Meperidine and Demerol

Meperidine (Demerol) IM or IV is a highly addictive narcotic which has been heavily used by the field of medicine for many years for pain control.  However, as can be seen below, it is clearly inferior as a pain reliever.  In study after study, it is either inferior in pain relieving efficacy to non-narcotic pain relievers or does no better than non-addictive pain relievers while causing more side-effects.  It has, however, been extremely popular with heroin addicts, resulting in thousands of unnecessary deaths.  Many patients have been turned into junkies thanks to its wide-spread medical use.  Pethidine and Dolantin are other terms used for meperidine in other countries.

In a total of 46 studies in which Meperidine has been compared to non-narcotic medications, the non-narcotics have been more effective pain relievers 23 times, equally effective but with fewer side-effects 10 times, and equal 13 times.  In only one, small study did meperidine do better than low dose ketorolac for headache patients.  However, in two other headache studies, a higher dose of ketorolac did as well and did better than meperidine.  In six studies, meperidine was no more effective than the placebo.  If meperidine were a sports team, it would have 1 win, 35 losses, and 14 ties.  Meperidine is a real loser.  Not only is it a failure for pain relief, it is highly addictive and helping fuel the narcotic epidemic which is destroying huge numbers of young adults in the U.S. and Europe.  It is immoral to needlessly subject another human being to powerful narcotics.  That has been common in the medical field ever since the introduction of morphine in 1830 and is rampant today.

Meperidine has been found inferior to ketamine, ketorolac, acetaminophen, metoclopramide, dihydroergotamine, lignocaine, zomepirac, diclofenac, and bupivacaine in various pain studies.  It has also been found inferior to clonidine for post-operative shivering and inferior to midazolam for sedating children prior to surgery.  Until proven otherwise, meperidine has no place in the practice of evidence-based medicine.

If a doctor wants to give you meperidine (Demerol), print out this webpage and give it to him.  If he still insists on giving you a narcotic, get another doctor.  If a doctor gave you meperidine and you became addicted and suffered some unfortunate consequence, the doctor and the narcotic manufacturer could be liable for malpractice.  Also, consider whether you should report the doctor to the state licensing board.  In view of the research, prescribing meperidine is or at least should be ruled malpractice.

Biliary Colic: Ketorolac as Good as Meperidine with Fewer Side-Effects: In a DB study of 324 adults with biliary colic, IV ketorolac 30 mg did just as well as IV meperidine 50 mg. The change in the pain scores at time 2 h was 6.2 cm for the ketorolac group, compared with 6.7 cm cm for the meperidine group, not a significant difference (p = 0.25). Patients receiving meperidine reported markedly higher incidences of nausea and  dizziness (p = 0.009 and 0.003). Researchers conclude the results favor ketorolac. Comparison of intravenous ketorolac and meperidine in the treatment of biliary colic. Henderson SO, et al. University of Southern California. J Emerg Med 2002 Oct;23(3):237-41.

Biliary Colic: No Difference Between Ketorolac and Meperidine for Pain: In a DB study of 30 patients in the emergency room with acute biliary colic, meperidine 1.5 mg/kg up to 100 mg or ketorolac 60 mg IM, pain relief at time 30 min was 3.8 in the ketorolac group and 3.9 in the meperidine group. Rescue medication for additional analgesia at 30 min was used in 4 patients in the meperidine group and in 2 patients in the ketorolac group (28.6% vs. 12.5%, respectively; NS). A prospective study comparing i.m. ketorolac with i.m. meperidine in the treatment of acute biliary colic. Dula DJ, et al. Geisinger Medical Center, Danville, PA. J Emerg Med 2001 Feb;20(2):121-4.

Cancer: Children: Ketamine Much Better than Meperidine for Bone Marrow Aspiration Pain: In a DB crossover study of 21 children with cancer having bone marrow aspiration or lumbar punctures, ketamine (1.5 mg/kg)/atropine/midazolam resulted in much less distress than meperidine (2 mg/kg)/midazolam (1.37 v 7.04 OSBD-R units; P < .05). Both operators and nurses rated KM more effective than MM. KM use was associated with earlier readiness for the procedure (19 v 24 minutes) and much more rapid recovery (39 vs. 74 minutes for removal of monitoring devices and 58 vs. 87 minutes for discharge). Procedures undertaken after ketamine sedation were associated with fewer side effects (hypoxia, 18% v 82%; hypotension, 17% v 56%; reduced respiratory rate, 0% v 39%). Parents and children expressed a preference for KM over MM in 12 of 18 cases (P < .05). Ketamine-midazolam versus meperidine-midazolam for painful procedures in pediatric oncology patients. Marx CM, et al. Case Western Reserve University. J Clin Oncol 1997 Jan;15(1):94-102.

