DEMEROL ... does Your unit use it?

Elvish, BSN, DNP, RN, NP · Jul 11, 2012

We have standing orders for Demerol 12.5 if the shivering is really bad, but I have yet to use it; haven't needed to. Don't know anyone else who has either.

We give our c/s pts Duramorph in the epidural as well*, but it lasts for 24 hours, so it's not like they are lying around hurting with nothing the entire time. However, I do find that the Duramorph starts to wear off somewhere around 18 hours. At that point, it's nice that we also give our c/s moms 30mg Toradol q6h for the duration of their Duramorph. That goes a long way in helping with the postop pain.

*- depending on anesthesia's preference, they will either get the full Duramorph dose in their epidural or they'll get half the dose in the epidural and the other half IV. Personally I like it better all in the epidural for postop pain.

jodyangel, RN · Jul 12, 2012

Well I gave most of my pts the demerol at my last job. Why? Because their shivering was bad..most reacted this way to their spinals..

Elvish, BSN, DNP, RN, NP · Jul 12, 2012

Well I gave most of my pts the demerol at my last job. Why? Because their shivering was bad..most reacted this way to their spinals..

That's odd, because I have seen maybe one case in almost seven years. That's not to say you are lying...I believe you...just never seen it myself. It's almost like people who see extrapyramidal symptoms from Phenergan all the time.....and I have only seen them once, and used to give Phenergan IV like it was water at my first job. Same thing, I think.

cebuana_nurse · Jul 18, 2012

I have never heard of Demerol can be used for shivering. Good thing I bumped into this topic. Most of my post C-sec patients gets IV Toradol x 6 doses. They either get Demerol or Morphine in the PACU. Once on the floor, they don't use those. I think it also depends per physician too.

LDRNMOMMY, BSN, RN · Jul 18, 2012

When I worked in NC some anesthesia providers wrote for Demerol for shivering, works like a charm. I didn't see it too often, but I did give it a few times.

Fyreflie · Jul 19, 2012

When I first started working OBs almost 5 years ago we used to give it in early labour but most places in Canada seem to have moved to morphine &gravol now. I've never given it post op--we rarely have pts with bad shivers though for some reason. If we give anything in the PARR it's toredol or ketorolac or morphine if they didn't have epi morph.

nurse4newlife · Jul 19, 2012

We use Demerol for shivering routinely. Our section pts get dilaudid and or morphine, plus iv toradol, and leave the pacu with a PCA pump...

psu_213, BSN, RN · Jul 19, 2012

I am not an OB Nurse, but I have heard of demerol being used for postop shivering in other specialties (we were actually just talking about this at work the other day).

As for the issue of verbal orders...most of of the places where I have worked and some others I have heard about reserve VOs for "emergency only" and, for the most part, I would not call post op shivering an emergency in most cases. Now I know some places where "emergency only" is said, but VOs are taken all the time. Perhaps this unit takes it seriously and kudos for them for that. As nurses take more and more VOs when the doctor is capable of writing the order, something is going to go wrong (such as an allergic reaction for a med ordered by VO) and some doctor will 'throw the nurse under the bus' (yikes, I hate that phrase).

jodyangel, RN · Jul 20, 2012

Well maybe I've been in nursing wayyy too long, but verbal orders were something used frequently at one time. Remember the repeat back thing.

lucyneel · Jul 31, 2012

Ok so I am in a new facility. My old facility used demerol 12.5-25mg post csection IF needed for shivering. Not sure why, but demeral cuts the shivering.
The other day my pt was shivering so bad her teeth were chattering. I called Anesthesia and asked if she could have some. He gave me a verbal order and I wrote it down and pulled it. When I told my preceptor that I was going to give it to her she looked at me like I had two heads!!
WHY?? She said. She had never heard of using it..and thought it would "snow" the mother.
She said maybe we could put the bear hugger on her if she was cold. I wanted to say, Noo shes not cold she has that post anesthesia shivering...but kept quiet. Both she and the charge nurse said Ohh we dont take any verbal orders, you'll get in trouble for that.
Hmmmm..ok.
So I put it back. Let the pt. shiver. I know its ideal to have the doc write the orders..but sometimes you need something right NOW..and well..ok so no verbal orders..shesh.
They give their CSection pts. Duramorph IN the epidural so they also get NO post surgery pain meds.

Demerol is a standing order for shivering on my unit. We also use Duramorph, but we give pain meds after 12 hours, and Toradol can be given every 6 hours after recovery.

lovemyjoblandd · Oct 24, 2012

At my first unit, which was an army hospital, we never used demerol and were incredibly stingy with pain meds for our c/s patients (1-2 perc q6h, toradol q6h x8, and MAYBE 2mg morphine IV. PCAs only for those who underwent general). I'm now at a civilian facility and we routinely have demerol ordered for our patients for post op pain AND either a PCEA or PCA of demerol. It most definitely works like a charm for the shivering, but have some phenergan on hand when you give it or else you will have a non-shivering, puking patient :)