Is Toradol still used after a C section?

Elvish, BSN, DNP, RN, NP · Mar 22, 2009

Contraindicated in labor, but not postpartum.

Haven't seen that NSAIDS in those doses impair healing nor increase bleeding.

morte, LPN, LVN · Mar 22, 2009

Contraindicated in labor, but not postpartum.
Haven't seen that NSAIDS in those doses impair healing nor increase bleeding.

hmm, LACTATION is included under contraindications

Elvish, BSN, DNP, RN, NP · Mar 22, 2009

We use Medications & Mother's Milk by Dr. Hale as our reference....the benefits of bfing while taking toradol by far outweigh the risks posed.

A lot of medications say that you can't/shouldn't take them while breastfeeding, but the reality is that there are very few medications that are absolutely contraindicated while breastfeeding. Even IV contrast, depending on which one used, can sometimes be compatible w/ BFing.

morte, LPN, LVN · Mar 22, 2009

[color=#0000cc][pdf][color=#0000cc]a. ll

toradol is not recommended for use in labor or postpartum. a. . it has been compared with administering motrin intramuscular- ...

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1552-6356.1997... - [color=#7777cc]similar pages

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1552-6356.1997.tb00945.x

this goes to http://www3.interscience.wiley.com/journal/119162547/abstract

which appears to cite awhonn

Jolie, BSN · Mar 22, 2009

According to the article I posted on the previous page, the FDA has not approved Toradol for use in breastfeeding moms, but the AAP has.

If we were to avoid every drug that lacks FDA approval for lactating mothers, we would have virtually nothing to offer these women for pain.

It's one of those situations where we simply have to do our best to weigh risks versus benefits.

Elvish, BSN, DNP, RN, NP · Mar 22, 2009

morte, that is interesting. However, I can tell you that I have given Toradol hundreds, if not thousands of times, without ill effects for mom or baby.

I see on the package insert that it's contraindicated for nursing mothers because of the possible risk of NSAID side effects on the nursing infant. Dr. Hale, who is the leading expert on breastfeeding, gives Toradol an L2 rating, which places it in the 'safer' category. (For reference, HIV+ status in the USA is given an L5 -- contraindicated.) L2 meds we use with breastfeeding all the time.

RedCell · Mar 22, 2009

Morte,

You bring up a valid argument. Many drugs in anesthesia however, have the potential to cause some pretty damn severe problems and you can find studies arguing for or against the question you are trying to answer. You have to weigh the benefit vs risk ratio. Toradol is one of those drugs that is pretty dicey in the OR. It works by inhibiting prostaglandin synthetase which leads to inhibition of platelet thromboxane production and decreased platelet aggregation. It also has the potential to cause renal complications due to the fact that the kidneys rely on prostaglandin to regulate afferent renal blood flow. In healthy patients this is not a common problem, especially if you can keep them euvolemic.

Usually, if I do not know the surgeon I will ask before giving this drug, as they are the ones managing the patient once out of the OR and we are merely a consultant service used for the operation. Also, with certain operations (major ortho trauma or vascular procedures) or certain medical histories, most people will refrain from giving this drug.

ImMrBill3, RN · Mar 23, 2009

Great discussion. I am a huge fan of EBP and going into the literature. Kudos Morte :up: . I have to agree with Elvish that Hale's :wink2: is the gold standard for breastfeeding. Here's hoping this thread inspires some research.

shamikab · Mar 23, 2009

I'm currently on a PP unit for my preceptorship and we give our moms toradol in 4 doses usually. The come down from L&D usually already having one dose and we give the remaining doses as needed with motrin and roxicet. The only thing with Toradol is that I've been told it takes a while for it to actually be effective and is probably why we give 4 doses of it..hope this helps :)

whipping girl in 07, RN · Mar 23, 2009

I've never worked L & D or PP, but I've had 3 babies, all c-sections.

The PO pain meds worked better for me. I don't know why. I had IV Toradol for 24 hours after my first C-section and I thought it was very helpful, but the PO Percocet and Motrin worked better for me. With my 2nd and 3rd c-sections I asked the nurse to take down the PCA early and just start the PO meds. And I breastfed, in spite of taking pain meds. And my babies were just fine.

I think Toradol is great for post-op pain if given around the clock scheduled in conjunction with narcotics. We often gave our CABGs Toradol 15 or 30 mg q6hr X 4 doses and it seemed they had better pain control and needed Morphine less often than those who didn't get it.

Elvish, BSN, DNP, RN, NP · Mar 23, 2009

Incidentally, whipping girl, you are far from the first mama to say that the PO stuff works waaaay better than the spinal/epidural. Although I generally hate epidurals post c/s, the one good thing about them is, I can pull them whenever Mom's ready and on to the PO stuff we go. Sometimes if I can, I'll just pull the epidural, leave the IV access, go to PO Percocet and still give the IV Toradol. Now THAT is a good combo.

LilyBlue · Mar 23, 2009

I was given Toradol when I had a 6 mm stone blocking my ureter and causing hydronephrosis, and it helped tremendously until I could get lithotripsy. They gave me Dilaudid prior to that, and it made me feel so loopy, and so nauseated, that the pain of the stone was preferable.