RE: Re: Stadol vs. Morphine

[Guest guest]

How about using throwing fentynl in there as well. That is what my

department uses and it works pretty good. Doesn't have as much of the

nausea side effects as morphine and doesn't take that much to get the job

done. Haven't worked with stadol before but looking forward to what people

have to say about it.

Re: Stadol vs. Morphine

What does everybody think about using Stadol vs. Morphine on muscoskeletal

or soft tissue injuries. How much more is Morphine useful than Stadol is.

Also is Stadol a safer medication to put in place for the pain on

muscoskeletal/soft tissue injuries in your protocols for your medics.

Just wondering everybody's opinion on this.

Thanks

[Guest guest]

How about using throwing fentynl in there as well. That is what my

department uses and it works pretty good. Doesn't have as much of the

nausea side effects as morphine and doesn't take that much to get the job

done. Haven't worked with stadol before but looking forward to what people

have to say about it.

Re: Stadol vs. Morphine

What does everybody think about using Stadol vs. Morphine on muscoskeletal

or soft tissue injuries. How much more is Morphine useful than Stadol is.

Also is Stadol a safer medication to put in place for the pain on

muscoskeletal/soft tissue injuries in your protocols for your medics.

Just wondering everybody's opinion on this.

Thanks

[Guest guest]

There is no role for Stadol (butorphanol) in prehospital care. It is

unpredictable, sometimes ineffective, causes the need for increased opiates

in the ED, and interferes with subsequent anesthesia should it be needed.

The same holds true for nalbuphine (Nubain). They have no role in modern

EMS.

BEB

E. Bledsoe, DO, FACEP

Midlothian, TX

Re: Stadol vs. Morphine

What does everybody think about using Stadol vs. Morphine on muscoskeletal

or soft tissue injuries. How much more is Morphine useful than Stadol is.

Also is Stadol a safer medication to put in place for the pain on

muscoskeletal/soft tissue injuries in your protocols for your medics.

Just wondering everybody's opinion on this.

Thanks

[Guest guest]

There is no role for Stadol (butorphanol) in prehospital care. It is

unpredictable, sometimes ineffective, causes the need for increased opiates

in the ED, and interferes with subsequent anesthesia should it be needed.

The same holds true for nalbuphine (Nubain). They have no role in modern

EMS.

BEB

E. Bledsoe, DO, FACEP

Midlothian, TX

Re: Stadol vs. Morphine

What does everybody think about using Stadol vs. Morphine on muscoskeletal

or soft tissue injuries. How much more is Morphine useful than Stadol is.

Also is Stadol a safer medication to put in place for the pain on

muscoskeletal/soft tissue injuries in your protocols for your medics.

Just wondering everybody's opinion on this.

Thanks

[Guest guest]

-- " Bledsoe " wrote:

There is no role for Stadol (butorphanol) in prehospital care. ...The same holds

true for nalbuphine (Nubain). They have no role in modern

EMS.

What about Toradol (aside for the patients with liver disease and asthma) for

musculoskeletal pain? We had a lot of sport injuries when I was with CLEMC and

we would usually give 15 or 30 IM or IV.

[Guest guest]

-- " Bledsoe " wrote:

There is no role for Stadol (butorphanol) in prehospital care. ...The same holds

true for nalbuphine (Nubain). They have no role in modern

EMS.

What about Toradol (aside for the patients with liver disease and asthma) for

musculoskeletal pain? We had a lot of sport injuries when I was with CLEMC and

we would usually give 15 or 30 IM or IV.

[Guest guest]

-- " Bledsoe " wrote:

There is no role for Stadol (butorphanol) in prehospital care. ...The same holds

true for nalbuphine (Nubain). They have no role in modern

EMS.

What about Toradol (aside for the patients with liver disease and asthma) for

musculoskeletal pain? We had a lot of sport injuries when I was with CLEMC and

we would usually give 15 or 30 IM or IV.

[Guest guest]

May as well give them 800 mg ibuprofen orally. Studies have shown the two

(parenteral ketorolac and oral ibuprofen) to be equal in effectiveness with

the ibuprofen about 100 times less expensive.