Cardiac Cath in Children: Ketamine/Midazolam Better than Meperidine Combination: An IM combination of meperidine, promethazine, and chlorpromazine (DPT) has been given as sedation for pediatric procedures for more than 40 years. In a DB study of 51 children congenital heart disease having cardiac catheterization, oral (PO) ketamine/midazolam was much better tolerated than the narcotic combination (P < 0.0005), had more rapid onset (P < 0.001), and provided much superior sedation (P < 0.005). Respiratory rate decreased after IM DPT only. Heart rate and shortening fraction were stable. Oxygen saturation and mean blood pressure decreased minimally in both groups. Supplemental propofol was more frequently required (P < or = 0.02) and in larger doses (P < 0.05) after IM DPT. Parental satisfaction ratings were higher (P < 0.005) and amnesia was more reliably obtained (P = 0.007) with PO ketamine/midazolam. Two patients needed airway support after the PO medication, as did two other patients when PO ketamine/midazolam was supplemented with IV propofol. Although PO ketamine/midazolam provided superior sedation and amnesia compared to IM DPT, this regimen may require the supervision of an anesthesiologist for safe use. Oral ketamine/midazolam is superior to intramuscular meperidine, promethazine, and chlorpromazine for pediatric cardiac catheterization. Auden SM, et al. University of Louisville and Kosair Children's Hospital. . Anesth Analg 2000 Feb;90(2):299-305.

Child Birth: Meperidine No Better than Placebo for Delivery Pain, But More Side-Effects: In a DB study of 84 women in delivery, there were no statistically significant differences in pain between meperidine and normal saline. Sedative scores, nausea/vomiting and dizziness were significantly worse with meperidine. However, opinion on the effectiveness of pain relief during labor was only 24% in the meperidine group, although it was significantly worse with placebo (7%). Effectiveness of intravenous meperidine for pain relief in the first stage of labour. Soontrapa S, et al. Khon Kaen University, Thailand. J Med Assoc Thai 2002 Nov;85(11):1169-75. Ed: It is virtually certain that using a real pain medication and not a narcotic would have resulted in less pain, fewer side-effects, and lowered the addictive programming of other the mothers and their newborns. One study has shown that children exposed to narcotics during delivery were more likely to develop narcotic programs in adulthood.

Children: Painful Procedures Better than Ketamine than Meperidine: In a DB study of 29 children requiring sedation for suturing, wound or burn debridement, or lumbar puncture, ketamine 4 mg/kg (KET) with combined meperidine 2 mg/kg, promethazine, and chlorpromazine (MPC), patients in the 2 groups had a similar duration of sedation, patients receiving KET had more rapid onset of sedation (3 min vs 18 min, P < .01) a shorter time to discharge (85 min vs 113 min, P 0 .01) and lower Observational Scale of Behavioral Distress scores (9.9 vs 19.2, P = .003). All 15 physicians using KET would request it again vs 5 of 12 (42%) of the physicians using MPC (P < .001). Intramuscular ketamine is superior to meperidine, promethazine, and chlorpromazine for pediatric emergency department sedation. Petrack EM, et al.  Case Western Reserve University. Arch Pediatr Adol Med 1996 Jul;150(7):676-81.

Children: Surgery: Ketorolac as Good as Meperidine Relieving Pain: In a DB PC study of 90 children having elective general surgery, orthopedic, or G-U procedures, ketorolac 0.75 mg/kg did as well as meperidine 1 mg/kg in relieving pain and both did better than placebo. Time to first rescue medication, total opioid requirement, pain scores, incidence of vomiting and length of stay were evaluated. Ketorolac and meperidine did not differ with regard to time until first rescue, cumulative proportion requiring rescue, or the number of rescue doses required. A single dose of IM ketorolac prolonged bleeding time by 53 seconds. Effect of ketorolac on bleeding time and postoperative pain in children: a double-blind, placebo-controlled comparison with meperidine. Bean-Lijewski JD, et al. Temple, TX. Clin Anesth 1996 Feb;8(1):25-30.

Children: Dental Pain: Meperidine No Added Value to Dental Procedures with Midazolam: In a DB crossover study of 20 children having dental restorative care, midazolam alone 1 mg/kg did as well as midazolam plus meperidine (0.5 and 1 mg/kg, respectively). All sedative agents were administered orally, and all sedations included 50% nitrous oxide administered via a nasal hood. Researchers concluded, "Oral midazolam alone is just as effective as midazolam with meperidine." Comparison of the efficacy of oral midazolam alone versus midazolam and meperidine in the pediatric dental patient. Musial KM, et al. United States Air Force, Lakenheath, England. Pediatr Dent 2003 Sep-Oct;25(5):468-74.

Children: Eye Surgery: Ketorolac Just as Good as Meperidine with Much Less Nausea and Vomiting: In a DB study of 52 children having strabismus surgery, IV ketorolac 0.9 mg/kg was as effective as IV meperidine 0.5 mg/kg Recovery scores, Objective Pain Scores and postoperative analgesic requirement were similar in both groups. However, post-op nausea and vomiting were much more frequent with meperidine (P < 0.001) Comparative effects of intravenous ketorolac and pethidine on perioperative analgesia and postoperative nausea and vomiting (PONV) for paediatric strabismus surgery. Shende D, et al. New Delhi, India. Acta Anesth Scand 1999 Mar;43(3):265-9.

Children: Eye Surgery: Ketoprofen Better than Meperidine Which Did No Better than Placebo: In a DB PC study of 91 children undergoing squint opthalmic surgery at King Abdel-Aziz University Hospital Riyadh, preoperative ketoprofen 1 mg/kg, meperidine 1 mg/kg or saline were given. Ketoprofen had lower post-operative pain scores and required less frequent analgesic therapy in the early postoperative period than meperidine. There were no differences in pain scores or analgesic requirements between pethidine and placebo. Analgesic effects of intra-muscular ketoprofen (Profenid) and pethidine for squint surgery in children. Alam K, et al. King Abdel-Aziz University Hospital, Riyadh. Middle East J Anesth 1999 Feb;15(1):31-8.

