The sky isn ’t the limit for NSAIDs analgesia

Using the one-dose/one-size approach is detrimental to patient health. As an ED clinician, I take enormous pride in taking care of patients presenting to my ED in pain. I take even bigger pride in the progress that Emergency Medicine has made over the past 15 years to perfect pain management. Armed with a solid knowledge base, great evidential support, and a broad array of analgesics, ED doctors across the country are providing effective and safe relief of pain. However, from time to time I am still reminded that so-called “traditional” teaching is pushing for the “one-dose,” “one-size” fits all approach (0.1 mg/kg of IV morphine, 30 mg of ketorolac IV or 60 mg IM, 800 mg of ibuprofen, etc). This “traditional” approach to ED pain management is frequently based on outdated information (in textbooks) or debunked research (10– to 20-year-old studies). Furthermore, the “one-dose/one-size fits all” approach is detrimental to safe and effective ED analgesia as it fails to provide a balance between the effective dose of therapeutics and occurrences of side effects. Does the dose of an analgesic in the ED matter? Even if given as a single dose? Sure it does. Even more so when we talk about NSAIDs. This class of analgesic, antipyretic and anti-inflammatory agents possess a unique pharmacologic phenomenon known as an “analgesic ceiling.” This phenomenon implies that after reaching a certain dosing threshold, any further increase in dosing will not result in ad...
Source: EPMonthly.com - Category: Emergency Medicine Authors: Source Type: news