Patient-controlled analgesia administration routes

Dosages and routes of administration Morphine is available in different salt forms but the hydrochloride and sulfate (Vermeire and Remon, 1999) are used preferentially. The compound can be administered by the oral, parenteral or intraspinal route. Oral application is preferred for chronic pain treatment and various slow release forms have been developed to reduce the administration frequency to 2-3 times per day (Bourke et al., 2000). Parenteral morphine is used in intravenous or intramuscular doses of 10 mg, mostly for postoperative pain and self-administration devices are available for patient-controlled analgesia (PCA). Morphine is additionally used for intraspinal (epidural or intrathecal) administration. Morphine is absorbed reasonably well in the lower gastrointestinal tract and can be given as suppositories. 

Dosages and routes of administration Oxymorphone is used parenterally by intramuscular or subcutaneous doses of 1-1.5 mg and as suppositories with a content of 5 mg. For patient controlled analgesia (PCA) i.v. bolus doses up to 300 pg are used (Sinatra and Harrison, 1989). 

Lately, the nasal route is receiving attention for the management of postoperative pain. Mucosal administration requires only a 1.1-1.5 times higher dose of fentanyl than the intravenous dose. ° For this new application field, called PCINA (patient-controlled-intranasal-analgesia), the pharmaceutical industry demands safety precautions of the delivery device, which can be fulfilled through implementation of intelligent microelectronic features. 

The more novel routes of administration of opioids, including oral, nasal, rectal, transdermal, spinal, and by patient-controlled methods, have been outlined (SEDA-17, 78). Oral transmucosal fentanyl administration, avoiding first-pass metabolism, produces analgesia and sedation in both adults and children undergoing short, painful outpatient procedures. The quality of analgesia is good, and the adverse effects are those typical of the opioids. 

Drug administration route Patient-controlled epidural analgesia with bupivacaine 0.06% and hydromorphone 10 micrograms/ml in postoperative 3736 orthopedic patients was associated with nausea (30%), pruritus (15%), hypotension (10%), and sedation (0.08%) [105. Respiratory depression was not reported, and Acre were no epidural hematomas or abscesses. 

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