Is there something comparable to Toradol that can be given IV for pain?

[bellehill]

Toradol is one of my favorite pain relief meds, if only it didn't harm the kidneys! Is there something comparable to Toradol that can be given IV for pain (usually post-op) either in place of a narcotic or in addition to narcotics? A lot of my patients don't like the way Dilaudid makes them feel and I don't like having them so sleepy when I am trying to assess them. I try to switch them to PO meds as soon as possible but if nausea sets in we are doomed to have a bad night. Any thougts?

[mwbeah]

I agree that we can disagree, however some posters require more direct measures.

My research focus is preemptive analgesia (look for the publication in August AANA Journal). If a patient has already developed central sensitization (first described by C.J. Woolf in 1983) status post peripheral sensitization and wind-up (discovered by Lorne Mendell in 1961) then the patient will actually need more medication for pain relief.

The "traditional" way we manage pain is just not effective, in fact that is why JCAHO made it the "5th" vital sign in 2001 secondary to 4 out of 10 patients (on average) complaining that their pain was not controlled.

Phenergan does not work, it may sedate the patient but when the patient metabolizes that medication we have a problem because we did not treat the pain, so now the patient is "wound-up".

Acute pain and chronic pain have distinct characteristics which require separate thoughts on intervention. If we treat acute pain with inappropriate agents, it could result in chronic or neuropathic pain, this would result in greater incurred costs for all involved. TCAs and GABA agonists are for the chronic pain population but I agree they are synergistic with opioids. Clifford Woolf, faculty at Harvard has some great information on the net if anyone is interested on the interventions for acute and chronic pain.

Mike

[janet r. gowen]

This is a subject that is hotlycontested throughout all fields of nursing.

In my opinion with a lot of years of nursing practice backing it up there are several guidelines to follow

1 don't judge pain, if a patient is uncomfortable, medicate them

2. Use the drugs as ordered, if they are not effective call the doctor and let him know

3. Treat the patient with consideration, kindness and knowledge of what was done to their body and the response you would expect to an invasive procedure.

4 We cannont create an addict in a hospital stay never saw it happen

I work on a busy cardiovascular unit open heart, vascular reconstruction etc

these patients have a set regimen to follow after surgery to allow them to recover if the regimen is not followed the patient is not able to walk as required, perform pulmonary toilet as required to resolve post op atelectasis and they are miserable

We use percocet on a q four hour basis with morphine for severe pain, reglan or zofran for nause and toradol for the inflammation if the platelet count and renal function allow it to be used safely.

As for phenergan, it is a contraversial drug, it does control nasusea and vomiting it does sedate and enhances the affect of the narcotic it also has some really strange effects on some folks.

A standard dose of phenergan is twelve and a half mg to twenty five mg IV q six hours in an older patient the twelve and half can send them into an acute psychotic state. or sedate them to the point the respirations drop to less than eight a minute, they desaturate and still are in pain.

General trends in our practice are limiting the use of phenergan and using other drugs as zofran and reglan that have far less adverse effects.

The key to pain management is to treat the patients pain and initiate the therapy immediately then to keep the comfort level present through administration of the medication throughout the day and night not let the pain rear to full force prior to giving more medication.

Personal opinions regarding what the patient should need are not part of the equation, we are not experiencing the patients discomfort therefore should not judge.

We have excellent recovery stats and use alot of percocet on our units

[janet r. gowen]

Don't stress about the Toradol! It is so much better than constantly taking narcotics. After abd surgery, I used it alternating with my pain pills, I feel that I would have been constantly fuzzy from the narcotics, plus the problems with too much Tylenol. Less problems with your kidneys than destroying your liver. :)

Please use caution with the toradol, we use it often but must remember to monitor platelet levels the patients with chest tubes, thoracic surgery and orthopedic surgery praise its effects but it must be used in conjunction with a narcotic to truly relieve the pain, the affect on coagulation cascades in a patient that is either in renal compromise or with altered coagulation factors can be critical and the limits on iv use are fourty eight hours po is four days.

We must always remember that the chemicals we use have adverse affects if the tylenol level is in question, use of percalone is recommmended it does not contain tylenol. Our job is not getting easier with the constant influx of new drugs but it is part of our job not to cause harm and meet our patients needs

and I don't like phenergan, prefer zofran less side eiffects thanks :balloons:

[mwbeah]

Please use caution with the toradol, we use it often but must remember to monitor platelet levels

I agree that toradol must be used with caution, but monitoring platelet levels has little meaning. Toradol doesn't decrease the platelet count (it affects the arachodonic acid cycle and inhibits cyclo-oxygenase), it renders the platelet dysfunctional for a period of time (just like the other NSAIDS). A bleeding time can be used but is an unreliable test. INR could also be used. A TEG would be great, but these tests all costs money.

Mike

[Tenesma]

1) the only useful test is TEG (INR and platelets and bleeding time are useless).

2) it does NOT need to be administered with a narcotic in order to relieve pain. 30mg IV toradol is equi-analgesic to 10mg Morphine!!!

3) and who came up with those limits to IV and PO use??? the recommendations are not to exceed 5 days and that can be applied to IV as well.

[curleysue]

Wow, I have learned a lot about phenergan in the last posts. Thanks, However I do have a question. What would happen if someone is given IV phenergan too much? Does it make them have weird symptoms? Tolerance? I mean if they are getting it everyday for about a week or so. Thanks, Curleysue

[mwbeah]

I agree with Tenesma, TEG is the test to use. If anyone has questions about toradol, Sota Omogui's Anesthesia Drug Handbook has more than enough info (MOA, morphine equivalency, etc)

Mike

[PA-C in Texas]

I think that other countries have some other NSAIDs and salicylates for parenteral admin. in their formularies.

I like Toradol, and I think it works, but numerous studies have indicated that it is no better than oral ibuprofen for most types of pain.

[Tenesma]

define "no better"

[z's playa]

define "no better"

Doesn't work any better than regular Ibuprofen and other anti inflammatories.

[PA-C in Texas]

Let me rephrase:

A review of the relevant literature will indicate that oral ibuprofen is equally effective as Toradol injection for relieving most types of pain.

[Tenesma]

true but you are comparing something that can be given IV vs something that can only be given PO...