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*Low doses may be effective when administered to the elderly or when injected in the cervical or thoracic region. *If combining with a local anesthetic, consider using 0.0625% bupivacaine. ^Duration of analgesia varies widely; higher doses produce longer duration.

*Low doses may be effective when administered to the elderly or when injected in the cervical or thoracic region. *If combining with a local anesthetic, consider using 0.0625% bupivacaine. ^Duration of analgesia varies widely; higher doses produce longer duration.

minimizing local anesthetic-induced complications of motor blockade and opioid-induced complications. Epidural opioid administration is widely used in the management of postoperative pain and for providing analgesia during labor and delivery. Lower systemic levels are achieved with epidural opioids, leading to less placental transfer and less potential for respiratory depression of the newborn. Intrathecal administration of opioids as a bolus ("spinal" anesthesia) also is popular for acute pain management. Chronic intrathecal infusions generally are reserved for use in chronic pain patients.

Rectal administration is an alternative for patients with difficulty swallowing or oral pathology and who prefer a less invasive route than parenteral. This route is not well tolerated in children.

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