Variability in Opioid Equivalence Calculations
Variability in Opioid Equivalence Calculations
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DOI：
10.1111/pme.12920
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发表时间：
2016-05-01
期刊：
影响因子：
3.1
通讯作者：
Fudin, Jeffrey
中科院分区：
文献类型：
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作者：
Rennick, Amanda;Atkinson, Timothy;Fudin, Jeffrey
Objective.等效镇痛转换方法通常用于将患者从一种阿片类药物转换为另一种阿片类药物，因为疼痛缓解效果不佳或不良事件。然而，没有普遍接受的阿片类药物转换方法，并且转换资源之间往往存在显著差异。因此，患者面临疼痛治疗不足和严重不良事件的风险。本调查的目的是比较护士执业，药剂师和医生之间的等效镇痛转换估计常用处方阿片类药物。使用Survey Monkey开发了一个调查表。通过社交媒体（例如，Facebook、Twitter、LinkedIn等）以及给专业组织发电子邮件，与他们的成员和追随者分享。收集的数据包括人口统计学和氢可酮80 mg、芬太尼透皮贴剂1，800 mcg（75 mcg/小时）、美沙酮40 mg、羟考酮120 mg和氢吗啡酮48 mg的估计吗啡当量（MEQ）。还要求参与者提供他们选择的用于完成转换的参考资料，包括个人知识。使用集中趋势的测量进行描述性分析。使用Pearson卡方检验和Fisher精确检验对分类数据进行假设检验，使用Kruskal-Wallis群体平等秩检验对连续数据进行假设检验，以评估专业组阿片类药物中位剂量之间的差异。纳入分析的答复者总数为319人。医生、药剂师和执业护士/医师助理分别占受访者的25.4%、56.7%和16.3%。芬太尼、氢可酮、氢吗啡酮、美沙酮和羟考酮的总体平均（+/-标准差）MEQ剂量分别为：176（+/- 117）mg、88（+/- 42）mg、192（+/- 55）mg、193（+/- 201）mg和173（+/- 39）mg。对于芬太尼，医生、药剂师和执业护士/医生助理的平均（+/-标准差）MEQ剂量分别为180（+/-122）mg、178（+/- 128）mg和157（+/- 68）mg。对于所有三组临床医生，芬太尼的MEQ剂量中位数为150 mg。医生、药剂师和执业护士/医师助理的美沙酮平均（+/-标准差）MEQ剂量分别为：214（+/- 142）mg、171（+/- 107）mg和185（+/- 129）mg。每个临床医生组的美沙酮MEQ中位剂量为160 mg。结论。正如大的标准差所证明的那样，在每种职业类型中，平均阿片类药物转换为MEQ剂量存在显着差异，特别是芬太尼和美沙酮。每种职业为阿片类药物转换提供的MEQ剂量中位数相同。不存在允许五种研究的阿片类药物中的每一种准确且一致地转化为另一种阿片类药物的通用方法（即，吗啡）。
Objective. Equianalgesic conversion methods are commonly used to switch patients from one opioid to another due to suboptimal pain relief or adverse events. There is no universally accepted opioid conversion method, however, and there is often significant variability between conversion resources. As a result, patients are at risk for undertreated pain and serious adverse events. The purpose of this survey was to compare the equianalgesic conversion estimates between nurse practitioners, pharmacists, and physicians for commonly prescribed opioids.Methods. A survey form was developed using Survey Monkey. Participation was solicited by providing a link to the survey via social media (e.g., Facebook, Twitter, LinkedIn, etc.) and emailing professional organizations for sharing with their members and followers. Data collected included demographics and estimated morphine equivalents (MEQs) of hydrocodone 80 mg, fentanyl transdermal patches 1,800 mcg (as 75 mcg/hour), methadone 40 mg, oxycodone 120 mg, and hydromorphone 48 mg. Participants were also asked to provide their choice of reference utilized to complete the conversions, including personal knowledge. Descriptive analyses were performed using measures of central tendency. Hypothesis testing was performed using Pearson's chi-squared and Fisher's Exact Test for categorical data and the Kruskal-Wallis equality of populations rank test for continuous data to assess differences between median opioid doses by professional groups.Results. The total number of respondents included in the analysis was 319. Physicians, pharmacists, and nurse practitioners/physician assistants comprised 25.4%, 56.7%, and 16.3%, respectively, of respondents. The overall mean (+/- standard deviation) MEQ doses for fentanyl, hydrocodone, hydromorphone, methadone, and oxycodone were: 176 (+/- 117) mg, 88 (+/- 42) mg, 192 (+/- 55) mg, 193 (+/- 201) mg, and 173 (+/- 39) mg, respectively. For fentanyl, the mean (+/- standard deviation) MEQ doses were 180 (+/- 122) mg, 178 (+/- 128) mg, and 157 (+/- 68) mg, for physicians, pharmacists, and nurse practitioners/physician assistants, respectively. For all three groups of clinicians, the median MEQ dose for fentanyl was 150 mg. The mean (+/- standard deviation) MEQ doses of methadone for physicians, pharmacists, and nurse practitioners/physician assistants were: 214 (+/- 142) mg, 171 (+/- 107) mg, and 185 (+/- 129) mg, respectively. The median MEQ dose for methadone was 160 mg for each of the clinician groups.Conclusions. As evidenced by large standard deviations, there was significant variation in mean opioid conversions to MEQ doses within each profession type, particularly for fentanyl and methadone. The median MEQ doses provided for opioid conversions were the same among each profession. No universal method exists that allows each of the five studied opioids to be accurately and consistently converted to another opioid (i.e., morphine).