to cite Nursing 2007 which stated that Dilaudid was the med of choice for pancreatitis, b/c it was believed that all opiods cause relaxation of the spinchter of oddi but dilaudid is preferred because demerol can cause seizures. (Demerol convertes to the antimetabolite normeperidine, which is known to cause seizures.) I also pointed out that he was already at risk for seizures due to his drinking. Anyway intern left the meds alone, even though I wanted an increase in either frequency or dose. Patient was in pain evidenced by increased b/p and lipase of 1,000. Had to wait for attending to make rounds at 5pm. Anyway wanted to know what your thoughts were on dilauded or demerol for pancreatitis.

[Lainee]

We use dilaudid as well. I assume you were giving an IV dose but 4 hours is a long time to go in between. We start at q3 and may even put them on a PCA if necessary.

There are a bunch of demerol-free hospitals popping up all over. We RARELY use the drug in my facility for the reasons you posted above.

[JerseyGirl1]

Correct me if I'm wrong...but don't the opioids cause the sphincters (including Sphincter of Oddi) to close, or contract, not to relax!

[EvanRN123]

I thought it Demerol was the best because of the islets or something.....

that being said though, we have done away with Demerol in the hospital completely. I really miss it. I find that people are not as comfortable with Dilaudid. The patient's miss too.

I guess Phenergan is going soon too....all the good ones.

[deeDawntee, RN]

Hi! Great question and controversial.

I am in the process of studying for the CCRN certification which I will take in the next month or so. In my study material, the correct answer for the test is to use Demerol for Pancreatitis because Morphine causes spasms in the Sphincter of Oddi. However, in all my resources, they indicate that research has shown no difference between Morphine and Demerol (or Dilaudid) in the degree of spasm in the Sphincter of Oddi. Also, I don't see anything about the seizure potential of Demerol in my resources, at least not for the CCRN exam. I was told that the correct answer on the CCRN exam at this point in time is that only Demerol is the drug of choice for Pancreatitis, however, that is clearly outdated. In my institution I have seen Dilaudid used. Occasionally, a Demerol PCA will crop up, but very rarely.

My material also says something about a neurolytic block of the celiac plexus for severe persistent pain. (I'm not sure exactly what that would be--some kind of epidural??)

[Nursebarebari]

Had a young patient the other day with pancreatitis, pretty much from drinking so much. Patient was receiving Dilaudid 2 mg Q 4 hours prn pain. Was getting it every four hours pretty much but would freak out everytime I was ten minutes late or so. (God forbid I have six other patients that need me) Called the house officer to see patient about pain meds, the doc came up and started saying something about Demerol being the drug of choice for pancreatitis because of dilaudid and morphine and the spinchter of oddi. I started to cite Nursing 2007 which stated that Dilaudid was the med of choice for pancreatitis, b/c it was believed that all opiods cause relaxation of the spinchter of oddi but dilaudid is preferred because demerol can cause seizures. (Demerol convertes to the antimetabolite normeperidine, which is known to cause seizures.) I also pointed out that he was already at risk for seizures due to his drinking. Anyway intern left the meds alone, even though I wanted an increase in either frequency or dose. Patient was in pain evidenced by increased b/p and lipase of 1,000. Had to wait for attending to make rounds at 5pm. Anyway wanted to know what your thoughts were on dilauded or demerol for pancreatitis.

I was thought at school and review center that demerol was the drug of choice for such patient, but we never use demerol for anything at my facility; infact, we don't we even carry that med.

[al7139, ASN, RN]

My unit is primarily a cardiac unit, but we do get medical patients as well. I have had two pts with acute pancreatitis since I have been ther and they both had Demerol ordered q3hrs prn. They also had Zofran ordered for nausea/vomiting, which can help with pain as well. For this discussion, I referred back to my old med/surg textbook from school (last edition 2006), which said that demerol is thought to cause less incidence of spasm of the smooth musculature of the pancreatic ducts and the sphincter of Oddi than other analgesics such as morphine. They do say the side effects have created other options, mainly Fentanyl patches and epidural morphine/ bupivacaine.

Amy

[crb613, BSN, RN]

We use demerol pca's like crazy .....Dilaudid is one we rarely use..... very interesting that a lot of places do not carry demerol.

[cardiacRN2006, ADN, RN]

I also thought demerol.

We keep demerol on hand for IR procedures that involve entering the kidney. It's what keeps the shivers/shakes away during the procedure...

So, for the people who don't have demerol in their facility, I wonder what their IR department uses?

[grantyRN06]

If I am not mistaken, I think Dilaudid and morphine causes the sphinter to spasm and that is why the demerol is the drug of choice. But Q4hrs that is a long time. Esp w/ acute pancreatitis..they are in sooooo much pain.

[shah]

You should have called the intern again to get off his butt and order something. Interns, by the way, should be used to let experienced nurses correct them, as they are newbies themselves.

[diane227, LPN, RN]

According to my updated reference information, Demerol is no longer recommended and Morphine would be the drug of choice.