The rectal route for analgesic administration has a long history of safety in children undergoing surgery and is an alternative when oral or parenteral analgesics are not an option in patients of any age (Pasero, 2010b). Although all of the first-line opioids can be given intravenously, there are currently only three IV nonopioid analgesic formulations available in the United States: acetaminophen, ketorolac, and ibuprofen (IV indomethacin is used primarily for closure of patent ductus arteriosus). Postoperative nausea and vomiting and NPO status limit the usefulness of the oral route of administration in many patients.
Although the rectal route is not a first-line route of administration, when parenteral and oral nonopioids are not options, the use of the rectal route to administer nonopioids should be considered. Studies have shown improved pain relief and reductions in opioid consumption with rectal nonopioid analgesics alone (Achariyapota & Titapant, 2008; Bahar, Jangjoo, Soltani, Armand, & Mozaffari, 2010). Other studies have demonstrated effective pain control with combinations of rectal acetaminophen and various NSAIDs or other analgesics (Bannwarth & Pehourcq, 2003; Carli et al., 2002; Ng, Swami, Smith, & Emembolu, 2008; Romsing, Møiniche, & Dahl, 2002).