Analgesic Routes of Administration
Oral - The preferred route
- Cost effective
- Safe easy administration
- Variety of forms (pills, liquid)
- Must be able to swallow and absorb
| Sublingual - Easy administration even if patient sedated
- Most long-acting products cannot be given this route.
- Absorption sometimes erratic
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IV Push - Fast onset for intermittent pain
- Short-acting
- Less painful than SQ if IV in place
- Can be prone to side effects
| IV Infusion - Effective for constant pain
- Allows for rapid dose titration
- Preferred access is central line
- Accumulation of drug can contribute to side effects
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Patient Control Analgesia - Fast onset for intermittent pain
- Short-acting
- Patient has control
- Patient must be awake and able to comprehend instructions
| Subcutaneous - Faster onset than oral/slower than IV
- No IV access needed
- May be painful
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Subcutanous Infusions - Effective alternative to IV drip when no IV access
- Only small volume (1-2 cc/hr) can be given.
| Rectal - Safe alternative to oral
- Many oral drugs can be given this route.
- Contraindicated in thrombocytopenia, neutropenia
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Transdermal - Effective for constant pain when stable dose of analgesia needed.
- Route of choice if patient unable to swallow, unable to absorb, or is noncompliant.
- Can be prone to side effects
| Epidural - Most effective in intractable pain when traditional routes ineffective
- May have less side effects since lower doses used
- Requires surgical placement of catheter and more monitoring.
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Source: Adapted from Pasero, C., Portenoy R. K., & McCaffery, M. (1999). Opioid analgesics. In M. McCaffery & C. Pasero (Eds.), Pain: clinical manual (2nd ed.) (pp. 161-299). St Louis: Mosby.