A systematic review of subcutaneous versus intramuscular or intravenous routes of opioid administration on pain outcomes in cancer and post-surgical clinical populations – challenging current assumptions in palliative care practice

Fairbairn, Lorna
Schuberth, Anna
Deacon, Laura
Gilkes, Hazel
Montgomery, Victoria
Bennett, Michael I
Mulvey, Matthew R

¹8229Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Wakefield, UK
²4472Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
³1406Waitemata District Health Board, North Shore Hospital, Auckland, New Zealand
⁴428303The Kirkwood and Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
⁵Academic Unit of Palliative Care, Leeds Institute of Health Sciences, 4468University of Leeds, Leeds, UK

Lorna Fairbairn, Specialist Palliative Care Team, Leeds Teaching Hospitals NHS Trust, St James Hospital, Beckett Street, Leeds, LS9 7TF, UK. Email: [email protected]

British Journal of Pain 17(2):p 152-165, April 2023. | DOI: 10.1177/20494637221135835

Objective

The objective of this review is to investigate the use of the subcutaneous route of administration of analgesics, common practice within palliative medicine.

Design

Systematic review using consensus approach, direct comparison of subcutaneous route with intravenous and intramuscular routes.

Results

The limited available evidence demonstrates non-inferiority of the subcutaneous route in both cancer patients and those post-surgery. Pain management is comparable to other routes. Route-related side effects are rare and systemic side effects are comparable.

Conclusion

Pain management is a critical role of palliative medicine. The subcutaneous route of administration offers a viable option for the delivery of parenteral analgesia within all settings, including the community. This review supports current practice, demonstrating equivalence with more invasive routes of administration.