Toradol for pain control after abdominal surgery?

[Double-Helix, BSN, RN]

I'm only a month off orientation, working in PICU, so this is a little new to me. I recently took care of a three month old baby post abdominal surgery. This poor kid has a reanastamosis, lysis of adhesions, appendectomy and exploratory laparotomy all in one go! I was having problems managing her pain and, despite increasing her morphine dose she would become very agitated/tachycardic/increased BP, etc. I wanted to supplement her with something in between the morphine and suggested Toradol to the resident.

The resident said that she didn't want to use Toradol because the baby just had abdominal surgery. She wanted to use Ativan. I was confused because the baby received a dose of Toradol in the OR and, while I've never received an abdominal surgery pt, we use Toradol post-op for other surgical patients. . I understand Toradol is an NSAID and there is a bleeding risk and it has the potential to cause GI ulcers. The anesthesiologist suggested we use it, and he works exclusively with kids.

So, long explaination, but my question is- do you use Toradol in pt's post abdominal surgery? Particularly in children?

[NotReady4PrimeTime, RN]

How interesting that this came up right now. I just finished reading an article about Toradol for infants post-op. You can read it here: http://www.medscape.com/viewarticle/750116_7 (You have to sign up for membership, but it's completely free, and there are lots of great articles there.)

We've given infants Toradol post-op abdo, ortho and cardiac surgery, as long as their kidneys and liver are oaky and they aren't at risk for bleeding.

[Double-Helix, BSN, RN]

Thank you for that article! It's exactly what I was looking for!

I wish I had known that when I was working with this patient. But I'm learning more and more everyday and next time I'll be able to advocate more effectively. Thanks!

[NotReady4PrimeTime, RN]

You're welcome. The more you know the more easily you can convince others that your suggestions are really something they should listen to. Go for it next time!

[rnguy25]

We use Toradol post-op for several our patients, excluding those at risk as janfrn has mentioned. We typically schedule the toradol for three doses then make it prn thereafter and have opiods for breakthrough pain. I have not read the article above (I sure will tho), but toradol use as an adjunct in controlling post-op pain also decreases the use of opioids in the long run as well, thus preventing other complications typical of opiod use.

It works beutifully!