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Discussion

Toradol

i have seen many of my post op joints and trauma patients get good relief with toradol. but yesterday i was speaking with one of the sugeons about it and he said it should never be given to a post op ortho patient because almost all are being anticoagulated. apparently, toradol cannot be used with coumadin, lovenox, asa, or fragmin as it can cause an intracranial bleed. anyone else have any thoughts on this?

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I just got finished with 2 years of ortho (never again!) Torodol is ok for joints, can't use it for more than 72 hours as it is extremely hard on the kidneys and liver (think APAP X 10) Our surgeaon absolutly forbid it for spines, it decreases the chance of a fusion working as much as nicotine does. A nonortho atending wrote for his patient to get torodol after a fusion (pmd trying to help out while rounding ) luckily it wasn't given but boy did he get reamed by the Ortho attending.

  • Expert

Kewl, what DVT prophylaxis did your totals have? Toradol cannot be used with heparin, coumadin or enoxeparin. That pretty much lets it out of most ortho cases. And being an NSAID it is forbidden in any type of fusion surgery. I've just left 22 years of ortho myself. Wish I could return.

Soem get lovenox, some get coumadin, some get heparin. Anti coags never seem to be a prob.

  • Author

p rn, why can't you give nsaids with fusion surgery??? :confused:

  • Expert

http://www.spine-health.com/topics/surg/spinalfus/spinalfus04.html

Tylenol is a relatively safe and effective pain medication and can be used when weaning off narcotic analgesics. Many surgeons recommend that patients avoid use of aspirin products and NSAID's for at least 3 months after lumbar fusion. These products tend to interfere with growth and development of new bone cells (the fusion mass). However, in some situations, use of these products cannot be avoided because they are necessary for treatment of other health conditions. It is important to discuss all medications with your surgeon and your primary care provider.

I also use a forum Spinal Disorders2 at BrainTalk. from the Mass General Hospital. Many people there have said that their docs forbid NSAIDS.

Our orthos forbid NSAIDS because of the great potential of hemarthrosis-bleeding into the joint space. That is a major complication that would possibly ruin the hip/knee and cause scarring of the capsule.

I hope I don't sound preachy. I dearly LOVE talking bones!

P

  • Expert

ooops double post :rolleyes:

  • Author

you are not preachy at all! i love the info-thank you! i checked out the site that you referenced and it has lots of good information. thank you. do you know of any other ortho sites that are as helpful?

anyway, celebrex and vioxx are both nsaids, but are they ok for backs and joints? i am beginning to see them written more often.....

  • Expert

The Cox2 inhibitors Vioxx etc. aren't usually permitted either. Their main benefit is the lessened effect on the stomach.

Fusion relies on a certain amount of "inflammation" as it were.

Re: sites...do you go to the Medscape sites? They have bulletins etc that you can get in e-mail. You can also research abstracts about almost anything. Medscape.com you will need to register, but it is free.

How many days s/p hip surgery can you use these drugs? If they are three or four days post-op. can you use them?

you can only use trorodol for 72 hours, it beats the hell out of your kidneys and liver.

Blue Bear: I was informed that some inflammation is necessary immediately post-op fusion/ lami and that Toradol is a no-no -- our chief will chew you a new one. Of course Toradol is never given preop for any ortho patient for bleeding purposes. I have yet to hear that the 72 hour dosing interferes with anticoags.

Our consultants don't like toradol on post-ops or pre-ops. Only people they give it to really are back pains, arthritis...stuff like that. Like the above, they would really crack up if one of the post-ops or pre-ops got toradol. Drug of choice for pain relief at the moment seems to be oxycodone orally or morphine s/c or im.

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