Availability of morphine sulfate and meperidine hydrochloride in total parenteral nutrition

At a comprehensive cancer center, patients experiencing severe chronic pain are managed by continuous infusion of narcotics via their TPN solutions. In some cases, patients have reported recurrence of pain when their narcotics were added to their TPN solutions shortly after titration in D5W. The purpose of this study was to evaluate the compatibility, stability and availability of two narcotics (morphine sulfate and meperidine hydrochloride) prepared in TPN and D5W. For this study a usual dose (300 mg) of each narcotic was mixed in the same types of products utilized with these patients (0.25 L bags of D5W and 3 L bags of TPN). Visually, each solution was examined immediately post-addition of drug to the bag and then every 12 hours for 36 hours. By high performance liquid chromatography (HPLC), the narcotic concentrations for each solution were determined prior to addition of drug to the bag, immediately post-addition of drug to the bag, and continuing every 4 hours for 36 hours. Results demonstrated no significant loss of morphine sulfate or meperidine hydrochloride due to adsorption to the polyvinyl chloride (PVC) bags. In addition, both narcotics were physically and chemically compatible, as well as, stable and available for at least 36 hours when stored at 21.5[degrees] C with no protection from environmental light.