Children: Surgery: Midazolam Pretreatment Better Separation and Induction than Meperidine Combination: In a DB study of 102 children undergoing out-patient surgery, pretreatment with 0.5 mg/kg midazolam resulted in significantly better improvement in scores at both separation and induction (P < .01) than .2 mL/kg of a combination of meperidine 6.0 mg/mL, atropine 0.08 mg/mL, and diazepam 0.6 mg/mL 15-45 minutes before separation from parents. In the meperidine/atropine/diazepam group, unacceptable scores were strongly associated with younger subjects (P < .01). There were no differences in analgesic requirements, side effects, or time to discharge between groups. Oral midazolam versus meperidine, atropine, and diazepam: a comparison of premedicants in pediatric outpatients. Pywell CA, et al. AANA J 1995 Apr;63(2):124-30.

Colonoscopy: Meperidine No Added Value for Patients Given Midazolam: In a DB PC study of 100 adults undergoing colonoscopies, midazolam plus placebo was compared to midazolam plus meperidine. There were no significant difference of grade of tolerance, pain and willingness to another colonoscopy between the two groups. After the colonoscopy, systolic blood pressure, oxygen saturation, and pulse rate were significantly decreased (p<0.05) in both groups with no differences. Adding meperidine to the midazolam before the colonoscopy does not seem to bring more beneficial effect to patients. Comparison of midazolam versus midazolam/meperidine during colonoscopy in a prospective, randomized, double-blind study. Jung HK, et al. Ewha Womans University, Seoul, Korea. . Korean J Gastroenterol 2004 Feb;43(2):96-103.

Colonoscopy Pain: Meperidine Added Some Benefit vs. Placebo: In a DB study of 253 patients undergoing colonoscopy, a single rapid intravenous bolus of 5 mg of midazolam did not do as well as 5 mg midazolam plus 50 mg meperidine. More patients (19%) in without meperidine reported moderate or severe pain (28% vs. 9%; p < 0.001), poor or unbearable tolerance (18% vs. 6%; p < 0.01) and unwillingness to undergo colonoscopy again in the future (14% vs. 5%; p < 0.05). Single bolus of midazolam versus bolus midazolam plus meperidine for colonoscopy: a prospective, randomized, double-blind trial. Radaelli F, et al. Valduce Hospital, Como, Italy. Gastrointest Endosc 2003 Mar;57(3):329-35. Ed: Of course, there are many non-narcotic pain medications which can also be used. Midazolam is a benzodiazepine anti-anxiety medication. Adding acetaminophen would very likely have done just as well and an NSAID would very likely have done better. This study really compares meperidine to placebo, so is not a study comparing it to a non-narcotic.

Dental Pain: Pre-Op Meperidine No Benefit; Acetaminophen May be Better: The pain threshold measured by electric pulp testing was significantly better with acetaminophen compared to meperidine, naproxen sodium, acetaminophen, and placebo. No elevation of the pain threshold occurred with narcotic drugs or with nonsteroidal anti-inflammatory drugs. Researchers question the philosophy of administering these drugs for change in pain threshold at the levels used here preoperatively. Change in pain threshold by meperidine, naproxen sodium, and acetaminophen as determined by electric pulp testing. Carnes PL, et al. University of Louisville School of Dentistry. Anesth Prog 1998 Fall;45(4):139-42.

Dental Surgery: Ketorolac Less Pain than Meperidine with Many Fewer Side-Effects: In a DB study of 145 patients having moderate to severe pain from extraction of 3 or more wisdom teeth, at least one of which was bone-impacted, patients received IM injections of 10 mg, 30 mg, or 90 mg of ketorolac, or 50 mg or 100 mg of meperidine. Adding up pain scores over the 8 hours, the effectiveness of 30 mg of ketorolac was similar to that of 90 mg ketorolac and both were significantly more effective than 10-mg ketorolac, 50-mg meperidine, or 100-mg meperidine. Patients who received 30 mg or 90 mg of ketorolac gave the study medication significantly higher ratings overall than did patients who received 50 mg or 100 mg of meperidine. Many fewer patients treated with ketorolac reported side-effects vs. meperidine (17% vs. 59%). Comparison of the efficacy and safety of ketorolac and meperidine in the relief of dental pain. Fricke JR Jr, et al. Austin Oral Surgical Associates, Texas. J Clin Pharmacol 1992 Apr;32(4):376-84.

Endoscopic Retrograde Cholangiopancreatography in Elderly Better with Propofol than with Meperidine with Midazolam: In a large DB study of 150 elderly aver age 79, propofol provided better cooperation (p<0.001), and was tolerated just as well. Recovery time was shorter with propofol (22 vs. 31 min.; p<0.01), with a better recovery score (p<0.01).Riphaus A, et al. Hannover, Germany. Am J Gastroent 2005 Sep;100:1957-63.

