Toradol prior to ortho eval

[practicing101]

Hi all, I'm at an Urgent Care where we see lots of fractures. I was wondering what the general consensus is about giving a fracture patient a dose of toradol... both on if it significantly increases bleeding into a possible hematoma at the fracture site and if the patient has to go stat to the OR what effect it might have. Do you guys use it still in these cases?

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[massmocha]

I would vote against it, we typically hold all NSAIDs for 5 days prior to elective surgery. Also a lot of trauma people don't like it because it slows fracture healing in rats... not sure there is any human studies on this

 

[cbest]

Just a heads up, I'm PM&R/Pain trained so it's not my fracture to manage usually BUT the literature I've read states COX-2 less impairment of bone healing and no documented increased risk of bleeding with post-op administration of Toradol.


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[OrthoTraumaMD]

Dealer's choice. Most won't give it because opiates work so much better. there is literature in human long bones and also in acetabular fractures that shows bone healing is impaired, but this is with consistent administration of NSAIDs over weeks, not a one time dose. Your best bet if you want to avoid opiates is IV Tylenol. Works very well, particularly postop.