Meperidine (Demerol) or Morphine for pancreatitis patients?

tsalagicara · Jun 21, 2014

As a pancreatitis sufferer myself (and a nurse) I can tell you that it is morphine that is notorious for causing spasm of the Sphincter of Oddi and Demerol is supposed to be the preferred pain med, but I am not sure if Demerol is used much anymore. At the very least, I have not been given it during any pancreatitis hospitalization. All opiates can cause spasm of the Sphincter of Oddi but morphine seems to be the worst as far as that goes. Maybe I can find some links to research for you that might help answer your question even better. If you have any questions feel free to PM me though! :-) Good luck to you for the NCLEX, and if you have already taken it I hope you passed!

toomuchbaloney · Jun 23, 2014

Can't help you.

Demerol is a drug without many advocates these days...

My SIL gets dilaudid for his pancreatitis pain.

tsalagicara · Jun 23, 2014

Dilaudid is the usual drug given to pancreatitis patients these days. Of course, every person is different with how they can tolerate the drugs, but morphine does still seem to be the worst offender in causing more spasms of the Sphincter of Oddi (which are extremely painful and can make the pancreatic duct that much more plugged up). Toomuchbaloney is right about there not being many advocates of Demerol nowadays. I believe its respiratory depression side effects are worse than other opiates, but someone please do correct me if I am wrong.

Shell120 · Jun 24, 2014

Thank you all for clearing that up as an almost employed nurse, I feel better knowing what is going on in the field. But if someone out there knows what the NCLEX board's view is, I would love a quick answer for studying purposes. My exam is Tuesday July 2, 2014. Don't know how to answer these exam practice questions d/t each practice company having a different rationale and answer. I have gotten them wrong both ways..... Thanks again. :)

jmjlori · Nov 13, 2016

I had pancreatitis earlier this year during a bout in ICU. Hitting the PCA with morphine would send searing pain through my abdomen. The nurses did not believe me when I would tell them. It was a terrible experience. They never found a pain medicine that helped, so I just had to endure the old-fashioned way. but I made sure they PCA was far away from anyone's hands. :-/

NewHam CRNA · Nov 30, 2017

Equal analgesic doses of fentanyl, morphine, meperidine, and pentazocine increase common bile duct pressure 99%, 53%, 61%, and 15% above predrug levels, respectively. Hydromorphone is similar to morphine in that regard. That's distinct from an actual spasm though, which occurs about 3% of the time for people receiving higher doses of fentanyl. For pancreatitis, the increase biliary tract pressure is usually tolerated OK, but like some of the posters said it might be met with an increase in pain and increase amylase levels. If a spasm happens, glucagon IV (2 mg for an adult) relieves the spasm.

offlabel · Dec 1, 2017

Typical BS question written by nurses so far removed from clinical reality they wouldn't know the diff b/t pancreatic dysfunction and gall bag dysfunction. Give morphine, for the purposes of this dumb question they were too lazy not to recycle after 30 years. Demerol is the new anti-Christ opiate because it can "cause seizures". In the real world both drugs are garbage and dilaudid is the most reasonable iv narcotic to give, but don't expect to see that on an NCLEX exam. They're trying to confuse you.

offlabel · Dec 1, 2017

Equal analgesic doses of fentanyl, morphine, meperidine, and pentazocine increase common bile duct pressure 99%, 53%, 61%, and 15% above predrug levels, respectively. Hydromorphone is similar to morphine in that regard. That's distinct from an actual spasm though, which occurs about 3% of the time for people receiving higher doses of fentanyl. For pancreatitis, the increase biliary tract pressure is usually tolerated OK, but like some of the posters said it might be met with an increase in pain and increase amylase levels. If a spasm happens, glucagon IV (2 mg for an adult) relieves the spasm.

But the glucagon is given after the narcotic so you might be treating something other than sphincter pain and it magically "resolves" after the glucagon. And everyone says "it was Oddi spasm!"