Analysis of Multiple Routes of Analgesic Administration in the Immediate Postoperative Period: a 10-Year Experience

  • Nalini Vadivelu
  • Alice M. KaiEmail author
  • Feng Dai
  • Susan Dabu-Bondoc
Other Pain (A. Kaye and N. Vadivelu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Other Pain


Purpose of Review

An increasing amount of literature supports a multimodal approach to analgesic administration in the management of postoperative pain. The purpose of this study and review was to further evaluate the differences in efficacy in controlling immediate postoperative pain among the various routes of analgesia administration.

Recent Findings

This study consisted of an analysis of the various routes of analgesic administration (parental, neuraxial, and oral/rectal) in 107,671 consecutive surgical cases performed over a 10-year period at Yale New Haven Hospital. This study included variables of postoperative pain score at initial request for analgesic, pain score at discharge, nausea and vomiting in the post-anesthesia care unit, and gender. The most common route of administration of analgesia in our study was via the parenteral route (29,962), and the least common route was the neuraxial route (1319). There was a significant decrease in pain scores at the time of discharge in all three groups relative to the pain score at first request for analgesia.


Multimodal analgesia via various routes of administration targets numerous proponents of the nervous system with the intent to reduce the adverse side effects of the individual analgesics if given alone or as an additive to produce synergistic analgesia. Our study suggests that although all the routes investigated (parenteral, neuraxial (intrathecal/epidural), and per os or per rectum (PO/PR)) promote significant pain relief on discharge from the PACU, the group that received neuraxial analgesia reported the lowest incidence of nausea and vomiting.


Postoperative pain Multimodal analgesia Route of administration 


Compliance with Ethical Standards

Conflict of Interest

Nalini Vadivelu, Alice M Kai, Feng Dai, and Susan Dabu-Bondoc declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Nalini Vadivelu
    • 1
  • Alice M. Kai
    • 2
    Email author
  • Feng Dai
    • 3
  • Susan Dabu-Bondoc
    • 1
  1. 1.Department of AnesthesiologyYale University School of MedicineNew HavenUSA
  2. 2.Department of Internal MedicineNYU-Winthrop HospitalMineolaUSA
  3. 3.Yale School of Public Health: BiostatisticsYale University School of MedicineNew HavenUSA

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