Demerol is passe?? Can anyone fill me in?

Specialties Pain

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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?

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

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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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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

Dave's gone... :crying2: He doesn't come here anymore as far as I know.

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Specializes in Neuro Critical Care.

I haven't used Demerol in about 2 years, but when I got out of school that was all I gave. I heard they don't use because it isn't metabolized as well, thus has a high incidence of accumulation. Honestly I had fewer problems with Demerol than I do with Dilaudid that I push now. I have given it before an amphotericin (sp) infusion to control shaking. I don't even think the hospital I am at stocks it in the pyxis routinely.

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Demerol has fallen out of favor in pain management due to the breakdown of demerol in the body produces nor-meperidine. With prolonged use as in chronic pain management this build up can cause dangerous and uncomfortable S/Es. As nor-meperidine builds up in the body it can cause confustion, combative behavior and can lower the seisure threshold. Demerol more specifically nor-meperidine is metabolised in the kidney thus anyone with kidney disease of dysfunction should not recieve it. Elderly people who are more prone to confusion (sun downers) ect should not recieve it. Demerol is fine for short lived acute pain in young healthy people although most Dr.s don't prescribe it correctly since in young healthy individuals with good kidney function will clear the drug quicker than the usual q 4 hrs it is prescribed Q2 to Q3 is more in line with the drugs bioavaliability. Demerol works well in post op especially for the patient who is having post operative shakes. Long term pain management is not the correct clinicle application of demerol. While I am on it Phenergan doesn't potentiate anything except sedation. Phenergan has been shown to actually increase pain perception in patients. We think we controll their pain we just knock them out with sedation and do nothing for their pain. FYI I learned most of this during a short stint as a hsopice nurse and through a chronic pain management seminar.

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Specializes in ICU, CM, Geriatrics, Management.
... 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.

Thanks, S. I needed that (the explanation).

Much appreciated.

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Specializes in cardiac/critical care/ informatics.

Our hospital is taking it it off the formulary.

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Specializes in Home care, LTC, subacute/acute rehab.

Ahhh, Dermerol. I've had two experiences with Demerol as a patient. The first time was 17 years ago when I had my gallbladder removed the old fashioned way. I had a large abdominal incision and was given Dermerol IM Q 3 hours round the clock. It was totally inefective and I deveoped swelling and erythema on both injections sites on my butt. One of my nurses was completely unempathetic and acted as though I was bothering her because I was crying in pain. My next experience was 12 years ago when I had a c-section. I was on a pca with demerol. When I was still in recovery I told the nurse I was in a lot of pain and was told I had the pump, so I shouldn't be in pain. Yeah...shouldn't. Demerol did nothing to control my pain. I cried for 8 long hours until the nurse on the second shift told my obgyn that demerol was not cutting it for me. They switched me to morphine and I finally recieved relief. I was tempted to add demerol as a allergy so they don't attempt to give it to me again....but as a lot of you have said, it's not used as commonly. As a nurse, I remember quite vividly how I felt I was not being listened to about my pain management and I try to address pain and push the issue with the doc if the patient feels the pain is unrelievedl I was always thankful to the nurse who finally told my doctor that demerol was ineffective. but, it took a long time.

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Specializes in Hospice, Palliative Care, OB/GYN, Peds,.

Demerol does have a dangerous metabolite and should not be used for more tha 2-3 days. i have found a non pharmacologic treatment for post op shivering which worked for me also-----doing math out loud works great. :yeah:

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demorol or (pethidine as its known in the UK) is only used in my hospital in maternity

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Demerol has fallen out of favor in pain management due to the breakdown of demerol in the body produces nor-meperidine. With prolonged use as in chronic pain management this build up can cause dangerous and uncomfortable S/Es. As nor-meperidine builds up in the body it can cause confustion, combative behavior and can lower the seisure threshold. Demerol more specifically nor-meperidine is metabolised in the kidney thus anyone with kidney disease of dysfunction should not recieve it. Elderly people who are more prone to confusion (sun downers) ect should not recieve it. Demerol is fine for short lived acute pain in young healthy people although most Dr.s don't prescribe it correctly since in young healthy individuals with good kidney function will clear the drug quicker than the usual q 4 hrs it is prescribed Q2 to Q3 is more in line with the drugs bioavaliability. Demerol works well in post op especially for the patient who is having post operative shakes. Long term pain management is not the correct clinicle application of demerol. While I am on it Phenergan doesn't potentiate anything except sedation. Phenergan has been shown to actually increase pain perception in patients. We think we controll their pain we just knock them out with sedation and do nothing for their pain. FYI I learned most of this during a short stint as a hsopice nurse and through a chronic pain management seminar.

We had an in-service 10 years ago from a pain specialist about this and the recommendation was not to use it.

steph

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demorol or (pethidine as its known in the UK) is only used in my hospital in maternity

I had Demerol during labor and it does nothing for pain - nothing. It just makes you a zombie between contractions.

Now Fentanyl . . . . :yeah:

steph

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