Heya Meddit, something I've been dealing with a lot on a surgical ward, and something I dealt with in the ED… NSAIDS IN critical care.
In my SICU, we don't even mention the stuff. Increases bleeding, healing, kills the kidneys on and on and on.
When I was in the ED, IM ketorolac was our bread and butter, it was wonderful! Now, being the good little education hamster I am, I hear a lot about dose pain ceilings and NSAIDS. I also rarely see this followed or even mentioned clinically, with some high doses for no real proven benefit. I've tried to do some literature searches, and tried to asks my big brains but have come up empty.
With the side effects of opioids, and all of this pain management non-sense, would more judicious DOSING of NSAIDS allow us to use it much more widely? It makes my skin crawl when I'm giving fentanyl or oxy for pretty minor stuff because Tylenol didn't work. From my cursory searches, most of the negative studies on NSAIDS and their side effects are using rather high doses, and doses that are not evidence based (script for 800mg or more is common). I'd like to hear your take.
Edit: My question is honestly specific to critical care, where acute pain is the main problem, PO access is a luxury, and often locals cannot be used (due to the use of bupivacaine (maybe you've seen those "warning! Exparel patient!" ID bands… injections during surgery, we can't use lido patches for 72 hrs…)
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