In the ACP Analgesia medical directive, it states patients with renal colic should routinely be considered for both ketorolac AND morphine or fentanyl. Are there any other scenarios where it would be indicated to consider both? Ex: acute back strain where you would want to reduce inflammation but also might need narcotics for extrication/transport purposes...
You can definitely give a narcotic in conjunction with a NSAID if there are no contraindications i.e allergy, GI bleed, etc. The two work on different pathways and provide a synergistic relief of pain.In the case of renal colic, it usually takes the toradol at least 20-30 minutes to provide relief, so IV morphine helps alleviate the pain immediately.The NSAID has a more prolonged duration of pain relief. It is common to prescribe both an NSAID for its anti-inflammatory properties as well as a narcotic for pain relief of acute medical conditions such as renal colic or sciatica.
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