E. Bledsoe, DO, FACEP

Midlothian, TX

RE: Re: Stadol vs. Morphine

-- " Bledsoe " wrote:

There is no role for Stadol (butorphanol) in prehospital care. ...The same

holds true for nalbuphine (Nubain). They have no role in modern EMS.

What about Toradol (aside for the patients with liver disease and asthma)

for musculoskeletal pain? We had a lot of sport injuries when I was with

CLEMC and we would usually give 15 or 30 IM or IV.

[Guest guest]

May as well give them 800 mg ibuprofen orally. Studies have shown the two

(parenteral ketorolac and oral ibuprofen) to be equal in effectiveness with

the ibuprofen about 100 times less expensive.

E. Bledsoe, DO, FACEP

Midlothian, TX

RE: Re: Stadol vs. Morphine

-- " Bledsoe " wrote:

There is no role for Stadol (butorphanol) in prehospital care. ...The same

holds true for nalbuphine (Nubain). They have no role in modern EMS.

What about Toradol (aside for the patients with liver disease and asthma)

for musculoskeletal pain? We had a lot of sport injuries when I was with

CLEMC and we would usually give 15 or 30 IM or IV.

[Guest guest]

May as well give them 800 mg ibuprofen orally. Studies have shown the two

(parenteral ketorolac and oral ibuprofen) to be equal in effectiveness with

the ibuprofen about 100 times less expensive.

E. Bledsoe, DO, FACEP

Midlothian, TX

RE: Re: Stadol vs. Morphine

-- " Bledsoe " wrote:

There is no role for Stadol (butorphanol) in prehospital care. ...The same

holds true for nalbuphine (Nubain). They have no role in modern EMS.

What about Toradol (aside for the patients with liver disease and asthma)

for musculoskeletal pain? We had a lot of sport injuries when I was with

CLEMC and we would usually give 15 or 30 IM or IV.

[Guest guest]

Fentanyl, morphine, nitrous oxide are the only analgesics that should be

used in EMS.

E. Bledsoe, DO, FACEP

Midlothian, TX

Re: Stadol vs. Morphine

What does everybody think about using Stadol vs. Morphine on muscoskeletal

or soft tissue injuries. How much more is Morphine useful than Stadol is.

Also is Stadol a safer medication to put in place for the pain on

muscoskeletal/soft tissue injuries in your protocols for your medics.

Just wondering everybody's opinion on this.

Thanks

[Guest guest]

Fentanyl, morphine, nitrous oxide are the only analgesics that should be

used in EMS.

E. Bledsoe, DO, FACEP

Midlothian, TX

Re: Stadol vs. Morphine

What does everybody think about using Stadol vs. Morphine on muscoskeletal

or soft tissue injuries. How much more is Morphine useful than Stadol is.

Also is Stadol a safer medication to put in place for the pain on

muscoskeletal/soft tissue injuries in your protocols for your medics.

Just wondering everybody's opinion on this.

Thanks

[Guest guest]

Fentanyl, morphine, nitrous oxide are the only analgesics that should be

used in EMS.

E. Bledsoe, DO, FACEP

Midlothian, TX

Re: Stadol vs. Morphine

What does everybody think about using Stadol vs. Morphine on muscoskeletal

or soft tissue injuries. How much more is Morphine useful than Stadol is.

Also is Stadol a safer medication to put in place for the pain on

muscoskeletal/soft tissue injuries in your protocols for your medics.

Just wondering everybody's opinion on this.

Thanks

[Guest guest]

THANK YOU, THANK YOU, THANK YOU, DR. BLEDSOE.

Nubain is still carried as a morphine substitute in many places, and it is

worthless. Maybe some medical directors will listen to you.

G

In a message dated 8/29/04 17:11:43 Central Daylight Time,

bbledsoe@... writes:

> Subj:RE: Re: Stadol vs. Morphine

> Date:8/29/04 17:11:43 Central Daylight Time

> From:bbledsoe@...

> Reply-to:

> To:

> Sent from the Internet

>

>

>

> Fentanyl, morphine, nitrous oxide are the only analgesics that should be

> used in EMS.

>

>

> E. Bledsoe, DO, FACEP

> Midlothian, TX

>

> Re: Stadol vs. Morphine

>

>

>

> What does everybody think about using Stadol vs. Morphine on muscoskeletal

> or soft tissue injuries. How much more is Morphine useful than Stadol is.

