Choosing a Route to Administer a Pharmacologic Agent

Systemic pain medications can be given orally, rectally, intravenously, intramuscularly, transmucosally, transdermally, by inhalation, or by epidural administration (Iable.32-6). Intravenous opioids are suitable for bolus administration or continuous infusion and are preferred to intermittent intramuscular injections. Patient controlled intravenous analgesic systems do have a role in the ED for the stabilized patient who is to be admitted. Repeated intramuscular injections can themselves cause pain and trauma and may deter patients from requesting pain medication. Oral administration is convenient and inexpensive and is appropriate once the patient can tolerate oral intake; it is a mainstay of pain management in the ambulatory ED population. Nonsystemic agents can be delivered transdermally or transmucosally or by infiltrative local and regional injection, or intravenously for specific regional blocks. Alternative delivery techniques such as iontophoresis and single-dose jet injectors, which are now available for topical local anesthetic drug delivery, warrant consideration and further investigation.

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