How to manage incident pain

Abstract

Discussion: Patient was switched from levorphanol to hydromorphone or oxycodone plus acetaminophen because of oversedation with levorphanol. However, the doses chosen for oral hydromorphone were too low to provide adequate relief, and the same applied to the oxycodone plus acetaminophen. Levorphanol 10 mg PO would be approximately equivalent to hydromorphone 18 mg PO, and two tablets of Percocet equivalent to levorphanol i.5 mg PO. It was obvious that the levorphanol had been increased to control the incident pain on movement, but the increased dose caused too much sedation. H y d ro m o rp h o n e 12 mg PO was chosen to control the patient's pain at rest, and hydromorphone 1.5 mg IM for incident pain whenever the patient had to be moved. Diazapam was discontinued, since it could cause sedation.