Toradol

If you can get them on PO, you can supplement with Vioxx.
I don't use it post-op, more in chronic pain but Indocin can be a decent supplmenting agent, and is availble in a PR form.
Other than Toradol, I know of nothing that is a good supplement. (But give me a minute or two more to think... I may come up with something).

BTW, does it HAVE to be Dilaudid? If they're ALL getting loopy, then you're giving a wee wittle bit too much. Perhaps MS04 would be better, as everyone is more familiar with it.

-Dave

I just had the same problem with one of my pts in clinical last week. She was taking MS04 and the dr's decided to send her down for a HIDA scan (came through ER night before with abd pain, possible chole) and of course you can't have any narcotics like 3 hours before a HIDA scan and they didn't want to give her Toradol b/c of the bleeding. They said there was really nothing then they could give her for the pain, but ended up giving her Toradol anyways. A lot of pts like to take Phenergan with their MS04, or some nurses just give Phenergan alone if it is not time for their pain meds yet. Maybe try PO meds and if nausea occurs give IV Phenergan or Zofran???

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.

Laws me...
I thought there had been enough education done to where EVERYONE knew that Phenergan IS NOT to be used in place of/to supplement ANY pain medication.

This goes for Vistaril, Compazine, Zofran, Kytril.

-Dave, who's thinking this may merit a thread of its own.

I agree with MiMi, Toradol is a great drug for pain. We see many different kinds of pain ie, bone, muscular,ha,etc... I also had surgery for acute appy last year the pain was baaaad, I was given toradol IV and had no pain....it was great and no drowsy or sleepiness.

Toradol is hands down the best non-narcotic medication for pain.

I wish we could use it on a long term basis.

-Dave

Just curious - why would someone use zofran, compazine, phenergan for pain relief? I thought they were just used for n/v. BTW, many orthopedic surgeons I work with are reluctant to use phenergan because of oversedation, but I find Zofran to be useless, and phenergan seems to work so much better.

The main reason people use an anti-emetic drug in combination with a pain medication IS sedation. I think the practice was originally started because people thought if you nocked them out, they wouldn't be in pain. Then came about some flawed studies (since proven wrong) that the pain releiving props of the medication was enhanced by using one of these drugs.

Its the same thing as the ER giving a patient Haldol for pain. NONE of these drugs are indicated for pain, and therefore SHOULD NOT be used for pain. Yes, I know about off-label useage, but I promise you... come into my hospital and give one of these drugs for pain (instead of choosing a proper method... you understand, don'tcha?) and you will be brought in front of our medical ethics review board. Just ask our residents who were using Haldol and Ativan for abdominal pain.

-Dave

I assumed it was because so MANY people have nausea as a side effect of the narcotics, particularly if they are unaccustomed to them.