Demerol vs. Morphine

[tunnelrat83]

Hey I heard some medics discussing this one the other day... just currious what everyone out here thinks. I just want to know what the differences are.. and what other ALS providers out there think of them... thnx

[Ridryder 911]

It all depends on the clinical problem

Morphine or Demeroanalgesics work as follows:

The opioid analgesics are "mu-agonist" drugs. The term "agonist" refers to a drug that binds to pain receptors to produce analgesia. Opioid analgesics include Morphine and Demerol & other drugs that relieve pain by binding to mu receptors in the nervous system.

The term "mu agonist" is used interchangeably with the terms full agonist, pure agonist and morphine-like drugs.

Examples of opioid analgesics are:

Codeine

Oxycodone

Meperidine (Demerol)

Propoxyphene (Darvon)

Fentanyl

Hydrocodone

Tramadol (Ultram)

Morphine

Hydromorphone (Dilaudid)

Methadone

Levorphanol (Levo-Dromoran)

Oxymorphone (Numorphan)

Of the three groups of analgesics – opioids, nonopioids, and coanalgesic drugs, only the morphine-like opioids have no analgesic ceiling. In other words, higher doses increase analgesia and only adverse effects limit how high the dose can be. Thus, there is no set maximum dose for morphine and morphine-like opioids

Morphine remains the standard against which all other opioid drugs are compared. Extensive clinical experience and multiple routes of delivery, including controlled release, make it the opioid most commonly used for cancer pain, burn pain. Morphine Sulfate is also a vasodilator and can promote venous poling in CHF, and is the preferred analgesic in acute myocardial infarct ions.

Where as Demerol (meperidine) is usually used for analgesia & sedation purposes.

I believe it all depends on amount of pain, & presenting diagnoses. I prefer Demerol for muscular or skeletal pain ( i.e back, abdominal pain (small amt 25 mg) For true pain for Burns, chest pain , etc.. Morphine Sulfate is the preferred choice, and has pooling effects as discussed earlier.

Be safe,

Ridryder 911

[1EMT-P]

I like to use Demerol for back pain, burns, orthopedic injuries & renal colic. I like MS for chest pain & CHF. I also like to use IM or IV Toradol.

When I give Demerol & MS, I also like to give the patient some Phenergan to keep them from getting n/v. It also helps make the patient more comfortable.

[Ridryder 911]

I too like Toradol for renal cholic (kidney stones) 30mg IV, but be sure they don't have a bleed, & not an asthmatic. Phenergran is good anti emetic & does potentiate Demerol, except for geriatric patients, really gets them going bonkers ! I agree Demerol has its place in the field for muscular skeletal pain, in lieu of Toradol...

I prefer a little M.S., for fxr's with Phenergran.. if allergic to phenergran then I use Zofran for the anti emetic, or Reglan.

Be safe,

Ridryder 911

[1EMT-P]

We no longer carry Demerol, they replaced it with Toradol, but when we did carry it. I would usually give 25 to 50 mg IV over 1 to 2 minutes with 12.5 mg of IV Phenergan. If I was giving it to an older patient I would usually give 12.5 to 25 mg IV with 6.25 mg of IV Phenergan.

I usually give 2 mg of MS IV slowly, followed by 12.5 mg of Phenergan. In an older patient I usually give 1 to 2 mg of MS IV slowly or 2 mg of MS SQ.

[Ace844]

I personally have become quite fond using either Fentanyl, or Etomidate in my Clinical practice.

[chipmunkemt_98]

Which do you prefer to ask for Diazapam or Morphine

First of all, Diazepam, AKA Valium, is not used for pain management. It is a benzodiazepine sedative hypnotic/anticonvulsant. Demerol, AKA Meperidine, on the other hand, is used for pain and is an opoid analgesic. We have both Demerol and MS on the truck, as well as Nubain, for pain, per Medical Control. When giving Meperidine (10 to 25 mg IV) and Morphine Sulfate (per protocol, 2-3 mg IV initially), I have encountered patients who experience nausea with both, and have given 12.5 phenergan to counteract the nausea.

[tunnelrat83]

sorry chipmunk mistated on the poll... thanks for the input... i had been told by the medics.. plus noticed that they usually give 12.5 (cc's i guess) of phenergren when they give the other stuff...

kep the answers rolling in if anyone else has comments opinions

[HeadInjuryHurt]

I currently take Demerol for my migraine pain as prescribed, 50mg pill (x2-4) format with (Gravol in Canada) Dimenhydrinate 50mg (x2) for the nausea. I weigh about 250lbs and am 28yrs old. I can get away with this regiment for now cause of age but honestly I've been through 4 neurologists and none of their pain regiments work and I'm seeing another in a couple months. In the meantime I need to be able to work and currently the Demerol and Gravol (Although I'm thinking of asking to switch to Maxeran.) is the only thing that keeps me at work. I have about 4-5 migraines a week or so, sometimes more and sometimes less. I've been on these pain meds for about 4 years now. I am VERY careful with dosage since I cannot afford to become abusive of the meds since they keep me working.

Is there something that you all may suggest that I try asking for for alternatives? I know you can't offer "official" medical advice but I'm looking just for some ideas from everyone, brainstorm if you will.

Also for history I had hydrocephalus as a result of my injury and had a 3rd ventriculostomy done in 97 for this as it was life threatening at the time (Onset was vicious.). Anyway any input would be appreciated.

[Ridryder 911]

I worked with a physician who worked at a migraine center on research. She as most physicians I work with no longer prescribe narcotics for migraine tx. Since basically, you are sedating the patient, hoping they will sleep It off. I am not familiar with all the neuro involving cluster H/A vs. storms etc. & do not claim to be specialized in this area..

She used a mixture of Decadron & Compazine I.V. I seen this provide analgesic approx. 90% of the time, including people who had been on M.S. pumps. I was very impressed with the results. You might talk to your neurologist & see his opinion on the use of this.

I know this can be dilapidating & very painful.

I wish you the best of luck.

Ridryder 911