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We thank Dr Badruddoja for the interest he has shown in our article. The reference referred to is available online from the American College of Surgeons (http:/www.acssurgery.com/cgi-bin/publiccgi.pl?loginOP), entitled “Principles and Practice,” within section 1, chapter 5 (“Postoperative Pain”) and section 9, chapter 1 (“The Elderly Surgical Patient”). Although we agree with that it is possible to use meperidine and never see an adverse reaction, the goal in medicine is to get the error rate as close to zero as possible (http:/www.rand.org/pubs/technical_reports/2005/RAND_TR276.pdf). The risk of adverse reactions with meperidine is substantial, more effective analgesics with a lower risk of adverse effects are available, and we do not have the ability clinically to predict in advance those who will experience adverse reactions with the drug. For these reasons, we again urge that hospitals and departments of surgery strongly consider eliminating meperidine from their pharmacopoeias, particularly when treating older adults.
Kornitzer BS, Leipzig RM. Meperidine Use in Older Surgical Patients—Reply. Arch Surg. 2006;141(8):835. doi:10.1001/archsurg.141.8.835-b