Equianalgesic potency ratios of opioids used in patient-controlled analgesia: A network meta-analysis

Authors

  • Hanns-Christian Dinges, MD
  • Ann-Kristin Schubert, MD
  • Gerta Rücker, PhD
  • Stephan Otto, MD
  • Susanne Waldmann, Dipl Ing Agr
  • Thomas Wiesmann, MD
  • Hinnerk Wulf, MD
  • Leopold Eberhart, MD, MA
  • Markus Gehling, MD

DOI:

https://doi.org/10.5055/jom.2022.0751

Keywords:

opioids, analgesic potency, patient-controlled analgesia, network meta-analysis, systematic review

Abstract

Objective: To determine equianalgesic potency ratios for opioids with an evidence-based approach without the use of pre-existing potency tables.

Design: Frequentist network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing opioids in patient-controlled analgesia (PCA).

Setting: A systematic review.

Data sources: A systematic search of MEDLINE, EMBASE, the Cochrane Library (CENTRAL), and Web of Science identified relevant RCTs from start of recording to 2019.

Eligibility criteria: RCTs comparing opioids via intravenous PCA in acute pain, with comparable resulting pain scores and identical treatment with coanalgesics at study level. The quality of studies was assessed using the Cochrane risk of bias tool with six items.

Results: 52 RCTs were identified with data for 16 opioids. Primary endpoint was the inverted ratio of means of the total consumption administered via PCA, which resembles the analgesic potency. The calculated analgesic potencies were sufentanil 423 [95 percent CI 334.99; 532.96], fentanyl 58 [48.22; 68.60], buprenorphine 37 [26.66; 50.81], remifentanil 13 [9.37; 19.13], alfentanil 7 [4.02; 11.01], hydromorphone 6 [4.96; 8.43], oxymorphone 6 [4.46; 8.84], butorphanol 4.5 [3.05; 6.73], diamorphine 2.2 [1.16; 4.10], morphine 1, oxycodone 0.9 [0.65; 1.34], piritramide 0.9 [0.55; 1.56], nalbuphine 0.7 [0.54; 0.95], pethidine 0.12 [0.10; 0.15], meptazinol 0.08 [0.03; 0.20], and tramadol 0.08 [0.07; 0.10].

Conclusions: The results in part contradict the values from the literature, which have been criticized for their imprecision. From clinical experience however, our findings seem very plausible. Short-acting opioids are less potent compared to longer acting drugs, eg, morphine, probably due to shorter intervals for readministration.

Author Biographies

Hanns-Christian Dinges, MD

Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany

Ann-Kristin Schubert, MD

Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany

Gerta Rücker, PhD

Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany

Stephan Otto, MD

Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany

Susanne Waldmann, Dipl Ing Agr

Central Medical Library, Philipps University Marburg, Marburg, Germany

Thomas Wiesmann, MD

Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany

Hinnerk Wulf, MD

Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany

Leopold Eberhart, MD, MA

Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany

Markus Gehling, MD

Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany; Pain Center Germany, Kassel, Germany

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Published

11/01/2022

How to Cite

Dinges, MD, H.-C., A.-K. Schubert, MD, G. Rücker, PhD, S. Otto, MD, S. Waldmann, Dipl Ing Agr, T. Wiesmann, MD, H. Wulf, MD, L. Eberhart, MD, MA, and M. Gehling, MD. “Equianalgesic Potency Ratios of Opioids Used in Patient-Controlled Analgesia: A Network Meta-Analysis”. Journal of Opioid Management, vol. 18, no. 6, Nov. 2022, pp. 567-86, doi:10.5055/jom.2022.0751.

Issue

Vol. 18 No. 6 (2022): November/December

Section

Review Articles

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