Expert: Dr Ian Jackson - please note UK based - 8/6/2007

Question
I am a new RN grad who works in the postpartum unit. We often get fresh C-section pts from surgery who we follow the anesthesiologist orders for 12-24 hrs post-op. A common analgesic ordered is Toradol (Ketorlac) IV q 6 hrs. Some nurses automatically don't give the ordered meds when they assess that a pt has a history of asthma. My feeling is if the anesthesiologist felt comfortable enough to give anesthesia in the first place and the pt is not having any current acute asthma symptoms, and there is no history of allergic reactions to NSAIDs then we should follow the orders. What is your expertise concerning this matter?  

Answer
Tammy
I am in total agreement with you on this, this is an important part of their analgesia that is being withheld. I routinely use NSAIDs for most patients unless there is a contraindication. Asthma is not a contraindication. I ask the patient if they have any problems with aspirin or other NSAIDs that are available for the public to buy in the UK e.g. Ibuprofen.
If they say they have no problem with these then I prescribe them. If the patient says they have never tried these drugs then I explain the situation and the possibility that a dose of this drug might make their asthma worse. I also explain that it is rare but if it does cause a problem then they merely need to stop taking the drug and it will resolve.
In the UK I would try and discuss this issue with the staff - perhaps your anaesthetic colleagues don't know this is happening and they can be enlisted to educate your colleagues.
Kind regards
Dr Ian Jackson