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

Specialties Pain

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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?

a few issues with toradol post-operatively:

1) platelet function: it interferes with platelet aggregation - it has nothing to do with heparin or other LMWH.

2) bone healing: it interferes with bone healing by inhibiting osteoclastic activity

I give/write for it post-operatively frequently!!! however, I would not give it to patients who had fine bony work (ie: ankle fusion), nor would i give it to somebody where hematoma formation would be dangerous: burn patients after excision and grafting, plastic surgery patients (breasts, abdominoplasty, facial, etc.), strong hx of GI bleeds, etc...

dont forget that toradol is a very powerful drug: 30mg IVis equi-analgesic to 10mg of IV Morphine... nothing to laugh at :)

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Specializes in Telemetry & Obs.

uh oh...we just learned LAST WEEK in my pharmacology class that phenergan is given with pain meds to potentiate their effects :o

i'm sooo glad i found this site :)

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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

Whatever...........! I found in my former life (when i worked in a recovery room) that when I would get a patient that would be crying and writhing in pain (acting a bit hysterical.....) after trying morphine, demerol, and toradol, that often a shot of good old Ativan would do the trick. If it works dont knock it. I have also taken care of a man with Chrons that said the only thing that worked for his abdominal pain was Ativan. Why would someone be brought in front of the medical ethics review board for a giving a drug that works?!

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Whatever...........! I found in my former life (when i worked in a recovery room) that when I would get a patient that would be crying and writhing in pain (acting a bit hysterical.....) after trying morphine, demerol, and toradol, that often a shot of good old Ativan would do the trick. If it works dont knock it. I have also taken care of a man with Chrons that said the only thing that worked for his abdominal pain was Ativan. Why would someone be brought in front of the medical ethics review board for a giving a drug that works?!

you are going to get a lot of flak for your statement, so i will try to soften the situation

1) while you are ABSOLUTELY right that Ativan will calm somebody down - it has to do with the fact that you are providing sedation, and in all truth, you are not providing pain relief... you may feel that the same goal has been achieved (ie: the patient isn't complaining anymore), but what you are not realizing is that a patient who is in pain will have a huge sympathetic outflow and release of catecholamines - which in turn can be quite harmful to the body (in fact, somebody with a bad heart can infarct for this exact reason).

So while the patient may look peaceful - the untreated pain will hurt the patient.

2) now there are certain situations where patients with primarily pre-existing anxieties or depression will have a lower threshold for pain, and that by mitigating the anxiety component of pain - you are actually improving their pain score.... that is entirely possible...

3) patient with Crohn's or any other chronic illness - remember benzodiazepines are extremely addictive, and there is a higher correlation between psychiatric/mental disease (including anxiety disorders/addiction disorders/depressive disorders) and Crohns (when compared to the normal population).... So would I give ativan to that patient? sure... but that doesn't mean much in the context of the original postings...

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All you're going to do is nock a patient out.

Ativan is a decent drug to use when a patients anxiety is making their pain worse, or when their pain is causing anxiety... but you will NOT use it by itself.

If you had thoroughly read my post which you quoted, you would have understood that I was referring to Haldol when speaking of ER docs being reviewed. Haldol has no effect on pain. It may calm the patient, but it will NOT help the pain.

I give ALOT of Ativan during the course of mananging a patients pain. It works extremely well. However it's cruel to use it as monotherapy. Think ICU when you have a patient paralyzed, but still in extreme pain. They may be outwardly calm, but on the inside they're a trainwreck.

