Recent discussions on rounds have centered on whether it is safe to give Toradol or other Non-steroidals to a patient who has recently had a nephrectomy for trauma. Drs. Kate Kopkash and Niva Shakya looked into this and found:
Ketorolac is a popular substitute for opiod based analgesia in several surgical settings. There was a study out of Memorial Sloan-Kettering's Urology department which was published in the Journal of Urology in 2004 which compared pain control with ketorolac to opioids in patients with partial nephrectomy. They performed a retrospective chart review of 154 patients who underwent partial nephrectomy with renal cortical tumors. Patients who received ketorolac had superior postoperative recovery with an earlier turn to solid diet and earlier discontinuation of patient controlled analgesia. Groups were similar in regards to creatinine, blood loss, transfusion rates and complication rates. Toradol was not associated with an increased risk of acute renal failure.
The Department of Urology at UCLA published a paper in Urology in 2002 which described a retrospective review of 198 patient who underwent living donor nephrectomy between 1998 and 2000. They performed a regression analysis of patients who did and did not receive toradol post-operatively for pain control. 83 patients received toradol (mean amount received was 200 mg). No differences were found in the creatinine clearance 3 months post-operatively between the two patient groups and there was no significant association between the amount received and renal function at any point tested.
Editor's notes:
Trauma patients may have other factors such as a period of hypotension that make their remaining kidney more vulnerable, but it appears that Toradol is safe when administered post-nephrectomy. In addition, these studies only looked at one NSAID, but we are more likely to give a parenteral NSAID than an enteral NSAID early in the hospital course.
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