Managing Vertebral Compression Fracture Pain: Accurate Codeine Dosage Calculation Guide

When a patient with a history of chronic back pain is admitted to the hospital with a vertebral compression fracture, it’s vital to address their pain promptly and effectively. The physician has ordered a “now” dose of codeine at 45 mg intramuscularly (IM) to manage the patient’s pain. However, the available codeine in stock is labeled as 60 mg/2 mL. So, the question arises: How many milliliters should the nurse administer to ensure the patient’s pain is managed optimally while maintaining safety and precision?

Understanding Vertebral Compression Fractures and Chronic Back Pain

A vertebral compression fracture is a painful injury to one or more of the vertebrae in the spine. This type of fracture is often associated with osteoporosis or trauma and can result in significant pain and reduced mobility. Patients with a history of chronic back pain may find this injury even more distressing, as it compounds their existing discomfort.

The Role of Codeine in Pain Management

Codeine is a commonly prescribed medication for pain relief. It falls under the category of opioid analgesics and works by binding to opioid receptors in the brain, reducing the perception of pain. For patients with severe pain due to conditions like vertebral compression fractures, codeine can offer much-needed relief.

Dosage Calculation for Codeine

The physician has ordered 45 mg of codeine IM for the patient. The codeine on hand is labeled as 60 mg per 2 mL. To determine the number of milliliters required, a straightforward calculation is necessary.

The goal is to provide the patient with 45 mg of codeine. Since the available codeine concentration is 60 mg per 2 mL, we need to find the equivalent amount in milliliters for the prescribed dose:

(45 mg / 60 mg) * 2 mL = 1.5 mL

Therefore, the nurse should administer 1.5 mL of the codeine solution IM to the patient to achieve the prescribed 45 mg dosage.

Nurse’s Responsibilities in Medication Administration

While accurate dosage calculation is a fundamental aspect of nursing, there are several other crucial responsibilities that nurses must fulfill when administering medication. Here are key steps to ensure safety and effectiveness:

  1. Patient Assessment: Conduct a thorough assessment of the patient, including their medical history, allergies, and current condition. Verify that codeine is the appropriate choice for pain management.
  2. Informed Consent: Explain the purpose of the medication, potential side effects, and expected outcomes to the patient or their caregiver. Obtain informed consent before administration.
  3. Medication Administration: Administer the medication correctly, ensuring that the route (IM in this case) and timing align with the physician’s orders.
  4. Monitoring: After administration, closely monitor the patient for any adverse reactions, pain relief, or side effects. This may include vital sign assessments and pain level evaluations.
  5. Documentation: Maintain thorough and accurate documentation of the medication administration, noting the dose, date, time, and the patient’s response. This documentation is vital for ensuring continuity of care.


Managing pain, especially in patients with a history of chronic back pain and those with vertebral compression fractures, is a vital aspect of healthcare. Codeine, when administered accurately, can be a valuable tool in providing relief and improving the patient’s comfort.

In summary, for a patient requiring a 45 mg dose of codeine with a stock solution of 60 mg/2 mL, 1.5 mL should be administered. Nurses must not only master dosage calculations but also excel in patient assessment, obtaining informed consent, precise administration, vigilant monitoring, and meticulous documentation. By combining these elements, healthcare providers can ensure that the patient’s pain is managed effectively and safely.


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