The dilemma of opioid conversion in intrathecal therapy

Abstract

Opioid conversion in the intrathecal space has been poorly studied or defined. Clinicians providing intrathecal therapy as an option in their practice often must rely on experiential-based guidelines. Spinal drug mechanics and lipid solubility heavily influence opioid dosing and conversion decisionmaking. Some clinically based guidelines for hydrophilic drug conversions are useful, but lipophilic drug conversions are best based on starting doses.