Fine Perry G, Portenoy Russell K
Department of Anesthesiology, Pain Research Center, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
J Pain Symptom Manage. 2009 Sep;38(3):418-25. doi: 10.1016/j.jpainsymman.2009.06.002.
Opioid rotation is a strategy applied during opioid therapy for pain that refers to a switch from one opioid to another in an effort to improve clinical outcomes (benefits or harms). It begins with the selection of a new drug at a starting dose that minimizes potential risks while ideally maintaining analgesic efficacy. The selection of a starting dose must be informed by an estimate of the relative potency between the existing opioid and the new one. Clinically relevant estimates of relative analgesic potency have been codified in the "equianalgesic dose table," which has been used with little modification for more than 40 years. New information about relative potency and the growing implementation of long-term opioid therapy for chronic pain provided a strong rationale for the convening of an expert panel to discuss the scientific foundation to opioid rotation and the elements that now should inform a clinical guideline for this practice. The panel affirmed both the value and the limitations of the current equianalgesic dose table and proposed a guideline intended to promote safety during opioid rotation.
阿片类药物转换是在阿片类药物疼痛治疗期间应用的一种策略，指的是从一种阿片类药物转换为另一种阿片类药物，以改善临床结局（益处或危害）。它始于选择一种起始剂量的新药，该剂量能将潜在风险降至最低，同时理想情况下维持镇痛效果。起始剂量的选择必须依据现有阿片类药物与新药之间相对效价的估计。相对镇痛效价的临床相关估计已编入“等效镇痛剂量表”，该表已沿用40多年，几乎没有修改。关于相对效价的新信息以及慢性疼痛长期阿片类药物治疗的日益广泛应用，为召集一个专家小组讨论阿片类药物转换的科学基础以及目前应为这种做法制定临床指南的要素提供了有力依据。该小组肯定了当前等效镇痛剂量表的价值和局限性，并提出了一项旨在促进阿片类药物转换期间安全性的指南。
