INTRAVENOUS OPIATES

see IV opiate pain protocol

CHOICE OF OPIATE

OPIATE PROS CONS
Morphine Cheap
Familiar
Long acting
Histamine release/Urticarial reactions
(local streaking on the vein does not count - give it slower or smaller boluses)
Not recommended in renal failure
??Makes biliary/renal colic worse
Fentanyl No histamine release
Novel routes such as intranasal, patches
Does not accumulate in renal failure
Expensive
Short-acting
Increased additive potential
Truncal rigidity (in high doses)
Pethidine No histimine release
Cheap
Long-acting
Increased Additive potential
Neurotoxic/Seizures/Confusion (in repeated doses)
Not recommend in renal failure
Excessively sedating
Painful when given SC
Codeine Cheap
Long-acting
Weak opioid
Constipating
Tramadol No histamine release
Less constipating
Expensive
Serotonergic side-effects