Ricket Abby, Mateyoke Greg, Vallabh Meghna, Owen Chelsea, Peppin John
J Pain Palliat Care Pharmacother. 2015 Jun;29(2):120-4. doi: 10.3109/15360288.2015.1035829.
Hydromorphone is a potent opioid analgesic commonly utilized in the hospital setting for the management of acute pain. Initial dose recommendations range from 0.1 to 2 mg of hydromorphone for opioid-naïve patients. This creates a challenge to optimally dose hydromorphone in opioid-naïve patients with the goals of avoiding opioid toxicities while also providing adequate pain management. In order to minimize the incidence of opioid toxicity, a community hospital implemented a dose-substitution hydromorphone policy that allows practitioners to automatically use a lower dose of hydromorphone within criteria limits. This pilot study was conducted to assess if the implementation of a low-dose hydromorphone protocol reduces the incidence of opioid toxicity while maintaining adequate pain management. This retrospective, observational, single-center cohort study examined hospitalized patients treated with hydromorphone between January 2013 and November 2013. Inpatients over 18 years of age who received hydromorphone were included in the study. The primary outcome of the study was the incidence of opioid toxicity. The secondary outcome of the study was adequate pain management. The results of this study showed no difference in opioid toxicity; however, patients required less per day hydromorphone and other opioids while still adequately managing patients' pain.
氢吗啡酮是一种强效阿片类镇痛药，常用于医院环境中急性疼痛的管理。对于未使用过阿片类药物的患者，氢吗啡酮的初始剂量建议为0.1至2毫克。这给未使用过阿片类药物的患者优化氢吗啡酮剂量带来了挑战，目标是在避免阿片类药物毒性的同时，也能提供充分的疼痛管理。为了尽量减少阿片类药物毒性的发生率，一家社区医院实施了一项氢吗啡酮剂量替代政策，允许从业者在标准范围内自动使用较低剂量的氢吗啡酮。本前瞻性研究旨在评估低剂量氢吗啡酮方案的实施是否能在维持充分疼痛管理的同时降低阿片类药物毒性的发生率。这项回顾性、观察性、单中心队列研究对2013年1月至2013年11月期间接受氢吗啡酮治疗的住院患者进行了检查。研究纳入了18岁以上接受氢吗啡酮治疗的住院患者。该研究的主要结局是阿片类药物毒性的发生率。该研究的次要结局是充分的疼痛管理。这项研究的结果显示阿片类药物毒性没有差异；然而，患者每天所需的氢吗啡酮和其他阿片类药物较少，同时仍能充分管理患者的疼痛。
