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Tue Oct 21 15:24:17 BST 2003

k:

I don't think your statement is entirely accurate. 

I've found several articles that not only reinforce
the safe use of Phenergan with Demerol and morphine,
but encourage it's use*.  In general, there is an
abundance of evidence supporting the use of
anti-emetics with morphine, including Reglan,
Compazine and Inapsine.  What's more striking is that
I've found a paucity of evidence or case reports to
support your argument about it's danger.  Since it is
apparent that Pret isn't the only one missing your
point, please provide your references to the contrary.

Ben 

*Terndrup TE, Cantor RM, Madden CM. Intramuscular
meperidine, promethazine, and chlorpromazine: analysis
of use and complications in 487 pediatric emergency
department patients. Ann Emerg Med. 1989
May;18(5):528-33.

Terndrup TE, Dire DJ, Madden CM, Davis H, Cantor RM,
Gavula DP. A prospective analysis of intramuscular
meperidine, promethazine, and chlorpromazine in
pediatric emergency department patients. Ann Emerg
Med. 1991 Jan;20(1):31-5. 

Suojaranta-Ylinen R, Hendolin H, Tuomisto L. The
effects of morphine, morphine plus scopolamine,
midazolam and promethazine on cerebrospinal fluid
histamine concentration and postoperative analgesic
consumption. Agents Actions. 1991 May;33(1-2):212-4.

Light RW, Stansbury DW, Webster JS. Effect of 30 mg of
morphine alone or with promethazine or
prochlorperazine on the exercise capacity of patients
with COPD. Chest. 1996 Apr;109(4):975-81.

Tarkkila P, Torn K, Tuominen M, Lindgren L.
Premedication with promethazine and transdermal
scopolamine reduces the incidence of nausea and
vomiting after intrathecal morphine. Acta Anaesthesiol
Scand. 1995 Oct;39(7):983-6. 

--- "Bjorn, Pret" <pbjorn at emh.org> wrote:
> Hoooboy.  Just when I thought I could predict what
> sets folks off around
> here.
>  
> Ken,
>  
> Let's start with me reiterating my opinion that
> antiemetics are largely
> unnecessary--and even when needed, are often
> effective in
> left-end-of-the-curve doses.  Plus, I'm on record
> against meperidine
> generally, and in trauma especially.
>  
> That said, I'll be damned if I haven't personally
> administered
> hundreds--nay, thousands!--of doses of Demerol and
> Phenergan, IV and IM,
> without any memorable consequences over a
> twenty-year span in and around our
> Emergency Department.  Ignorance, I can attest from
> experience, is in fact
> bliss.
>  
> But now I'm forced to ask: what literature did I
> miss?  Or is it possible
> that you've gone a bit hyperbolic on me?
>  
> In deepest respect, as always.
>  
> Pret
> 
> -----Original Message-----
> From: KMATTOX at aol.com [mailto:KMATTOX at aol.com]
> Sent: Tuesday, October 21, 2003 10:28 AM
> To: trauma-list at trauma.org
> Subject: Opiates & antiemetics - NOT
> 
> 
> I can find NO data to support the combination of
> antiemetics with opiates.
> I do find reports condemning the use of
> phenathiazides (like phenergan) with
> opiates.   I do believe that any order for morphine
> (or Demerol) and
> phenergan together, should also automatically
> trigger a QA review and a
> mandate for an explanation as to why a potentially
> dangerous and potentially
> fatal combination has been ordered by a physician.  
>  
> k
> 
> > --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html

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