What are
the advantages and disadvantages of intramuscular opioid therapy?
For years, intramuscular (IM) opioids were the
main-stay of postoperative pain management. An order such as “meperidine 75 mg
IM q4H prn pain” was the gold standard by which other analgesic regimens were
judged.
Advantages of the use of IM opioids include
ease of administration, familiarity with the technique, and low cost.
Disadvantages include long delays from a patient’s complaint of pain to actual
time of drug administration, long onset of action, as well as variable and
unreliable absorption. When IM opioids are administered every 3–4 hours, bolus
doses lead to alternating periods of analgesic-induced over-sedation and
painful under-medication. During IM administration, only during one third to
one half of the time is the patient’s blood opioid concentration in the
“analgesic therapeutic window”, where they are com-fortable but not having
side-effects. Standard IM opioid orders do not take into account the
variability seen between patients with regard to dosing of opioids to achieve
analgesia. Individual variability may account for up to a sevenfold difference
in the plasma opioid concentra-tion required to achieve analgesia. Each patient
possesses particular plasma opioid concentration at which analgesia becomes
adequate and only by individual titration can this be achieved.
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