> Also is Stadol a safer medication to put in place for the pain on

> muscoskeletal/soft tissue injuries in your protocols for your medics.

>

>

> Just wondering everybody's opinion on this.

>

>

> Thanks

>

>

>

>

>

>

>

>

[Guest guest]

My personal experience (kidney stones....UGH...) has been that ketorolac

(Toradol) is very effective in a non-narcotic manner as opposed to morphine.

However, as a great doctor once told me, if you're going to give it orally, give

ibuprofen; IM, give toradol. For some reason, PO toradol just doesn't work quite

as well as IM toradol does, you might as well be using ibuprofen. I've heard

toradol referred to as " ibuprofen on crack. "

I have seen multiple kidney stone offenders be just as satisfied and

experience just as much pain relief from IM non narcotic toradol as from

morphine.

Same holds true for a lot of severe sprains and strains.

Just something to consider from the non-perpetuating drug abusers standpoint.

Having said that though, a drug abuser will tell you point blank, " I'm

ALLERGIC to toradol, ibuprofen, Tylenol, reglan, etc., BUT 150 mg of Demerol and

50

mg of Phenergan IM usually seem to work just fine... "

Just my humble . 02 cents..

Cristi

[Guest guest]

My personal experience (kidney stones....UGH...) has been that ketorolac

(Toradol) is very effective in a non-narcotic manner as opposed to morphine.

However, as a great doctor once told me, if you're going to give it orally, give

ibuprofen; IM, give toradol. For some reason, PO toradol just doesn't work quite

as well as IM toradol does, you might as well be using ibuprofen. I've heard

toradol referred to as " ibuprofen on crack. "

I have seen multiple kidney stone offenders be just as satisfied and

experience just as much pain relief from IM non narcotic toradol as from

morphine.

Same holds true for a lot of severe sprains and strains.

Just something to consider from the non-perpetuating drug abusers standpoint.

Having said that though, a drug abuser will tell you point blank, " I'm

ALLERGIC to toradol, ibuprofen, Tylenol, reglan, etc., BUT 150 mg of Demerol and

50

mg of Phenergan IM usually seem to work just fine... "

Just my humble . 02 cents..

Cristi

[Guest guest]

My personal experience (kidney stones....UGH...) has been that ketorolac

(Toradol) is very effective in a non-narcotic manner as opposed to morphine.

However, as a great doctor once told me, if you're going to give it orally, give

ibuprofen; IM, give toradol. For some reason, PO toradol just doesn't work quite

as well as IM toradol does, you might as well be using ibuprofen. I've heard

toradol referred to as " ibuprofen on crack. "

I have seen multiple kidney stone offenders be just as satisfied and

experience just as much pain relief from IM non narcotic toradol as from

morphine.

Same holds true for a lot of severe sprains and strains.

Just something to consider from the non-perpetuating drug abusers standpoint.

Having said that though, a drug abuser will tell you point blank, " I'm

ALLERGIC to toradol, ibuprofen, Tylenol, reglan, etc., BUT 150 mg of Demerol and

50

mg of Phenergan IM usually seem to work just fine... "

Just my humble . 02 cents..

Cristi

[Guest guest]

> There is no role for Stadol (butorphanol) in prehospital care.

..

> The same holds true for nalbuphine (Nubain).

Amen, Amen and amen

Mike

[Guest guest]

> There is no role for Stadol (butorphanol) in prehospital care.

..

> The same holds true for nalbuphine (Nubain).

Amen, Amen and amen

Mike

[Guest guest]

OK guys, I have not really looked over the studies. I'm just speaking from

personal observation over the years and personal experience. As someone who has

had kidney stones in the past and PMS every month, Toradol does something

Ibuprofen cannot. Ibuprofen has never touched a kidney stone, nor is it very

effective for menstrual cramps, however, 60 mg of Toradol does the trick very

nicely.

I was given Morphine once for kidney stones and where it took away the pain,

the side effects were undesirable. I didn't find that with Toradol. Any woman

having cramps can tell you though, 800 mg of Ibuprofen is not only

ineffective, but you will spend the rest of the day/night with even worse

stomach cramps

from the diarrhea you're going to get from taking that much Ibuprofen at one

sitting.

