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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?
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.
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.
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.
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.
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...
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.