DEMEROL or MORPHINE for PANCREATITIS?

californiaboy · Feb 19, 2013

clarification to recent studies please..
Taking NY licensure
SALAMAT(thank YOU)...

Demerol.

tyvin, BSN, RN · Feb 19, 2013

This has been discussed before on this site before I believe...remember scanning and saw something. Research shows that meperidine has metabolites that can cause seizures and some other nasty neuro stuff. For this reason the last place I worked did not use it. All meds have potential for side effects but this question is going to be specific to house/state rules/practices. Oddi sphincter spasms are associated with morphine and could exacerbate the pain.

obloom14 · Feb 19, 2013

Demerol

chare · Feb 20, 2013

This is another nursing sacred cow that needs to be put to pasture. It is acceptable, and most likely preferable, to use morphine in treating pain associated with pancreatitis. The origin of this myth is unclear; however this has never been clinically proven. All narcotics can cause the sphincter of Oddi to spasm, however it remains to be determined whether these spasms are clinically significant or not.

personal thoughts are these. As Tyvin noted, normeperiding, one of the active metabolites of meperidine, can precipitate seizures, as well as other neurological problems. More importantly, even if you're not going to use meperidine long enough for the metabolites to become problematic, why would you want to use an inferior analgesic agent.

A brief Google search returned the following. Although I only glanced at the abstracts and/or treatment sections of the following articles, all of them recommend the use of morphine over meperidine. In fact, one of the abstracts noted the results of one study that demonstrated a greater increase in pressure associated with the use of meperidine.

Narcotic analgesic effects on the sphinct... [Am J Gastroenterol. 2001] - PubMed - NCBI

JAMA Network | JAMA Internal Medicine | Meperidine vs Morphine in Pancreatitis and Cholecystitis

http://sfghdean.ucsf.edu/barnett/EBM/CATs/MeperidineMorphineAcutePancreatitis.pdf

http://www.medscape.org/viewarticle/557675

Meperidine versus morphine, and PPIs with clopidogrel - JAAPA

https://tdm.pharm.buffalo.edu/pic/get_drug_information_paper.php?attachment_id=52

Focus On: Acute Pancreatitis

Acute Pancreatitis: Pancreatitis: Merck Manual Professional

I did, however, find two sources that still recommend the preferential use of meperidine over morphine

http://emedicine.medscape.com/article/775867-overview

http://www.jkscience.org/archive/volume64/Acute.pdf

allnurses Guide · Feb 20, 2013

We never use Demerol in onc patients when other options exists.

The duration of action is too short, oral absorption is poor, the toxic metabolite normeperidine, has a long half-life and causes seizures, especially in renal insufficiency or dehydration, and Demerol can not be reversed in event of overdose.

For questions like this, I consider Dr. Abraham's book my bible.

St_Claire, ADN, RN · Feb 20, 2013

For the NCLEX it's Demerol.

ylove88 · Feb 20, 2013

According to Kaplan you do not give Morphine because it causes spasms on the Sphincter of Oddie. But there are older discussions here on allnurses.com that will let you know more. But for the NCLEX purpose.. give Demerol.

jpinay28 · Feb 21, 2013

DEMEROL -for pain coz it causes less incidence of smooth muscle spasm of the pancreatic ducts and sphincter of oddi than some other medications..(Saunders )

dah doh, BSN, RN · Feb 21, 2013

Real world...neither one! Fentanyl usually. For NCLEX: pick the one that is not Morphine! (Demerol is rarely used anymore except for post-op or hypothermia shivering.)

loriangel14, RN · Feb 21, 2013

I just had a patient with pancreatitis and he was on morphine. I hardly ever see Demerol where I work.

dragon_lady · Feb 21, 2013

Nclex or book says Demerol but in real world,I asked my sister who's working in an acute care,she said they give morphine instead of Demerol.Just follow Demerol then if you encounter such question in NCLEX.