Like I said, I'm not trying to argue, and I have not looked at the studies,

this is just personal experience. I think Toradol is very effective in

controlling certain types of pain and is a wonderful alternative for addicts

(recovering and not) and may help to curb abuse potential in some.

Anyone ever looked at the top stolen narcs from a hospital, ambulance, etc.?

Fentanyl, Morphine, Stadol...

Cristi

[Guest guest]

Now, this illustrates a problem with EMS (no offense meant Christi). After

the discussion of ibuprofen and ketorolac for emergency analgesia, I

provided information from a non-drug company publication called The Medical

Letter which concluded oral ibuprofen is just as effective as IM Toradol at

a fraction of the cost. Christi posts her experience with the drugs. But,

Christi's experience is what we call " anecdote " . If you will look at the

literature, the science shows that Christi's perceptions are incorrect.

Because of this, EMS must be based upon the science and not anecdote,

Acad Emerg Med. 2000 Aug;7(8):857-61. Related Articles, Links

Comment in:

Acad Emerg Med. 2000 Aug;7(8):925-6.

Patients' perceptions of route of nonsteroidal anti-inflammatory drug

administration and its effect on analgesia.

Schwartz NA, Turturro MA, Istvan DJ, Larkin GL.

University of Pittsburgh Affiliated Residency in Emergency Medicine, PA,

USA. nickschwartz@...

OBJECTIVE: There is a commonly held belief among health care providers that

patients respond better to parenteral nonsteroidal anti-inflammatory drugs

(NSAIDs) than to oral forms by virtue of the patients' belief that getting

an injection means they are receiving " stronger " medicine. To the authors'

knowledge, this effect has never been adequately documented in the

literature. The objective of this study was to compare the effects of a

placebo analgesic injection vs placebo oral analgesia on patients with acute

musculoskeletal pain. METHODS: A convenience sample of emergency department

(ED) patients with acute musculoskeletal pain secondary to trauma were

enrolled. Patients received 225 mL of orange-flavored drink containing 800

mg of ibuprofen. Patients then received either a physiologically inactive

starch tablet resembling ibuprofen 800 mg in taste and appearance or a

physiologically inactive saline intramuscular (IM) injection resembling

ketorolac 60 mg. Both patients and research nurses were blinded to the

addition of ibuprofen to the drink and the inactive nature of subsequent

medication. Pain was evaluated at time 0 and at 30, 60, 90, and 120 minutes

on a 10-mm visual analog scale (VAS). RESULTS: Sixty-four patients completed

the study protocol. The VAS scores between groups did not differ

significantly at baseline or at each subsequent interval (p = 0.86).

CONCLUSIONS: These results contradict the belief that parenteral medications

confer a selective placebo effect stemming from patients' beliefs regarding

route of administration and efficacy. Therefore, the routine use of IM

administration of NSAIDs for suspected enhanced analgesia appears

unwarranted.

E. Bledsoe, DO, FACEP

Midlothian, TX

Re: Re: Stadol vs. Morphine

My personal experience (kidney stones....UGH...) has been that ketorolac

(Toradol) is very effective in a non-narcotic manner as opposed to morphine.

However, as a great doctor once told me, if you're going to give it orally,

give ibuprofen; IM, give toradol. For some reason, PO toradol just doesn't

work quite as well as IM toradol does, you might as well be using ibuprofen.

I've heard toradol referred to as " ibuprofen on crack. "

I have seen multiple kidney stone offenders be just as satisfied and

experience just as much pain relief from IM non narcotic toradol as from

morphine.

Same holds true for a lot of severe sprains and strains.

Just something to consider from the non-perpetuating drug abusers

standpoint.

Having said that though, a drug abuser will tell you point blank, " I'm

ALLERGIC to toradol, ibuprofen, Tylenol, reglan, etc., BUT 150 mg of Demerol

and 50 mg of Phenergan IM usually seem to work just fine... "

Just my humble . 02 cents..

Cristi

[Guest guest]

Now, this illustrates a problem with EMS (no offense meant Christi). After

the discussion of ibuprofen and ketorolac for emergency analgesia, I

provided information from a non-drug company publication called The Medical

Letter which concluded oral ibuprofen is just as effective as IM Toradol at

a fraction of the cost. Christi posts her experience with the drugs. But,

Christi's experience is what we call " anecdote " . If you will look at the

literature, the science shows that Christi's perceptions are incorrect.

