Dilaudid IM

[OUAnesthesia]

Saw someone do this before emergence while on the interview trail for jobs and just curious if anyone else does this...tried to read up on it but wasn't terribly successful so just curious for some anecdotal input.

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[Planktonmd]

Saw someone do this before emergence while on the interview trail for jobs and just curious if anyone else does this...tried to read up on it but wasn't terribly successful so just curious for some anecdotal input.

Yes, it is a good idea and it helps in PACU.

 

[nap$ter]

Saw someone do this before emergence while on the interview trail for jobs and just curious if anyone else does this...tried to read up on it but wasn't terribly successful so just curious for some anecdotal input.

if you don't have an IV...

i have some older partners who still do IM opiates for tonsils. in my mind there is no rationale for it - you have an IV - why risk an injection site reaction and a sore muscle?

 

[Arch Guillotti]

I think it sounds silly.

 

[dhb]

I think it sounds silly.

Why? I do it regularly, last longer than iv

 

[Hoya11]

Why? I do it regularly, last longer than iv

sore muscle, possible hematoma, unpredictable onset and offset and potency with site and size variability. and the general idea of this does not make sense and is unnecessary, if you just dose your iv opiate correctly you can have someone narcd out on residual fentanyl/dilaudid for a couple of hours if that's your goal for whatever reason

 

[deleted171991]

if you don't have an IV...

i have some older partners who still do IM opiates for tonsils. in my mind there is no rationale for it - you have an IV - why risk an injection site reaction and a sore muscle?

Because of the longer duration of action and more uniform plasma concentration. I don't use it but, at the right dose, I think it's a great idea for any inpatient that would need long-acting opiates post-op anyway.

I would also expect less nausea (especially for morphine), because the peak plasma concentration is much lower.

 

[dhb]

sore muscle, possible hematoma, unpredictable onset and offset and potency with site and size variability. and the general idea of this does not make sense and is unnecessary, if you just dose your iv opiate correctly you can have someone narcd out on residual fentanyl/dilaudid for a couple of hours if that's your goal for whatever reason

Are you serious?

 

[Hoya11]

Are you serious?

yup, sounds like a stupid idea to this pain fellowship trained anesthesiologist

 

[gasdoc77]

yup, sounds like a stupid idea to this pain fellowship trained anesthesiologist

What would you think about IM ketamine? I am a big proponent of K and think it is underutilized. I use very very small IV doses, but haven't considered small IM doses.

 

[Planktonmd]

It's not silly and it offers longer duration of action and slower rise of plasma level, both desirable in PACU.
Being "fellowship trained" does not mean you are the ultimate authority on peri-operative pain!

 

[dhb]

yup, sounds like a stupid idea to this pain fellowship trained anesthesiologist

I don't see what a pain fellowship adds to basic OR management otoh if you are removed from the OR i can understand why you don't get this approach.
I encourage the naysayers to try it and you will realize how smooth this is. Btw i don't use a bigass IM needle a small 23 or 25 is fine i don't care technically if it's IM or subcutaneous.

 

[OUAnesthesia]

yup, sounds like a stupid idea to this pain fellowship trained anesthesiologist

I'm not sure giving a drug in a completely reasonable route of administration with noted benefits warrants that response. I can understand the concerns you raised but I just wanted to see what kind of success people had who actually do it. It's easy to call something stupid when you've never done it yourself.

What dose are you all giving?

 

[DreamLover]

What would you think about IM ketamine? I am a big proponent of K and think it is underutilized. I use very very small IV doses, but haven't considered small IM doses.

I give Ketamine IM in the right patient population. No more than 1-2mg/kg IBW. I like it a lot for my chronic pain people or my heroin users etc.

Honestly, it's a bit simpler and easier than setting up a small dose infusion or multiple small IV doses. I've done all of the above and I just really like IM Ketamine. So do my PACU nurses.

 

[nap$ter]

Because of the longer duration of action and more uniform plasma concentration. I don't use it but, at the right dose, I think it's a great idea for any inpatient that would need long-acting opiates post-op anyway.

I would also expect less nausea (especially for morphine), because the peak plasma concentration is much lower.

if it's such a great idea why don't you (and most anesthesiologists) do it?

 

[dhb]

How is morphine given post-op on the wards to patient who don't have a PCA? Here IM or SC is the common route so i 'don't see why it's such a big deal...

 

[deleted171991]

if it's such a great idea why don't you (and most anesthesiologists) do it?

Because I do mostly outpatient procedures where I can't experiment with stuff that could delay discharge.