Headache (Migraine): Dihydroergotamine as Good as Meperidine with Fewer Side-Effects: In a DB study in the emergency rooms of 11 hospitals of 171 adults with migraine headaches, 1 mg dihydroergotamine did as well as 1.5 mg/kg meperidine by intramuscular injection. Both groups received the anti-nauseant hydroxyzine. Reduction of headache pain as measured on a 100-mm visual analog scale was 41 mm (54% reduction) for DHE vs. 45 mm (56% reduction) for MEP at 60 minutes after treatment, virtually identical. CNS side-effects were less common with DHE: 24% vs. 38%, especially dizziness. Double-blind, multicenter trial to compare the efficacy of intramuscular dihydroergotamine plus hydroxyzine versus intramuscular meperidine plus hydroxyzine for the emergency department treatment of acute migraine headache. Carleton SC, et al. University Hospital of Cincinnati. . Ann Emerg Med 1998 Aug;32(2):129-38.

Headaches: Metoclopramide Better than Demerol for Severe Headaches in ER: In a DB PC study of 336 patients in the emergency room with acute severe migraine or tension headaches for no more than 7 days in a row, metoclopramide produced more effective analgesia than pethidine in both types of headaches. Prospective, randomised, double blind, controlled comparison of metoclopramide and pethidine in the emergency treatment of acute primary vascular and tension type headache episodes. Cicek M et al. Dokuz Eylul University Medical School, Izmir, Turkey. Emerg Med J 2004 May;21(3):323-6. Studies of intravenous MTP reported benefit over placebo and in one a success rate of 67%.

Headaches: Ketorolac Better Than Meperidine Which Was No Better Than Placebo for Headaches in ER: Intramuscular ketorolac 60 mg, meperidine 50 mg plus promethazine 25 mg, and normal saline were compared in acute exacerbations of tension headaches in 41 adults. All three groups showed a significant improvement that persisted for the 6 hours of evaluation. Ketorolac treatment was significantly better than placebo at 0.5 and 1 hour by the Visual Analog Scale (VAS) and Pain Rating Index, and better than meperidine at 2 hours (by the VAS). Meperidine and placebo did not differ at any time point. Harden RN, Rogers D, Fink K, et al. Controlled trial of ketorolac in tension-type headache. Neurology 1998;50:507–9.

Headaches: Dihydroergotamine as Good as Meperidine with Fewer Side-Effects: In a DB study of 27 adults with acute migraine headaches, 75 mg meperidine with 25 mg promethazine IM did no better than .5 mg dihydroergotamine with 10 mg metoclopramide IV, but side effects were significantly greater in the meperidine with promethazine. The dihydroergotamine with metoclopramide regimen is effective, and has minimal side effects. Comparison of dihydroergotamine with metoclopramide versus meperidine with promethazine in the treatment of acute migraine. Scherl ER, et al. University of Kentucky. Headache 1995 May;35(5):256-9.

Headaches: Dihydroergotamine Combination Superior to Meperidine Combination: In a DB study of 28 patients with acute headaches, dihydroergotamine 1 mg and metoclopramide 10mg IV and a placebo injection IM, did much better than meperidine 75 mg and hydroxyzine 75 mg IM and a placebo injection IV for improvement in pain scale score (P = 0.006). The number of patients having a mild or no headache with dihydroergotamine was (13/14) vs. (3/14) for meperidine. (P < 0.001) The authors conclude, " The combination of dihydroergotamine and metoclopramide IV should replace the standard IM narcotic and anti-emetic as the parenteral treatment of choice for severe migraine headache." Current emergency treatment of severe migraine headaches. Klapper JA, et al. St. Joseph Hospital, Denver, CO. Headache 1993 Nov-Dec;33(10):560-2.

Headaches: Ketorolac IM as Good as Meperidine with Hydroxyzine IM: In a DB study of 47 adult migraine patients, IM ketorolac 60 mg did as well as meperidine 100 mg with hydroxyzine 50 mg with almost identical pain relief scores. Ketorolac versus meperidine and hydroxyzine in the treatment of acute migraine headache: a randomized, prospective, double-blind trial. Duarte C, et al. University of Illinois, Peoria. Ann Emerg Med 1992 Sep;21(9):1116-21. Ed: Since hydroxyzine in other studies has been found to have some pain relieving effect, this study is no a true comparaison.

Headaches: Migraines: Meperidine IM Did Better than Ketorolac in Small Study: In a small DB study of 31 adults with acute migraine headaches, ketorolac 30 mg IM did not do as well as meperidine 75 mg. At one hour, ketorolac was significantly less effective than meperidine in reducing headache pain (P = .02) and in improving clinical disability (P = .01). Ketorolac also was less effective at reducing nausea, photophobia, and the need for additional medication (P< .05). A randomized, double-blind, comparative study of the efficacy of ketorolac tromethamine versus meperidine in the treatment of severe migraine. Larkin GL, et al. West Virginia University. Ann Emerg Med 1992 Aug;21(8):919-24.

Headaches: Migraines: Methotrimeprazine Did as Well as Meperidine: In a DB study of 74 patients with severe migraines, IM methotrimeprazine, a non-narcotic, nonaddicting phenothiazine did just as well as a combination of meperidine and dimenhydrinate. There were no statistical differences in pain intensity one hour after treatment, change in pain intensity, or pain relief as measured on a visual-analog scale; need for additional analgesia; persistence of nausea or vomiting; adverse effects; or follow-up status, except for prolonged drowsiness, in the group receiving methotrimeprazine. The authors conclude, " Methotrimeprazine may be considered an effective, nonaddicting, IM alternative to narcotics for the management of this problem." Methotrimeprazine versus meperidine and dimenhydrinate in the treatment of severe migraine: a randomized, controlled trial. Stiell IG, et al. University of Ottawa, Canada. Ann Emerg Med 1991 Nov;20(11):1201-5.

