Any good reason to use IM injection for post op pain control when IV is available?

[charrn26]

Hi,

I work as a prn nurse in the pacu of an ambulatory surgical facility.

Some of our patients can stay up to 23hrs. for procedures such as cholecystectomies. Most of the nurses who have worked there for years insist that these patients recieve an IM injection of Demerol or Morphine with Phenergan before moving to their overnight room. They insist these patients do better and the pain relief lasts longer than IV. I haven't been convinced and drug manuals don't back this up. I don't like using Demerol (increased neurotoxic metabolites) unless necessary and the pain and trauma of an IM injection seems unecessary. I feel this is a case of nurses not wanting to change old habits.

Any experience or suggestions out there? Thank you!!!

[FireStarterRN, BSN, RN]

I'm pretty sure IM releases more slowly, which goes along with common sense. The problem is, it hurts to give it!!! Why not give IV more often until they are ready for PO? That's what I would want done for me...

[rjflyn, ASN, RN]

You give it IM if thats how its ordered. That said it the IM route has a poor absorption profile for a lot of meds hence IV is usually a better choice for pain control. Also you mention Demerol most facilities have all but done away with that but in rare instances. We use it for shivering in our hypothermia protocol post arrest for example.

As jlsRN said IM's hurt so if I were your pt and I have an IV hell no your not giving me an IM med.

Rj

[nrsang97, BSN, RN]

I agree with the others. If ordered IM then give that way, but why not IV? I can't believe you are still giving demerol. We only give it if pts are shivering due to alsius (cooling cath). We have done away with it for pain control because of all the side effects, and poor control of pain.

[FireStarterRN, BSN, RN]

As jlsRN said IM's hurt so if I were your pt and I have an IV hell no your not giving me an IM med.

Rj

You and me both.

It sounds as if there are some old-fashioned doctors at the OP's workplace. Where I work, IM is reserved for when IV access is unavailable.

[OC_An Khe]

I agree with IV to PO especially if the patient is going home. You need to know if PO route will control painbefore the patient goes home. In the small doses that Demerol is used post op, particularly for shivering the amount of metabolytes are minimal.

[TopazLover, BSN, RN]

I don't know of any good reason to avoid IV use except on the rare occ. of blood or other incompatible fluids.

IMs are so unpredictable in absorption that in this day and age, why traumatize good muscle when you already have access.

Maybe they were trained like I was in dino-days and have been working with MDs who were also?

[charrn26]

Thank you all for your feedback!

You've basically confirmed how I feel on all of these issues.

We have standing orders for prn pain meds (IV) and Demerol for shivering, but some older Docs will order prn IMs with Demerol for pain.

I just wanted to get some feedback before I pushed harder on this issue.

Thanks again!!!

[FireStarterRN, BSN, RN]

I don't know of any good reason to avoid IV use except on the rare occ. of blood or other incompatible fluids.

IMs are so unpredictable in absorption that in this day and age, why traumatize good muscle when you already have access.

Maybe they were trained like I was in dino-days and have been working with MDs who were also?

In that case, it's very easy to stop the imcompatable infusion, flush the line well, flush well afterwards, and restart the blood or other infusion.

How long does it take to give an IV med???

[Mommy_of_3_in_AL..RN]

MOst of our patients get IV pain med (usually morphine or dilaudid) q 2-4 hour prn with IM toradol q 6 hour scheduled. I am told the toradol is usually given IM becuase it absorbs more slowly and lasts longer, and the prn is for breakthrough pain. I am in SICU and most patients there are in real pain from their trauma or procedure, and an IM injection is usually well tolerated, although i still tend to try to make sure they have had something IV shortly before giving it!

[EJSRN, BSN, RN]

I have never given IM toradol. But it seems to work great in conjunction with PCA's.

[rjflyn, ASN, RN]

You mention Toradol, one of out surgeons uses it as well. He orders it IV pre-op. Have given to pt in the ER going for Appy's . He says it slightly increases the risk of bleeding, but it greatly cuts down on post op pain and the need of large amounts of narcotics later.

Rj.