Least painful injection site

PMHNP10 · Dec 30, 2004

Hi everyone,
I work in a clinic where I give many intramuscular injections for sexually transmitted diseases. I am mainly giving either Penicillin or Ceftriaxone (Rocephin) IM. My nursing school training (finished 3 years ago!) teaches me to use the ventrogluteal site but I have some reservations...
From my experience, the ventrogluteal site is FAR more painful than the old dorsogluteal site. I was wondering if this is just my experience or if other people have found this? I find that anything more than 2mL can be very painful for my patients in the ventrogluteal site. I understand the proposed safety advantages of this site but I thing it is far outweighed by the discomfort. I think the muscles under this site are more tense and there is 'less room' for the injection to go causing more pain.
Several weeks ago a young patient with syphillis found her first IM penicillin shot given ventrogluteally exruciatingly painful and I wondered if she would ever return for her subsequent shots. She did, and I used the dorsogluteal site, which she still found painful but much better.
I now use both sites but always use the dorsogluteal for the ceftriaxone shots which patients seem to find particuarly painful.
Doing a literature search I can find many articles arguing that the ventrogluteal site is safer but can't find any research on patient pain.
What do you other thing?
-Kate

I typically use the ventrogluteal as much as possible, because of a couple reasons: 1. It's farther away from the sciatic nerve; 2. I believe there is a greater concentration of muscle in the area, hence better absorption than the dorsogluteal or delt site. As for pain, all of them hurt but I believe I remember that the vastus lateralis hurts the worst, and the delt should only be used for injections

Charge205 · Sep 10, 2007

Have you ever tried Rocephin mixed with Lidocaine? Its less painful

jeepgirl, LPN, NP · Sep 10, 2007

Have you ever tried Rocephin mixed with Lidocaine? Its less painful

I think its pretty standard to mix it, but you're right... you NEVER know...

ajtcsx · Jun 4, 2012

From a patient perspective I prefer to have all of my shots given in the dorsogluteal location. No way I would want it in the ventrogluteal location. Personal preference.

kids · Jun 4, 2012

From a patient perspective I prefer to have all of my shots given in the dorsogluteal location. No way I would want it in the ventrogluteal location. Personal preference.

And from this patient's perspective I'd rather have a more painful injection in a safer site. I've experienced nerve irritation from a DG injection, the pain can last for weeks, I'll never go through it again if it can be avoided.

VG site really should be less painful because it has a lower concentration of nerves.

To the OP, I realize you've been giving the injections on a regular basis for a while but I'd encourage you to review your landmarks and really think about needle placement.

I know that in my own practice I've developed habits over time that stray from from the optimal technique and have to take a step back and remember how to do it the 'right' way.

The antibiotics you're giving on a regular basis can be painful (even using Lido in rocephen). Just because you can inject >2cc in a site doesn't mean you have to, you might consider splitting the injection over two sites to give it more comfortably in the optimal location.

FORTHELOVEOF!!!! · Jun 4, 2012

I don't think it's possible to have a pain free shot of Rocephin, that stuff BURNS!!!