Does Meperidine Still Have a Place in Pain Control? The Evaluation of Meperidine Use in Adult Patients in a teaching hospital

Objectives:

Due to concerns about meperidine drug interactions and its metabolite normeperidine neurotoxicity, Taiwan FDA has issued “Meperidine Guideline” in order to reduce the use of meperidine as a first-line agent for analgesia in September, 2011. The study is designed to reduce meperidine use by means of providing physician education and pharmacist intervention.

Methods:

The study was executed at the Orthopedics Department in Shuang-Ho hospital in Taiwan. We included inpatients who received at least one dose of parenteral morphine or meperidine between September and December, 2011. Physician education and pharmacist intervention were provided. The study duration was divided into 3 periods: pre-education, post-education, and paharmacist intervention period. We compared the number of doses ordered between three periods, and assessed the change of pain score and respiration rate in whole period between two opioids.

Results:

The number of meperidine doses ordered was shown to decline by 18.1% (45.1% to 27%) in the post-education period. During the pharmacist intervention period, the number of meperidine doses ordered was decreased by an additional 2%. Physician acceptance rate of pharmacist recommendations were reached to 89.47%; 17 out of 19 pharmacist's recommendation of morphine usage were accepted. The changes in pain score and repiratory rate between meperidine and morphine in all periods were statistically equivalent with p-value of 0.74 and 0.47, respectively.

Conclusion:

The changes in pain score and respiratory rate indicate that the effectiveness and respiratory inhibition of two opioids are not significantly different. Given the fact that neurotoxicity is associated with normeperidine, meperidine is not an appropriate first-line narcotic for pain management. Pharmacists have the responsibility to modify the habitual prescription with appropriate rationale. Pharmacists’ active involvement in the collaborative care of patients with pain control has reduced the use of meperidine, and the possible risk of neurotoxicity as well.