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Discussion

Stadol question

So I work on a Neuro med/surg floor but I also get a lot of regular med/surg patients as well.

So I had a patient on the floor that was on IV abx(ceftriaxone) due to pyleo that had not responded to oral agents. She was in quite a bit of pain(I've been there before a few times..ouch had to have a PCA during one admission) so the resident ordered IV stadol 2mgQ3 hours prn. I am familiar with stadol obviously working a Neuro floor I have had patients that were on the nasal spray for migraines. But I've never had a patient on it for acute pain not caused by a migraine. It seemed like a really odd choice and it wasn't because the patient had allergies to other opiates.

My question is do any of you guys have any experience using stadol for acute pain? I know its used frequently in OB for labor pain. It wasn't working at all for my patient so I called the resident and he was pretty adamant about using it so all he did was bump it up to every 2 hours which obviously wasn't helpful. My patient wasn't on any long acting narcs or any other narcs for chronic pain so the stadol reversing the effects of other narcs wasn't the issue. It just wasn't helping. Perhaps it just isn't that effective for pain? Like I said I had pyleo before and it hurts terribly so I was on the phone with the resident calling all day to get the order changed and finally got orders for 6mgs of IV morphine q2 along with some IV ketorolac 30mgs q6 and finally my patient felt much better.

What do you think? Is Stadol effective for acute pain not related to labor or migraines? I dont know why this resident was so into the stadol. I've never had any other doctor that gave these orders, this was my first experience with this particular resident.

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    It's for pain, and 2mg Q3h is at the top end of the recommended dosing, so the resident wasn't being stingy, especially once he bumped it to Q2h. There's a lot of pressure on MDs these days not to Rx the typical opiates, maybe that was it. Also, and I'm only guessing here, but if the Stadol had been effective, it may have looked better or more creative to his attending rather than just pumping morphine right off the bat.

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    Thank you for the response. I just don't have a lot of experience with IV stadol for acute pain. Most docs order dilaudid and morphine or order fentanyl PCAs. I just wasn't sure if stadol maybe just isn't as effective for pain as the regulars. Luckily this resident did seem to know his dosing as he did order 6mgs of morphine. I can't stand when patients come up with 2mgs of morphine ordered q4. 99 percent of the time I'm calling to get those orders changed because its just not enough often enough.

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    If the patient was a neuro patient, I find that our doctors won't order narcotics because it changes the neuro score. Narcotics can cause a decrease of awareness, ability to respond appropriately, and if this happens it requires a CT or MRI of the head. Perhaps that's the reason?

    If the patient was a med-surg patient, then I agree with EGSpirit.

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    If the patient was a neuro patient, I find that our doctors won't order narcotics because it changes the neuro score. Narcotics can cause a decrease of awareness, ability to respond appropriately, and if this happens it requires a CT or MRI of the head. Perhaps that's the reason?

    If the patient was a med-surg patient, then I agree with EGSpirit.

    Yeah the patient was NOT a Neuro patient. She was a med/surg patient admitted with pyleonephritis that didn't respond to oral abx. She needed IV antibiotics and was in quite a bit of pain obviously in her flank area.

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    This might be a great question to ask the prescribing doctor. We can guess here, but we will never know the reasoning. Ask him and get back to us! I'd love to know.

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    We are seeing a lot more creative pain management plans because of the nation wide shortage of narcs, and because the DEA is cutting the production of prescription narcs.

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