Every third-year medical student on the general surgery clerkship learns from the intern to prescribe meperidine hydrochloride instead of morphine sulfate as an analgesic for patients with pancreatitis and cholecystitis. The Washington Manual of Medical Therapeutics recommends meperidine for these patients because, "it has no significant effect on the sphincter of Oddi."1 Standard references like Goodman and Gilman's Pharmacological Basis of Therapeutics2 perpetuate the idea of possible pancreatic complications from sphincter of Oddi spasm with morphine without giving the primary reference. An extensive literature search failed to find the basis for the preference of meperidine over morphine in patients with cholecystitis and pancreatitis. We speculate that this prejudice against morphine might possibly be based on old case reports, beginning with Walters et al.3 Although human studies show that morphine causes increases in sphincter of Oddi pressure,4 clinical evidence does not link morphine with increased risk over other opioids in relation to causing or aggravating pancreatitis or cholecystitis. In a study comparing equianalgesic doses of morphine and meperidine in 40 patients undergoing cholecystectomy, meperidine raised the common bile duct pressure 14% more than morphine.5
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 5
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.