Labor Pains: Narcotics Ineffective and Unethical: In a DB study of 10 healthy nulliparous women in active labour, even after repeated doses (up to 0.15 mg/kg body weight morphine and up to 1.5 mg/kg body weight meperidine) the findings were uniform, with very high pain scores maintained in each group as assessed with visual analogue scale. The women were all significantly sedated and several fell asleep but were awakened by pain during contractions. It was concluded that labor pain is not sensitive to systemically administered morphine or pethidine. These drugs only cause heavy sedation. Authors state, "It therefore seems unethical and medically incorrect to meet parturients' requests for pain relief by giving them sedation. Considering the well documented negative effects on newborn infants, we also believe systemic meperidine should be avoided in labor." Lack of analgesic effect of systemically administered morphine or pethidine on labour pain. Olofsson C, et al. Karolinska Hospital, Stockholm, Sweden. Br J Obstet Gynec 1996 Oct;103(10):968-72.

Pain in Emergency Room: Ketorolac as Good as Meperidine with Fewer Side-Effects: In a DB study of 93 patients in the emergency room with acute pain, ketorolac 60 mg IM did as well for pain relief as meperidine. Ketorolac caused much less sedation than did meperidine at one hour (p < 0.005). Additional analgesia was requested by 15% of meperidine patients vs. 10% for ketorolac (p = NS). Side-effects occurred in 38% on meperidine vs. 17% on ketorolac (p = 0.0452). Ketorolac vs meperidine for the management of pain in the emergency department. Koenig KL, et al. Highland Hospital Oakland, CA. Acad Emerg Med 1994 Nov-Dec;1(6):544-9.

Propofol Injection Pain: Lignocaine Better than Meperidine: In a DB study of 150 patients receiving propofol, meperidine 25 mg was not as effective as lignocaine 10 mg at reducing pain on injection of propofol. Both active treatments were significantly better than placebo (p < 0.01). A comparison of pethidine and lignocaine. Lyons B, et al. Cappagh Orthopaedic Hospital, Dublin, Ireland. Anesth 1996 Apr;51(4):394-5.

Propofol Injection Pain: Lidocaine as Good as Meperidine with Fewer Side-Effects; Morphine, Fentanyl Inferior: In a DB PC study comparing I.V. pretreatment with fentanyl 150 microg, morphine 4 mg, meperidine 40 mg, 2% lidocaine 3 mL or placebo in reducing propofol injection pain in 175 patients, lidocaine and meperidine significantly reduced propofol injection pain more than placebo (P < 0.05), but there were more side effects in the meperidine group. Fentanyl and morphine reduced the intensity of propofol injection pain (P < 0.05) and had some effect in reducing the incidence of propofol injection pain, but the difference did not reach statistical significance. The analgesic effect of fentanyl, morphine, meperidine, and lidocaine in the peripheral veins: a comparative study. Pang WW, et al. Show-Chwan Memorial Hospital, Changhua, Taiwan. Anesth Analg 1998 Feb;86(2):382-6.

Renal Colic: Ketorolac More Effective and Quicker Discharge: In a DB PC study of renal colic in 70 emergency room patients, 60 mg of ketorolac was more effective than 100 to 150 mg meperidine (P < .05) at 40, 60, and 90 minutes. Of patients who were discharged home, those treated with ketorolac left the ER significantly earlier than those treated with meperidine (3.46 v 4.33 h, P < .05). Efficacy of ketorolac tromethamine versus meperidine in the ED treatment of acute renal colic. Larkin GL, et al. Mercy Hospital of Pittsburgh, University of Pittsburgh. Am J Emerg Med 1999 Jan;17(1):6-10.

Renal Colic: IV Indomethacin as Good as Meperidine: In a DB study of 150 patients with acute renal colic, IV lysine acetylsalicylate 1.8 g was less effective than IV indomethacin 100 mg and IV meperidine 100 mg which did equally well. Comparative study of the efficacy of lysine acetylsalicylate, indomethacin and pethidine in acute renal colic. al-Sahlawi KS, et al. Mubarak Al-Kabeer Hospital, Kuwait. Eur J Emerg Med 1996 Sep;3(3):183-6.

Renal Colic: IV Ketorolac as Good as IV Meperidine and Combination was No Better: In a DB study of 154 adults with renal colic, IV ketorolac 60 mg did significantly better than meperidine 50 mg.  Both combined did no better than ketorolac alone for pain relief and time elapsed before the need for supplemental meperidine. By 30 minutes, 75% of the ketorolac group and 74% of the combination group had a 50% reduction in pain scores, compared with 23% of the meperidine group (P < .001). Comparison of intravenous ketorolac, meperidine, and both (balanced analgesia) for renal colic. Cordell WH, et al. Methodist Hospital of Indiana. . Ann Emerg Med 1996 Aug;28(2):151-8.

Renal Colic: Ketorolac Did Better for Pain than Meperidine with Fewer Side-Effects: In a DB study of 76 adults with renal colic, ketorolac 30 mg IM did better than meperidine 100 mg IM. 88% of each group and less pain at 1 hour, but the summed pain intensity favored ketorolac (P < 0.05). Additional pain medication was requested by 56% of ketorolac and 74% of meperidine patients. Side-effects were lower with ketorolac 28% vs. 51%. A comparison of intramuscular ketorolac and pethidine in the alleviation of renal colic. Sandhu DP, et al. Leicester General Hospital, UK. Br J Urol 1994 Dec;74(6):690-3.