Because of this, EMS must be based upon the science and not anecdote,

Acad Emerg Med. 2000 Aug;7(8):857-61. Related Articles, Links

Comment in:

Acad Emerg Med. 2000 Aug;7(8):925-6.

Patients' perceptions of route of nonsteroidal anti-inflammatory drug

administration and its effect on analgesia.

Schwartz NA, Turturro MA, Istvan DJ, Larkin GL.

University of Pittsburgh Affiliated Residency in Emergency Medicine, PA,

USA. nickschwartz@...

OBJECTIVE: There is a commonly held belief among health care providers that

patients respond better to parenteral nonsteroidal anti-inflammatory drugs

(NSAIDs) than to oral forms by virtue of the patients' belief that getting

an injection means they are receiving " stronger " medicine. To the authors'

knowledge, this effect has never been adequately documented in the

literature. The objective of this study was to compare the effects of a

placebo analgesic injection vs placebo oral analgesia on patients with acute

musculoskeletal pain. METHODS: A convenience sample of emergency department

(ED) patients with acute musculoskeletal pain secondary to trauma were

enrolled. Patients received 225 mL of orange-flavored drink containing 800

mg of ibuprofen. Patients then received either a physiologically inactive

starch tablet resembling ibuprofen 800 mg in taste and appearance or a

physiologically inactive saline intramuscular (IM) injection resembling

ketorolac 60 mg. Both patients and research nurses were blinded to the

addition of ibuprofen to the drink and the inactive nature of subsequent

medication. Pain was evaluated at time 0 and at 30, 60, 90, and 120 minutes

on a 10-mm visual analog scale (VAS). RESULTS: Sixty-four patients completed

the study protocol. The VAS scores between groups did not differ

significantly at baseline or at each subsequent interval (p = 0.86).

CONCLUSIONS: These results contradict the belief that parenteral medications

confer a selective placebo effect stemming from patients' beliefs regarding

route of administration and efficacy. Therefore, the routine use of IM

administration of NSAIDs for suspected enhanced analgesia appears

unwarranted.

E. Bledsoe, DO, FACEP

Midlothian, TX

Re: Re: Stadol vs. Morphine

My personal experience (kidney stones....UGH...) has been that ketorolac

(Toradol) is very effective in a non-narcotic manner as opposed to morphine.

However, as a great doctor once told me, if you're going to give it orally,

give ibuprofen; IM, give toradol. For some reason, PO toradol just doesn't

work quite as well as IM toradol does, you might as well be using ibuprofen.

I've heard toradol referred to as " ibuprofen on crack. "

I have seen multiple kidney stone offenders be just as satisfied and

experience just as much pain relief from IM non narcotic toradol as from

morphine.

Same holds true for a lot of severe sprains and strains.

Just something to consider from the non-perpetuating drug abusers

standpoint.

Having said that though, a drug abuser will tell you point blank, " I'm

ALLERGIC to toradol, ibuprofen, Tylenol, reglan, etc., BUT 150 mg of Demerol

and 50 mg of Phenergan IM usually seem to work just fine... "

Just my humble . 02 cents..

Cristi

[Guest guest]

Well, Dr. Bledsoe, the article is interesting. But let's be realistic here.

As rigorous as the study might have been designed to be, a sample size of 64

patients and a resultant p-value of 0.86 definitely does NOT make this study

in any way conclusive.

I can't find abstracts for any more statistically conclusive trials that

compare ibuprofen with parenteral ketorolac. However, there is a scattering

of smaller trials that all seem to suggest that ibuprofen is just as

effective. Taken together, the weight of the evidence does seem to support

your conclusion, but I don't think the statistical evidence is such that we

can call this an opened and closed case. You may still be right Christi!

We need to scrutinize statistical evidence as thoroughly as we scrutinize

anecdotal evidence and resist the temptation to just bow down every time

someone throws some numbers around.

-

Re: Re: Stadol vs. Morphine

My personal experience (kidney stones....UGH...) has been that ketorolac

(Toradol) is very effective in a non-narcotic manner as opposed to morphine.

