Moderator EMEDPA Posted August 8, 2017 Moderator Share Posted August 8, 2017 Just tried this for the first time based on a new study. 100 mg of 2% preservative free(cardiac) lidocaine in a 100 kg pt (1 mg/kg) took pain from 10/10 to 2/10 in 2 min! but only lasted 10 min or so. based on my n=1 I will likely use this as an adjunct to other tx but not as a stand alone tx. anyone else tried it yet? Link to comment Share on other sites More sharing options...
Marinejiujitsu Posted August 8, 2017 Share Posted August 8, 2017 I read that but I have yet to stray away from the norm being a little ol PA. I read it works really well though. Sent from my SAMSUNG-SM-G935A using Tapatalk Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted August 8, 2017 Share Posted August 8, 2017 What about potential for pro-arrhythmic effect since given IV? Not familiar with the study.Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
sk732 Posted August 8, 2017 Share Posted August 8, 2017 There a link to this study? I think I may have some issues convincing some of the risk averse docs I work with to trying this...toradol or silver bullets for now. SK Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 8, 2017 Author Moderator Share Posted August 8, 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141707/ this is 2011. I believe there is a newer study as well yup, 2016 study as adjunct tx: http://www.sciencedirect.com/science/article/pii/S0735675715010402 speaking of toradol. I am on the low dose toradol bandwagon now as well. some pretty good studies show 15 mg as good as 30 mg or 60 mg with much less renal toxicity. Link to comment Share on other sites More sharing options...
dmdpac Posted August 8, 2017 Share Posted August 8, 2017 We recently had a discussion about this very topic brought about by this article. References are listed at the end of the piece. Several of my colleagues have used IV lido for kidney stones with good success with relief times lasting upwards of several hours. This is second hand info at the moment as I haven't had the chance to use it yet. However, we're on a kick at one of our EDs to "think alternatives to opioids". Toradol (which I've used with great success) and IV lido are encouraged as options in place of narcotic pain relief in this particular patient presentation. Link to comment Share on other sites More sharing options...
Marinejiujitsu Posted August 8, 2017 Share Posted August 8, 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141707/ this is 2011. I believe there is a newer study as well yup, 2016 study as adjunct tx:http://www.sciencedirect.com/science/article/pii/S0735675715010402 speaking of toradol. I am on the low dose toradol bandwagon now as well. some pretty good studies show 15 mg as good as 30 mg or 60 mg with much less renal toxicity.Now toradol 10 mg iv is said to be the most affective dose for pain. I believe that was on EMRAP.Sent from my SAMSUNG-SM-G935A using Tapatalk Link to comment Share on other sites More sharing options...
sk732 Posted August 8, 2017 Share Posted August 8, 2017 I've only seen one place where the toradol was in 10mg aliquots, so I use 15 out of the 30mg vials we get until we see the 10mg ones. I notice there was a cutoff on the age of 50 yo - was that random by patient presentation or by design I wonder to potentially stave off cardiac S/E's? Oh, just read dmdpac's article and it suggested closer consideration in elderly/renal insufficiency patients... Shouldn't "guy look" without full coffee load on, lol SK Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted August 8, 2017 Share Posted August 8, 2017 I'd like to go back to the pro-arrhythmic question if I could. While not as problematic as some of the other agents it does still exist. That being said, I note that in the study with the Iranian subjects that they were all relatively young, as are most kidney stone folks (<60, though tell my 87 y/o mom that after Mother's Day weekend), thus the risk of underlying CVD is less than older populations. I don't see mention of monitoring of the patient's rhythm status though there was the one lady with slurring of speech and dizziness (no mention of arrhythmia). Would you guys be as comfortable giving same to a population group >50 y/o for example? E, how old was your test subject? Link to comment Share on other sites More sharing options...
karebear12892 Posted August 8, 2017 Share Posted August 8, 2017 13 hours ago, EMEDPA said: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141707/ this is 2011. I believe there is a newer study as well yup, 2016 study as adjunct tx: http://www.sciencedirect.com/science/article/pii/S0735675715010402 speaking of toradol. I am on the low dose toradol bandwagon now as well. some pretty good studies show 15 mg as good as 30 mg or 60 mg with much less renal toxicity. I showed this study to an ED attending physician, who began adopting this practice as well. Unfortunately, he ran into a problem with nurses coming to him and complaining that it was a pain (no pun intended) to give only 15 mg when the medication comes in 30 mg vials. Eventually, so many nurses were asking him if they "could just give the whole 30 mg" that he went back to what he (and the other providers there) have always done. Oh well, I tried. :) Link to comment Share on other sites More sharing options...
sk732 Posted August 8, 2017 Share Posted August 8, 2017 2 hours ago, karebear12892 said: I showed this study to an ED attending physician, who began adopting this practice as well. Unfortunately, he ran into a problem with nurses coming to him and complaining that it was a pain (no pun intended) to give only 15 mg when the medication comes in 30 mg vials. Eventually, so many nurses were asking him if they "could just give the whole 30 mg" that he went back to what he (and the other providers there) have always done. Oh well, I tried. :) The admin geeks would get a huge happy one out of that - two doses for price of one...maybe pharm/admin should have a sit down with medical and nursing? I don't know what the nurses' issue is - you draw up half the stuff and put it back in the Pyxis after only saying 15 vice 30mg - odds are they'll be using another dose shortly thereafter on someone else. I get the same issue here - I think it's because they've never read the research (or plain don't) or just think more is better. I've been using the stuff long enough to have seen GI bleeds and AKI from it. SK Link to comment Share on other sites More sharing options...
dmdpac Posted August 8, 2017 Share Posted August 8, 2017 We get it in 30mg single use vials. Nursing won't draw two doses out of it because it's labeled "Single Use Only". Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 9, 2017 Author Moderator Share Posted August 9, 2017 my patient was a healthy 64. started with lido then moved on to iv toradol 15 mg with complete relief. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted August 9, 2017 Share Posted August 9, 2017 I don't know what it is but there's something about this that gives me the heebie jeebies, especially if I had a known cardiac pt. s/p MI, hx. CHF, or CM. Viscous lidocaine is 300 mg. max q3h and it can be swallowed so I guess it isn't THAT big of a deal. Guess I won't have to worry about it if I just stay put until I ride off into the sunset. As Latarian likes to say, "It's fun to do bad things." Link to comment Share on other sites More sharing options...
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