Quote from JaredCNA
Good info. I'm just full of questions right now because I've been flipping through my Pharmacology book for next semester.
Now I'm wondering why our lumbar lams and ACDs get Toradol. And the doc who does the ACDs will schedule the Toradol q4h for his pts...not prn.
I think it's really a matter of surgeon/facility preference. Most of the orthopedic surgeons where I work will prescribe PRN toradol, but we DC it before the patient starts any anti-coagulation therapy (like warfarin/lovenox). So usually we can give toradol for the first 24 hours. Sometimes patients don't get anti-coag therapy and in those cases I think we can give PRN toradol for up to 5 days. At that point it gets DCed so the pt's kidneys don't get screwed up. We just have to be on our toes and aware of the other meds the patient is on or conditions they have (like a hx of stomach ulcers) before we make the decision to go ahead and push toradol.
Personally, I like toradol - since it is not an opiate type pain med. Not that I have a problem with opiates, but opiates have a LOT of side effects that toradol doesn't (like respiratory depression or making elderly people go off their rocker). For some people it really really works well. There are others that it doesn't work well on at all. I will usually try it in conjunction with an oral medication like oxycontin or vicodin. If toradol isn't cutting it I switch to SQ dilaudid. Believe me, if the toradol isn't working it usually pretty obvious within an hour or so!
Like I said, it's just a matter of surgeon preference, so don't wrack your brain too hard trying to figure out the whys. At my facility there are 3 neurosurgeons who do lamis and discectomies. Surgeon A always prescribes IM demerol for pain control (and sometimes vicodin if the pt is lucky). Surgeon B will prescribe every pain med under the sun, except he will always choose morphine instead of dilaudid for the IV push pain med. Surgeon C only prescribes IV valium, SQ dilaudid, and tylox. It's not really consistent, but that's just the way they practice. I personally find that no one pain med is ever better than another 100% of the time, it's really just a matter of finding what works for the individual patient. If you are really curious about it, you could just ask the surgeon why they prescribe med A over med B, they'd probably be happy that you asked and would explain their point of view (they love talking about that kind of stuff).