Numerous studies have documented over and over that narcotics give inferior pain relief to children, and cause more side-effects.  Yet, doctors keep committing malpractice in this way, abusing children, needlessly causing them to suffer excessive pain while conditioning their developing nervous systems to crave narcotics.  A huge amount of research shows that the younger the age a child starts using a drug (alcohol, nicotine, marijuana), the more likely the child is to become addicted to that drug and the more severe the addiction.  Parents are never given a choice and aren't even forewarned that their child will be given narcotics.  

There needs to be a law protecting children and their parents requiring all doctors wishing to use narcotics on children to first inform the parents that non-addictive alternatives are available, inform the parents of the research findings, and allow the parents to make an informed decision.

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 v 74 minutes for removal of monitoring devices and 58 v 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. sauden@aol.com. 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.

Child Birth: 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 parturients 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.

Debridement: 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.

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.

Ear Surgery: Butorphanol Inferior to Ketoprofen But Better than Acetaminophen: In a DB study of 120 children undergoing bilateral myringotomy and tube placement plain acetaminophen 10 mg/kg orally, was compared to acetaminophen 10 mg/kg with 1 mg/kg of codeine orally, transnasal butorphanol 25 micro g/kg given immediately after the induction of anesthesia, and ketorolac 1 mg/kg given IM immediately after the induction of anesthesia. All children received oral midazolam before surgery. IM ketorolac did best. Time to first rescue analgesic was longest in the ketorolac group, and there was no associated postoperative vomiting or nausea. Butorphanol provided superior analgesia when compared with acetaminophen with codeine or plain acetaminophen. Children who received ketorolac versus butorphanol had less vomiting in the 24 h after surgery. Postoperative analgesia in children undergoing myringotomy and placement equalization tubes in ambulatory surgery. Pappas AL, et al. Loyola University. apappas@lumc.edu. Anesth Analg 2003 Jun;96(6):1621-4. 

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.

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.

General 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.

Out-Patient 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.

Babies: Morphine Bad for Premees, But Its Use Goes On: In a DB PC study of 898 premees (gestational age 23-32 weeks) given morphine or placebo until they were weaned from the ventilator or for 14 days, whichever occurred earlier, morphine results in significantly longer ventilator therapy : 7 days vs 6 days). Some of the sicker Infants in both groups received open-label intermittent morphine doses. After adjustment for birth weight, Clinical Risk Index for Babies scores, maternal chorioamnionitis, RDS requiring surfactant, and patent ductus arteriosus in a logistic regression model, the use of additional analgesia with morphine was associated independently with increased air leaks and longer durations of high-frequency ventilation, nasal continuous positive airway pressure, and oxygen therapy. Morphine did not improve short-term pulmonary outcomes among ventilated preterm neonates. Additional morphine was associated with worsening respiratory outcomes among preterm neonates with RDS. Morphine administration and short-term pulmonary outcomes among ventilated preterm infants. Bhandari V, et al. NEOPAIN Trial. Albert Einstein, Philadelphia. vineet.bhandari@yale.edu. Pediatrics 2005 Aug;116(2):352-9.