Demerol is passe?? Can anyone fill me in?

  1. 0 Hi, not a pain specialist, but I have been hearing demerol being criticized as ineffective for pain relief a lot lately. Where is this research coming from? Is there a resource anyone can recomened for learning more about this?
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  3. Visit  steel magnolia} profile page

    About steel magnolia

    43 Years Old; Joined Mar '04; Posts: 44; Likes: 1.

    23 Comments so far...

  4. Visit  Tweety} profile page
    0
    I know one of the reasons that demerol has fallen out of favor is that it accumulates and can cause seizures. Don't have any references though.
  5. Visit  purplemania} profile page
    0
    the elderly are particularly sensitive to having altered mental status when on Demerol. I believe the thinking is that since other drugs can effectively treat pain without psychotropic side effects, we should not use Demerol.
  6. Visit  RN-PA} profile page
    0
    Now that you mention it, I can't remember the last time I had a Demerol order for pain. It's generally been Morphine or Dilaudid that's being ordered on our med-surg unit.
  7. Visit  z's playa} profile page
    0
    Demerol does exaserbate siezures and cause tremors after prolonged use however I feel Demerol is getting a bad rap overall because this the drug of choice for many so-called drugseekers but it is also very effective for migraines (when used as strictly pain control...not abortive agent) and other pain when combined with say Torodol or other nsaids. Its also a good second choice if one is allergic to morphine since Fentanyl is a short acting. (according to my pcp) That's my .02 cents.

    AAARGH! Where's Dave when you need him?
  8. Visit  rollingstone} profile page
    0
    Demerol (meperidine) when metabolized produces noremeperidine which lowers the seizure threshhold. Lately I've used small (25mg) IVP doses in patients to control shivering.
  9. Visit  nurse_robin} profile page
    0
    Quote from rollingstone
    Demerol (meperidine) when metabolized produces noremeperidine which lowers the seizure threshhold. Lately I've used small (25mg) IVP doses in patients to control shivering.
    Yeah, there's usually an order for Demerol for fresh post-op pts during recovery for shivering.
  10. Visit  Palpitations} profile page
    0
    When I was fresh post-op for a thyroidectomy, I remember being in #10 pain when I awoke. I asked the nurse "What did you give me, Narcan?". She said "I have given you a 100 mgs. of Demerol!" I told her that Demerol didn't kill my pain. She called the doctor, got the order for morphine and that did the job. Also, Toradol works better for me then Demerol.

    Demerol can be a cerebral irritant esp. in certain patient populations.


    http://www3.us.elsevierhealth.com/WOW/op024.html


    Quote from nurse_robin
    Yeah, there's usually an order for Demerol for fresh post-op pts during recovery for shivering.
  11. Visit  IMustBeCrazy} profile page
    0
    A bit off track but a question...

    Demerol (meperidine) when metabolized produces noremeperidine which lowers the seizure threshhold. Lately I've used small (25mg) IVP doses in patients to control shivering.
    In what circumstance would you want to control shivering post op? I was taught shivering is a normal and necessary physiologic response resulting from being in a cool OR?
  12. Visit  sharann} profile page
    2
    IMUSTBECRAZY, you ask a good question. Shivering post-op actually leads to heat loss, increased risk for cardiac arrythmias, and increased pain. After surgery, one of our key goals is to maintain core and surface body temps. If a patient is hypothermic they are at risk for more post-op complications including taking the oxygen away from cells(shivering uses oxygen) and acidosis.
    mew808 and
  13. Visit  Gldngrl} profile page
    0
    Also seen Demerol given (25mg) IV for rigours with Albecet. (Premedicated as well w/ Benedryl/Tylenol).
  14. Visit  klgann} profile page
    0
    Just spent about 10 months working PACU, in a normothermic post-op shivering patient, 12.5 - 25mg IVP Demerol works quite effectively.
    Some of the younger Anesthesiologists however, won't touch it with a ten foot pole secondary to the potential for seizures. I still see it used for pain control with pancreatitis patients, but rarely see it used for much else. Haven't pulled the study to find out the particulars, just see the change in practice...
    -Kelly
  15. Visit  Traveler} profile page
    0
    My husband was put on Demerol after bilat. total knee after he had a reaction to eiidural meds and also had severe episodes of vasovagal syncope where hr dropped to about 20. It was explained to me that a s/e of Demerol is to raise hr.

    I did read somewhere that Demerol/Phenergan combo. isn't thought of as necessary. Perhaps Dave could comment on this.

    Ann


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