Practical management of opioid rotation and equianalgesia

Abstract

PurposeTo review the recent literature on opioid rotation (ie, switching from one opioid drug to another or changing an opioid’s administration route) in cancer patients experiencing severe pain and to develop a novel equianalgesia table for use in routine clinical practice.MethodsThe MEDLINE database was searched with terms “cancer pain,” “opioid rotation,” “opioid switching,” “opioid ratio,” “opioid conversion ratio,” and “opioid equianalgesia” for the major opioids (morphine, oxycodone, fentanyl, and hydromorphone) and the intravenous, subcutaneous, oral, and transdermal administration routes. Selected articles were assessed for the calculated or cited opioid dose ratio, bidirectionality, and use of the oral morphine equivalent daily dose or a direct drug-to-drug ratio.ResultsTwenty publications met our selection criteria and were analyzed in detail. We did not find any large-scale, prospective, double-blind randomized controlled trial with robust design, and most of the studies assessed relatively small numbers of patients. Bidirectionality was investigated in seven studies only.ConclusionThe updated equianalgesic table presented here incorporates the latest data and provides information on bidirectionality. Despite the daily use of equianalgesic tables, they are not based on high-level scientific evidence. More clinical research is needed on this topic.

The effects of intravenous lidocaine on wound pain and gastrointestinal function recovery after laparoscopic colorectal surgery

“…The extracted information included the name of the main author, country, year of publication, surgery, size of the sample, group assignment, and outcomes; visual analogue scale (VAS) scores (at rest and on movement) at 2, 4, 12, 24, and 48 hours after surgery; total opioid consumption (milligrams) in the first 24 hours after surgery; the incidence of PONV; recovery of gastrointestinal function (the time of first flatus [hours], first defecation [hours], and normal dietary [hours]); the length of hospital stay ([LOS] [days]); and C‐reactive protein (CRP, [mg/mL]). The original data were represented by a median and interquartile range, so data conversions were made to a mean and SD through the methods described by Wan et al The consumption of analgesic drugs was converted to a morphine equivalent by using a published equivalence formula …”

“…The original data were represented by a median and interquartile range, so data conversions were made to a mean and SD through the methods described by Wan et al 16 The consumption of analgesic drugs was converted to a morphine equivalent by using a published equivalence formula. 17…”

Serratus Plane Block Is Effective for Pain Control in Patients With Blunt Chest Trauma: A Case Series

“…Patient characteristics and trauma characteristics were collected. In addition, the following parameters were measured: total opioid consumption, systematically converted and expressed as oral morphine consumption (1 mg IV morphine = 3 mg oral morphine), and pain assessment with the Numeric Pain Rating Scale (NPRS) (scored from 0 to 10) 24 hours before and 24 hours after SPB and for the duration of the SPB catheter insertion (NPRS only) if used. Pain was assessed every 4 hours, at rest, and at cough.…”

The application of preoperative self-anticipating pain scores in predicting surgical pain after elective surgery

“…All anesthetic and surgical interventions, including procedures and medications, administered in this study followed standard clinical practice protocol or physician's decision. The equivalent doses of opioids used during the perioperative period was calculated according to the updated practical opioid rotation and equianalgesic tables [17]. A culturally relevant depression screening questionnaire, the Taiwanese Depression Questionnaire (TDQ), was used for the assessment of depression in the surgical patients [18].…”