Toradol after abdominal surgery (in infants)

  1. 0
    I'm only a month off orientation, working in PICU so this is a little new to me. I recently took care of a three month old baby post abdominal surgery. This poor kid has a reanastamosis, lysis of adhesions, appendectomy and exploratory laparotomy all in one go! I was having problems managing her pain and, despite increasing her morphine dose she would become very agitated/tachycardic/increased BP, etc. I wanted to supplement her with something in between the morphine and suggested Toradol to the resident.

    The resident said that she didn't want to use Toradol because the baby just had abdominal surgery. She wanted to use Ativan. I was confused because the baby received a dose of Toradol in the OR and, while I've never received an abdominal surgery pt, we use Toradol post-op for other surgical patients. . I understand Toradol is an NSAID and there is a bleeding risk and it has the potential to cause GI ulcers. The anesthesiologist suggested we use it, and he works exclusively with kids.

    So, long explaination, but my question is- do you use Toradol in pt's post abdominal surgery? Particularly in children?
  2. 6 Comments so far...

  3. 5
    I'll let someone with current experience answer the Toradol question. It wasn't used in my NICU days, but that was quite a while ago.

    There are other things that concern me more about your post. Ativan is not a pain med, and while it may "quiet" a restless infant, it will not relieve pain, so the resident's desire to use it is concerning to me. Secondly, if a resident gives an answer that doesn't make sense to you, please don't hesitate to ask him/her to explain it, or go to your charge nurse and/or attending physician for guidance.

    Your post makes me wonder if the resident understood neonatal pain management.
    Crux1024, BuckyBadgerRN, umcRN, and 2 others like this.
  4. 0
    Quote from Jolie
    I'll let someone with current experience answer the Toradol question. It wasn't used in my NICU days, but that was quite a while ago.

    There are other things that concern me more about your post. Ativan is not a pain med, and while it may "quiet" a restless infant, it will not relieve pain, so the resident's desire to use it is concerning to me. Secondly, if a resident gives an answer that doesn't make sense to you, please don't hesitate to ask him/her to explain it, or go to your charge nurse and/or attending physician for guidance.

    Your post makes me wonder if the resident understood neonatal pain management.
    The ativan concerned me too. The attending wasn't around at the time this issue came up and we eventually decided to increase the frequency of the morphine for the time being. I'm new, so I still question my nursing judgement and I'm learning to be more assertive about my instincts/assessment. The patient quieted, but remained tachycardic, so we gave her a fluid bolus (this I had to go to the attending to get). I agree that the resident didn't seem to know what to do pain management wise.
  5. 2
    I've never used it in NICU. I can understand the need to give something, but I agree with you guys that Ativan isn't it.

    I did find one study (only 51 patients) that looked at ketorolac in post-op patients 2-18 months old. It wasn't found to be unsafe, but it didn't seem to reduce the frequency of morphine either.

    They did exclude former preemies from the study I found, and preemies are going to constitute a huge percentage of infants having abdominal surgery. A particular concern with relatively young former preemies might be the issues with renal function.

    Does your OR ever place epidurals in this type of baby once they are under general? Recently, a couple of our opioid-habituated babies had what I think are significant results using epidural pain pumps.
    Crux1024 and wooh like this.
  6. 0
    Quote from Ashley, PICU RN
    So, long explaination, but my question is- do you use Toradol in pt's post abdominal surgery? Particularly in children?
    An RN friend of mine got snapped at by an MD for asking about Toradal for a post abdominal surgery patient asking for more pain control. I think the doc was more frustrated by the patient than anything.
  7. 0
    When I worked in (adult) ER, we never had Toradol ordered for abdominal pain. Head pain, back pain, neck pain, knee pain, arm pain, etc- but I don't recall giving it much, if ever, for abdominal pain. This leads me to believe that it wouldn't be effective on abdominal pain.

    When I went to the PICU, it was rarely used, and when it was, it was in patient's that had had spinal fusions, or some other orthopedic surgery, and it was usually scheduled.

    I must be in the minority, because if I had tried morphine, and the child was still agitated and tachycardic, I WOULD have asked for ativan. Maybe it wasn't all pain related...maybe she was anxious? I frequently asked for ativan after giving multiple PRN's and had a pretty good deal of success with it.

    In short- I haven't heard (or practiced) giving toradol for any kind of abdominal issues, be it acute or surgical pain, in children or adults.
  8. 0
    I worked PICU for many years and took care of many post op abdominal surgeries. We never used Toradol for pedi GI surgeries. However, we almost always had an order for ativan to be given with the post op morphine. I would probably have questioned the frequency of the morphine doses...our standing orders were usually for Morphine q 1hr but I have given it as frequently as q 15 minutes if the pt was in extreme pain. You didn't mention how much or how frequent the dose was. Was the patient just being under dosed?


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