Renal Colic: Diclofenac and NSAID Dipyrone Both Did as Well Meperidine in Large Study: In a DB study of 451 patients with renal colic, IM dipyrone 1 and 2 g, IM diclofenac and IM meperidine were compared. Rescue treatment was required in 93 patients: 24% given dipyrone 1 g; 22% given dipyrone 2 g; 16% given diclofenac; and 19% given pethidine. The authors conclude, " Diclofenac sodium is a valid alternative, which shows similar analgesic efficacy." Comparative study of the efficacy of dipyrone, diclofenac sodium and pethidine in acute renal colic. Collaborative Group of the Spanish Society of Clinical Pharmacology. Eur J Clin Pharm 1991;40(6):543-6.

Renal Colic: IM Ketorolac 90 mg Better than IM Meperidine 100 mg: In a DB study of 121 patients with moderate to severe renal colic pain, IM ketorolac 90 mg did better than IM meperidine 100 mg although the differences were not statistically significant. Many fewer patients given ketorolac 90 mg (17%) required a further dose of analgesic within 10 hours than with ketorolac 10 mg (39%) or meperidine 100 mg (47%). The difference was statistically significant. The authors conclude, "IM ketorolac is efficacious in the treatment of renal colic." A double-blind single dose comparison of intramuscular ketorolac tromethamine and pethidine in the treatment of renal colic. Oosterlinck W, et al. University Hospital, Ghent, Belgium. J Clin Pharm 1990 Apr;30(4):336-41.

Renal Colic: NSAID Voltaren as Good as Narcotic Ketogan, But with Fewer Side-Effects: In a DB study of 56 patients with renal or ureteric colic, IM Voltaren did just as well as IM Ketogan (ketobemidone), a European narcotic similar to meperidine. There were no significant differences regarding pain-relief but side effects were fewer in patients treated with Voltaren. Analgesic effect and tolerance of Voltaren and Ketogan in acute renal or ureteric colic. Sommer P, et al. Copenhagen County Hospitals, Gentofte, Denmark. Br J Urol 1989 Jan;63(1):4-6.

Renal Colic: Meperidine Inferior to Diclofenac: In two single-blind, randomized studies totalling 207 patients with renal colic of single intramuscular doses of diclofenac (75 mg) versus a dipyrone (1 g)/spasmolytics combination, and a second study of diclofenac (75 mg) versus pethidine (meperidine) (75 mg), patients treated with diclofenac showed an earlier onset of analgesia and a higher incidence of total pain relief compared to those treated with dipyrone/spasmolytics or pethidine. Although the mean duration of analgesia was only slightly greater for diclofenac than dipyrone/spasmolytics, a significantly longer effect was seen for diclofenac vs. pethidine (p less than 0.01). Pain relief was greater with diclofenac after 60 minutes vs. dipyrone/spasmolytics (p less than 0.05) and after 30 minutes vs. pethidine (p less than 0.05). Global efficacy assessments by the physician rated diclofenac superior to dipyrone/spasmolytics (p less than 0.01) and pethidine (p less than 0.001). Diclofenac sodium was better tolerated than either of the others. Marthak KV, Gokarn AM, Rao AV, Sane SP, Mahanta RK, Sheth RD, et al. Bombay, India. A multi-centre comparative study of diclofenac sodium and a dipyrone/spasmolytic combination, and a single-centre comparative study of diclofenac sodium and pethidine in renal colic patients in India. Current Medical Research & Opinion 1991;12(6):366{73) 2044396.

Renal Colic: Meperidine Inferior to Rectal Diclofenac: This DB study compared IV meperidine to rectal diclofenac. Thompson JF, Pike JM, Chumas PD, Rundle JS. Rectal diclofenac compared with pethidine injection in acute renal colic. BMJ 1989;299(6708):1140{1. 2513026.

Shivering Post-Op and Pain: Meperidine No Better than Ketamine: In a DB PC study of 90 patients undergoing general anesthesia, meperidine 20 mg IV was no better than ketamine 0.5 mg/kg IV 20 min before completion of surgery for either prevention of shivering or time to first request for analgesia although both were better than placebo.

Shivering Postanesthetic: Clonidine Relieved 100% and Demerol No Better: In a DB study of 60 patients shivering during recovery from general anesthesia, 25 mg meperidine IV, and 0.15 mg clonidine IV did equally well and better than 25 mg urapidil IV. If shivering did not stop within 5 min, the treatment was repeated once; clonidine was replaced with saline for the second dose. Clonidine stopped shivering in all 20 patients. A single dose of meperidine stopped the shivering in 18 of 20 patients, with the other 2 patients needing a second dose. Urapidil was less effective: the first dose stopped the shivering in only six patients; the second dose was effective in another six; it was ineffective in 8 of 20 patients. A comparison between meperidine, clonidine and urapidil in the treatment of postanesthetic shivering. Schwarzkopf KR, et al. University Hospital, Jena, Germany. Anesth Analg 2001 Jan;92(1):257-60. Same results: Anesth Analg 2000 Apr;90(4):954-7. Ed: Narcotics are often used for post-op shivering. This study shows that the inexpensive and non-addictive clonidine works just as well.  Opiates are not needed.

