tag:blogger.com,1999:blog-7675087351939177300.post4116572508608648529..comments2023-08-15T09:39:41.235-05:00Comments on Sutured for a Living: Toradolrlbateshttp://www.blogger.com/profile/15236331355857884458noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-7675087351939177300.post-63724729036314193582007-10-21T18:32:00.000-05:002007-10-21T18:32:00.000-05:00Hey. Saw your post, thought I ought to comment. To...Hey. Saw your post, thought I ought to comment. Toradol, you know, carries a "black box warning" which, in my (fairly extensive) medico-legal experience is a kiss of death if there is a complication. It's almost like a "res ipsa loquitor." You know; the outcome (bleeding) is considered as being beyond the need for proof as to negligent cause if toradol was administered. Having said this, I have used it extensively, and still do on occasion if the situation specifically warrants; that is, if I can make an argument justifying its use despite the concerns; i.e. heavy chronic narcotic users with obstructive sleep apnea. That is not to say that it is particularly risky in my view; I don't think it is. Clinically, anecdotally, it seems to be about as platelet inhibiting as other nsaids, and not as much so as chronic aspirin. This is not the first important drug to get whacked this way; droperidol, the most effective post-op anti-emetic, got the same black box warning, based upon its effect on prolonging QT interval in high doses and driving folks into torsades. I still use it after carefully documenting a regular or short QTc. The other drug that was whacked was nisentil (long before you were born) It was killed because DENTISTS were using it and precipitating respiratory arrests; so none of us could have it, whether we knew what we were doing or not.<BR/>A little antiplatelet activity is arugably a good thing; continuing aspirin after cardiac surgery decreases incidence of intercurrent organ system damage (stroke, increased creatinine) (Managano-NEJOM a couple of years back; old enough to be free on line) SPD's work at least in part by some anti-clotting activity besides just squeezing, too; so my surgeons say-I haven't read the literature.<BR/><BR/>My advice; use it yourself when your back hurts, but don't give it to patients. Play with tramadol if you want a non-narcotic analgesic. 800 of ibuprofen is pretty good, too, especially with tramadol. (If you are not comfortable with 800 of ibuprofen, then you shouldn't be comfortable with toradol)<BR/><BR/>Best regards.<BR/><BR/>MitchMitch Keamyhttps://www.blogger.com/profile/02552695021608383465noreply@blogger.comtag:blogger.com,1999:blog-7675087351939177300.post-62174050227838228672007-10-14T07:33:00.000-05:002007-10-14T07:33:00.000-05:00Enrico, I don't use bupivacaine or anything like ...Enrico, I don't use bupivacaine or anything like it. Most of my patients do quite well in the pain department and are back to work on Monday after surgery on Thursday (whether submuscular or subglandular). <BR/><BR/>What makes it "ok" for reductions--I think (and always try) that hemostasis is important in every operation. But if you do get a hematoma in an augmentation patient, it is not a simple place needle and aspirate management, as it can be in a reduction patient. Because of the implant and it's risk of injury but said needle, it requires a return to the operating room. I've done that in three patients over 17 yrs of pactice, none that had Toradol.<BR/><BR/>I don't like the reason I've been using--"because Dr.__ said ......." We all know that even when all things are done correctly, sometimes complications occur. I would love to have some "science" to back me up. I think using Toradol is safe.rlbateshttps://www.blogger.com/profile/15236331355857884458noreply@blogger.comtag:blogger.com,1999:blog-7675087351939177300.post-70245194196983137342007-10-13T22:14:00.000-05:002007-10-13T22:14:00.000-05:00Since opiates are so controlled and have to meet s...Since opiates are so controlled and have to meet strict indications here in Mexico (read: docs and pharmacies don't want the hassle of "random" (often motivated by non-random factors) audits by the sec. of health "DEA" equivalent, so there's not a lot of liberal use outside the immediate perioperative period), drugs like ketorolac are used ALL the time solo or as adjuncts to opiate drugs (when _really_ needed). <BR/><BR/>Granted, there is not nearly the same litigious climate here, but the attitude here is, as the article said, only contraindicated when "strict hemostasis" is required and/or with coagulopathy (obviously).<BR/><BR/>Do you liberally infiltrate with bupivacaine or the like before closure? Also, what makes it "OK" to use it for reductions but not augmentations (from a wound/pt mgmt POV)?Enricohttps://www.blogger.com/profile/08544256228237038990noreply@blogger.com