toradol

[Gas you down]

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anesthesiologist here. just looking for a few opinions in this forum regarding toradol in hysterectomies. imho a little toradol is just fine, but one of my OB/Gyn surgeons flips out if you give it.
i mean, c'mon it's not like it's tPA or anything. i really, really doubt that it would ever cause enough bleeding to cause a bringback...
thoughts?

 

[anonperson]

anesthesiologist here. just looking for a few opinions in this forum regarding toradol in hysterectomies. imho a little toradol is just fine, but one of my OB/Gyn surgeons flips out if you give it.
i mean, c'mon it's not like it's tPA or anything. i really, really doubt that it would ever cause enough bleeding to cause a bringback...
thoughts?

Depends on surgeon preference.

There's some literature out there in the ENT journals that indicate that pre operative toradol increases bleeding in the setting of tonsillectomy
http://link.springer.com/article/10.1007/BF03011766?LI=true
http://archotol.jamanetwork.com/article.aspx?articleid=623642

Not exactly the same, but I can see why some OB/GYNs would be a little paranoid.

I'll say that in robotic and straight stick laparoscopic hysterectomies, toradol use is generally the norm.

For an open case, it depends on how bloody the surgery was, adhesions etc and concern for post op bleeding.

I will say that I will generally use toradol fairly routinely for post cesarean patients (and the blood loss for a routine c section is nearly always going to be higher than a typical hysterectomy) and haven't run into any real issues

 

[THP]

The only time I don't use toradol is in severe asthmatics and PreE with low platelets or renal impairment. It's rare that I do an open hysterectomy but I have no problem with toradol in that setting. I give post op toradol in almost all laparoscopic cases.

 

[Gas you down]

Depends on surgeon preference.

There's some literature out there in the ENT journals that indicate that pre operative toradol increases bleeding in the setting of tonsillectomy
http://link.springer.com/article/10.1007/BF03011766?LI=true
http://archotol.jamanetwork.com/article.aspx?articleid=623642

Not exactly the same, but I can see why some OB/GYNs would be a little paranoid.

I'll say that in robotic and straight stick laparoscopic hysterectomies, toradol use is generally the norm.

For an open case, it depends on how bloody the surgery was, adhesions etc and concern for post op bleeding.

I will say that I will generally use toradol fairly routinely for post cesarean patients (and the blood loss for a routine c section is nearly always going to be higher than a typical hysterectomy) and haven't run into any real issues

yes i agree it is not the same. the study dose was much larger, 1mg/kg. and the dose was preoperative, before the cutting and bovie/suturing happens.
i do agree that a preoperative dose could cause some increased bleeding, as this and other articles support this. but if bleeding is controlled at the end of the case, imho it will not cause a need for a bring back, especially at a reasonable dose 15-30mg in an adult. i mean, c'mon some neurosurgeons use it post op on spine cases!!!
.

 

[Gas you down]

Depends on surgeon preference.

There's some literature out there in the ENT journals that indicate that pre operative toradol increases bleeding in the setting of tonsillectomy
http://link.springer.com/article/10.1007/BF03011766?LI=true
http://archotol.jamanetwork.com/article.aspx?articleid=623642

Not exactly the same, but I can see why some OB/GYNs would be a little paranoid.

I'll say that in robotic and straight stick laparoscopic hysterectomies, toradol use is generally the norm.

For an open case, it depends on how bloody the surgery was, adhesions etc and concern for post op bleeding.

I will say that I will generally use toradol fairly routinely for post cesarean patients (and the blood loss for a routine c section is nearly always going to be higher than a typical hysterectomy) and haven't run into any real issues

what you say is reasonable, i just don't understand the hardline approach by others, meaning no toradol for hysterectomies or postop C/S's EVER!

thanks for the input, take care🙂

 

[THP]

yes i agree it is not the same. the study dose was much larger, 1mg/kg. and the dose was preoperative, before the cutting and bovie/suturing happens.
i do agree that a preoperative dose could cause some increased bleeding, as this and other articles support this. but if bleeding is controlled at the end of the case, imho it will not cause a need for a bring back, especially at a reasonable dose 15-30mg in an adult. i mean, c'mon some neurosurgeons use it post op on spine cases!!!
.

I agree with this.