Shivering: Clonidine Better than Meperidine: In 60 patients undergoing elective microsurgical vertebral disc resection, patients received either pethidine (0.3 mg/kg) or clonidine (2 microg/kg) or 0.9% saline 5 minutes prior to the end of surgery. Postoperative shivering with clonidine (5%) was less with pethidine (25%) or saline (55%). No significant differences among the pain scores and the analgesics demand were noted. Comparative study of pethidine and clonidine for prevention of postoperative shivering. A prospective, randomized, placebo-controlled double-blind study. Grundmann U, et al. Universitatskliniken des Saarlandes, Homburg. Anasthesiol Intensivmed Notfallmed Schmerz 1997  Jan;32(1):36-42.

Surgery: Abdominal and Thoracic Post-Op Pain: IV Propacetamol(Acetaminophen) as Good as IM Meperidine: In a DB study of 40 patients with moderate to severe thoracic or abdominal post-op pain,  2 g propacetamol in 100 ml normal saline IV did as well as meperidine 50 mg IM for post-op analgesia. Pain was evaluated 10 times with visual analog scale and verbal describing scale during 6 h from the beginning of propacetamol infusion. A randomized, double blind, and controlled clinical trial of the non-addictive propacetamol in postoperative analgesia. Ma EL, et al. PUMC Hospital, Beijing, China. . Zhong Guo Yi Xue Ke Xue Yuan Xue Bao 2003 Jun;25(3):329-32.

Surgery: Abdominal: Ketorolac Did as Well as Meperidine: In a DB PC study of 129 patients after major abdominal surgery, during the first 2 h, meperidine 100 mg had a more rapid onset of action than ketorolac or placebo. Thereafter 100 mg pethidine and 30 mg ketorolac were equally effective. 30 mg ketorolac had a similar efficacy to 100 mg meperidine over the 8-h study period and 10 mg ketorolac being slightly less effective than 30 mg ketorolac. Placebo-controlled comparison of single intramuscular doses of ketorolac tromethamine and pethidine for post-operative analgesia. Folsland B, et al. Ulleval Hospital, Oslo, Norway. J Int Med Res 1990 Jul-Aug;18(4):305-14.

Surgery: Abdominal Hystectomy: IM Diclofenac Longer Pain Relief with Less Bowel Paralysis than Meperidine: In a DB PC study of 63 patients with moderate to severe pain after an abdominal hystectomy, diclofenac IM gave significantly longer pain relief than meperidine or placebo. Few side-effects were reported after diclofenac and post-operative bowel paralysis tended to be shorter than with meperidine. Diclofenac versus pethidine in the treatment of pain after hysterectomy. Carlborg L, et al. Lanssjukhuset, Halmstad, Sweden. Eur J Anesth 1987 Jul;4(4):241-7.

Surgery: C-Section: Ketorolac Did as Well as Meperidine with Fewer Side-Effects: In a DB study of 100 women undergoing elective C-sections, IM ketorolac 30 mg and IM meperidine 75 mg in the recovery ward up to every 6 hours found no difference in the duration of analgesia. Pain VAS and overall assessment of analgesia was similar between groups, although more side-effects (nausea, dizziness) were noted in the meperidine. Analgesia after caesarean section with intramuscular ketorolac or pethidine. Gin T, et al. Chinese University of Hong Kong. Anesth Intensive Care 1993 Aug;21(4):420-3.

Surgery: C-Section and Orthopedic: Indoprofen IV as Good as Meperidine: In a DB study of 40 C-section patients and 40 orthopedic surgery patients, Indoprofen (400 mg) IV did as well for pain as meperidine (1,5 mg/kg). Indoprofen--a new non-opioid analgesic. A comparison with pethidine. Brock-Utne JG, et al. S Afr Med J 1985 Nov 23;68(11):803-4.

Surgery: General: Lysine Acetylsalicylate as Good as Meperidine: In a DB study of general surgery patients, twice the customary dose of lysine acetylsalicylate did as well as meperidine in subjective and objective pain relief and performed very well overall with respect to other parameters. Treatment of postoperative pain with non-narcotic drugs; evaluation of lysine acetylsalicylate in high doses. Double-blind controlled study. Pagni E, et al. Minerva Anesth 1981 May;47(5):215-20.

Surgery: Hip Replacement: Diclofenac Less Pain than Meperidine and Fewer Side-Effects: In a DB PC study of 68 patients the day after hip replacement for arthrosis, an IM injection of diclofenac 75 mg resulted in less pain and fewer side-effects than IM meperidine 50 mg, or placebo (a second injection was usually given after 3.5 h). Pain was recorded before and for 3 h after these injections.Diclofenac for pain after hip surgery. Lingren U, et al. Acta Orthop Scand 1985 Feb;56(1):28-31.

Surgery: Hysterectomy and Cholescystectomy: Ketorolac as Good as Meperidine for Pain and Better for Outcome: In a DB study of 210 adults after abdominal hysterectomy or cholescystectomy, IM ketorolac 30 mg every 3-6 hours as needed then 10 mg every 4-6 hours resulted in higher functioning during the first 3 days post-op when compared to IM meperidine 100 mg every 3-6 hours then acetaminophen with codeine (600/60). Patients receiving ketorolac had lower nursing utilization scores, too. Times to first bowel movement, walking without assistance, and first oral fluids were significantly shorter after ketorolac than meperidine. Mean pain intensity scores and pain relief were comparable between ketorolac and meperidine. Comparison of ketorolac and meperidine in patients with postoperative pain--impact on health care utilization. Stahlgren LR, et al. St. Joseph's Hospital, Denver, Colorado. Clin Ther 1993 May-Jun;15(3):571-80; discussion 570.

