Switching to prn dosing later in the postoperative course provides pain relief while reducing the risk of adverse effects as the patient's analgesic dose requirement diminishes. Route Intravenous administration is the parenteral route of choice after major surgery. Repeated intramuscular injections can themselves cause pain and trauma and may deter patients from requesting pain medication. Rectal and sublingual administration are alternatives to intramuscular or subcutaneous routes when intravenous access is problematic. All routes other than intravenous require a lag time for absorption into the circulation.
Oral administration is convenient and inexpensive.
It is appropriate as soon as the patient can tolerate oral intake and is the mainstay of pain management in the ambulatory surgical population. Simple relaxation strategies can be effective in helping to manage pain. Patients benefit from periodic reinforcement and coaching in the use of relaxation techniques. Commonly used physical agents include applications of heat and cold, massage, movement, and rest or immobilization. The Clinical Practice Guideline contains a more complete discussion of the special considerations for pain management in the elderly.