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Meperidine-induced seizure after revision hip arthroplasty
Paul E Beaulé1, M Iain Smith, Vinh N Nguyen
1David Geffen School of Medicine at the University of California Los Angeles, 90017, USA.
Abstract:
Musculoskeletal injuries secondary to seizures are well documented and have a variable incidence. Meperidine (Demerol [Abbott, Abbott Park, IL]) has been used for many years in the postoperative setting for pain control; however, in high doses, it has been associated with seizure. We report the case of patient who experienced a tonic-clonic seizure 5 days after hip revision surgery, resulting in dissociation of the socket from the acetabulum with an associated acetabular fracture. In this patient, meperidine administered for patient-controlled analgesia within recommended range caused the seizure.
Insights
High-dose meperidine can trigger seizures, even within recommended ranges. This case highlights a seizure causing hip implant dislocation and fracture after surgery.
Area of Science:
- Orthopedic Surgery
- Neurology
- Pharmacology
Background:
- Musculoskeletal injuries from seizures are common.
- Meperidine (Demerol) is a common postoperative pain reliever.
- High doses of meperidine are linked to seizures.
Observation:
- A patient experienced a tonic-clonic seizure five days post-hip revision.
- The seizure led to acetabular dissociation and fracture.
- Meperidine was administered via patient-controlled analgesia within recommended dosage limits.
Findings:
- The patient's seizure was attributed to meperidine, despite doses being within the recommended range.
- This suggests a potential for meperidine-induced seizures at lower thresholds than previously understood.
- The seizure resulted in significant orthopedic complications.
Implications:
- Clinicians should exercise caution when prescribing meperidine for postoperative pain, even at recommended doses.
- Consider alternative analgesics or closer monitoring in patients at risk for seizures.
- This case underscores the importance of recognizing potential drug-induced neurological events in orthopedic patients.