No More Demerol IV Push???

imenid37 · Aug 8, 2005

We still give demerol in the PACU post C.Section for shivering. Rarely, but sometimes do we use it for other post op discomfort.

Aneroo, LPN · Aug 9, 2005

We were just talking about this today Vicki!

We don't use Demerol at all in the ED (I've never seen it given, been down there almost two months). We go with toradol, morphine or dilaudid. Today they mentioned it was due to the metabolites and the risk for toxicity, plus the fact it's very addicting.

I've had pt's get very upset with me when I go to give them morphine for their pain, and they tell me Demerol is all that works for them. I think we may still use it in PACU or some of the ICU's, but def not downstairs in the ED. -Andrea

BabyRN2Be · Aug 9, 2005

I had read somewhere that Demerol was becoming passe for the reasons mentioned. Some have tried to fight it, but apparently the days of using Demerol seem to be limited.

elizabells, BSN, RN · Aug 10, 2005

I had read somewhere that Demerol was becoming passe for the reasons mentioned. Some have tried to fight it, but apparently the days of using Demerol seem to be limited.

They're teaching us in nursing school (at least at mine) that Demerol is pretty much bad news. I don't remember exactly what the notes said, but it was definitely not pro-Demerol

glascow · Aug 10, 2005

This is news to me! I work post-op and we give Demerol ALL THE TIME, IV and IM.

I did read a couple of research articles yrs ago about why you shouldn't use Demerol, but have not seen a difference in practice by the MDs ordering it.

sweetyjen · Aug 10, 2005

Hi! I'm a new grad and yes, we learned that demerol is pretty much being "phased out". HOWEVER, I just had a post op patient today on a Demerol PCA! Very interesting. I have had demerol IV before and honestly, it worked for about 5 minutes tops...i think it is a horrible drug for pain control and all alternatives should be done first!

Glimmer · Aug 10, 2005

I had a major knee surgery about a week ago so I found this thread interesting.

I was being given Morphine IV push and also fentanyl between doses to try to ease the pain... once it pretty much caught up with me I was then told that we would try to manage the pain PO or else I would have to be admitted and put on a PCA pump. My po med was Demerol and my nurse was very unhappy about that. I was on it for 2 days before demanding something else for pain control... something much WEAKER. I hated the fact that I could touch my arm, leg, etc and know I was touching it because I could see myself do it but I would have no senesation for a couple of seconds... very freaky out of body type experience. I took about 3 days of being off the Demerol before everything returned to normal... I found myself wondering how in the world people could get addicted to that crap! LOL (I was told that I was taking high doses and that is why I had these affects...) My PACU nurse said she hates to see demerol used anywhere and that they no longer had it on the floor for pain management.

rn/writer, RN · Aug 10, 2005

A few months ago, I had two trips to the cardiac cath lab within ten days. The first time, I got a stent. The second time, just a precautionary going-over. Both times I had an IV cocktail of Versed (midazolam) and Demerol, aka Dazzle and Dem.

I don't know how I would feel about Demerol for post-procedure pain control but each time I had it, I asked when they would start the cath and was told they had already finished. I had no complaints about feeling grogged afterward.

A few weeks later, my 23-yo daughter was injured by the jet spray of a pool slide at a big water park and had to be scoped to check for rectal tearing. She got the same cocktail and doesn't remember much of anything, thank goodness.

Is the use of Demerol for pain control during procedures as frowned upon as its use for post-op analgesia? My daughter and I were both quite pleased with our results.

Miranda

CrohnieToo · Aug 10, 2005

Goshes, our hospital outpatient Endoscopy department still uses Versed for amnesia and demerol for analgesia and phenergan, if needed, for nausea, all of them PIV. Since I get agitated and hostile on Versed and prefer to watch the monitor anyway, after some strong differences of opinion w/my gastro, I now have my colonoscopies w/just PIV demerol. My gastro wanted to call in an anesthesiologist with Diprivan for my scopes. Sometimes when we get to the transverse colon/hepatic flexure my vagus nerve takes offense and gets in a twit at which time they will add a little phenergan to the PIV cocktail. I'm good to go for discharge very shortly if they didn't have to add the phenergan. I like and appreciate being aware and seeing for myself what is going on via the monitor, the phenergan does make me a bit fuzzy if they have to use it and it takes longer before they will release me. Now if they could just come up with a more pleasant prep for the scope!!!!!

southern_rn_brat · Aug 10, 2005

My first husband had acute intermittent porphyria. We had him on IV Demerol, push and PCA. For months, his doc and I thought his porphyria symptoms were worsening and I was preparing myself for the worst. Another doc suggested she try morphine instead (his mom had always insisted he was allergic to morhpine)...so crash cart ready, they tried him on morphine. Within DAYS he was back to normal. He took morphine until he passed away recently and never had anymore of those symptoms.

caroladybelle, BSN, RN · Aug 10, 2005

Many vietnam vets will say that they are "allergic" to morphine but very few actually are...they saw fellow vets get addicted in the service and don't understand the benefits of its' appropriate use. In addition, people tend to freak about Morphine merely because of its' rep and tend to equate it with heroin use (Dealt with the issues with my late father). Ironically, my mother had a anaphylactic reaction and the MD listed as one of the few that he had seen due to MS. She can get dilaudid with no difficulty.

In addition, many/most people will get nauseous with the first dose or two, as well as many will get mild itching for a few doses. These effects are generally transient, the nausea more so than the itching. They are also common to many pain killers. As well as generally people receive MS either postop, when they are sick or in pain, in severe respiratory difficulty or having chest pain....any of which puts one at risk for nausea.

As far as phenergan, the 5HT drugs (brand names Zofran, Kytril, Anzemet, Aloxi) are relatively new on the market and most have been used predominantly in Oncology, for which they were initially developed. Cisplatin (known to oncology nurses as the most puke-icidal drug used in mankind - EVERYONE (99.999%) used to vomit their guts up during and for days after the infusion - and phenergan/compazine were completely useless) is now premedded with a 5HT and decadron. The breakthrough nausea is maybe 5% and generally relieved by ativan. They cost substantially more than reglan, phenergan and compazine...as such some hospitals "reserve" their use for which they are absolutely necessary. However, Zofran is becoming much more common, and it is, I believe the longest on the market, so hopefully becoming cheaper. I would think a diagnosis of IBD (Crohn's/UC) would rate use of the 5HT drugs. They also have less side effects associated with them.

I had long had Demerol/Versed/phenergan for endos. I recently had one done with profolol and it was absolutely perfect. No pain whatsoever, wore off very rapidly, no nausea, no nasty versed headache.

CrohnieToo · Aug 11, 2005

.... I had long had Demerol/Versed/phenergan for endos. I recently had one done with profolol and it was absolutely perfect. No pain whatsoever, wore off very rapidly, no nausea, no nasty versed headache.

The problem with propofol is that our Endo department requires an anesthesiologist (or maybe it is a Michigan thing) to administer it rather than a nurse anesthetist. I've had it once. It was great as you say, IF, you don't mind not knowing what is going on. My problem is that I do NOT like not knowing what is going on. Maybe it is a control thing, maybe it is a lack of trust thing, I don't know. But I want to SEE FOR MYSELF what is going on. My gastro and I had some strong differences of opinion before I convinced her that we WOULD do my colonoscopies with "just" demerol so that I could watch the monitor and remember what I was seeing. Occasionally, we do need to add some demerol when we get to the transverse colon/hepatic flexure due to the vagus nerve getting in a twit. Even then we need to use a very light dose because phenergan does make me "fuzzy" and/or sleepy. The one scope I had with Versed was incomplete as I got agitated and then hostile.