Opioid Switching: a Descriptive Analysis

Abstract

Introduction: The use of opioids must be individualized and changing for another opioid may be necessary (opioid switching). Objective: Identify how the opioid switching was performed and whether the desired effect was achieved in patients admitted at a public palliative oncologic care specialized hospital. Method: Post hoc analysis of the profile study of patients admitted to a public oncologic palliative care hospital in Rio de Janeiro between September and November 2016. Hospitalizations were followed longitudinally by reviewing the charts with daily collection of the numeric rating scale (NRS). Pain was considered controlled when NRS = 0. Doses, route of administration, switch (drugs and motif ) of the opioids were observed. The time for pain control was calculated when this was the reason. Results: 104 opioid switching were observed in 90 hospitalizations (22.5%), 49% of which were strong opioids and 43%, from mild to strong. Main reasons were pain (40%) and dyspnea (36%). The time to NRS = 0 was 1.6 days (+/-1.8; 95% CI 1.0-2.1), taking longer to switch to methadone (mean 2.7 days +/-2.5; 95% CI 1.0-4.4). Comparing the dose of oral morphine by analgesic equipotency, a 10% increase in the target opioid dose occurred, and when rotating due to dyspnea (38%), the increase was greater. Conclusion: Although pain control was higher tan described in other studies, the increase in the equipotent dose of opioid is not corroborated by protocols. Extensive surveillance and other studies are recommended in the unit.