In fact, DuPen and Williams propose a conversion tool for this problem that takes into account not only the patient's systemic morphine requirements but also factors such as pain severity, age, and the existence of neuropathic pain when determining the appropriate starting neuraxial opioid dose.27 To our.
Eighty-three respondents completed the survey. 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. 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. Conversion ratios were calculated and entered into graphical scatter plots. 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.
The equianalgesic conversion ratio for IV to epidural to intrathecal opioids varies depending upon the meningeal permeability of the opioid in question. How lipophilic the drug is, as well as in part by its molecular weight, and possibly structure, affect meningeal permeability. The mechanisms of analgesia for intrathecal.
This causes less intrathecal spread of hydrophobic opioids, and thus a smaller area of analgesia, with lower risk of respiratory depression. Hydrophobic opioids bind anywhere on the white matter of the spinal cord, and are more likely to leave the intrathecal space and be systemically absorbed. The intrathecal concentration will remain elevated for longer periods of time as compared to lipophilic opioids, and thus are more likely to cause delayed respiratory depression via rostral spread. When administered directly into the intrathecal space, hydrophilic opioids are more likely to bind specific receptors in the dorsal horn, where they are most effective.
Essentials of Pain Management, Vadivelu, Urman, Hines.
OpenAnesthesia content is intended for educational purposes only and not intended as medical advice.
Filed Under: O, Pain, Subspecialty: Pain and Regional Anesthesia.
When administered epidurally, hydrophilic opioids work primarily through a direct spinal effect, as these drugs are less likely to be absorbed systemically in the epidural space, less likely to bind to epidural fat, and thus more likely move into the intrathecal space.
Calculation of daily oral morphine equivalent (OME) dose is an important practice tool when monitoring chronic pain patients or rotating opioid medications in a chronic pain or palliative patient. Hydromorphine is five times more potent than morphine and a 25 mcg/day fentanyl patch is equivalent to.
2700 - 10020 100 Street NW Edmonton, AB T5J 0N3 Canada Phone:
Incorrect dose calculations have, on occasion, resulted in overdose and even death. Monitoring total OME dose is an important tool to use with patients and to ensure safe transfer from one opioid to another. Calculation of daily oral morphine equivalent (OME) dose is an important practice tool when monitoring chronic pain patients or rotating opioid medications in a chronic pain or palliative patient. Hydromorphine is five times more potent than morphine and a 25 mcg/day fentanyl patch is equivalent to approximay 100 mg oral morphine daily.
These tables are guidelines and other factors must be considered when calculating a dose or changing to a different opioid medication:
It is recommended that physicians err on the side of caution and start with a low dose and titrate slowly. For more information on calculation of oral morphine equivalence, see the following link: http://nationalpaincentre.mcmaster.ca/opioid/cgop_b_app_b08.html.
Please join the conversation below or post your comments to.
The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (2010) recommends that chronic non-cancer pain can be managed effectively in most patients with OME dosages at or below 200 mg/day. Consideration of a higher dosage requires careful reassessment of the pain condition and risk of misuse, with more frequent monitoring and evidence of improved outcomes. The following morphine equivalence tables are taken from the guideline:.
College of Physicians and Surgeons of Alberta September 6, 2013 Messenger, Prescribing Corner Leave a Comment.
This Opioid Calculator Application is a tool for the calculation of total oral Morphine Equivalent Daily Dose (oMEDD). A particular design feature of the app is that it simplifies the calculation of oMEDD in cases where combinations of opioids are used. It is designed to provide easy accessibility and.
This app is only available on the App Store for iOS devices.
Discover and share new music, movies, TV, books, and more.
Discover and share new apps.
We are unable to find iTunes on your computer. To download the free app Opioid Calculator by ANZCA, get iTunes now.
Already have iTunes? Click I Have iTunes to open it now.
Compatible with iPhone, iPad, and iPod touch. Compatibility: Requires iOS 8.0 or later.
Follow us @iTunes and discover new iTunes Radio Stations and the music we love.
It is designed to provide easy accessibility and consistency to facilitate research, improve education and fill a void in availability of reference conversion data in clinical practice. This Opioid Calculator Application is a tool for the calculation of total oral Morphine Equivalent Daily Dose (oMEDD). A particular design feature of the app is that it simplifies the calculation of oMEDD in cases where combinations of opioids are used. This opioid calculator is produced by the Faculty of Pain Medicine of the Australian and New Zealand college of Anaesthetists (FPM ANZCA) which is the peak body responsible for the education, training, continuing professional development and maintenance of standards of clinical practice for specialist pain medicine physicians in Australia and New Zealand.
Follow us on @AppStore.
Epocrates, Inc. The leading provider of handheld and web based clinical reference tools, helping healthcare professionals avoid medication errors and practice more efficiently. Epocrates products are compatible with Palm OS and Pocket PC PDA's, and with Windows and Macintosh computers.
Print l a friend.
Select mobile device. Important: MedTools applications require the latest version of one of the following installed on your Device: Epocrates Rx, Epocrates Rx Pro, Epocrates Essentials or Epocrates Essentials Deluxe.
5. Tap “Calculate” and view results. top Device compatibility chart.
1. Select an opiate that the patient is receiving and enter the dose.
Basic Operation: View complete instructions and cautions.
3. Select a drug for conversion and tap “Next page.”.
2. Adjust for cross-tolerance.
Back to Epocrates MedTools Overview.
With this free application at your fingertips, quickly and easily calculate equivalent or adjusted dosing for patients on one or more opioid analgesics.
Select additional opiates the patient is receiving, if applicable. 4.
Epocrates MedTools applications require the latest version of one of the following installed on your device: Epocrates Rx, Epocrates Rx Pro, Epocrates Essentials or Epocrates Essentials Deluxe. Detailed Features Detailed Features Compare Products.
2011 Epocrates, Inc.
Manage your Epocrates MedTools Browse by content.
Skip navigation, go directly to content.