A synthesis of oral morphine equivalents (OME) for opioid utilisation studies

Nielsen, Suzanne; Degenhardt, Louisa; Hoban, Bianca; Gisev, Natasa

doi:10.1002/pds.3945

Cited by 414 publications

(301 citation statements)

References 7 publications

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“…[33] When calculating OME, narcotics dosed through the TEA were considered equivalent (1:1) to IV narcotic dosing administered either through intravenous line or IV-PCA.…”

Section: Methodsmentioning

confidence: 99%

A Randomized Controlled Trial of Postoperative Thoracic Epidural Analgesia Versus Intravenous Patient-controlled Analgesia After Major Hepatopancreatobiliary Surgery

et al. 2017

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Objectives The primary objective of this randomized trial was to compare thoracic epidural analgesia (TEA) to intravenous patient controlled analgesia (IV-PCA) for pain control over the first 48 hours after hepatopancreatobiliary (HPB) surgery. Secondary endpoints were patient-reported outcomes, total narcotic utilization and complications. Summary of Background Data Although adequate postoperative pain control is critical to patient and surgeon success, the optimal analgesia regimen in HPB surgery remains controversial. Methods Using a 2.5:1 randomization strategy, 140 patients were randomized to TEA (N=106) or IV-PCA (N=34). Patient-reported pain was measured on a Likert scale (0–10) at standard time intervals. Cumulative pain area under the curve (AUC) was determined using the trapezoidal method. Results Between the study groups key demographic, comorbidity, clinical and operative variables were equivalently distributed. The median AUC of the postoperative time 0 to 48 hour pain scores was lower in the TEA group (78.6 vs 105.2 pain-hours, p=0.032) with a 35% reduction in patients experiencing ≥7/10 pain (43% vs 66%, p=0.05). Patient-reported outcomes and total opiate use further supported the benefit of TEA on patient experience. Anesthesia related events requiring change in analgesic therapy were comparable (12.2% vs. 2.9%, respectively, p=0.187). Grade ≥3 surgical complications, median length of stay (6 days vs 6 days), readmission (1.9% vs 3.1%), and return to the OR (0.9 vs 3.1%) were similar (all p>0.05). There were no mortalities in either group. Conclusions In major HPB surgery, TEA provides a superior patient experience through improved pain control and less narcotic use, without increased length of stay or complications.

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“…[33] When calculating OME, narcotics dosed through the TEA were considered equivalent (1:1) to IV narcotic dosing administered either through intravenous line or IV-PCA.…”

Section: Methodsmentioning

confidence: 99%

A Randomized Controlled Trial of Postoperative Thoracic Epidural Analgesia Versus Intravenous Patient-controlled Analgesia After Major Hepatopancreatobiliary Surgery

et al. 2017

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“…Using this database structure, we were able to define continuous periods of medication possession as the period starting from the date of service of a prescription plus the number of days supplied (30). For each prescription, we calculated an average daily dose and converted this into standardized oral morphine equivalents to account for differences in potency among individual opioid agents (Supplemental Table 1) (31). Dosages of opioid and opioid/acetaminophen agents were combined during periods of overlapping possession, and we excluded values exceeding the 95th percentile of oral morphine equivalents.…”

Section: Exposure Variablesmentioning

confidence: 99%

Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients

Ishida

McCulloch

Steinman

et al. 2018

CJASN

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Background and objectives Patients on hemodialysis frequently experience pain and may be particularly vulnerable to opioid-related complications. However, data evaluating the risks of opioid use in patients on hemodialysis are limited.Design, setting, participants, & measurements Using the US Renal Data System, we conducted a cohort study evaluating the association between opioid use (modeled as a time-varying exposure and expressed in standardized oral morphine equivalents) and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture among 140,899 Medicare-covered adults receiving hemodialysis in 2011. We evaluated risk according to average daily total opioid dose (.60 mg, #60 mg, and per 60-mg dose increment) and specific agents (per 60-mg dose increment).Results The median age was 61 years old, 52% were men, and 50% were white. Sixty-four percent received opioids, and 17% had an episode of altered mental status (15,658 events), fall (7646 events), or fracture (4151 events) in 2011. Opioid use was associated with risk for all outcomes in a dose-dependent manner: altered mental status (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.23 to 1.34; higher dose: hazard ratio, 1.67; 95% confidence interval, 1.56 to 1.78; hazard ratio, 1.29 per 60 mg; 95% confidence interval, 1.26 to 1.33), fall (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.21 to 1.36; higher dose: hazard ratio, 1.45; 95% confidence interval, 1.31 to 1.61; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.03 to 1.05), and fracture (lower dose: hazard ratio, 1.44; 95% confidence interval, 1.33 to 1.56; higher dose: hazard ratio, 1.65; 95% confidence interval, 1.44 to 1.89; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.04 to 1.05). All agents were associated with a significantly higher hazard of altered mental status, and several agents were associated with a significantly higher hazard of fall and fracture.Conclusions Opioids were associated with adverse outcomes in patients on hemodialysis, and this risk was present even at lower dosing and for agents that guidelines have recommended for use.

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“…Source: Modified from Nielsen and colleagues. 52 tion. 46 We are seeking funds to support the development, delivery and measurement of a national knowledge translation strategy.…”

Section: Methodsmentioning

confidence: 99%