Toradol

For the people who think putting your title after your name is special, multiple titles I am more impressed by. Phenergan doesnt help with pain?, next time assess it by asking your patient before and after- I will bet they say YES it is better. Yes, Phenergan will also cause sedation, which also is nice after painful surgery. Comfort is always nice for our patients, do we need a journal,study, or expert opinion from someone with impressive initials after there name to tell us this?

Phenergan is not a drug to treat pain, here is its mechanism of action:

The head of our OB department puts his post-op c-sections on round the clock Phenergan in addition to their Morphine PCA; they are all so snowed that they could not complain of pain even if they wanted to, which is what I think he is trying to accomplish. (This is the man who responds to all phone calls with, "Why you calling me with this stupid stuff?") But if my patients are too sedated to open their eyes or move in the bed, I hold the Phenergan.

I did a clinical rotation through a local ER where the attending doc would routinely order ativan and toradol together, esp for chest pain. I even heard that he was trying to find a way to market the combination as tordivan...... The patient that I saw it used on came in with a c/o chest pain and elevated bp. The meds were given, the bp came down, the pain went away and the patient went to sleep......

I am impressed by the knowledge, but I cant help but wonder if all this knowledge actually impeads patient care? I like my patients to leave my unit comfortable and happy as can be. Phenergan helps in some cases no matter what your PDR says. It is important to also have narcotic on board, dont start with phenergan as your pain reliever. When in doubt ask the patient. Merry Christmas, Michael

Michael, your posts speak for themself. You obviously don't care enough for your patients to ensure they have the appropriate agents to address the appropriate patient needs. Making a patient "sleepy" doesn't address the patient's pain. Additionally, opioids are a great tool but they themself, if used over time can lead to a hyperalgesia.

If you want to understand the how to manage pain appropriately start with this link www.pain.com

Mike

Moderator's note: Please remember to keep your comments focused on the subject of pain control. One CAN remain respectful even when disagreeing.

A tense and anxious patient hurts more than a relaxed patient, all other things being equal. Therefore, I would expect that a patient with an anxiolytic or sedating agent would find relief from pain medication faster than one who had only the pain medication. If a patient has been under-medicated and is already "wound up", then it often takes a smaller total amount of pain medication to bring the pain back under control if given in conjunction with something to help them relax.

It is not unusual for opioids to cause nausea in the narcotic naive, so prophylactic doses of an agent to prevent nausea make perfect sense. Too often, the phenergan is only ordered AFTER the patient has gotten sick and the brain has already formed an association between being nauseated and the opioid.

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

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

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