-Dave

Whatever...........! I found in my former life (when i worked in a recovery room) that when I would get a patient that would be crying and writhing in pain (acting a bit hysterical.....) after trying morphine, demerol, and toradol, that often a shot of good old Ativan would do the trick. If it works dont knock it. I have also taken care of a man with Chrons that said the only thing that worked for his abdominal pain was Ativan. Why would someone be brought in front of the medical ethics review board for a giving a drug that works?!
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a few issues with toradol post-operatively:

1) platelet function: it interferes with platelet aggregation - it has nothing to do with heparin or other LMWH.2) bone healing: it interferes with bone healing by inhibiting osteoclastic activity

I give/write for it post-operatively frequently!!! however, I would not give it to patients who had fine bony work (ie: ankle fusion), nor would i give it to somebody where hematoma formation would be dangerous: burn patients after excision and grafting, plastic surgery patients (breasts, abdominoplasty, facial, etc.), strong hx of GI bleeds, etc...

dont forget that toradol is a very powerful drug: 30mg IVis equi-analgesic to 10mg of IV Morphine... nothing to laugh at :)

The above statement about Toradol having nothing to do with LMWH or Heparin is NOT true. Toradol taken wiht an oral anticoagulant can actually INCREASE the effect of an LMWH or Heparin, therefore greater risk for bleeding.

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nursekatydid: how does toradol increase the effect of heparin or a LMWH??? while both drugs play a role in coagulation they are involved in two distinct pathways?

toradol: inhibits platelet aggregation, inhibits platelet thromboxane production

fragmin/lovenox: increases anti-factor Xa

heparin: catalyst for atIII

the two classes of drugs have NOTHING to do with each other... HOWEVER

there are many studies looking at interactions between toradol and LMWH/heparin, and none so far have found any interaction whatsoever...

your point that toradol augments the effect of LMWH is therefore wrong.

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Specializes in Neuro Critical Care.
a few issues with toradol post-operatively:

1) platelet function: it interferes with platelet aggregation - it has nothing to do with heparin or other LMWH.

2) bone healing: it interferes with bone healing by inhibiting osteoclastic activity

I give/write for it post-operatively frequently!!! however, I would not give it to patients who had fine bony work (ie: ankle fusion)...

dont forget that toradol is a very powerful drug: 30mg IVis equi-analgesic to 10mg of IV Morphine... nothing to laugh at :)

Thanks for the info on the fusion surgery, that is what I needed to know! Didn't realize Toradol was so powerful, no wonder it works.

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Tanesma,

I got that information directly from Saunders Nursing Drug Handbook (2003 edition, pgs.633-635.)

Toradol effects the platelets and heparin affects the coagulation cascade. When both parts of coagulation are interfered with, then bleeding can be a problem.

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Tanesma,

I got that information directly from Saunders Nursing Drug Handbook (2003 edition, pgs.633-635.)

Toradol effects the platelets and heparin affects the coagulation cascade. When both parts of coagulation are interfered with, then bleeding can be a problem.

you have to be careful how you describe things.... and I wouldn't reference a Nursing Drug Handbook when discussing the intricacies of pharmacology. There is a huge difference between saying "toradol increases the effects of heparin" compared to "toradol and heparin are additive in their contribution to bleeding" (which is what your last sentence, correctly, is alluding to).

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you have to be careful how you describe things.... and I wouldn't reference a Nursing Drug Handbook when discussing the intricacies of pharmacology.

Perhaps you can suggest a book that you feel is adquate?

Mind you, as nurses we have to have a book which will keep us very well informed. We're not only responsible for giving the medication, but making sure the medication and the doseage that the DOCTOR ordered isn't high enough to kill T-Rex.

-Dave

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don't get me wrong i think the Nursing Drug Handbook is a great resource for a quick check to look up a med or a dose... but when the finer points are being discussed it is often in error or vague or nebulous or misleading.

MicroMedex is a great resource online if your hospital provides access to it - i still think that the classic resoucre is Goodman & Gillman's Pharm book as well as Stoeltings Pharmacology - and if you want to be even more cutting edge you can look it up on pubmed online (that is free and available to everybody)... or even better, have a discussion (like we are doing now) about the drug with people who are a bit more familiar with it...

i am not trying to be condescending - just want to help guide and provide information, and i apologize if it comes across as rude...

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