Drugs are best given by mouth if possible but the rectal route may be tolerated better if vomiting is a problem. Intramuscular injections should be avoided as they may be very painful themselves and subcutaneous or intravenous routes are to be preferred. Local anaesthetic creams are available that can be applied under an occlusive dressing to produce anaesthesia of the underlying skin for up to an hour. These may enable painless placement of venous catheters or allow infiltration of the area with local anaesthetic. These creams should not be used rectally, directly on the wound or on mucous membranes.
Many procedures associated with the relief of pain can themselves be painful.
The performance of regional blockade, wound infiltration and the placement of intravenous or subcutaneous lines and catheters may be carried out without discomfort or resistance whilst the patient is anaesthetised. Infiltration of local anaesthetic agent into the wound before wakening can reduce postoperative pain for long periods. Equally, regional anaesthesia undertaken while the child is under general anaesthesia can give prolonged control of pain and avoid the use of opioids. It is particularly suitable where early discharge from hospital is required. Extradural anaesthesia by the caudal route will provide excellent analgesia for any surgery below the waist such as herniorrhaphy, orchidopexy or circumcision.