Intramuscular Stadol for Analgesia during Tumescent Liposuction
Authors: Raskin Bernard I. , Dye Robert 
Published: January 2017

Introduction:

Narcotics may be required during tumescent liposuction. Typically, Demerol (meperidine) is utilized intravenously (IV) or intramuscularly (IM). Intramuscular Stadol (butorphanol tartrate) represents an excellent analgesic because of rapid onset and minimal risk of significant respiratory depression at the low dosing utilized during tumescent liposuction. Stadol is not classified as a controlled substance, so no triplicate forms, logs, or special double-lock storage is required. Stadol is a partial agonist that reduces risks of respiratory depression and postoperative nausea compared to meperidine. This study evaluates the safety and dosing of an IM Stadol and antihistamine combination with and without additional Versed in tumescent liposuction patients and reviews the authors' experience and recommendations for this drug.

Materials and Methods:

In this retrospective study, 2 groups of patients totaling 101 tumescent liposuction patients composed of 70 of the authors' patients and 31 additional patients from the University of California-Los Angeles (UCLA) were given varying doses of oral Valium or Halcion, intramuscular (IM) Stadol, and antihistamine (diphenhydramine or hydroxyzine) IM. One to two milligrams of intravenous (IV) Versed was given in 13 patients. All patients were monitored with pulse oximetry, blood pressure, and electrocardiography (EKG). The two groups of patients were studied separately to avoid single-author bias. Total IM Stadol dosing ranged from 0.5 to 4 mg IM over the entire liposuction, with an average total dose of 1.47 mg in the authors' patients and 2.25 mg in the UCLA group. Initial doses ranged from 0.5 to 2.0 mg IM, with supplemental injections needed hourly or less frequently. Average Valium was 7.5 mg sublingual, or Halcion 0.25 mg PO, and average antihistamine was 50 mg IM. There were 99 females and 2 males, age range 20–71. Areas treated were 63 abdomens, 50 flanks, 2 buttocks, 63 thighs, 4 chins, 1 tibia, 8 backs, 14 knees, 1 breast, 4 upper arms, and 1 axilla. Average liposuction was 1350 mL fat (range 50–4125 mL). Infusion lidocaine concentration average was 0.07% (range 0.05–0.1%). Maximum tumescence was 55 mg/kg of Klein formulation. The authors' 70 patients were given Stadol and antihistamine only if needed and no Versed. The UCLA group differed in that all patients were premedicated with Halcion 0.25, Stadol 2 mg IM, and diphenhydramine 50 mg IM, and Versed is subsequently given if needed.

Results:

In all patients who did not receive Versed (total 88), vital signs remained stable. Pulse oximetry was within 5% of baseline (90–100) for all patients, with the exception of a single transient reading of 88 in a healthy nonsmoking 25 year old given 1 mg Stadol, 25 mg Benadryl, and 10 mg Valium sublingual having liposuction of the upper arms only. In the 13 patients given Versed, a 21-year-old healthy female experienced a single pulse oximetry reading of 82 without other alteration of vital signs or level of consciousness. This patient had been given 2 mg Stadol IM, Benadryl 50 mg IM, 0.25 mg Halcion, and 2 mg Versed IV for liposuction of the abdomen, flanks, and thighs, total 2950 mL fat removed.

Conclusion:

Based on this study, IM Stadol appears to be a safe, effective medication with low risk and minimal postoperative effects, and it avoids the need for special logs, storage, and triplicate forms.