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

bellehill, RN · Feb 24, 2004

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

Our doctors love Dilaudid for just about anything, they say it has fewer side effects than Morphine. We actually use sliding scales for the pain meds...if the patients pain is 1-5 they get so much and if it is 5-10 they get so much (sometimes it is broken down into smaller increments). I wish Toradol was a standard order but for some reason they don't like to use it with our lumbar fusion sugeries, any ideas why?

Dave ARNP · Feb 24, 2004

The neuros I know order it.

I'll have to inquire about why one would NOT want to use it in this case. Never had to consult on one of their patients, so I have pretty limited knowledge there.

-Dave

z's playa · Feb 24, 2004

Does anyone know if its normal to get the extreme agitation and tremors with Maxeran and Toradol together? How about Decadron thrown into the equation? I think Toradol is grreat but not ALL the time in my case. Makes me freak out.

Dave ARNP · Feb 24, 2004

Adding some Decadron to the mix?

Yea... that's WHY !

-Dave

fab4fan · Feb 24, 2004

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.

Back in the Paleolithic, when I went to nursing school, we were taught that Phenergan "potentiated" the effect of a narcotic...it made the pain relief even better, in other words. Of course, this is hogwash. What they were seeing was increased sedation, and we all know that sedation does not equal pain relief (everyone nod your head and say "yes").

Dave ARNP · Feb 24, 2004

I'm nodding Fab, I'm nodding!

However it appears others have a neck injury.

-Dave

bellehill, RN · Feb 25, 2004

Back in the Paleolithic, when I went to nursing school, we were taught that Phenergan "potentiated" the effect of a narcotic...it made the pain relief even better, in other words. Of course, this is hogwash. What they were seeing was increased sedation, and we all know that sedation does not equal pain relief (everyone nod your head and say "yes").

I am nodding! I was taught the potentiating effect of Phenergan when I was in school and that was just 4 years ago. When I got out I worked on a women's health floor and everyone got Demerol and Phenergan together...the doctors would even order it that way. Now we realize the danger in using Demerol and we know Phenergan doesn't help with pain...what do you figure we will learn tomorrow or the day after? :eek:

Home Health Columnist / Guide · Feb 25, 2004

Husband has had 90+ kidney stones. When IV Toradol first given to him, he couldn't believe the relief he got for Sever Renal Colic 20/10 scale!

Much better than IV Dilaudid without nausea. Toradol is the first thing he requests in ER. Thankfully, stones are now about 18 months apart, 95% are passed instead of every 6 weeks as was happening about 7 years ago.

i just call him my own personal rock quarry. :chuckle

Anniekins · Feb 25, 2004

Its my undertanding that Toradol interfears with the clotting of blood, and in fact potentiates drugs such as coumadin, heperin, lovonox...etc. So why would this drug be prescribed soon before or after a major surgery? That does not make sense to me.... :rolleyes:

Dave ARNP · Feb 25, 2004

I'll post below a snippet from a page which I will use to answer your question.

Current dosing recommendations vary according to patient population, risk category, and weight. In general, the physician will use LMWH before general surgery or after surgery for orthopedic surgery. Low-molecular-weight heparin can also be combined with warfarin until a therapeutic international normalized ratio (INR) is achieved. The physician will start warfarin on the day of or the day after surgery, depending on the type of surgery. He may use LMWH alone if the patient is at higher risk for bleeding, can't achieve a consistent warfarin level, or can't safely regulate the warfarin dosing. Note that there may be an increased risk of bleeding if the patient is receiving ketorolac (Toradol) while on LMWH (especially enoxaparin).

Here is the link.

http://www.nursingcenter.com/prodev/ce_article.asp?tid=53590

Answer your question?

-Dave

bellehill, RN · Feb 25, 2004

Its my undertanding that Toradol interfears with the clotting of blood, and in fact potentiates drugs such as coumadin, heperin, lovonox...etc. So why would this drug be prescribed soon before or after a major surgery? That does not make sense to me....

Most of our surgery patients have between 25 and 100cc blood loss in surgery, they are at a low risk for continued bleeding. Besides that they come back to the floor with drains so we can assess them frequently for bleeding that may not show up on the dressing. Toradol works but if your patient has lost a lot of blood or is at an increased risk of bleeding don't use it.

Gldngrl · Feb 25, 2004

Never see toradol used in abd transplant, due to bleeding/renal issues. Use Dilaudid or MSO4 PCA until po, then Dilaudid, Morphine, or Percocet. Long term chronic pain issues, I've seen addressed w/ Methadone. Very few people complain of feeling "loopy", but many of our population has past history of substance use/abuse, so pain control remains the focus.