Ketorolac

[Hardcastle, Tim, Dr <tch at sun.ac.za>]

Guy

Exactly what our anaesthesiologiests do and the complication I was aluding to; not only are sterile abscesses reported, but numerous cases of necrotising fasciitis are reported, some leading to limb loss. Remember the pH of Diclofenac (Voltaren IM) is just over 1 - like injecting pool acid into your muscles!!!!!

tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
Program Manager: Emergency Medicine (SU)
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Department of Surgery Room 4064
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Guy Jackson
Sent: Tuesday, August 08, 2006 3:57 PM
To: Trauma & Critical Care mailing list
Subject: Re: Ketorolac


Tim and Lorick,

The problem with im diclofenac is sterile abscess, which generated a number of case reports. Not nice which ever way you look at it.

I use it iv. Either in a bag of Hartman's (Ringer's Lactate) or diluted in 20 ml 0.9% saline over 20 minutes. The incidence of thrombophlebitis is less with greater dilution. A pharmacist also told me once that a little bicarb was needed if you put it in saline. This is fairly standard practice in the UK. However, the introduction of iv paracetamol into the UK has made me use this more recently.

Cheers,

Guy

  ----- Original Message ----- 
  From: Lorick Fox, PA-C 
  To: Trauma & Critical Care mailing list 
  Sent: Tuesday, August 08, 2006 2:19 PM
  Subject: RE: Ketorolac


  At 03:53 PM 8/8/2006, you wrote:

    Guy

    As long as you give it orally or rectally - the incidence of complications after IMI diclofenac is so high that the Medical Protection Society in South Africa considers this an indefencible action and the Health Professions Council of SA a reason for investigation of a doctor for negligence (Personal communication with KD Boffard of the HPCSA Disciplinary Committtee)


  Tim,
  That policy seemed a bit strong (based on my anecdotal experience, which is just that, but which has seen zero adverse reactions to a LOT of IM Toradol/ketorolac) so I just did a literature search and can't find any case reports of ADR's either.  We heard about a single case of acute renal failure on either list or CCM-L (not sure), but that actually is the only ADR I know of.
  Can you shed any light on that reasoning of Dr. Boffard (I understand that it is not necessarily yours)?
  I am a bit surprised that an everyday occurrence in the U.S. with many, many doses given is considered negligence elsewhere, just because of the numbers involved and lack of published reports (or did I miss them in my search?).

  THANKS! 

  Lorick



  Lorick Fox, MPAS, PA-C
  SEAVIN/GSC
  USAF Peace Vector IV
  Gianaclis Egyptian Air Force Base
  Gianaclis, Egypt
  +(20)3-448-2335 or FAX +(20)3-448-2339
  www.lorick.org



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