Surgery: Joints: Ketoprofen as Effective as Meperidine with Fewer Side-Effects and Longer Action: In a DB study of 59 patients undergoing painful knee arthrolysis and ligamentoplasty, carpal or foot surgery, ketoprofen was as affective as meperidine with pain relief 67% with ketoprofen vs. 63% with meperidine). Pain relief lasted 9.2 h with ketoprofen and 8 h with pethidine. Ketoprofen probably acts more through its central analgesic effect than its antiinflammatory effect. It had fewer side-effects. It does not have the risks of respiratory depression or tolerance unlike the opiate drugs. Comparative study of ketoprofen and pethidine in severe postoperative pain. Langlais F, et al. Hopital-Sud, Rennes. Ann Fr Anesth Reanim 1987;6(5):408-12.

Surgery: Orthopedic: Ketorolac Better than Meperidine: In a DB study of 244 patients with at least moderate pain after major orthopaedic surgery, IM Ketorolac (60 mg followed by 30 mg) did as well at 3 hours and better at 6 hours and thereafter compared to IM meperidine (100 mg or placebo) when each was given every 2 to 6 hours as needed for as many as 5 days. In both patient and observer evaluations, Ketorolac was significantly better tolerated than meperidine, and the number of patients reporting adverse events was lower with Ketorolac than with meperidine. Ketorolac was better tolerated than meperidine. Ketorolac versus meperidine for pain relief after orthopaedic surgery. DeAndrade JR, et al. Emory University. Clin Orthop Rel Res 1996 Apr;(325):301-12.

Surgery: Post-Op Pain: IM Zomepirac Superior to IM Meperidine: In a DB Study of 88 patients with moderate or severe postoperative pain, IM zomepirac 100 mg. was superior to meperidine 50 mg and as effective as meperidine 100 mg. Total analgesia provided by zomepirac was greater than that with meperidine 100 mg, which was greater than that with meperidine 50 mg. Significantly fewer patients needed remedication during the observation period, and mean time to remedication was significantly longer for the zomepirac group than for either meperidine group. A double-blind study comparing single dose of intramuscularly injected zomepirac to meperidine in the treatment of postoperative pain. Baird WM, et al. Pharmacother 1986 Sep-Oct;6(5):219-27.

Surgery: Post-Op Pain: IM Ketorolac Better than IM Meperidine:In a DB study of 125 post-op patients with moderate to severe pain, ketorolac IM 30 mg or 90 mg were both superior to meperidine 50 mg IM on six of nine efficacy measures of pain over the first 6 hours. The onset of and peak analgesic effect of both doses of ketorolac and of meperidine were equivalent. Ketorolac had significantly longer duration of analgesic effect. Authors state, " The prolonged efficacy of IM ketorolac combined with the reduced risk of respiratory depression suggest an important use of this drug for the relief of postoperative pain." Efficacy and safety of single doses of intramuscular ketorolac tromethamine compared with meperidine for postoperative pain. Stanski DR, et al. Stanford University. Pharmacother 1990;10(6 ( Pt 2)):40S-44S.

Surgery of Prostate: Bupivacaine Better than Meperidine for Pain: In a DB study of 40 patients undergoing transurethral resection of prostate, 2 ml 0.5% bupivacaine intrathecally did as well at pain relief as 40 mg of meperidine intrathecally. Meperidine had significantly greater reduction in heart rate, a lower degree of motor block, shorter period before requests for postoperative analgesia but a higher incidence of sedation, nausea and vomiting. Intrathecal pethidine: an alternative anaesthetic for transurethral resection of prostate? Sia AT, et al. Toa Payoh Hospital, Singapore. Anesth Intensive Care 1997 Dec;25(6):650-4.

Surgery: Pulmonary: IM Ketamine as Good as IM Meperidine: In a DB study of 30 pulmonary surgery patients, IM ketamine (1 mg/kg) did as well as relieving pain as meperidine (1 mg/kg); however, the duration of action of ketamine appeared to be slightly longer. Throughout the study PaCO2 was significantly lower in the ketamine group. Heart rates increased significantly only with meperidine. Intramuscular low-dose ketamine versus pethidine for postoperative pain treatment after thoracic surgery. Dich-Nielsen JO, et al. University of Copenhagen, Denmark. Acta Anesth Scand 1992 Aug;36(6):583-7.

Surgery: Tonsillectomy in Children: Tramadol, Ketamine, and Meperidine All Similar in Effectiveness: In a DB study of 45 children undergoing tonsillectomy comparing intramuscular 0.5 mg/kg ketamine, 1 mg/kg tramadol or 1 mg/kg meperidine on post-operative pain, the effects of ketamine, meperidine and tramadol on post-operative pain following adenotonsillectomy in children were similar. Pain relief for children after adenotonsillectomy. Ertugrul F, et al. AkdenizUniversity, Antalya, Turkey. [email protected]. J Int Med Res 2006 Nov-Dec;34(6):648-54.

Thomas E. Radecki, M.D., J.D.

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