PCA DEMEROL

  1. we are thinking of using demerol pca for pt's in early labor instead of epidural's looking for info if any units are using demerol this way, problems with infants, and amt's used.
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  2. 13 Comments

  3. by   Rose
    I don't agree to using PCA DEMEROL for labor---demerol has too many side effects---we use Nubain IVP or IM depending purpose for use at the time---it relaxes the pt--they go ahead and dilate-if they are in true labor--however most caregivers do not give it in early labor if the dilating is not up to at 4cm---Nubain does not effect the newborn unless a dose is given just before delivery---which is not a good idea to do and i can't recall in my experience giving it late in labor--ieushing, etc---we very seldom have to give Narcan to our newborns--

    good luck in your labor and del experiences


  4. by   Pearl
    Susan,

    Don't do it! Studies have shown that Demerol builds up in the system and is not reversed by Narcan. A baby born depressed by Demerol does poorly. Got this information from an anesthiaoligst at a seminar concerning narcotics in delivery. This also applies, in that Demerol passes through the breastmilk. A baby that receives Demerol from the breastmilk will become a "lazy baby" and nurses poorly.

    Our doctors no longer use Demerol during labor or post C section. We use Nubain and Stadol and a morphine PCA pump post C section.

    Hope this information is useful.

  5. by   travelrn
    I agree with Pearl...plus Demerol is more likely to cause nausea and vomiting...Lord knows we see enough of that without adding Demerol to the mix...
  6. by   mother/babyRN
    I had a demerol pca AFTER my csection and had no problem...I wouldn't even THINK about using demerol on a continual basis for labor, even though we used to use demerol and sometimes mepergan before that went by the wayside. Narcan does reverse it BUT it does stay in the system,as has been previously stated and you will end up with some VERY sleepy icky babies if you go that route...That will probably lead to scads of lawsuits..Best thing I have seen beyond epidurals has been nubain and stadol...Stadol being the better of the two ONLY in MY opinion...
    Why would anyone EVER want to run a continuous IV narcotic drip in labor???That is a catastrophe waiting to happen...
    Afterwards, such as with a csection, it is now more customariy to use Morphine PCA, especially with breast feeding moms, because it has a short half life...You couldn't pay me to participate in a labor clouded by PCA demerol........
  7. by   P_RN
    Demerol and pca are a dangerous combo. It's the metabolite of Meperidine that builds up and can allow seizures. Having a laboring mom seizing isn't part a normal delivery. Please NO Demerol PCA.
  8. by   cannoli
    Who's thinking about it? The doctors?
  9. by   VivaLasViejas
    From my own experiences, Demerol is AWFUL when used during labor......it doesn't take away the really severe pain, and it messes up your concentration when you're trying to breathe through a contraction....both bad, as far as I'm concerned. It's also NOT good for the baby (my daughter's resps were depressed for several minutes after birth, and she was sluggish for the first few days of her life.....not good when you're trying to establish breastfeeding!). I wouldn't recommend Demerol to ANYONE giving birth, unless it's the only drug they can tolerate, and there aren't too many people who can (legitimately) tolerate *only* Demerol for pain........
  10. by   SmilingBluEyes
    baaaaaaaaaaaaaaaaad idea for the reaons mentioned

    also demerol is linked w/increased seizure activity in patients....cant' remember exact study. will go look it up.

    we dont use demerol PCA for anyone on our floor, OB's ESPECIALLY....just Morphine or dilaudid...and perhaps fentanyl. don't even stock demerol PCA any longer. dr's wont' use it.
  11. by   Spidey's mom
    I'm in complete agreement with you all. We don't use Demerol much at all for any kind of pain issue. I can't imagine a Demerol PCA for a laboring mom. Demerol does absolutely nothing for the pain of contractions but just makes you zone out in between. You still feel every darn one of those buggers (I know - I had it and my 2nd son had to be resuscitated at delivery). I agree that it just makes you less able to concentrate.

    I can't think of a much worse idea . . . except using meth.

    steph
  12. by   BETSRN
    It has been hypothsized that demerol has some effects on breastfeeding. We do NOT use PCA's in labor at all. I think meds on a pump in labor are NOT a good idea. Too much medication for maybe too long a period of time.
  13. by   BETSRN
    You say "early labor" Why would you use meds at all? How about the shower, walking, rocking, changing positions? You do your patients a biog disservce is meds are used too early: not to mention you may slow down or stop the labor alltogether.
  14. by   Dave ARNP
    I do pain mgt....

    Yes... You can do Dem via PCA....
    NO YOU CANNOT DO IT in L&D with a baby in the mother!
    NEVER
    NOT NEVER
    NOT EVER!

    BAD IDEA!
    Okay... I'm calm now. I wouldn't want to use it post op for a mother who delivered a viable baby. Any chance that baby can get this drug... I DON'T LIKE IT!

    Bad combo! And frankly, Narcan may simply not cut it when it comes to getting it out of baby.

    But not to worry... You won't be using it long. NICU will either kill your OB docs, your mothers will sue them out of practice, or the patients will be scared away :-D

    David Adams, ARNP
    -ACNP, FNP

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