I’m curious what it was I was given for pain about 30 years ago. Somebody took me to the emergency room for kidney stone pain and I was quickly admitted for what turned out to be ten days. I had four stones jammed together in my ureter, including a 13 mm stone and a 9 mm stone. On an emergency basis they did a good old fashioned lithotomy, leaving about a 7" scar in my flank and equipping me with a drain and two - count 'em, two – catheters, one of which crossed my bladder and went up the ureter to the kidney.
At some point either shortly before or shortly after the surgery I was in a very great deal of pain and they produced a huge needle and gave me a shot into the front of my thigh, which gave me very powerful pain relief and also changed my disposition. I think this was soon after the surgery, in my hospital room, but I’m not sure. The person giving the injection apologized, saying this needle would hurt, but I didn’t even notice the needle itself.
I did have the misfortune to wake up on the operating table after they had closed me but before they moved me onto a gurney. I remember one of the team saying “Hey, he’s waking up” and another saying “Hey, go back to sleep, you don’t want to be awake” and I thought it a bit uncouth that they would all begin their sentences with “Hey”. This moment was extremely painful, hurting around the incision.
I’ve had oxycodone, hydromorphone, and other narcotic painkillers by injection before and since, but none of them seemed anywhere near this powerful. I do know that when I’m passing even a much smaller stone of 5 mm, it’s still painful enough that 20 or 30 mg of oxycodone doesn’t handle the pain and I can’t even say I can tell that I’ve taken it (though if the stone passes quickly, as the pain rapidly subsides I suddenly realize the oxydocone has left me dizzy and loopy, thinking that gee I must have taken it after all).
So I’m simply curious. From this description is it possible to guess what painkiller this was?
My semi-educated guess would be Demerol (meperidine) or morphine or possibly Dilaudid (hydromorphone).
How one perceives the euphoria/analgesia/sedative effects of any particular opioid depends in a large part upon the physiologic state of the patient at the moment, in addition to the drug’s own properties.
I’d hardly call ketamine a local anesthetic. Locals are things like lidocaine and bupivacaine, and others which cause numbness or loss of sensation in the anatomic location in which they’re given. Ketamine is very much a general anesthetic.
Dilaudid would be my guess too. I had a gallbladder attack and went from pain beyond the world OWIEOWIEOWIE to* pain? what pain?, I don’t got no stinkin’ pain* in the space of about a minute and a half… it was lovely.
I would also guess Dilaudid. They gave it to me once when my back went into spasm, and it made mawkishly sentimental - I was thanking my wife for taking care of me in my hour of need, and generally running on like a sloppy drunk.
About a year and a half later, my back went into spasm again. As they wheeled me into the emergency room, my wife asked the doctor “Can you give him a shot of that stuff that turns him into a nice guy?”
Given the time period, I’d say it was most likely Demerol (probably mixed with Vistaril).
It has largely fallen out of favor because it has a slew of undesirable side effects (including nasty seizures), it is highly addictive, and it has many adverse interactions with other medications. There are simply better options these days.
mmm
Yeah. Mr. Demerol was my very good friend when I had my kidney stone 30 years ago. I had one about six months ago and the ER said that they don’t use Demerol any more. I was heartbroken.
Ketamine is more of an amnesic agent. My guess is that the OP was given Demerol (meperidine). It’s only recommended for short-term use, mainly because of a potential toxic metabolite. It is also the drug of choice for gall- or kidney stones because it’s also a smooth muscle relaxer.
Vistaril (hydroxyzine pamoate) is an antihistamine that is also very sedating and has some anti-nausea effects.
Meperidine has largely fallen out of favor, but there are still plenty of circumstances where it’s useful for the treatment of intense, short-term pain. I’ve even seen it used in labor following a fetal demise.
It’s a dissociative drug, actually. A class of hallucinogen. Detaches one from the pain experience.
I can’t think of any situation where I’d use it over other short-acting opioids. It really is a crappy drug. I moved away from using it decades ago. Sure was tough to get the OB community to leave it alone, in some places.
Where do you think it’s better than other opioid alternatives?
I still see primary care and neurology offices giving their migraineurs IM Demerol and Phenegan and then expecting me to follow suit (in the ER) when they are closed or too busy to see the patient on short notice.
:smack:
Its advantage nowadays, MHO, is in the antispasmodic effect. Otherwise, there are plenty of other drugs that are better.
“Dissociative” - that’s the word I should have used. Before I went to college, a man I was dating told me about the pre-medication he’d been given prior to an operation he had when he was a teenager, and he said he was fully conscious, could still feel pain, etc. but he just plain old didn’t care. Several years later, when the professor started talking about Innovar (fentanyl and droperidol), I knew that was probably what he got.
Innovar was already off the market by the time I graduated in 1994, and a Google search took me to (among other things) this.
Could you elaborate on this some more?
Context:
I suffer from long term chronic pain. Treatment for this has ranged from Oxycontin to Morphine to Fentanyl.
While each, depending on the dose, is effective in reducing my pain to tolerable levels, I have NEVER experienced any “high” or other pleasurable effect such as others have described in upstream posts.
Ie: these drugs kill the pain, and that’s it.
Why is that?
When I had shoulder surgery they gave me some kind of nerve block and told me it may or may not take but it was supposed to numb my arm. When I woke up from surgery I quickly realized it didn’t work and I was in a great deal of pain. They gave me some Hydromorphone, which at that point I had never had, in an IV and let me tell you within seconds I was a drooling idiot, that was some powerful stuff, they kept asking me questions but I was completely spaced out staring at my hand.
Demerol’s much touted apparent efficacy as an antispasmodic agent is due to its analgesic effects, which makes it much like every other opioid as far as spasm relief goes. It does not seem to have actual antispasmodic effects in humans.
Interestingly, Demerol was the first synthetic opioid created, and it was originally touted as an antispasmodic, and a non-addicting substitute for morphine. Both assertions turned out to be incorrect.