However, as a great doctor once told me, if you're going to give it orally,

give ibuprofen; IM, give toradol. For some reason, PO toradol just doesn't

work quite as well as IM toradol does, you might as well be using ibuprofen.

I've heard toradol referred to as " ibuprofen on crack. "

I have seen multiple kidney stone offenders be just as satisfied and

experience just as much pain relief from IM non narcotic toradol as from

morphine.

Same holds true for a lot of severe sprains and strains.

Just something to consider from the non-perpetuating drug abusers

standpoint.

Having said that though, a drug abuser will tell you point blank, " I'm

ALLERGIC to toradol, ibuprofen, Tylenol, reglan, etc., BUT 150 mg of Demerol

and 50 mg of Phenergan IM usually seem to work just fine... "

Just my humble . 02 cents..

Cristi

[Guest guest]

Well, Dr. Bledsoe, the article is interesting. But let's be realistic here.

As rigorous as the study might have been designed to be, a sample size of 64

patients and a resultant p-value of 0.86 definitely does NOT make this study

in any way conclusive.

I can't find abstracts for any more statistically conclusive trials that

compare ibuprofen with parenteral ketorolac. However, there is a scattering

of smaller trials that all seem to suggest that ibuprofen is just as

effective. Taken together, the weight of the evidence does seem to support

your conclusion, but I don't think the statistical evidence is such that we

can call this an opened and closed case. You may still be right Christi!

We need to scrutinize statistical evidence as thoroughly as we scrutinize

anecdotal evidence and resist the temptation to just bow down every time

someone throws some numbers around.

-

Re: Re: Stadol vs. Morphine

My personal experience (kidney stones....UGH...) has been that ketorolac

(Toradol) is very effective in a non-narcotic manner as opposed to morphine.

However, as a great doctor once told me, if you're going to give it orally,

give ibuprofen; IM, give toradol. For some reason, PO toradol just doesn't

work quite as well as IM toradol does, you might as well be using ibuprofen.

I've heard toradol referred to as " ibuprofen on crack. "

I have seen multiple kidney stone offenders be just as satisfied and

experience just as much pain relief from IM non narcotic toradol as from

morphine.

Same holds true for a lot of severe sprains and strains.

Just something to consider from the non-perpetuating drug abusers

standpoint.

Having said that though, a drug abuser will tell you point blank, " I'm

ALLERGIC to toradol, ibuprofen, Tylenol, reglan, etc., BUT 150 mg of Demerol

and 50 mg of Phenergan IM usually seem to work just fine... "

Just my humble . 02 cents..

Cristi

[Guest guest]

Well, Dr. Bledsoe, the article is interesting. But let's be realistic here.

As rigorous as the study might have been designed to be, a sample size of 64

patients and a resultant p-value of 0.86 definitely does NOT make this study

in any way conclusive.

I can't find abstracts for any more statistically conclusive trials that

compare ibuprofen with parenteral ketorolac. However, there is a scattering

of smaller trials that all seem to suggest that ibuprofen is just as

effective. Taken together, the weight of the evidence does seem to support

your conclusion, but I don't think the statistical evidence is such that we

can call this an opened and closed case. You may still be right Christi!

We need to scrutinize statistical evidence as thoroughly as we scrutinize

anecdotal evidence and resist the temptation to just bow down every time

someone throws some numbers around.

-

Re: Re: Stadol vs. Morphine

My personal experience (kidney stones....UGH...) has been that ketorolac

(Toradol) is very effective in a non-narcotic manner as opposed to morphine.

However, as a great doctor once told me, if you're going to give it orally,

give ibuprofen; IM, give toradol. For some reason, PO toradol just doesn't

work quite as well as IM toradol does, you might as well be using ibuprofen.

I've heard toradol referred to as " ibuprofen on crack. "

I have seen multiple kidney stone offenders be just as satisfied and

experience just as much pain relief from IM non narcotic toradol as from

morphine.

Same holds true for a lot of severe sprains and strains.

Just something to consider from the non-perpetuating drug abusers

standpoint.

Having said that though, a drug abuser will tell you point blank, " I'm

ALLERGIC to toradol, ibuprofen, Tylenol, reglan, etc., BUT 150 mg of Demerol

and 50 mg of Phenergan IM usually seem to work just fine... "

Just my humble . 02 cents..

Cristi