Limits...
Survey of pain specialists regarding conversion of high-dose intravenous to neuraxial opioids

View Article: PubMed Central - PubMed

ABSTRACT

The conversion of high-dose intravenous (IV) opioids to an equianalgesic epidural (EP) or intrathecal (IT) dose is a common clinical dilemma for which there is little evidence to guide practice. Expert opinion varies, though a 100 IV:10:EP:1 IT conversion ratio is commonly cited in the literature, especially for morphine. In this study, the authors surveyed 724 pain specialists to elucidate the ratios that respondents apply to convert high-dose IV morphine, hydromorphone, and fentanyl to both EP and IT routes. Eighty-three respondents completed the survey. Conversion ratios were calculated and entered into graphical scatter plots. The data suggest that there is wide variation in how pain specialists convert high-dose IV opioids to EP and IT routes. The 100 IV:10 EP:1 IT ratio was the most common answer of survey respondent, especially for morphine, though also for hydromorphone and fentanyl. Furthermore, more respondents applied a more aggressive conversion strategy for hydromorphone and fentanyl, likely reflecting less spinal selectivity of those opioids compared with morphine. The authors conclude that there is little consensus on this issue and suggest that in the absence of better data, a conservative approach to opioid conversion between IV and neuraxial routes is warranted.

No MeSH data available.


Hydromorphone scatter plots.Notes: Respondents’ answers to survey question 7 were converted into IV:EP (A) and IV:IT (B) ratios. These ratios were entered into scatter plots. The most common response was 10:1 for the IV:EP (A) and 100:1 for the IV:IT (B). “Aggressive” and “conservative” answers are highlighted in blue and yellow shaded areas.Abbreviations: EP, epidural; IT, intrathecal; IV, intravenous.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC5036565&req=5

f3-jpr-9-693: Hydromorphone scatter plots.Notes: Respondents’ answers to survey question 7 were converted into IV:EP (A) and IV:IT (B) ratios. These ratios were entered into scatter plots. The most common response was 10:1 for the IV:EP (A) and 100:1 for the IV:IT (B). “Aggressive” and “conservative” answers are highlighted in blue and yellow shaded areas.Abbreviations: EP, epidural; IT, intrathecal; IV, intravenous.

Mentions: Approval to conduct this study was obtained from the Mayo Clinic Institutional Review Board. All survey respondents were informed of the authors’ intent to use their responses anonymously for academic publication. Focusing on morphine, hydromorphone, and fentanyl, a ten-question survey was developed to assess respondents’ opinions regarding conversion of high-dose IV to both EP and IT opioids (Figure 1). We identified 724 pain medicine practitioners and obtained their contact information via personal contacts, Internet searches, and websites of pain organizations. The survey was formatted on surveymonkey.com® (Palo Alto, CA, USA), and the survey link was distributed to potential participants via email. Demographic and practice data were tabulated. The answers to questions 6–8 were transformed into ratios of IV:EP and IV:IT. These ratios were entered into standard graphical scatter plots (Figures 2–4).


Survey of pain specialists regarding conversion of high-dose intravenous to neuraxial opioids
Hydromorphone scatter plots.Notes: Respondents’ answers to survey question 7 were converted into IV:EP (A) and IV:IT (B) ratios. These ratios were entered into scatter plots. The most common response was 10:1 for the IV:EP (A) and 100:1 for the IV:IT (B). “Aggressive” and “conservative” answers are highlighted in blue and yellow shaded areas.Abbreviations: EP, epidural; IT, intrathecal; IV, intravenous.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5036565&req=5

f3-jpr-9-693: Hydromorphone scatter plots.Notes: Respondents’ answers to survey question 7 were converted into IV:EP (A) and IV:IT (B) ratios. These ratios were entered into scatter plots. The most common response was 10:1 for the IV:EP (A) and 100:1 for the IV:IT (B). “Aggressive” and “conservative” answers are highlighted in blue and yellow shaded areas.Abbreviations: EP, epidural; IT, intrathecal; IV, intravenous.
Mentions: Approval to conduct this study was obtained from the Mayo Clinic Institutional Review Board. All survey respondents were informed of the authors’ intent to use their responses anonymously for academic publication. Focusing on morphine, hydromorphone, and fentanyl, a ten-question survey was developed to assess respondents’ opinions regarding conversion of high-dose IV to both EP and IT opioids (Figure 1). We identified 724 pain medicine practitioners and obtained their contact information via personal contacts, Internet searches, and websites of pain organizations. The survey was formatted on surveymonkey.com® (Palo Alto, CA, USA), and the survey link was distributed to potential participants via email. Demographic and practice data were tabulated. The answers to questions 6–8 were transformed into ratios of IV:EP and IV:IT. These ratios were entered into standard graphical scatter plots (Figures 2–4).

View Article: PubMed Central - PubMed

ABSTRACT

The conversion of high-dose intravenous (IV) opioids to an equianalgesic epidural (EP) or intrathecal (IT) dose is a common clinical dilemma for which there is little evidence to guide practice. Expert opinion varies, though a 100 IV:10:EP:1 IT conversion ratio is commonly cited in the literature, especially for morphine. In this study, the authors surveyed 724 pain specialists to elucidate the ratios that respondents apply to convert high-dose IV morphine, hydromorphone, and fentanyl to both EP and IT routes. Eighty-three respondents completed the survey. Conversion ratios were calculated and entered into graphical scatter plots. The data suggest that there is wide variation in how pain specialists convert high-dose IV opioids to EP and IT routes. The 100 IV:10 EP:1 IT ratio was the most common answer of survey respondent, especially for morphine, though also for hydromorphone and fentanyl. Furthermore, more respondents applied a more aggressive conversion strategy for hydromorphone and fentanyl, likely reflecting less spinal selectivity of those opioids compared with morphine. The authors conclude that there is little consensus on this issue and suggest that in the absence of better data, a conservative approach to opioid conversion between IV and neuraxial routes is warranted.

No MeSH data available.