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Evidence-based Practice and Quality Improvement

Opioid dose ratios in pain therapy - An evidence-based contemplation


Michaeli, K.; Liebhauser, M.; Bornemann-Cimenti, H.; Wejbora, M.; Sandner-Kiesling, A.

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European Journal of Anaesthesiology (EJA): June 12th, 2010 - Volume 27 - Issue 47 - p 25-26
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Background and Goal of Study: If one opioid doesn't suffice in pain therapy, an opioid rotation is necessary. The dose ratio tables currently used are based on references from pharmaceutic companies and books. The aim of our study was to evaluate the evidence available for the opioid dose ratios and assessing a potential gender aspect.

Materials and Methods: We collected data from electronic databases (PubMed, Ovid, Embase) from 1950 to September 2009. These data were statistical analysed and presented as medians plus range. The results were compared with currently used tables.

Results and Discussion: Concerning i.v. therapy, our evidence based table corresponds in 33% with the empiric tables, and 50% in p.o.-therapy. No publication focussed on the gender aspect of opioid dose ratios.

Conclusion(s): The existing opioid dose ratio tables are showing less evidence resulting. In 33% in i.v.-application and 50% in p.o.-application the empiric and evidence-based tables match. Therefore, unfavourable side effects can occur. The gender aspect was disregarded. New opioids should be tested obligatory regarding their does ratio, potency and regarding the gender differences prior to the licensing process.

Table 1
Table 1:
i.v.-intravenous, p.o.- per os, MO-Morphine, PET-Pethidine, HM-Hydromorphone, PIR-Piritrinamid, MET-Methadone, BUP-Buprenorphine, FEN-Fentanyl, SUF-Sufentanil, REM-Remifentanil, OXY-Oxycodone, TRA-Tramadol, ALF-Alfentanil, NAL-Naloxone, n/a-not applicable


1 Shaheen PE et al., JPSM 2009;38:409-417.
    © 2010 European Society of Anaesthesiology